Revisions

To ensure that we are providing our clients with the industry's best and most current clinical information, we complete a "post-publication" process and receive feedback regarding opportunities to add additional information or, in rare cases, make revisions.

Below is information on revisions, corrections, or modifications to existing monographs that have been identified in the past 12 months.

Acyclovir (Systemic) – November 2018

Revision in the Dosing: Adult field of the Acyclovir (Systemic) monograph in the Lexi-Drugs database, available online and in mobile apps.

The monograph previously read:

Dosing: Adult (only portion of field impacted is presented):

Herpes zoster (shingles), treatment:

Immunocompromised patients: Oral: 800 mg 5 times daily for 7 days (Pott Junior 2018; Shafran 2004). Initiate at earliest sign or symptom (most effective when initiated ≤48 hours of rash onset); may initiate treatment >72 hours after rash onset if new lesions are continuing to appear (Cohen 1999).

It has been revised to read:

Dosing: Adult (only portion of field impacted is presented):

Herpes zoster (shingles), treatment:

Immunocompetent patients: Oral: 800 mg 5 times daily for 7 days (Pott Junior 2018; Shafran 2004). Initiate at earliest sign or symptom (most effective when initiated ≤48 hours of rash onset); may initiate treatment >72 hours after rash onset if new lesions are continuing to appear (Cohen 1999).

These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.

Sodium Phenylbutyrate – November 2018

Revision in the Dosing: Pediatric field of the Sodium Phenylbutyrate monograph in the Pediatric and Neonatal Lexi-Drugs database, available online and in mobile apps, as well as the following print publications: Pediatric & Neonatal Dosage Handbook 24th edition and Pediatric & Neonatal Dosage Handbook with International Trade Name Index 24th edition

The monograph previously read:

Dosing: Pediatric (only portion of field impacted is presented):

Urea Cycle Disorder, chronic management: Note: The use of sodium phenylbutyrate tablets in children weighing ≤20 kg is not recommended.

Infants and Children <20 kg: Oral: 450 to 600 mg/kg/day in divided doses with meals/feedings 3 to 6 times daily; minimum daily dose: 20 g/day

Children ≥20 kg and Adolescents: Oral: 9.9 to 13 g/m2/day in divided doses with meals 3 to 6 times daily; maximum daily dose: 20 g/day

It has been revised to read:

Dosing: Pediatric (only portion of field impacted is presented):

Urea Cycle Disorder, chronic management: Note: The use of sodium phenylbutyrate tablets in children weighing ≤20 kg is not recommended.

Infants and Children <20 kg: Oral: 450 to 600 mg/kg/day in divided doses with meals/feedings 3 to 6 times daily; maximum daily dose: 20 g/day

Children ≥20 kg and Adolescents: Oral: 9.9 to 13 g/m2/day in divided doses with meals 3 to 6 times daily; maximum daily dose: 20 g/day

These changes have been automatically posted to online and mobile app databases. Please update your mobile Pediatric and Neonatal Lexi-Drugs application to get the updated monograph.

Fat Emulsion (Fish Oil Based) – November 2018

Revision in the Administration field of the Fat Emulsion (Fish Oil Based) monograph in the Pediatric and Neonatal Lexi-Drugs database, available online and in mobile apps.

The monograph previously read:

Administration (only portion of field impacted is presented):

IV: Administer by IV infusion via peripheral line or central venous infusion using DEHP-free administration sets and lines. All fat emulsion infusions should be filtered whether part of an admixture or infused separately using a 1.2-micron in-line filter only (ISMP 2016). May be simultaneously infused with amino acid and dextrose mixtures by means of Y-connector located near infusion site (flow rates of each solution should be controlled separately by infusion pumps). When administered with dextrose and amino acids as an admixture, the choice of a central or peripheral infusion depends on the osmolarity of the final infusate (osmolarity ≥900 mOsm/L must be infused through a central vein). Use a vented infusion set when infused from the bottle, avoid multiple connections, do not connect multiple medications in series, and turn off pump before the bottle runs dry.

Rate: Initial rate of infusion should not exceed 0.5 mL/minute for the first 15 to 30 minutes; gradually increase until reaching the required rate after 30 minutes as tolerated. Do not exceed a rate of 1.5 mL/kg/hour. Infusion should be completed within 12 hours when using a Y-connector and within 24 hours when used as part of an admixture.

