Term
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Definition
Triazolam
Indication: short-term txt of insomnia
Dosing: 0.125mg-0.25mg at hs
usual/max: 0.25-0.5mg
PK: short half life, high potential for rebound and anterograde amnesia
DI: azole, antifungals, omeprazole, cimetidine and nefazodone may increase Cp
CI: Preg Cat. X. strong CYP 3A4 inhibitors
Notes: 0.125mg if elderly, short-term(7-10days). C IV. |
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Term
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Definition
temazepam
Indication: short-term insomnia
Dosing: 15-30mg before hs
Usual/max: 7.5-30mg
PK: conjugated with no active metablites
Notes: short-term use (10 days). C IV. Preg Cat X. |
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Term
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Definition
zolpidem
Indication: short-term txt of insomnia
dosing: 5 or 10 mg at hs
Max: 10mg
Notes: 5 mg if female, elderly, or hepatic impairment. Preservation of sleep cycle stages 3 and 4 |
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Term
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Definition
zolpidem
Indication: short-term txt of insomnia
dosing: 6.25 or 12.5mg at hs
max: 12.5mg
notes: 6.25mg if female, elderly, or hepatic impairment. Do not crush or chew. Preservation of sleep cycle stages 3 and 4 |
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Term
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Definition
zaleplon
Indication: short-term txt of insomnia. No decrease in nighttime awakenings. No prolongation of sleep time. Lower likelihood of residual sedation/memory impairment
Dosing: 5-10mg at hs
Max: 20 mg
DI: cimetidine, grapefruit juice, and rifampin. Food delays absorption up to 3 hrs
Notes: 5 mg if elderly or hepatic impairment or on cimetidine. Take on empty stomach |
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Term
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Definition
eszopiclone
Indication: short-term txt of insomnia. Approved for up to 6 months of use.
Dosing: 2 mg at hs
max: 3 mg
PK: rapidly absorbed within 1 hr. CYP 3A4
DI: azole antifungals, clarithromycin, nefazodone
Notes: 1 mg if elderly or hepatic impairment/CYP3A4 inhibitor. Take on empty stomach for rapid absorption |
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Term
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Definition
Ramelteon
Indication: insomnia due to difficulty with sleep onset
Dosing: 8 mg at hs
CI: h/o angioedema associated with ramelteon; do not administer with fluvoxamine
PK: CYP 1A2 substrate
Notes: take within 30 min of bedtime; avoid high-fat meal. Not controlled. No renal adjustment needed. Observe for complex behaviors with amnesia |
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Term
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Definition
Hydroxyzine
Indication: symptomatic relief of anxiety/tension. Pruritis
Dosing: 25 mg tid-qid
usual/max: 50-100mg qid
DI: CNS depressants
AE: drowsiness and dry mouth
Notes: forms include hydroxyzine base and vistaril (pamoate salt) |
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Term
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Definition
Meclizine
Indication: vertigo. OTC and Rx
Dosing: 12.5-25 mg tid-qid
Precautions: asthma, glaucoma, BPH
AE: drowsiness, dry mouth
Notes: can dose 1 hr prior to travel for motion sickness |
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Term
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Definition
amitriptyline (TCA)
Indication: depression
Dosing: 40-150 mg in divided doses or qhs
AE: high drowsiness and sedation |
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Term
