CV: edema, HF, MI.
Derm: DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), EXFOLIATIVE DERMATITIS, pruritus, purpura, STEVENS-JOHNSON SYNDROME, sweating, TOXIC EPIDERMAL NECROLYSIS, urticaria.
EENT: ↑ lacrimation (spray), nasal discomfort (spray), throat irritation (spray).
F and E: hyperkalemia.
GI: ↑ liver enzymes, abdominal pain, abnormal taste, diarrhea, dry mouth, dyspepsia, GI BLEEDING, nausea.
GU: oliguria, renal toxicity, urinary frequency.
Hemat: prolonged bleeding time.
Local: injection site pain.
Neuro: drowsiness, abnormal thinking, dizziness, euphoria, headache, paresthesia, STROKE.
Resp: asthma, dyspnea.
Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS).
Oral therapy is indicated only as a continuation of parenteral therapy. Total duration of therapy by all routes should not exceed 5 days
- PO (Adults <65 yr): 20 mg initially, followed by 10 mg every 46 hr (not to exceed 40 mg/day).
- PO (Adults ≥65 yr, <50 kg, or with renal impairment): 10 mg every 46 hr (not to exceed 40 mg/day).
- PO (Children 216 yr, <50 kg): 1 mg/kg as a single dose. No data available for multiple doses.
- IM (Adults <65 yr): Single dose: 60 mg. Multiple dosing: 30 mg every 6 hr (not to exceed 120 mg/day).
- IM (Adults ≥65 yr, <50 kg, or with renal impairment): Single dose: 30 mg. Multiple dosing: 15 mg every 6 hr (not to exceed 60 mg/day).
- IM (Children 216 yr, <50 kg): Single dose: 0.41 mg/kg (maximum: 30 mg/dose). Multiple dosing: 0.5 mg/kg every 6 hr.
- IV (Adults <65 yr): Single dose: 30 mg. Multiple dosing: 30 mg every 6 hr (not to exceed 120 mg/day).
- IV (Adults ≥65 yr, <50 kg, or with renal impairment): Single dose: 15 mg. Multiple dosing: 15 mg every 6 hr (not to exceed 60 mg/day).
- IV (Children 216 yr, <50 kg): Single dose: 0.41 mg/kg (maximum: 15 mg/dose). Multiple dosing: 0.5 mg/kg every 6 hr.
- Intranasal (Adults <65 yr): 1 spray in each nostril every 68 hr (not to exceed 4 sprays in each nostril/day).
- Intranasal (Adults ≥65 yr, <50 kg, or with renal impairment): 1 spray in only one nostril every 68 hr (not to exceed 4 sprays in one nostril/day).
Therapeutic Classification: nonopioid analgesics
Pharmacologic Classification:
Absorption: Rapidly and completely absorbed following all routes of administration.
Distribution: Well distributed to tissues.
Protein Binding: 99%.
Metabolism/Excretion: Primarily metabolized by the liver. Primarily by the kidneys (92%); 6% excreted in feces.
Half-life: 4.5 hr (range 3.86.3 hr; ↑ in geriatric patients and patients with impaired renal function).