It has been revised to read:

Administration (only portion of field impacted is presented):

IV: Administer by IV infusion via peripheral line or central venous infusion using DEHP-free administration sets and lines. All fat emulsion infusions should be filtered whether part of an admixture or infused separately using a 1.2-micron in-line filter only (ISMP 2016). May be simultaneously infused with amino acid and dextrose mixtures by means of Y-connector located near infusion site (flow rates of each solution should be controlled separately by infusion pumps). When administered with dextrose and amino acids as an admixture, the choice of a central or peripheral infusion depends on the osmolarity of the final infusate (osmolarity ≥900 mOsm/L must be infused through a central vein). Use a vented infusion set when infused from the bottle, avoid multiple connections, do not connect multiple medications in series, and turn off pump before the bottle runs dry.

Rate: Initial rate of infusion should not exceed 0.05 mL/minute for the first 15 to 30 minutes; gradually increase until reaching the required rate after 30 minutes as tolerated. Do not exceed a rate of 1.5 mL/kg/hour. Infusion should be completed within 12 hours when using a Y-connector and within 24 hours when used as part of an admixture.

These changes have been automatically posted to online and mobile app databases. Please update your mobile Pediatric and Neonatal Lexi-Drugs application to get the updated monograph.

Digoxin Oral – October 2018

Revision in the Dosing: Pediatric field of the Digoxin Oral monograph in the Facts & Comparisons eAnswers database, available online.

The monograph previously read:

Dosage: Pediatric (only portion of field impacted is presented):

Heart failure

Oral solution

Loading dose

If a loading dose is needed, it can be administered with roughly half the total given as the first dose. Additional fractions of this planned total dose may be given at 4- to 8-hour intervals, with careful assessment of clinical response before each additional dose. If the patient's clinical response necessitates a change from the calculated loading dose of digoxin, then calculation of the maintenance dose should be based on the amount actually given as the loading dose.2

Digoxin Oral Solution Estimated Loading Dose2

Age

Oral loading dose

Premature

20 to 30 mcg/kg

Full-term

25 to 35 mcg/kg

1 to 24 mo of age

35 to 60 mcg/kg

2 to 5 y of age

30 to 45 mcg/kg

5 to 10 y of age

20 to 45 mcg/kg

> 10 y of age

10 to 15 mcg/kg

It has been revised to read:

Dosage: Pediatric (only portion of field impacted is presented):

Heart failure

Oral solution

Loading dose

If a loading dose is needed, it can be administered with roughly half the total given as the first dose. Additional fractions of this planned total dose may be given at 4- to 8-hour intervals, with careful assessment of clinical response before each additional dose. If the patient's clinical response necessitates a change from the calculated loading dose of digoxin, then calculation of the maintenance dose should be based on the amount actually given as the loading dose.2

Digoxin Oral Solution Estimated Loading Dose2

Age

Oral loading dose

Premature

20 to 30 mcg/kg

Full-term

25 to 35 mcg/kg

1 to 24 mo of age

35 to 60 mcg/kg

2 to 5 y of age

30 to 45 mcg/kg

5 to 10 y of age

20 to 35 mcg/kg

> 10 y of age

10 to 15 mcg/kg

These changes have been automatically posted online.

Ribociclib – August 2018

Revision in the Dosage: Adult field of the Ribociclib monograph in the Drug Facts & Comparisons database, available online, and in Integrated Facts & Comparisons.

The monograph previously read:

Dosage: Adult (only portion of field impacted is presented):

Ribociclib Dose Modification and Management for Neutropeniaa,b(1)

Grade 3 (ANC 500 to <1,000/mm3)

Interrupt dosing until recovery of neutropenia to Grade ≤2. Resume ribociclib at the next lower dose level. If toxicity recurs at Grade 3, interrupt dosing until recovery, then resume ribociclib at the next lower dose level.

It has been revised to read:

Dosage: Adult (only portion of field impacted is presented):

Ribociclib Dose Modification and Management for Neutropeniaa,b(1)

Grade 3 (ANC 500 to <1,000/mm3)

Interrupt dosing until recovery of neutropenia to Grade ≤2. Resume ribociclib at the same dose. If toxicity recurs at Grade 3, interrupt dosing until recovery, then resume ribociclib at the next lower dose level.

