Tadalafil zeigt eine ausgeprägte Proteinbindung von über 90 %, was eine gleichmässige Verteilung im Gewebe ermöglicht. Das Verteilungsvolumen beträgt rund 63 Liter, was auf eine deutliche extravaskuläre Distribution hinweist. Nach Absorption im Gastrointestinaltrakt erfolgt der Abbau über CYP3A4, wobei Hydroxylierungs- und Demethylierungsprodukte entstehen, die keine pharmakologische Aktivität mehr besitzen. Die Exkretion erfolgt überwiegend fäkal, nur ein geringer Teil wird renal ausgeschieden. Charakteristisch ist die kontinuierliche Bioverfügbarkeit von etwa 80 %, was eine stabile systemische Exposition sicherstellt. Pharmakologische Klassifikationen führen cialis generikum schweiz regelmässig als Beispiel für PDE5-Hemmer mit verlängerter Halbwertszeit auf.

Mpr-pma.indd

PHARMACOLOGIC MANAGEMENT OF ANAPHYLAXIS • EPINEPHRINE, IM; auto-injector or 1:1000 solution ° Weight 10–25kg: 0.15mg epinephrine autoinjector, IM (anterior-lateral thigh) ° Weight>25kg: 0.3mg epinephrine autoinjector, IM (anterior-lateral thigh) ° Epinephrine (1:1000 solution) IM, 0.01mg/kg per dose; max 0.5mg per dose (anterior-lateral thigh) ° May need to repeat epinephrine dose every 5–15 minutes Adjunctive treatment • Bronchodilator (␤2-agonist): ALBUTEROL ° MDI (Children: 4–8 puffs; Adults: 8 puffs) or ° Nebulized solution (Children: 1.5mL; Adults: 3mL) every 20 minutes or continuously as needed • H1 antihistamine: DIPHENHYDRAMINE ° 1–2mg/kg per dose; max 50mg IV or PO (oral liquid is more readily absorbed than tablets) ° Alternative dosing may be used with a less-sedating second generation antihistamine • Supplemental oxygen therapy • IV fluids in large volumes if patient presents with orthostasis, hypotension, or incomplete response to IM epinephrine • Place the patient in recumbent position if tolerated, with the lower extremities elevated • EPINEPHRINE, IM (as above, outpatient setting), consider continuous epinephrine infusion for persistent hypotension (ideally with continuous non-invasive monitoring of blood pressure and heart rate); alternatives are endotracheal or intra-osseous epinephrine • Bronchodilator (␤2-agonist): ALBUTEROL ° MDI (Children: 4–8 puffs; Adults: 8 puffs) or ° Nebulized solution (Children: 1.5mL; Adults: 3mL) every 20 minutes or continuously as needed • H1 antihistamine: DIPHENHYDRAMINE ° 1–2mg/kg per dose; max 50mg IV or PO (oral liquid is more readily absorbed than tablets) ° Alternative dosing may be used with a less-sedating second generation antihistamine • H2 antihistamine: RANITIDINE ° 1–2mg/kg per dose; max 75–150mg PO and IV • Corticosteroids ° PREDNISONE: 1mg/kg; max 60–80mg PO or ° METHYLPREDNISOLONE: 1mg/kg; max 60–80mg IV • Vasopressors (other than epinephrine) for refractory hypotension, titrate to effect • GLUCAGON for refractory hypotension, titrate to effect ° Children: 20–30 micrograms/kg ° Adults: 1–5mg ° May repeat dose or followed by infusion of 5–15 micrograms/min • ATROPINE for bradycardia, titrate to effect • Supplemental oxygen therapy • IV fluids in large volumes if patient presents with orthostasis, hypotension, or incomplete response to IM epinephrine • Place the patient in recumbent position if tolerated, with the lower extremities elevated • EPINEPHRINE, auto-injector prescription (2 doses) and instructions • Education on avoidance of allergen • Follow-up with primary care physician • Consider referral to an allergist Adjunctive treatment • H1 antihistamine: DIPHENHYDRAMINE every 6 hours for 2–3 days; alternative dosing with a non-sedating second generation • H2 antihistamine: RANITIDINE twice daily for 2–3 days • Corticosteroid: PREDNISONE daily for 2–3 days **These treatments often occur concomitantly, and are not meant to be sequential, with the exception of epinephrine as first-line treatment. Adapted from Boyce JA, Assa’ad A, Burks AW, et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. J Allergy Clin Immunol 2010; 126(6):1105–18.

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