Author: V. Dimov, M.D., Allergist/Immunologist, Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist, Assistant Professor at NSU
Inhaled Medications
Pulmicort (budesonide) Flexhaler DPI 90 mcg, 180 mcg INH BID, max dose 1440 mcg/day. More info at PulmicortFlexhaler.com
Pulmicort (budesonide) Respules 0.25 mg/0.5 mg/1 mg in 2 ml NEB BID (prior steroid - max dose 1 mg/day, no prior steroid - max dose 0.5 mg/day). More info at Epocrates and PulmicortRespules.com
Asmanex (Mometasone) Twisthaler 110 mcg, 220 mcg DPI, dose 220-440mcg/day qd/bid. If 4-11 yrs, dose 110 mcg/day, if older than 12, dose 220-440 mcg/day qd/bid. More info at Asmanex.com. Momethasone is also in Dulera (ICS/LABA)
Advair (fluticasone/salmetrol) Diskus 100/50, 250/50, 500/50 one puff bid, 4-11 yrs, dose 100/50 bid, if older than 12yrs, dose 100/50 – 250/50 1 puff bid
Advair HFA 45/21, 115/21, 230/21 two puff bid, if older than 12 yrs, dose 90/42 – 460/42
Symbicort (budesonide/formoterol) 80/4.5 mcg, 160/4.5 mcg/spray MDI 2puffs bid, if older than 12yrs 2 puffs bid. More info at SymbicortTouchpoints.com
Dulera (momethasone/formoterol) 100 mcg/5 mcg, 200 mcg/5 mcg/spray MDI, 2 INH BID. More info at Dulera.com
Flovent (fluticasone) HFA 44, 110, 220, 4-11 yrs 88 mcg bid, if older than 12 yrs 88-440 bid, 440-880 if prior oral steroid use. Flovent is available as Diskus, 100 mcg and 250 mcg, more info at Epocrates
Azmacort (triamcinolone) 75 mcg/spray MDI, 300mcg bid, tid or qid - max dose 1200/day, 6-12 yrs, dose 150-300mcg bid, if older than 12 yrs, dose 300mcg bid - max dose 1200/day
Relative binding affinity for glucocorticoid receptor (GR): mometasone > fluticasone > budesonide > triamcinolone.
Albuterol NEB 0.63 mg, 1.25 mg, and 2.5 mg/3 ml, TID/QID PRN
Atrovent NEB one vial 300 mcg tid/qid
Xopenex NEB 0.31, 0.63, 1.25mg/3ml, 6-11 yrs, dose 0.31 mg tid, if older than 11 yrs, 0.63mg tid
Xolair (Omalizumab) 150-375 mg q2-4 weeks ( older than 12yrs, severe refractory asthma, IgE 30-700, evidence of sensitization to at least one perennial aeroallergen)
Nose Sprays and Eye Drops (see Rhinitis Action Plan)
Nasonex (mometasone) 50 mcg/spray, Age 2-12 y, Dose: 1 spray/nostril qd. Age older 12 yo, Dose: 2 sprays/nostril qd.
Atrovent nasal, if older than 6yr, dose 0.03, 0.06% 2 spray/nostril bid
Astelin (Azelastine), 5-11 yrs, dose 1 spray/nostril bid, if older than 12 yrs, dose 1-2 spray/nostril bid
Patanase (Olopatadine), if older than 12 years, dose 2 sprays/nostril b.i.d.
Nasalcrom (Cromolyn Na), if older than 2 yrs, dose 1 spray/nostril q4-6 hrs
Patanol (Olopatadine) 0.1%, if older than 3 years, 1 gtt. in eyes b.i.d.
Ketotifen (Zaditor), if older than 3 yrs, 1 gtt in eyes bid/tid. Over-the counter options include Zaditor/Zaditen, Alaway, Zyrtec Itchy-Eye Drops, and Claritin Eye. A generic version of ketotifen fumarate ophthalmic solution, 0.025%, is available as store brands.
Lotemax/Alrex (Loteprednol), adults, 1-2 gtt in eyes qid
Optivar (Azelastine), if older than 3 yrs, 1 gtt in eyes bid
Oral Antihistamines
Fexofenadine (Allegra), 2-11 yrs, dose 30 mg bid, older than 12 yr, dose 180 mg. Children’s Allegra Oral Suspension, Fexofenadine HCl 30 mg/5 ml, adults and children 12 years of age and over take 2 teaspoonfuls (10 mL) every 12 hours, children 2 to under 12 years of age take 1 teaspoonful (5 mL) every 12 hours.
Zyrtec (cetirizine) 5mg/5ml, 2 – 6 yrs, dose 2.5- 5mg qd, 6 and above, dose 5-10mg qd
Xyzal (levocetirizine), 6 months – 5 yrs, dose 1.25 mg qd, 6 – 11 yrs, dose 2.5 mg qd, if older than 12 yrs, dose 2.5 – 5 mg qd
Hydroxyzine, younger than 6 yrs, dose 2mg/kg/day, 6 – 12 yrs, dose 12.5 – 25 mg q6hrs, older than 12 yrs, dose 25-100 mg q 6 hrs
Cyproheptadine (4; 2 mg/5ml), 2 – 6 yrs, dose start 0.25mg/kg/day - increase to 2mg q 8-12 hrs (max 12 mg/day), 7 – 14 yrs, start 0.25mg/kg/day - increase to 4 mg q 8-12hrs (max 16mg/day)
Leukotriene antagonist (LTRA)
Singulair (montelukast), Dosage forms: 10; 4,5 CH; 4 mg granule pkt. Age 12-24 mo, Dose: 4 mg PO qpm, use granules. Age 2-5 yo, Dose: 4 mg PO qpm; use chew tabs or granules, Age 6-14 yo, Dose: 5 mg PO qpm; Age older than 15 yo, Dose: 10 mg PO qpm.