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Definition
nortriptyline (TCA)
Indication: depression
Dosing: 75-150 mg in divided doses or qhs
AE: less sedation |
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Term
| Tofranil, Tofranil PM caps |
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Definition
imipramine (TCA)
Indication: childhood enuresis (>= 6 y/o)
Dosing: enuresis start <= 25 mg 1 hr before hs. Depression 50-150 mg qd
usual/max: enuresis 50mg (age <12); 75mg (age >=12)
Notes: NO MORE THAN 2.5 mg/kg/day according to weight
AE: less sedating |
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Term
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Definition
clomipramine (TCA)
Indication: OCD
Dosing: 25 mg qhs
Usual/Max: 25-100 mg qhs. Max 250mg/day |
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Term
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Definition
doxepin (TCA)
Indication: depression and/or anxiety
Dosing: 75-150 mg in divided doses or qhs
Usual: 300 mg qd (severe disease)
AE: more sedating |
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Term
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Definition
paroxetine (SSRI)
Indication: depression, OCD, panic disorder, SAD
Dosing: 10-20 mg qd
Max: 50mg/day (60mg/day OCD)
PK: CYP 2D6 inhibitor
DI: phenytoin, phenobarbital, cimetidine, warfarin
Notes: start elderly 10mg/day. Shorter half-life which makes withdrawal effect more pronounced and quicker if missed dose
AE: weight gain high, somnolence, constipation |
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Term
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Definition
paroxetine
Indication: depression
Dosing: 12.5-25 mg qd
Max: 62.5 mg/day |
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Term
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Definition
fluoxetine (SSRI)
Depression 10-20 mg qd, max 80 mg. Weekly 90 mg once a week, initiate 7 days after 13 weeks of 20mg/day
OCD 10 mg qd, max 80 mg
PK: CYP 2D6 inhibitor
DI: phenytoin, carbamazepine, benzos, sumatriptan
CI: concomitant use of thioridazine, MAOI
AE: insomnia, anorexia
Notes: divide doses >20 mg; long acting agents |
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Term
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Definition
sertraline (SSRI)
Indication: depression or OCD
Dosing: 25-50 mg qd
Max: 200 mg
PK: CYP 3A4, 2D6. 98% protein bound
DI: warfarin, diazepam
AE: NAUSEA, dyspepsia |
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Term
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Definition
citalopram (SSRI)
Indication: depression
Dosing: 10-20 mg qd
Max: 40 mg
PK: CYP 3A4, 2C19 substrate
Warnings/precaution: QT interval
DI: strong CYP 2C19 inhibitors (cimetidine, omeprazole)
AE: nausea, dry mouth
Notes: max 20 mg for age 60 and over |
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Term
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Definition
escitalopram (SSRI)
Indication: depression
Dosing: 10 mg qd
Max: 20 mg
PK: CYP 3A4, 2C19 substrate
DI: strong CYP 2C19 inhibitors (cimetidine, omeprazole)
AE: nausea
Notes: 10 mg if elderly or hepatic impairment |
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Term
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Definition
venlafaxine (SNRI)
Indication: depression/anxiety disorders
Dosing: 25 mg tid or 37.5 mg bid
Max: 225 mg
DI: MAOI, CNS active drugs (including antihistamines)
CI: MAOI
Precautions: preexisting HTN--especially higher doses, seizures, history of mania, renal impairment/cirrhosis of the liver (require dosage adjustment)
AE: nausea, HA, dizziness, drowsiness, increase in BP
Notes: bid-tid dosing; 375 mg max for severe depression.