These changes have been automatically posted to online and mobile app databases. Please update your application to get the updated monograph. These changes will be available with the September 5, 2018 monthly iFC API issue.

Burosumab-twza – July 2018

Revision in the Dosing: Adult field of the Burosumab-twza monograph in the Lexi-Drugs database, available online and in mobile apps.

The monograph previously read:

Dosing: Adult (only portion of field impacted is presented):

Re-Initiation Dosing

Previous Dose (mg/dose) every 2 weeks

Re-Initiation Dosea (mg/dose) every 2 weeks

40

20

50

20

60

30

70

30

≥80

40

aRecheck fasting serum phosphorus 2 weeks after dose adjustment; based on results, determine if additional dosing adjustment necessary.

It has been revised to read:

Dosing: Adult (only portion of field impacted is presented):

Re-Initiation Dosing

Previous Dose (mg/dose) every 4 weeks

Re-Initiation Dosea (mg/dose) every 4 weeks

40

20

50

20

60

30

70

30

≥80

40

aRecheck fasting serum phosphorus 2 weeks after dose adjustment; based on results, determine if additional dosing adjustment necessary.

These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.

Methylene Blue – July 2018

Revision in the Dosing: Adult field of the Methylene Blue monograph in the Lexi-Drugs and Facts & Comparisons databases, available online and in mobile apps, as well as the following print publications: Drug Information Handbook 27th edition, Drug Information Handbook with International Trade Names Index 27th edition, and Drug Information Handbook for Oncology 15th edition.

The monograph previously read:

Dosing: Adult (only portion of field impacted is presented):

Sentinel node mapping in breast cancer surgery (off label use): Intraparenchymal: 5 mg of a 1% solution administered once during procedure (Simmons 2001; Simmons 2003; Thevarajah 2005). Additional data may be necessary to further define the role of methylene blue in this condition.

It has been revised to read:

Dosing: Adult (only portion of field impacted is presented):

Sentinel node mapping in breast cancer surgery (off-label use): Intraparenchymal: 5 mL of a 1% solution administered once during procedure (Simmons 2001; Simmons 2003; Thevarajah 2005).

These changes have been automatically posted to online and mobile app databases. Please update your mobile applications to get the updated monograph.

Immune Globulin (Human) Intravenous (Gammagard S/D) – June 2018

Revision in the Dosing: Pediatric field of the Immune Globulin (Human) Intravenous (Gammagard S/D) monograph in the Facts & Comparisons database, available online.

The monograph previously read:

Dosage: Pediatric (only portion of field impacted is presented):

FDA-approved uses

Kawasaki syndrome

Usual dosage

Either a single 1 g/kg dose IV or a dose of 400 mg/kg IV for 4 consecutive days beginning within 7 days of the onset of fever.(1)

Concomitant therapy

Administer concomitantly with appropriate aspirin therapy (80 to 100 mg/kg/day in 4 divided doses).(1)

It has been revised to read:

Dosage: Pediatric (only portion of field impacted is presented):

FDA-approved uses

Kawasaki syndrome

Off-label

Infants and children

2,000 mg/kg IV as a single dose over 10 to 12 hours; usually given within 10 days of disease onset; however, may be given >10 days from onset in patients with delayed diagnosis or with persistent symptoms of systemic inflammation with persistent fever and/or coronary artery aneurysms; must be used in combination with aspirin; if signs and symptoms persist ≥36 hours after completion of the infusion, retreatment with a second 2,000 mg/kg IV infusion may be considered with or without corticosteroids. Note: Corticosteroids may be added for primary treatment in patients identified as high risk for development of coronary artery aneurysms.(72)

These changes have been automatically posted to online databases.

Bupropion – June 2018

Revision in the Dosing: Adult field of the Bupropion monograph in the Lexi-Drugs database, available online and in mobile apps.

The monograph previously read:

Dosing: Adult (only portion of field impacted is presented):

Major depressive disorder (unipolar):

…            

24-hour extended release: Oral:

Hydrochloride salt: Initial: 150 mg once daily in the morning; if tolerated, may increase as early as day 4 of dosing to 450 mg once daily.

