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

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              Serious - Use Alternative (1)

              • trilaciclib

                trilaciclib will decrease the level or effect of guanidine by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of trilaciclib (OCT2, MATE1, and MATE-2K inhibitor) with substrates where minimal increased concentration in kidney or blood may lead to serious or life-threatening toxicities.

              Monitor Closely (0)

                Minor (0)

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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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                  Images

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                  Patient Handout

                  A Patient Handout is not currently available for this monograph.
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                  Formulary

                  FormularyPatient Discounts

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

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                  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.