Pt Consult: alcohol precautions, do not crush, chew or divide capsules. Do not abruptly DC. Have BP monitored weekly |
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Term
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Definition
venlafaxine (SNRI)
Indication: depression/anxiety disorders
Dosing: 37.5-75 mg qd
Max: 225 mg
Notes: generally once daily dosing |
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Term
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Definition
desvenlafaxine (SNRI)
Indication: depression
Dosing: 50 mg qd
usual/Max: 50-100 mg
DI: MAOI, CNS active drugs (including antihistamines)
CI: MAOI
Precautions: preexisting HTN--especially higher doses, seizures, history of mania, renal impairment (require dosage adjustment)
AE: nausea, HA, dizziness, drowsiness, increase in BP
Pt Consult: alcohol precaution. Do not crush or chew. Do not abruptly DC. Have BP monitored weekly
Notes: extended release tabs |
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Term
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Definition
duloxetine (SNRI)
Indication: depression/anxiety disorders
Dosing: 20-30 mg bid
Max: 60 mg
PK: CYP 2D6, 1A2 substrate
DI: 2D6- TCA, phenothiazines, fluoxetine, paroxetine. 1A2- fluvoxamine, fluoroquinolones
CI: use of MAOI, narrow angle glaucoma
Precautions: preexisting HTN--especially higher doses), seizures, history of mania
AE: nausea, dry mouth, constipation, insomnia, decreased appetite
Pt Consult: alcohol precaution. Do not abruptly DC
Notes: can dose once daily |
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Term
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Definition
trazodone (SARI)
Indication: depression (+/- anxiety. Off-label for insomnia
Dosing: 150 mg in divided doses
Max: 400mg/24 hrs
PK: absorption slowed/enhanced with food
DI: CNS depressants, phenytoin, grapefruit juice (increase levels)
Precautions: priapism, recent MI, arrhythmias
AE: drowsiness, dry mouth, dizziness, OHTN (due to alpha 1 inhibitory activity)
Pt Consult: take with food for best absorption, alcohol precautions, male counseling related to priapism, do not abruptly DC
Notes: give larger doses at hs if drowsiness occuring |
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Term
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Definition
mirtazapine (NaSSA)
Indication: depression
Dosing: 15-45 mg qd at hs
Max: 45 mg
DI: MAOI, CNS depressants
CI: MAOI
AE: DROWSINESS, dry mouth, increased appetite/weight gain, dizziness
Pt Consult: alcohol precautions, do not abruptly DC |
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Term
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Definition
bupropion (NDRI)
Indication: depression
Dosing: regular 100 mg bid up to 100 mg tid.
SR 150 mg qd up to 150 mg bid.
XL 150 mg qd up to 300 mg qd.
Max: 450 mg/day
DI: MAOI, levo-dopa (due to added augmentation of dopamine activity), alcohol
CI: use of MAOI, seizure disorder, bulimia, anorexia
Precautions: may produce mania, psychosis
AE: dizziness, nausea, anorexia/weight loss, insomnia, tremor
Pt Consult: important to keep on a regular dosage schedule, avoid alcohol, weight loss or gain may be temporary
Notes: regular - titrate no sooner than every 72 hrs |
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Term
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Definition
buspirone (NDRI)
Indication: generalized anxiety
Dosing: 5 mg tid
Max: 60 mg (30 mg bid)
Precautions: renal or hepatic dysfunction, potential for movement disorders related to dopamine receptors
AE: HA, fatigue, dizziness, insomnia, nausea
Pt Consult: dizziness, report abnormal/involuntary muscle mvmt, take consistently with OR without food, does not work immediately to relieve anxiety (not prn)
Notes: May take up to 8 wks for full effect. Not controlled. |
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Term
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Definition
lorazepam
Indication: anxiety disorders, insomnia, status epilepticus
Dosing: 0.5 mg bid up to 3 mg bid
Max: 10 mg
PK: intermediate half-life and no active metabolites
CI: preg cat D
Precautions: hepatic dysfunction, renal impairment, depression, psychosis
Pt Consult: drowsiness, withdrawal potential
Notes: benzos best for short-term use/situational. C IV |
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Term
