Make a report on the annual cost of the 6 medicines.
2023/11/4 10:47
Drug summary – MICROMEDEX
Aducanumab-avwa
DrugPoint
综述
DOSING/ADMINISTRATION
Adult Dosing
Important Note
Prior to initiation: Confirm the presence of amyloid beta pathology [1].
Monitor for amyloid-related imaging abnormalities (ARIA) -edema (ARIA-E) and hemosiderin deposition (ARIA-H): Obtain brain MRI prior (recent) to initiating
treatment, prior to the 5th infusion (first dose of 6 mg/kg), 7th infusion (first dose of
10 mg/kg), 9th infusion (third dose of 10 mg/kg), and 12th infusion (6th dose of 10
mg/kg) [1].
General Dosage Information
Aducanumab-avwa is approved by the US FDA as the originator biological product.
Alzheimer’s disease, Mild cognitive impairment or mild dementia stage of disease
Use patient’s actual body weight to calculate dose [2]
Titration, 1 mg/kg IV over 1 hour every 4 weeks for infusions 1 and 2; then 3 mg/kg
IV over 1 hour every 4 weeks for infusions 3 and 4; and then 6 mg/kg IV over 1 hour
every 4 weeks for infusions 5 and 6 [3]
Usual dosage (infusion 7 and beyond), 10 mg/kg IV over 1 hour every 4 weeks. If 10
or more new incident microhemorrhages or more than 2 focal areas of superficial
siderosis (radiographic severe amyloid related imaging abnormalities hemosiderin
deposition [ARIA-H]) is observed, treatment may be continued with caution only after a
clinical evaluation and a follow-up MRI demonstrates radiographic stabilization (ie, no
increase in size or number of ARIA-H) and resolution of symptoms [3]
Pediatric Dosing
Important Note
Prior to initiation: Confirm the presence of amyloid beta pathology [1].
Monitor for amyloid-related imaging abnormalities (ARIA) -edema (ARIA-E) and hemosiderin deposition (ARIA-H): Obtain brain MRI prior (recent) to initiating
treatment, prior to the 5th infusion (first dose of 6 mg/kg), 7th infusion (first dose of
10 mg/kg), 9th infusion (third dose of 10 mg/kg), and 12th infusion (6th dose of 10
mg/kg) [1].
General Dosage Information
Safety and effectiveness in pediatric patients have not been established [2]
FDA Uses
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2023/11/4 10:47
Drug summary – MICROMEDEX
Alzheimer’s disease, Mild cognitive impairment or mild dementia stage of disease
Non-FDA Uses
无可用结果
Dose Adjustments
Renal impairment: No specific recommendations are available [2]
Hepatic impairment: No specific recommendations are available [2]
Amyloid-related imaging abnormalities-edema (ARIA-E; asymptomatic with mild MRI
severity): May continue at current dose and schedule [1]
ARIA-E (asymptomatic with moderate or severe MRI severity): Suspend dosing until
MRI demonstrates radiographic resolution; consider follow-up MRI to assess for
resolution 2 to 4 months after initial identification; resumption of dosing should be
guided by clinical judgment; may resume at that same dose and titration schedule
prior to the dosing suspension; the benefits of reaching and maintaining the 10 mg/kg
dosage should be considered when evaluating a potential dose suspension [3]
ARIA-E (mild symptom severity [discomfort noticed, but no disruption of normal daily
activity] and mild MRI severity): May continue based on clinical judgement [3]
ARIA-E (mild [discomfort noticed, but no disruption of normal daily activity], moderate
[discomfort sufficient to reduce or affect normal daily activity], or severe
[incapacitating, with inability to work or to perform normal daily activity] symptom
severity and mild, moderate, or severe MRI severity): Suspend dosing until MRI
demonstrates radiographic resolution and symptoms resolve; consider follow-up MRI
to assess for resolution 2 to 4 months after initial identification; resumption of dosing
should be guided by clinical judgment; may resume at that same dose and titration
schedule prior to the dosing suspension; the benefits of reaching and maintaining the
10 mg/kg dosage should be considered when evaluating a potential dose suspension
[3]
ARIA-hemosiderin deposition (ARIA-H; asymptomatic with mild MRI severity): May
