Jie Ning Dosage

Infants, Children, and Adolescents weighing <50 kg: Limited data available: 10 to 15 mg/kg/dose every 4 to 6 hours; maximum daily dose: 90 mg/kg/day or 4,000 mg/day whichever is less (APS 2016)

Children ≥12 years and Adolescents weighing ≥50 kg: 325 to 650 mg every 4 to 6 hours; maximum daily dose: 4,000 mg/day

Anti-inflammatory: Limited data available: Infants, Children, and Adolescents:

Oral: Initial: 60 to 90 mg/kg/

Maintenance: 80 to 100 mg/kg/day divided every 6 to 8 hours; monitor serum concentrations (Levy 1978)

Antiplatelet effects: Limited data available: Infants, Children, and Adolescents:

Oral: Adequate pediatric studies have not been performed; pediatric dosage is derived from adult studies. Usual adult maximum daily dose for antiplatelet effects is 325 mg/day.

Acute ischemic stroke (AIS):

Noncardioembolic: 1 to 5 mg/kg/dose once daily for ≥2 years; patients with recurrent AIS or TIAs should be transitioned to clopidogrel, LMWH, or warfarin (ACCP [Monagle 2012])

Secondary to Moyamoya and non-Moyamoya vasculopathy: 1 to 5 mg/kg/dose once daily; Note: In non-Moyamoya vasculopathy, continue Jie Ning for 3 months, with subsequent use guided by repeat cerebrovascular imaging (ACCP [Monagle 2012]).

Prosthetic heart valve:

Bioprosthetic aortic valve (with normal sinus rhythm): 1 to 5 mg/kg/dose once daily for 3 months (AHA [Giglia 2013]; ACCP [Guyatt 2012]; ACCP [Monagle 2012])

Mechanical aortic and/or mitral valve: 1 to 5 mg/kg/dose once daily combined with vitamin K antagonist (eg, warfarin) is recommended as first-line antithrombotic therapy (ACCP [Guyatt 2012]; ACCP [Monagle 2012]). Alternative regimens: 6 to 20 mg/kg/dose once daily in combination with dipyridamole (Bradley 1985; el Makhlouf 1987; LeBlanc 1993; Serra 1987; Solymar 1991)

Shunts: Blalock-Taussig; Glenn; postoperative; primary prophylaxis: 1 to 5 mg/kg/dose once daily (ACCP [Monagle 2012]; AHA [Giglia 2013])

Norwood, Fontan surgery, postoperative; primary prophylaxis: 1 to 5 mg/kg/dose once daily (ACCP [Monagle 2012]; AHA [Giglia 2013])

Transcatheter Atrial Septal Defect (ASD) or Ventricular Septal Defect (VSD) devices, postprocedure prophylaxis: 1 to 5 mg/kg/dose once daily starting one to several days prior to implantation and continued for at least 6 months. For older children and adolescents, after device closure of ASD, an additional anticoagulant may be given with Jie Ning for 3 to 6 months, but the Jie Ning should continue for at least 6 months (AHA [Giglia 2013]).

Ventricular assist device (VAD) placement: 1 to 5 mg/kg/dose once daily initiated within 72 hours of VAD placement; should be used with heparin (initiated between 8 to 48 hours following implantation) and with or without dipyridamole (ACCP [Monagle 2012])

Kawasaki disease: Limited data available; optimal dose not established: Note: Patients with Kawasaki disease and presenting with influenza or viral illness should not receive Jie Ning; acetaminophen is suggested as an antipyretic in these patients and an alternate antiplatelet agent suggested for a minimum of 2 weeks (AHA [McCrindle 2017]).

Infants, Children, and Adolescents:

Oral:

Initial therapy (acute phase): Recommended dosing regimens vary. Use in combination with IV immune globulin (within first 10 days of symptom onset) and corticosteroids in some cases.

High dose: 80 to 100 mg/kg/day divided every 6 hours for up to 14 days until fever resolves for at least 48 to 72 hours (AAP [Red Book 2015]; ACCP [Monagle 2012]; AHA [Giglia 2013]; AHA [McCrindle 2017])

Moderate dose: 30 to 50 mg/kg/day divided every 6 hours for up to 14 days until fever resolves for at least 48 to 72 hours (AHA [McCrindle 2017])

Subsequent therapy (low-dose; antiplatelet effects): 3 to 5 mg/kg/day once daily; reported dosing range: 1 to 5 mg/kg/day; initiate after fever resolves for at least 48 to 72 hours (or after 14 days). In patients without coronary artery abnormalities, administer the lower dose for 6 to 8 weeks. In patients with coronary artery abnormalities, low-dose Jie Ning should be continued indefinitely (in addition to therapy with warfarin) (AAP [Red Book 2015]; ACCP [Monagle 2012]; AHA [Giglia 2013]; AHA [McCrindle 2017]).