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Definition
clorazepate
Indication: anxiety disorders, alcohol withdrawal
Dosing: 7.5-15 mg bid-tid
Max: 60 mg/24 hrs
PK: long half-life with active metabolites
DI: CNS depressants, azole antifungals, omeprazole, cimetidine, nefazodone may increase Cp
CI: preg cat X
Precautions: renal, hepatic dysfunction, elderly
Pt Consult: drowsiness, withdrawal potential
Notes: also available 11.25 and 22.5 mg extended release. C IV |
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Term
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Definition
diazepam
Indication: anxiety disorders and skeletal muscle spasm
Dosing: 2-10 mg tid-qid
Max: anxiety disorders 40 mg
PK: long half-life with active metabolites
DI: CNS depressants, omeprazole, cimetidine, grapefruit juice
CI: preg cat D
Precautions: renal, hepatic dysfunction, elderly
Pt Consult: drowsiness, withdrawal potential
Notes: benzos best for short-term use/situational. C IV |
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Term
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Definition
alprazolam
Indication: anxiety/panic disorders
Dosing: 0.25-0.5 mg tid
Max: 4 mg/day
PK: intermediate half-life with active metabolites
DI: CNS depressants, azole antifungals, omeprazole, cimetidine, nefazodone may increase Cp
CI: preg cat D
Precautions: renal, hepatic dysfunction, elderly
Pt Consult: drowsiness, withdrawal potential
Notes: Xanax XR indicated for panic. Benzos best for short-term use/situational. C IV |
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Term
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Definition
clonazepam
Indication: seizures
Dosing: 0.5 mg tid titrated to seizure control
Max: 20 mg/day
CI: liver disease, untreated open angle glaucoma
Precautions: abrupt DC may precipitate seizures or withdrawal symptoms
Pt Consult: drowsiness, avoid alcohol, do not stop abruptly
Notes: other uses: insomnia, restless legs. C IV |
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Term
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Definition
haloperidol
Indication: psychotic disorders
Dosing: 3-5 mg bid to tid (more severe)
Max: 100 mg
DI: anticholinergics, CNS depressants
CI: Parkinson's
Precautions: NMS; irreversible tardive dyskinesia, prolonged QT interval, OHTN
AE: extrapyramidal symptoms, drowsiness
Pt Consult: alcohol precaution |
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Term
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Definition
thioridazone
Indication: psychotic disorders
Dosing: 200-800 mg divide in 2-4 doses
Max: 800 mg
DI: anticholinergics, CNS depressants
CI: drugs that inhibit metabolism, prolonged QT interval or use with drugs that prolong QT interval
Precautions: NMS; irreversible tardive dyskinesia, OHTN, glaucoma
AE: EPS, anticholinergic effects, OTHN, drowsiness
Pt Consult: alcohol precaution |
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Term
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Definition
fluphenazine
Indication: psychotic disorders
Dosing: 2.5-10 mg divided q 6-8hrs
Max: 20 mg
DI: anticholinergics, CNS depressants
Precautions: NMS; irreversible tardive dyskinesia, OHTN
AE: EPS, drowsiness
Pt Consult: alcohol precaution
Notes: reduce dose to lowest effective (1-5 mg/day) |
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Term
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Definition
clozapine
Indication: schizophrenia
Dosing: 12.5-25 mg bid
DI: anticholinergic agents, additive HTN with antihypertensives
CI: myeloproliferative disorders, h/o low WBC count
Precautions: seizure disorders, cardiovascular disease, narrow angle glaucoma
AE: drowsiness, tachycardia, dizziness, OHTN, risk of agranulocytosis
Pt Consult: mandatory WBC monitoring-counsel on s/sx of infection
Usual/max: 200-900 mg |
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Term
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Definition
risperidone
Indication: schizophrenia, acute mania
Dosing: 1 mg bid to start
Usual/max: 4-12 mg per day
Precautions: NMS; irreversible tardive dyskinesia, prolonged QT interval, OHTN, seizure disorders, potential hyperglycemia
AE: EPS, insomnia, agitation, somnolence, tachycardia
Pt Consult: food or milk if needed, OHTN, alcohol precaution, avoid excessive sunlight |