It has been revised to read:

Dosing: Adult (only portion of field impacted is presented):

Major depressive disorder (unipolar):

24-hour extended release: Oral:

Hydrochloride salt: Initial: 150 mg once daily in the morning; if tolerated, may increase as early as day 4 of dosing to 300 mg once daily; if no clinical improvement after 2 weeks, may increase to 450 mg once daily.

These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.

Warfarin (Agent of Toxicity) – April 2018

Revision in the Treatment: Antidote(s) field of the Warfarin (Agent of Toxicity) monograph in the Lexi-Tox database, available online and in mobile apps.

The monograph previously read:

Treatment: Antidote(s) (only portion of field impacted is presented):

Adults maintained on warfarin:

If the INR is above the therapeutic range to <4.5 (no evidence of bleeding): Lower or hold the next vitamin K dose and monitor frequently; when the INR approaches the desired range, resume vitamin K dosing with a lower dose (Patriquin 2011).

If the INR is 4.5 to 10 (no evidence of bleeding): The 2012 ACCP guidelines recommend against routine phytonadione (aka, vitamin K) administration in this setting (Guyatt 2012). Previously, the 2008 ACCP guidelines recommended that if no risk factors for bleeding exist, to omit the next 1 or 2 vitamin K doses, monitor INR more frequently, and resume with an appropriately adjusted vitamin K dose when the INR is in the desired range; may consider administering vitamin K orally 1 to 2.5 mg if other risk factors for bleeding exist (Hirsh 2008). Others have recommended consideration of vitamin K 1 mg orally or 0.5 mg IV (Patriquin 2011).

It has been revised to read:

Treatment: Antidote(s) (only portion of field impacted is presented):

Adults maintained on warfarin:

If the INR is above the therapeutic range to <4.5 (no evidence of bleeding): Lower or hold the next warfarin dose and monitor frequently; when the INR approaches the desired range, resume warfarin dosing with a lower dose (Patriquin 2011).

If the INR is 4.5 to 10 (no evidence of bleeding): The 2012 ACCP guidelines recommend against routine phytonadione (ie, vitamin K) administration in this setting (Guyatt 2012). Previously, the 2008 ACCP guidelines recommended if no risk factors for bleeding exist, to omit the next 1 or 2 warfarin doses, monitor the INR more frequently, and resume with an appropriately adjusted warfarin dose when the INR is in the desired range; may consider administering vitamin K orally 1 to 2.5 mg if other risk factors for bleeding exist (Hirsh 2008). Others have recommended consideration of vitamin K 1 mg orally or 0.5 mg IV (Patriquin 2011).

These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Tox application to get the updated monograph.

Ofloxacin (Systemic) – April 2018

Revision in the Dosing: Adult field of the Ofloxacin (Systemic) monograph in the Lexi-Drugs database, available online and in mobile apps, as well as the following print publication: Drug Information Handbook 27th edition

The monograph previously read:

Dosing: Adult (only portion of field impacted is presented):

Epididymitis (off-label use): Oral:

Likely caused by enteric organisms: 300 mg twice daily for 10 days (CDC [Workowski 2015]) or 200 mg twice daily for 14 days (Canadian STI Guidelines 2008 [Update 2014])

Likely caused by sexually transmitted chlamydia and gonorrhea and enteric organisms in men who practice insertive anal sex: 300 mg once daily for 10 days in combination with ceftriaxone (CDC [Workowski 2015])

It has been revised to read:

Dosing: Adult (only portion of field impacted is presented):

Epididymitis (off-label use): Oral:

Likely caused by enteric organisms: 300 mg twice daily for 10 days (CDC [Workowski 2015]) or 200 mg twice daily for 14 days (Canadian STI Guidelines 2008 [Update 2014])

Likely caused by sexually transmitted chlamydia and gonorrhea and enteric organisms in men who practice insertive anal sex: 300 mg twice daily for 10 days in combination with ceftriaxone (CDC [Workowski 2015])

These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.

Anticoagulant Rodenticides, Long-Acting – April 2018

Revision in the Treatment: Antidote(s): Phytonadione field of the Anticoagulant Rodenticides, Long-Acting monograph in the Lexi-Tox database, available online and in mobile apps.

The monograph previously read:

Treatment: Antidote(s): Phytonadione (only portion of field impacted is presented):

Phytonadione (Vitamin K1):

Serious bleeding: IV: Clinically-significant coagulopathy:

Children: Note: Limited data are available in children; 30 mg/kg; repeat dosing may be required. Administer slow IV push and observe anaphylactoid reaction precautions. Both IM and SubQ administration may result in hematomas.