continue at current dose and schedule [1]
ARIA-H (asymptomatic with moderate MRI severity): Suspend dosing until MRI
demonstrates radiographic stabilization; consider a follow-up MRI to assess for
stabilization 2 to 4 months after initial identification; resumption of dosing should be
guided by clinical judgment; may resume at that same dose and titration schedule
prior to the dosing suspension; the benefits of reaching and maintaining the 10 mg/kg
dosage should be considered when evaluating a potential dose suspension [3]
ARIA-H (asymptomatic with severe MRI severity): Suspend dosing until MRI
demonstrates radiographic stabilization; use clinical judgment in considering whether
to continue treatment or permanently discontinue; may resume at that same dose and
titration schedule prior to the dosing suspension; the benefits of reaching and
maintaining the 10 mg/kg dosage should be considered when evaluating a potential
dose suspension [3]
ARIA-H (symptomatic with mild or moderate MRI severity): Suspend dosing until MRI
demonstrates radiographic stabilization and symptoms resolve; consider a follow-up
MRI to assess for stabilization 2 to 4 months after initial identification; resumption of
dosing should be guided by clinical judgment; may resume at that same dose and
titration schedule prior to the dosing suspension; the benefits of reaching and
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2023/11/4 10:47
Drug summary – MICROMEDEX
maintaining the 10 mg/kg dosage should be considered when evaluating a potential
dose suspension [3]
ARIA-H (symptomatic with severe MRI severity): Suspend dosing until MRI
demonstrates radiographic stabilization and symptoms resolve; use clinical judgment
in considering whether to continue treatment or permanently discontinue; may resume
at that same dose and titration schedule prior to the dosing suspension; the benefits of
reaching and maintaining the 10 mg/kg dosage should be considered when evaluating
a potential dose suspension [3]
Intracerebral hemorrhage (greater than 1 cm in diameter): Suspend dosing until MRI
demonstrates radiographic stabilization and symptoms, if present, resolve; in studies,
dosing was permanently discontinued; use clinical judgment in considering whether to
continue treatment after radiographic stabilization and resolution of symptoms or
permanently discontinue [3]
Signs or symptoms of hypersensitivity reaction: Promptly discontinue the infusion and
initiate appropriate therapy [1]
Administration
Intravenous
Use patient’s actual body weight to calculate dose, total volume of solution, and
number of vials needed [2]
Vial solution is clear to opalescent and colorless to yellow; do not use if opaque
particulate matter, discoloration, or other foreign particles are present [3]
Each 100 mg/mL vial is single-use and more than 1 vial may be needed for a full
dose; discard any unused portion [3]
Must dilute prior to administration by adding dose to a 100 mL infusion bag of NS; do
not use other IV diluents; gently invert diluted solution to mix completely; do not
shake [3]
Use diluted solution immediately; if not administered immediately, store refrigerated
at 2 to 8 degrees C (36 to 46 degrees F) for up to 3 days, or at room temperature up to
30 degrees C (86 degrees F) for up to 12 hours. Do not freeze [3]
Prior to infusion, allow diluted solution to warm to room temperature [2]
Infuse diluted solution IV over approximately 1 hour through line containing a sterile,
low-protein binding, 0.2 or 0.22 micron in-line filter [2].
Missed dose: Resume administration at same dose as soon as possible and at least 21
days apart [3]
Comparative Efficacy
无可用结果
Place In Therapy
无可用结果
Last Modified: September 20, 2023
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2023/11/4 10:48
Drug summary – MICROMEDEX
Donepezil Hydrochloride
DrugPoint
综述
DOSING/ADMINISTRATION
Adult Dosing
General Dosage Information
Beers Criteria: Use caution or avoid use as potentially inappropriate in older adults [2].