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Term
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Definition
quetiapine
Indication: schizophrenia, acute mania, bipolar
Dosing: 25-50 mg bid to start
Usual: 300-400 mg per day
Precautions: NMS; rare irreversible tardive dyskinesia, OHTN, seizure disorders; eye examinations for developing cataracts, potential hyperglycemia
AE: somnolence, dizziness, constipation, postural hypotension, dry mouth
Pt consult: OHTN precautions, alcohol precaution
Notes: generally divide bid-tid; max is 800 mg per day |
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Term
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Definition
olanzapine
Indication: schizophrenia, acute mania, bipolar
Dosing: 5-10 mg qhs
Usual/Max: 5-20 mg (30 mg max)
Precautions: NMS; irreversible tardive dyskinsea, OHTN, seizure disorders, potential for hyperglycemia
AE: somnolence, agitation, insomnia, dizziness, postural hypotension
Pt Consult: alcohol precaution, avoid excessive sunlight
Notes: titrate no sooner than weekly; also 5,15 mg ODT |
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Term
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Definition
ziprasidone
Indication: schizophrenia, acute mania, bipolar
Dosing: 20 mg bid
Usual/Max: 40-160 mg
PK: CYP 3A4
DI: carbamazepine, ketoconazole, agents that prolong QT interval
CI: acute MI, decompensated CHF, QT prolongation or receiving agents that prolong QT interval
Precautions: NMS; irreversible tardive dyskinesia, seizure disorders
AE: somnolence, nausea, constipation, dizziness, postural hypotension
Pt Consult: alcohol precaution, take with food to increase absorption
Notes: generally divide bid |
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Term
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Definition
aripiprazole
Indication: schizophrenia, acute mania, bipolar
Dosing: 10-15 mg qd
Usual/Max: 10-30 mg
PK: CYP 3A4, 2D6
DI: carbamazepine, fluoxetine, paroxetine
Precautions: NMS; irreversible tardive dyskinesia, seizure disorders
AE: HA, insomnia, anxiety
Pt Consult: alcohol precaution |
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Term
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Definition
varencycline
Indication: smoking cessation aid
Dosing: 0.5 mg q am x 3 days, bid x 4 days, 1 mg bid
Usual: 12 wk initial txt
PK: high renal elimination
DI: nicotine replacement therapies
Precautions: MED WATCH- mood changes/suicidal ideation, erratic behavior reported
AE: nausea, HA, insomnia, abnormal dreams
Pt Consult: lifestyle mods/precautions prior to quit date (remove ashtrays, avoid prior routines related to smoking)
Notes: start 7 days prior to cessation |
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Term
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Definition
brimonidine
Indication: open-angle glaucoma
Dosing: 1 gtt in affected eye q 8hrs
DI: additive effects with BB
AE: allergic conjunctivitis, eye pruritis, burning, hyperemia, dry mouth, visual disturbance
Notes: ideally wait 5-10 min before using other eye drops, remove contact lenses prior to instillation |
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Term
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Definition
betaxolol
Indication: open-angle glaucoma
Pharmacology: beta 1 selective
dosing: 1-2 gtts in affected eye bid
CI: sinus bradycardia, heart block, overt CHF
Precations: bronchial asthma/severe COPD
AE: ocular burning, blurred vision, hyperemia, itching |
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Term
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Definition
timolol
Indication: open-angle glaucoma
Pharmacology: nonselective
Dosing: start with 0.25% 1 gtt in affected eye bid
CI: asthma, severe COPD, sinus bradycardia, heart block, overt CHF
AE: ocular burning, blurred vision, HA
Notes: ideally wait 5-10 min before using other eye drops |
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Term
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Definition
dorzolamide/timolol
Indication: open-angle glaucoma
Pharmacology: combo with nonselective BB
Dosing: 1 gtt in affected eye bid
CI: asthma, severe COPD, sinus bradycardia, heart block, overt CHF, hypersensivity to sulfonamides
AE: taste perversion, ocular burning, blurred vision, hyperemia, itching
