guanidine (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 125mg

Lambert-Eaton Myasthenic Syndrome

Indicated to symptoms of muscle weakness and fatigue associated with Eaton-Lambert myasthenic syndrome (LEMS)

10-15 mg/kg/day PO divided in 3-4 doses initially; may gradually increase to 35 mg/kg total daily dose as tolerated

Dosage Modifications

Renal or hepatic impairment: No dosage adjustment provided in prescribing information

Dosing Considerations

Measure blood counts with differentials at baseline and regularly thereafter

Monitor renal function

Safety and efficacy not established

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Interactions

Interaction Checker

and guanidine

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Hematologic: Anemia, leukopenia, thrombocytopenia owing to bone marrow suppression

            General: Sore throat, rash, fever

            Neurologic: Paresthesia of lips, face, hands, feet; cold sensations in hands and feet; nervousness, lightheadedness, jitteriness, increased irritability; tremor, trembling sensation; ataxia; emotional lability; psychotic state; confusion; mood changes, and hallucinations

            Gastrointestinal: Dry mouth; gastric irritation; anorexia; nausea; diarrhea; abdominal cramping

            Dermatologic: Rash, flushing or pink complexion; folliculitis; petechiae, purpura, ecchymoses; sweating; skin eruptions; dryness and scaling of the skin

            Renal: Elevation of blood creatinine, uremia; chronic interstitial nephritis, acute interstitial nephritis, and renal tubular necrosis

            Hepatic: Abnormal liver function tests

            Cardiac: Palpitation, tachycardia, atrial fibrillation, hypotension

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            Warnings

            Contraindications

            Hypersensitivity

            Cautions

            Fatal bone-marrow suppression, apparently dose related, can occur

            Discontinue upon appearance of bone marrow suppression

            May cause renal impairment; regularly measure serum creatinine

            Use cautiously with hepatic disease; drug-induced liver dysfunction may occur

            GI adverse effects may occur; significant GI disease (eg, peptic ulcer disease) may preclude guanidine use

            Use caution with history of psychosis; carefully monitor patients with known behavioral or mood disorders

            Drug interactions overview

            • Avoid coadministration with other drugs that cause bone marrow suppression
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            Pregnancy & Lactation

            Pregnancy

            Owing to a lack of data assessing fetal risk, and the potential for hematologic, neurologic, and cardiac toxicity associated with the drug, guanidine should be used during pregnancy only if clearly needed

            Lactation

            Excreted in breast milk; discontinue breastfeeding during treatment

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Acts by enhancing acetylcholine release following nerve impulses; also slows depolarization and repolarization rates of muscle cell membranes

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            Administration

            Oral Administration

            Administer daily dosage in 3-4 divided doses

            Storage

            Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F)

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.