It has been revised to read:

Treatment: Antidote(s): Phytonadione (only portion of field impacted is presented):

Phytonadione (vitamin K1)

Clinically-significant coagulopathy:

Serious bleeding: IV:

Infants, Children, and Adolescents: Note: Limited data are available; dosing derived from doses used for the reversal of vitamin K antagonists (eg, warfarin): 0.03 mg/kg/dose; if significant bleeding is present, consider use of fresh frozen plasma (FFP), prothrombin complex concentrates (PCC), or recombinant factor VIIa (Bolton-Maggs 2002; Monagle 2012)

These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Tox application to get the updated monograph.

Hydromorphone – April 2018

Revision in the Dosing: Renal Impairment field of the Hydromorphone monograph in the Lexi-Drugs and Pediatric and Neonatal Lexi-Drugs databases, available online and in mobile apps., as well as the following print publications: Drug Information Handbook 27th edition and Drug Information Handbook for Advanced Practice Nursing 17th edition

The monograph previously read:

Dosing: Renal Impairment: Adult (only portion of field impacted is presented):

Injectable, oral (immediate release): Initiate with 25% to 50% of the usual starting dose depending on the degree of impairment. Use with caution and monitor closely for respiratory and CNS depression.

Oral (extended-release tablet): Hydromorphone ER:

CrCl >40 mL/minute: There are no dosage adjustments provided in the manufacturer's labeling.

CrCl 40 to 60 mL/minute: Initiate with 50% of the usual starting dose for patients with normal renal function. Use with caution and monitor closely for respiratory and CNS depression.

CrCl <30 mL/minute: Initiate with 25% of the usual starting dose for patients with normal renal function. Use with caution and monitor closely for respiratory and CNS depression. Consider use of an alternate analgesic with better dosing flexibility.

It has been revised to read:

Dosing: Renal Impairment: Adult (only portion of field impacted is presented):

Injectable, oral (immediate release): Initiate with 25% to 50% of the usual starting dose depending on the degree of impairment. Use with caution and monitor closely for respiratory and CNS depression.

Oral (extended-release tablet): Hydromorphone ER:

CrCl >60 mL/minute: There are no dosage adjustments provided in the manufacturer's labeling.

CrCl 40 to 60 mL/minute: Initiate with 50% of the usual starting dose for patients with normal renal function. Use with caution and monitor closely for respiratory and CNS depression.

CrCl <30 mL/minute: Initiate with 25% of the usual starting dose for patients with normal renal function. Use with caution and monitor closely for respiratory and CNS depression. Consider use of an alternate analgesic with better dosing flexibility.

These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.

Amoxicillin and Clavulanate – March 2018

Revision in the Dosing: Adult field of the Amoxicillin and Clavulanate monograph in the Lexi-Drugs database, available online and in mobile apps.

The monograph previously read:

Dosing: Adult (only portion of field impacted is presented):

Susceptible infections: Oral: 250 mg every 8 hours or 500 mg every 8 to 12 hours or 875 mg every 12 hours or 2,000 mg every 12 hours

It has been revised to read:

Dosing: Adult (only portion of field impacted is presented):

Susceptible infections: Oral: Immediate release: 250 mg every 8 hours or 500 mg every 8 to 12 hours or 875 mg every 12 hours or Extended release: 2,000 mg every 12 hours

These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.

Meperidine – March 2018

Revision in the Dosing: Pediatric field of the Meperidine monograph in the Lexi-Drugs database, available online and in mobile apps.

The monograph previously read:

Dosing: Pediatric

Sickle cell disease, acute crisis; opioid-naïve patients: (APS 1999): Infants ≥6 months, Children, and Adolescents: Note: Not recommended for use unless it is the only opioid effective for the patient (NHLBI 2014). Initial:

Patient weight ,50 kg: IV: 0.75 to 1 mg/kg every 3 to 4 hours as needed; maximum dose: 1.75 mg/kg/dose or 100 mg/dose

Patient weight ≥50 kg: IV: 50 to 150 mg every 3 hours as needed

It has been revised to read:

Dosing: Pediatric

Sickle cell disease, acute crisis; opioid-naïve patients: (APS 1999): Infants ≥6 months, Children, and Adolescents: Note: Not recommended for use unless it is the only opioid effective for the patient (NHLBI 2014). Initial:

Patient weight <50 kg: IV: 0.75 to 1 mg/kg every 3 to 4 hours as needed; maximum dose: 1.75 mg/kg/dose or 100 mg/dose

Patient weight ≥50 kg: IV: 50 to 150 mg every 3 hours as needed

These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.