Pt Consult: remove contacts prior, re-insert after 15 min
Notes: ideally wait 5-10 min before using other eye drops |
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Term
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Definition
latanoprost
Indication: open-angle glaucoma
Dosing: 1 gtt in affect eye q pm
Precautions: iris can permanently change color (darkening) with long-term use
AE: blurred vision, burning/stinging, itching, increased pigmentation (long-term use)
Pt Consult: store in fridge but lasts 6 wks at room temp after dispensed
Notes: ideally wait 5-10 min before using other eye drops |
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Term
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Definition
bimatoprost
Indication: open-angle glaucoma. Latisse indicated for lash growth
Dosing: 1 gtt in affected eye q pm
AE: hyperemia, growth of eyelashes, ocular itching and burning, darkening of eyelashes
Pt Consult: awareness of eye/eyelash changes
Notes: may cause brown pigmentation in the iris |
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Term
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Definition
travoprost
Indication: open-angle glaucoma
Dosing:1 gtt in affected eye q pm
AE: hyperemia, eye discomfort/itching
Pt Consult: awareness of eye/eyelash changes
Notes: may cause brown pigmentation in the iris |
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Term
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Definition
sulfacetamide
Indication: bacterial conjunctivitis, corneal ulcer and other superficial ocular infections
Dosing: 1-2 gtts q 1-4 hrs for 7-10 days
Caution: sulfonamide allergy
Notes: ideally wait 5-10 min before using other eye drops |
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Term
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Definition
tobramycin
Indication: bacterial conjunctivitis
Dosing: 1-2 gtts q 4hrs (mild-mod infection.
Max 2 gtts hourly (severe infection)
CI: fluoroquinolone allergy
Precautions: prolonged use may promote secondary fungal infection
AE: itching, swelling, hyperemia
Pt Consult: advise pt not to wear contacts during use, administer other eye drops BEFORE ointment if applicable
Notes: 1/2" ointment bid-tid or q 3-4hrs til improved |
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Term
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Definition
tobramycin/dexamethasone
Indication: steroid responsive with infection or risk
Dosing: start 1-2 gtts q 2hrs x 1-2 days then 1-2 gtts q 4-6hrs treat until resolved
CI/precautions: herpes simplex keratitis, varicella/other viral infections of cornea/conjunctiva, fungal infections of the eye
AE: itching, swelling, hyperemia
Pt Consult: shake suspension well, administer other eye drops BEFORE ointment if applicable
Notes: for ointment 1/2" tid-qid |
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Term
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Definition
cyclosporine emulsion
Indication: tear insufficiency in specific pt types
Dosing: 1 gtt each eye every 12 hrs
CI: pts with ocular infections
AE: burning, eye pain, pruritis
Pt Consult: invert the vial a few times to obtain a uniform emulsion before using
Notes: space artificial tears at least 15 min from Restasis |
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Term
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Definition
moxifloxacin
Indication: bacterial conjunctivitis
Dosing: 1 gtt in affected eye tid for 7 days
CI: fluoroquinolone allergy
Precautions: do not wear contacts during txt
AE: ocular discomfort, hyperemia, itching
Notes: ideally wait 5-10 min before using other eye drops |
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Term
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Definition
olopatadine
Indication: allergic conjunctivitis
Dosing: 1 gtt bid (at 6-8 hr interval)
Precautions: not to be used with contacts or to treat contact-related irritation
AE: HA, blurred vision, burning/stinging, dry eye
Pt Consult: remove contact lenses prior, re-insert after at least 10 min. Advise not to wear contacts if eyes are red
Notes: wait 10 min after use before inserting contact lens |
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Term
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Definition
donepezil