Alzheimer’s disease – Dementia (Mild to Moderate)
Initial, 5 mg orally once daily at bedtime; if suboptimal clinical response, may increase
to MAX of 10 mg orally once daily at 4 to 6 weeks [3]
Alzheimer’s disease – Dementia (Moderate to Severe)
(Tablet) Initial, 5 mg orally once daily at bedtime; titrate to 10 mg orally once daily at
4 to 6 weeks; if suboptimal clinical response, may increase to MAX of 23 mg orally
once daily at 3 months [3]
(Disintegrating tablet) Initial, 5 mg orally once daily at bedtime; titrate to 10 mg orally
once daily at 4 to 6 weeks [3]
Dementia – Psychotic disorder
5 or 10 mg orally each day (off-label dosage) [4]
Multi-infarct dementia
5 to 10 mg orally once daily (off-label dosage) [5]
Senile dementia of the Lewy body type
Initial, 10 mg orally once daily; may decrease to 3 to 5 mg/day if higher dosage is not
tolerated (off-label dosage) [6]
Pediatric Dosing
General Dosage Information
Safety and effectiveness not established in children [3]
FDA Uses
Alzheimer’s disease – Dementia (Mild to Moderate)
Alzheimer’s disease – Dementia (Moderate to Severe)
Non-FDA Uses
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2023/11/4 10:48
Drug summary – MICROMEDEX
Alzheimer’s disease; Prophylaxis – Impaired cognition (Mild)
Dementia – Psychotic disorder
Multi-infarct dementia
Senile dementia of the Lewy body type
Dose Adjustments
无可用结果
Administration
Oral
Take in the evening prior to retiring; may be taken with or without food [3]
(Orally disintegrating tablets) Allow to dissolve on tongue and follow with a glass of
water [3]
(23 mg tablets) Do not split, crush, or chew [3]
Comparative Efficacy
无可用结果
Place In Therapy
无可用结果
Last Modified: November 02, 2023
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2023/11/5 09:56
Drug summary – MICROMEDEX
Rivastigmine Tartrate
DrugPoint
综述
DOSING/ADMINISTRATION
Adult Dosing
General Dosage Information
Beers Criteria: Use caution or avoid use as potentially inappropriate in older adults [1].
Oral capsule and solution formulations are interchangeable at equal doses [2]
Treatment interruption: If dosing is interrupted for 3 days or less, reinitiate with the
same or lower daily dose; if dosing is interrupted for more than 3 days, reinitiate with
1.5 mg twice daily and titrate back to maintenance dose [2]
Alzheimer’s disease – Dementia (Mild to Moderate)
Initial, 1.5 mg orally twice daily for 2 weeks [2]
Titration, if well tolerated, increase in increments of 1.5 mg orally twice daily at
minimum of every 2 weeks; MAX 12 mg/day; if intolerable adverse effects (eg, nausea,
vomiting, abdominal pain, loss of appetite), interrupt treatment for several doses and
restart at same or lower dose [2]
Dementia (Mild to Moderate) – Parkinson’s disease
Initial, 1.5 mg orally twice daily for 4 weeks [2]
Titration, if well tolerated, increase in increments of 1.5 mg orally twice daily at
minimum of every 4 weeks; MAX 12 mg/day; if intolerable adverse effects (eg, nausea,
vomiting, abdominal pain, loss of appetite), interrupt treatment for several doses and
restart at same or lower dose [2]
Pediatric Dosing
General Dosage Information
Safety and effectiveness not established in children [2]
FDA Uses
Alzheimer’s disease – Dementia (Mild to Moderate)
Dementia (Mild to Moderate) – Parkinson’s disease
Non-FDA Uses
Senile dementia of the Lewy body type
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2023/11/5 09:56
Drug summary – MICROMEDEX
Dose Adjustments
Renal impairment, moderate to severe (GFR less than 50 mL/min): Use lower doses [2]
Hepatic impairment, mild to moderate (Child-Pugh score 5 to 9): Use lower doses;
severe impairment, no dosing recommendations available [2]
Low body weight (less than 50 kg): Close monitoring for toxicities (eg, excessive
nausea and vomiting); reduce dose if toxicities develop [2]
Administration
Oral
Take twice daily with meals, morning and evening [2]
(Solution) Use supplied dosing syringe; may swallow directly from syringe or mix with
water, cold fruit juice, or soda; stir well before drinking [2]
(Solution) If mixed with cold fruit juice or soda, the mixture is stable at room
temperature for up to 4 hours [2]
Comparative Efficacy
无可用结果
Place In Therapy
无可用结果
Last Modified: October 10, 2023
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2023/11/5 09:57
Drug summary – MICROMEDEX
Galantamine Hydrobromide
DrugPoint
综述
DOSING/ADMINISTRATION
Adult Dosing
General Dosage Information
Beers Criteria: Use caution or avoid use as potentially inappropriate in older adults [4].