Phenylbutazone – March 2018

Revision to move information from the Dosing: Hepatic Impairment: Adult field to the Dosing: Renal Impairment: Adult field in the Phenylbutazone monograph in the Lexi-Drugs Multinational database, available online and in mobile apps.

The monograph previously read:

Dosing: Renal Impairment: Adult

Mild or moderate impairment: There are no dosage adjustments provided in the manufacturer's labeling; use with caution.

Severe impairment: Use is contraindicated.

Dosing: Hepatic Impairment: Adult

Mild or moderate impairment: There are no dosage adjustments provided in the manufacturer's labeling; use with caution. The KDIGO guidelines recommend discontinuation of NSAIDs in patients with eGFR 30 to <60 mL/minute/1.73 m2 and intercurrent disease that increases risk of acute kidney injury (KDIGO 2013).

Severe impairment: Use is contraindicated.

It has been revised to read:

Dosing: Renal Impairment: Adult

Mild or moderate impairment: There are no dosage adjustments provided in the manufacturer's labeling; use with caution. The KDIGO guidelines recommend discontinuation of NSAIDs in patients with eGFR 30 to <60 mL/minute/1.73 m2 and intercurrent disease that increases risk of acute kidney injury (KDIGO 2013).

Severe impairment: Use is contraindicated.

Dosing: Hepatic Impairment: Adult

Mild or moderate impairment: There are no dosage adjustments provided in the manufacturer's labeling; use with caution.

Severe impairment: Use is contraindicated.

These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs Multinational application to access the updated monograph.

Milrinone – March 2018

Revision in the Dosing: Pediatric field of the Milrinone monograph in the Pediatric & Neonatal Lexi-Drugs database, available online and in mobile apps.

The monograph previously read:

Dosing: Pediatric (only portion of field impacted is presented):

Low cardiac output syndrome (LCOS) following CHD corrective surgery, prevention: Limited data available: Infants and Children: IV: Loading dose: 0.25 or 75 mcg/kg administered over 60 minutes followed by a continuous IV infusion of 0.25 or 0.75 mcg/kg/minute (Hoffman 2003). Dosing based on a double-blind, placebo-controlled trial which randomized 227 postoperative cardiac surgery patients (age range: 2 days to 6.9 years, median: 3 months) at high risk for LCOS to low-dose milrinone (loading dose: 25 mcg/kg, continuous infusion: 0.25 mcg/kg/minute), high-dose milrinone (loading dose: 75 mcg/kg, continuous infusion: 0.75 mcg/kg/minute), and placebo; results showed patients in the high-dose milrinone group had a 64% relative risk reduction for the development of LCOS compared to placebo; low-dose milrinone trended toward statistical significance in reducing the development of LCOS (Hoffman 2003).

It has been revised to read:

Dosing: Pediatric (only portion of field impacted is presented):

Low cardiac output syndrome (LCOS) following CHD corrective surgery, prevention: Limited data available: Infants and Children: IV: Loading dose: 25 or 75 mcg/kg administered over 60 minutes followed by a continuous IV infusion of 0.25 or 0.75 mcg/kg/minute (Hoffman 2003). Dosing based on a double-blind, placebo-controlled trial which randomized 227 postoperative cardiac surgery patients (age range: 2 days to 6.9 years, median: 3 months) at high risk for LCOS to low-dose milrinone (loading dose: 25 mcg/kg, continuous infusion: 0.25 mcg/kg/minute), high-dose milrinone (loading dose: 75 mcg/kg, continuous infusion: 0.75 mcg/kg/minute), and placebo; results showed patients in the high-dose milrinone group had a 64% relative risk reduction for the development of LCOS compared to placebo; low-dose milrinone trended toward statistical significance in reducing the development of LCOS (Hoffman 2003).

These changes have been automatically posted to online and mobile app databases. Please update your mobile Pediatric & Neonatal Lexi-Drugs application to access the updated monograph.