Antibiotics
Bactrim (Trimethoprim), older than 2months, dose 15-20 mg/kg/day, prophylaxis 2-4 mg/kg/day
Augmentin 125/31.25/5ml, 200/28.5/5ml, 250/62.5/5ml, 400/57/5ml - if more than 40 kg, use adult dose, younger than 3 months, 30 mg/kg/day bid, older than 3 mo, less than 40 kg, 25-45 mg/kg/day bid
Augmentin ES-600 (amoxicillin/ clavulanate), 600/42.9/5 mL, for acute otitis media, dose: 90 mg/kg/day PO div q 12 hr x10 days.
Clindamycin, 75 mg,150 mg, 300 mg tabs; 75/5 mL. Infants/children, 10 – 20 mg/kg/day (tid dosing), Adolescent, 150-300 mg q6hrs.
Omnicef (Cefdinir), 6 mo-12 yrs, 14 mg/kg/day qd-bid for 10 days, older than 13 yrs, 300 mg bid
Azithromycin 100 mg/5ml, 200mg/5ml. Pediatric dose: 10 mg/kg qd x 1, and then 5 mg/kg qd x 4 days.
Cephalexin (Keflex), 50,500; 125,250/5 mL. Children: infections, bacterial, [25-50 mg/kg/day PO div q6-12h]. Max: 4000 mg/24h. Adults: 1000-4000 mg/day PO div q6-12h. Max: 4000 mg/24h.
Oral steroids
Dose: 1-2 mg/kg/day PO divided qd-bid; Max: 60 mg/day.
Prelone/Orapred (prednisolone) 15/5ml
Veripred 20 (prednisolone) 20/5ml
Prednisone
Dexamethasone, dosage forms: 0.25,0.5,0.75,1,1.5,4,6; 0.5/5 mL; 1/mL. Croup: 0.6 mg/kg PO x1. Max: 10 mg/dose; Alt: 0.15 mg/kg PO x1; Info: higher dose regimen may also be divided into 4 doses given q6h.
Topical creams and ointments for atopic dermatitis
Triamcinolone cream/ointment 0.025, 0.1, (15, 80, jar 453.6gm) 0.5% (15gm), lot .025, 0.1% (60ml)
Cutivate (Fluticasone) 0.05% crm/oint (15, 30, 60gm). lotion 0.05% 120ml
Desonide crm/oint 0.05% (15, 60gm), lotion (59, 118ml)
Protopic (Tacrolimus), 2-15 yrs, only use 0.03 oint (30, 60gm), for adults, 0.1% oint (30, 60, 100gm)
Elidel (Pimecrolimus) 1% crm, older than 2 yrs (30, 60, 100gm)
Cough medications
Expectorants
Mucinex ER (guaifenesin), 600 mg tablets, dose for older than 12 years, 1-2 tables BID. More info at Mucinex.com
Mucinex Children's (guaifenesin), 4-6 yrs, 5 ml q 4 hr; 6-12 yrs, 10 ml q 4 hr; older than 12 years, use adult Muciner ER. More info at Mucinex.com and Epocrates
Cough suppressants
Delsym (dextromethorphan) syrup, Dose: 4-6 years, 2.5 mL every 12 hours; 6-12 years, 5 mL; adults and children 12 years of age and over, 10 mL every 12 hours. More info at Delsym.com
Mucinex Cough for Kids (dextromethorphan/guaifenesin), 4-5 yo, Dose: 2.5-5 mL PO q4h prn; Max: 30 mL/24h; Info: give w/ plenty of water; 6-11 yo, Dose: 5-10 mL PO q4h prn; Max: 60 mL/24h; Info: give w/ plenty of water. More info at Mucinex.com and Epocrates
Mucinex DM (dextromethorphan/guaifenesin), oral ER tablet, Older than 12 yo, Dose: 1-2 tabs PO q12h prn; Max: 4 tabs/24h; Info: do not cut/crush/chew; give w/ plenty of water. More info at Mucinex.com and Epocrates
Anaphylaxis
EpiPen Jr, [15-30 kg], Dose: 0.15 mg SC/IM once; Info: may repeat dose.
EpiPen, [0.3 mg SC/IM once]; Info: may repeat dose.
Epinephrine (adrenaline) is the first-line the treatment of anaphylaxis. Adult intramuscular dose is 0.3 to 0.5 ml of 1:1,000 concentration. This should be given in the lateral aspect of the thigh by intramuscular injection. The dose can be repeated every 5 to 15 minutes, depending upon the response, for 3-4 doses. The same is true for children except the dose is 0.01 mg per kg (AAAAI Ask the Expert, 2012).
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Published: 02/21/2010
Updated: 04/27/2014
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