Alzheimer’s disease – Dementia (Mild to Moderate)
(Immediate-release tablet and oral solution) Initial, 4 mg orally twice daily for a
minimum of 4 weeks, then 8 mg twice daily if previous dose tolerated; further
increases to 12 mg twice daily can be attempted only after a minimum of 4 weeks at
the previous dose [5][6]
(Extended-release capsule) Initial, 8 mg orally once daily for a minimum of 4 weeks,
then 16 mg once daily for a minimum of 4 weeks, further increases to 24 mg/day may
be attempted after a minimum of 4 weeks at the previous dose, MAX 24 mg/day [5][6]
Multi-infarct dementia
16 to 24 mg orally daily (off-label dosage) [7]
Pediatric Dosing
General Dosage Information
Safety and efficacy have not been established in pediatric patients [5][6]
FDA Uses
Alzheimer’s disease – Dementia (Mild to Moderate)
Non-FDA Uses
Alzheimer’s disease – Cerebrovascular disease
Multi-infarct dementia
Dose Adjustments
Moderate renal impairment: Do not exceed 16 mg orally per day [5][6]
Severe renal impairment (CrCl less than 9 mL/min): Use not recommended [5][6]
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2023/11/5 09:57
Drug summary – MICROMEDEX
Moderate hepatic impairment (Child-Pugh score of 7 to 9): Do not exceed 16 mg
orally per day [5][6]
Severe hepatic impairment (Child-Pugh score of 10 to 15): Use not recommended [5]
[6]
Administration
Oral
Ensure adequate fluid intake [5][6]
(Extended-release capsule) Take in morning, preferably with food [5][6]
(Tablets, oral solution) Give preferably with morning and evening meals [5][6]
(Oral solution) Caregiver should read supplied instruction sheet prior to administering
oral solution [5][6]
Comparative Efficacy
无可用结果
Place In Therapy
无可用结果
Last Modified: November 02, 2023
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2023/11/5 10:00
Drug summary – MICROMEDEX
Memantine Hydrochloride
DrugPoint
综述
DOSING/ADMINISTRATION
Adult Dosing
Alzheimer’s disease (Moderate to Severe)
(Immediate-release) Initial, 5 mg orally once daily; titrate in 5-mg increments at
intervals of at least 1 week to 10 mg/day (5 mg twice daily), 15 mg/day (5 mg and 10
mg in separate doses), and 20 mg/day (10 mg twice daily); target daily dose is 20
mg/day [1]
(Immediate-release) If a single dose is missed, take next dose as scheduled (do not
double up on next dose); if doses missed for several days, may need to resume at
lower doses and re-titrate [1]
(Extended-release) Initial, 7 mg orally once daily; titrate in 7-mg increments at
intervals of least 1 week as tolerated to a maintenance dose of 28 mg once daily; MAX,
28 mg/day [2]
Dementia – Psychotic disorder
10 or 20 mg orally each day (off-label dosage) [3]
Migraine; Prophylaxis
10 or 20 mg/day orally (off-label dosage) [4]
Obsessive-compulsive disorder; Adjunct
10 mg orally twice daily added to stable and maximally-tolerated dose of SSRI therapy
[5]; may begin at 5 mg [6] or 10 mg once daily [7] and increase as tolerated (off-label
dosage) [7][6]
Schizophrenia; Adjunct
Initial, 5 or 10 mg/day orally and titrate to 20 mg/day (off-label dosage) [8]
Pediatric Dosing
General Dosage Information
Safety and efficacy not established in pediatric patients [2][1]
FDA Uses
Alzheimer’s disease (Moderate to Severe)
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2023/11/5 10:00
Drug summary – MICROMEDEX
Non-FDA Uses
Dementia
Dementia – Psychotic disorder
Migraine; Prophylaxis
Obsessive-compulsive disorder; Adjunct
Schizophrenia; Adjunct
Dose Adjustments
Renal impairment, CrCl of 30 to 80 mL/min: No adjustment necessary [2][1]
Renal impairment, CrCl, 5 to 29 mL/min: Immediate-release, reduce dosage to 5 mg
orally twice daily [1]; extended-release, reduce dosage to 14 mg orally once daily [2]
Hepatic impairment, mild to moderate: No adjustment necessary [2][1]
Hepatic impairment, severe: Administer with caution [1]
Administration
Oral
Take with or without food [2][1].