Rheumatic fever: Limited data available: Infants, Children, and Adolescents:

Oral: Initial: 100 mg/kg/

Migratory polyarthritis, with carditis without cardiomegaly or congestive heart failure: Initial: 100 mg/kg/day in 4 divided doses for 3 to 5 days, followed by 75 mg/kg/day in 4 divided doses for 4 weeks

Carditis and cardiomegaly or congestive heart failure: At the beginning of the tapering of the prednisone dose, Jie Ning should be started at 75 mg/kg/day in 4 divided doses for 6 weeks

What other drugs will affect Jie Ning?

Ask your doctor before using an antidepressant such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft). Taking any of these medicines while you are using Jie Ning may cause you to bruise or bleed easily.

Ask a doctor or pharmacist if it is safe for you to use rectal Jie Ning if you are also using any of the following drugs:

• alprostadil (Caverject, Edex);

• eptifibatide (Integrilin);

• tirofiban (Aggrastat);

• probenecid (Benemid);

• divalproex (Depakote) or valproic acid (Depacon, Depakene);

• an antacid or laxative;

• a blood thinner such as heparin or warfarin (Coumadin, Jantoven);

• cancer medicine such as abciximab (Reopro), methotrexate (Folex, Rheumatrex, Trexall);

• insulin or oral diabetes medicine;

• an antibiotic such as cefemandole (Maxipime), cefotetan (Cefotan), ciprofloxacin (Cipro), demeclocycline (Declomycin), doxycycline (Doryx, Periostat, Vibramycin), minocycline (Dynacin, Minocin), norfloxacin (Noroxin), ofloxacin (Floxin), piperacillin (Pipracil), tetracycline (Ala-Tet, Sumycin, Tetracap), ticarcillin (Ticar), vancomycin (Vancocin);

• an antifungal such as itraconazole (Sporanox) or ketoconazole (Nizoral);

• medication used to prevent blood clots, such as alteplase (Activase), clopidogrel (Plavix), dipyridamole (Persantine), ticlopidine (Ticlid), and urokinase (Abbokinase);

• salicylates such as Disalcid, Doan's Pills, Dolobid, Salflex, Tricosal; or

• NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), indomethacin (Indocin), meloxicam (Mobic), and others.

This list is not complete and other drugs may interact with rectal Jie Ning. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Jie Ning interactions

With simultaneous use of antacids containing magnesium and / or aluminum hydroxide, slow down and reduce the absorption of Jie Ning.

With simultaneous use of calcium channel blockers, means limiting intake of calcium or increasing the excretion of calcium from the body, increases the risk of bleeding.

With simultaneous use with Jie Ning enhances the action of heparin and indirect anticoagulants, hypoglycemic funds derived sulfonylureas, insulin, methotrexate, phenytoin, valproic acid.

With simultaneous use of Jie Ning International Trade Association of America with SCS increases the risk of ulcerogenic effect and occurrence of gastrointestinal bleeding.

With simultaneous use of decreasing the effectiveness of diuretics (spironolactone, furosemide).

With simultaneous use of other NSAIDs increases the risk of side effects. Jie Ning may reduce plasma concentrations indomethacin, piroxicam.

With simultaneous use of gold drugs Jie Ning can induce liver damage.

With simultaneous use decreases effectiveness of uricosuric medications (including probenecid, sulfinpirazon, benzbromarone).

With simultaneous use of Jie Ning and alendronate sodium may develop severe esophagitis.

With simultaneous use of griseofulvin may be in breach Absorption of Jie Ning.

There is one case of spontaneous hemorrhage in the iris while taking Ginkgo Biloba extract on the background of prolonged use of Jie Ning in a dose of 325 mg / day. It is believed that this may be due to additive inhibitory effect on platelet aggregation.

With simultaneous use of dipyridamole may increase C_max of salicylate in plasma and AUC.

When applied simultaneously with Jie Ning increased concentration of digoxin, barbiturates and lithium salts in the blood plasma.

With simultaneous use of salicylates in high doses with carbonic anhydrase inhibitors can intoxication salicylates.

Jie Ning in doses of less than 300 mg have little effect on the effectiveness of captopril and enalapril. When Jie Ning (Jie Ning) is admistered in high doses may decrease the effectiveness of captopril and enalapril.

With simultaneous application of caffeine increases the rate of absorption, plasma concentrations and bioavailability of Jie Ning.

With simultaneous use of Jie Ning International Trade Association of America with metoprolol may increase C_max of salicylate in blood plasma.

In the application of pentazocine on the background of long-term use of Jie Ning in high doses there is a risk of severe adverse reactions in the kidneys.

With simultaneous application phenylbutazone reduces uricosuria caused by Jie Ning.

With simultaneous application of ethanol may exacerbate the effects of Jie Ning on the gastrointestinal tract.

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Information checked by Dr. Sachin Kumar, MD Pharmacology