The BMT/SCT pharmacopoeia

Individual drugs and classes of drugs page 431 Analgesics and adjuvant analgesics 431 Antibiotics 439 Anticoagulants and protamine 450 Antidiarrheal drugs 456 Antiemetics 458 Antifungal agents: systemic use 458 Antifungal agents: Topical oral use 462 Antifungal agents: Topical dermatologic use 463 Antineoplastic agents 466 Antivirals 471 Electrolytes 476 Immunosuppressive agents 480 Targeted Therapies 487 Miscellaneous 488 Further reading 491 The list of side effects discussed in this chapter is far from complete; the specialized literature, databases and package inserts should always be carefully consulted. Individual drugs and classes of drugs Analgesics and adjuvant analgesics Effective control of pain, especially from oropharyngeal mucositis secondary to the pretransplant conditioning regimen or posttransplant methotrexate, is essential in the BMT unit. Some of the most common medications used for pain are reviewed in this section. Acetaminophen Acetaminophen (Paracetamol) is an analgesic and antipyretic, but has no anti-inflammatory activity. It is well-absorbed orally and rectally, and comes in dosage forms including tablets, capsules, oral liquid, and suppositories. Acetaminophen is metabolized in the liver, and its metabolites are excreted in urine. Its duration of action is about 4 hours. Acetaminophen does not cause gastric irritation and is the analgesic of choice for mild pain. The maximum recommended daily dose of acetaminophen is 4 g. In some cases, such as in the palliative care setting or for acute pain, higher doses can be given for short durations. In these situations, risk factors must be taken into account, and patients must be monitored carefully.