If a single dose is missed, take next dose as scheduled (do not double up on next
dose); if doses missed for several days, may need to resume at lower doses and retitrate [2][1].
(Oral solution) Do not mix with any other liquids [1].
(Oral solution) Use the dosing device that comes with the drug to withdraw the correct
dose volume [1].
(Oral solution) Slowly squirt dose volume into the corner of the mouth [1].
(Extended-release) Do not chew, crush, or divide dose [2].
(Extended-release) May open capsule and sprinkle entire contents on applesauce to
be consumed [2].
Comparative Efficacy
无可用结果
Place In Therapy
无可用结果
Last Modified: October 25, 2023
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2023/11/5 10:02
Drug summary – MICROMEDEX
Suvorexant
DrugPoint
综述
DOSING/ADMINISTRATION
Adult Dosing
Delirium; Prophylaxis
(Less than 65 years) 20 mg orally or via nasogastric tube once daily in the evening;
treatment was continued until the patient developed delirium or received treatment for
7 consecutive days (off-label dosage) [1]
(65 years or greater) 15 mg orally or via nasogastric tube once daily in the evening;
treatment was continued until the patient developed delirium or received treatment for
3 to 7 consecutive days (off-label dosage) [1][2]
Insomnia
10 mg orally taken no more than once/night, within 30 minutes of bedtime and with
at least 7 hours available prior to awakening; may increase to MAX 20 mg/night; for all
doses, take no more than once per night; use lowest effective dose [3]
Pediatric Dosing
General Dosage Information
Safety and efficacy not established in pediatric patients [4]
FDA Uses
Insomnia
Non-FDA Uses
Delirium; Prophylaxis
Dose Adjustments
Renal impairment: Dose adjustment is not needed [4]
Hepatic impairment (mild to moderate): Dose adjustment is not needed [4]
Hepatic impairment (severe): Use not recommended [4]
Geriatric: No clinically significant differences were observed between patients 65 years
or older, 75 years or older, and younger patients; elderly patients may be at an
increased risk for falls [3]
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Drug summary – MICROMEDEX
Concomitant use with other CNS depressants: Dose adjustments of suvorexant may be
needed [4].
Concomitant use (moderate CYP3A inhibitors): Suggested dose is 5 mg/night taken no
more than once per night and should generally not exceed 10 mg/night[3]
Concomitant use (strong CYP3A inhibitors): Use is not recommended [3]
Female gender: Exposure is increased; evaluate risk of exposure-related adverse
events prior to increasing the dose, especially in obese women [4]
Obese patients: Exposure is increased; evaluate risk of exposure-related adverse
events prior to increasing the dose, especially in obese women [4]
Administration
Oral
If taken with food or soon after a meal, time to effect will be delayed [4]
Comparative Efficacy
无可用结果
Place In Therapy
无可用结果
Last Modified: October 06, 2023
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Formatting
Title Page
Citation
Outline