Valproic Acid and Derivatives – March 2018

Revision in the Dosing: Adult field of the Valproic Acid and Derivatives monograph in the Lexi-Drugs database, available online and in mobile apps, as well as the following print publications: Drug Information Handbook for Advanced Practice Nursing 17th edition

The monograph previously read:

Dosing: Adult (only portion of field impacted is presented):

Status epilepticus (off-label use): IV: Loading dose: 20 to 40 mg/kg administered at rate of 3 to 6 mg/kg/minute; if necessary, may give an additional dose of 20 to 40 mg/kg administered at rate of 3 to 6 mg/kg/minute; if necessary, may give an additional dose of 20 mg/kg 10 minutes after the loading infusion (NCS [Brophy, 2012]).

It has been revised to read:

Dosing: Adult (only portion of field impacted is presented):

Status epilepticus (off-label use): IV: Loading dose: 20 to 40 mg/kg administered at rate of 3 to 6 mg/kg/minute; if necessary, may give an additional dose of 20 mg/kg 10 minutes after the loading infusion (NCS [Brophy 2012]) or 40 mg/kg as a single dose (maximum dose: 3,000 mg) (AES [Glauser 2016]).

These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.

Lamivudine – January 2018

Revision in the Lamivudine monograph in the Dosing: Pediatric field in the Lexi-Drugs database, available online and in mobile apps, and the Dosage: Pediatric field in Facts & Comparisons database, available online, as well as the following print publications: Drug Information Handbook 26th edition, Drug Information Handbook with International Trade Names Index 26th edition, and Drug Information Handbook for Advanced Practice Nursing 17th edition.

The monograph previously read:

Dosing: Pediatric (only portion of field impacted is presented):

HIV-1 nonoccupational postexposure prophylaxis (nPEP) (off-label use) (HHS [nPEP] 2016):

Adolescents ≥16 years of age: Oral solution (10 mg/mL) or oral tablet:

<50 kg: 4 mg/kg/day twice daily (maximum: 150 mg/dose)

≥50 kg: 150 mg twice daily or 300 mg once daily

It has been revised to read:

Dosing: Pediatric (only portion of field impacted is presented):

HIV-1 nonoccupational postexposure prophylaxis (nPEP) (off-label use) (HHS [nPEP] 2016):

Adolescents ≥16 years of age: Oral solution (10 mg/mL) or oral tablet:

<50 kg: 4 mg/kg twice daily (maximum: 150 mg/dose)

≥50 kg: 150 mg twice daily or 300 mg once daily

These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.

Remifentanil – January 2018

Revision in the Dosing: Usual field of the Remifentanil monograph in the Pediatric and Neonatal Lexi-Drugs database, available online and in mobile apps, as well as the following print publications: Pediatric & Neonatal Dosage Handbook, 21st - 24th editions.

The monograph previously read:

Dosing: Usual (only portion of field impacted is presented):

Anesthesia, total intravenous (TIVA); with or without propofol induction: Limited data available: IV: Loading dose (may omit if propofol induction used): 0.5 mcg/kg/minute for 3 minutes (total dose: 1.5 mcg/kg) or 1 mcg/kg over 1 minute; followed by an initial maintenance dose: 0.05-1 mcg/kg/minute; titrate in 0.05 mcg/kg/minute increments every 3 minutes to effect; usual effective range: 0.2-0.5 mcg/kg/minute; has been used in combination with propofol (bolus and/or infusion) (Malherbe, 2010a; Malherbe, 2010b; Mani, 2010; Shen, 2012)

It has been revised to read:

Dosing: Usual (only portion of field impacted is presented):

Anesthesia, total intravenous (TIVA); with or without propofol induction: Limited data available: IV: Loading dose (may omit if propofol induction used): 0.5 mcg/kg/minute for 3 minutes (total dose: 1.5 mcg/kg) or 1 mcg/kg over 1 minute; followed by an initial maintenance dose: 0.05-0.1 mcg/kg/minute; titrate in 0.05 mcg/kg/minute increments every 3 minutes to effect; usual effective range: 0.2-0.5 mcg/kg/minute; has been used in combination with propofol (bolus and/or infusion) (Malherbe, 2010a; Malherbe, 2010b; Mani, 2010; Shen, 2012)

These changes have been automatically posted to online and mobile app databases.