Indication: mild to moderate Alzheimer's dementia
Dosing: 5 mg q hs. Max 10 mg q hs
DI: phenytoin, carbamazepine, phenobarbital
Precautions: sick-sinus syndrome (due to vagotonic effects), prior ulcers/GI bleeding, asthma or COPD
AE: nausea, diarrhea, anorexia common
Pt Consult: take at bedtime without regard to food |
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Term
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Definition
rivastigmine
Indication: mild to moderate Alzheimer's dementia
Dosing: start 1.5 mg bid. Usual 3-6 mg bid. Titrate every 2 wks according to response. Max 6 mg bid
DI: anticholinergics, cholinergic potentiation
AE: nausea, vomiting, anorexia, diarrhea, dizziness, HA |
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Term
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Definition
memantine
Indication: moderate to severe Alzheimer's dementia
Dosing: start 5 mg daily x 1 wk. Then 5 mg bid x 1 wk. Add 5 mg weekly x 2 wks (max 10 mg bid. Titrate no more often than weekly
DI: competitive renal tubular secretion (decreased bioavailability of HCTZ), carbonic anhydrase inhibitors alkalinize urine and decrease memantine clearance
AE: dizziness, HA, constipation |
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Term
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Definition
galantamine
Indication: mild to moderate Alzheimer's dementia
Dosing: Start 4 mg bid. Max 16-24 mg/day bid. Titrate no more often than every 4 wks
DI: 2D6 and 3A4 inhibitors increase galantamine Cp (azole antifungals, paroxetine, fluoxetine, amitriptyline)
Precautions: sick-sinus syndrome (due to vagotonic effects), prior ulcers/GI bleeding, asthma or COPD
AE: nausea, diarrhea, anorexia common
Pt Consult: take with food |
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Term
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Definition
benztropine
Indication: Parkinson's disease
Dosing: start 0.5-1 mg q hs. Usual 1-2 mg q hs. Max 6 mg daily
CI: children < 3 y/o
Precautions: risk of tachycardia, aggravation of BPH, narrow angle glaucoma, risk of ileus when used with other anticholinergics
AE: dry mouth, blurred vision, constipation, nausea
Pt Consult: take with food or milk if GI upset. Do not abruptly DC
Notes: titrate in gradual 0.5 mg increments |
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Term
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Definition
entacapone
Indication: adjunct in Parkinson's disease ("wearing off"). Only given WITH sinemet
Dosing: 200 mg per carbidopa/levodopa dose. Max 1600 mg/day
CI: MAOI
Precautions: do not abruptly withdraw Comtan; hypotension, mvmt disorders after initiation; hepatic impairment decreases clearance
AE: nausea, diarrhea, dyskinesia/hyperkinesia, orthostatic precautions
Notes: take with Sinemet doses |
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Term
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Definition
selegiline
Indication: adjunct in Parkinson's disease
Dosing: 5 mg at breakfast and lunch
CI/avoid combo: dextromethorphan, MAOI, merperidine, methadone, tramadol, agents elevating neurotransmitters (TCA, SSRI, SNRI), stimulants (methylphenidate)
Warnings: tyramine containing foods
AE: dizziness, nausea, insomnia (a metabolite is amphetamine)
Pt Consult: for bid dosing administer with breakfast and lunch, avoid alcohol and OTC/herbal products without consultation
Notes: do not exceed 10 mg/day |
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Term
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Definition
rasagiline
Indication: monotherapy or adjunct to sinemet in Parkinson's disease
Dosing: Start 0.5 mg qd if adjunct to sinemet. 1 mg qd if monotherapy.
CI/avoid combo: dextromethorphan, MAOI, meperidine, methadone, tramadol, agents elevating neurotransmitters (TCA, SSRI, SNRI), stimulants (methylphenidate), cyclobenzaprine
Warnings: tyramine containing foods
DI: CYP 1A2 inhibitors (ciprofloxacin)
Pt Consult: avoid alcohol and OTC/herbal products without consultation
Notes: limit to 1 mg daily or 0.5 mg daily if on 1A2 inhibitor |
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Term
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Definition
pramipexole
Indication: Parkinson's disease
Dosing: Start 0.125 mg tid. Usual 1.5-4.5 mg/day divided in 3 doses. Max 4.5 mg/day
DI: cimetidine, ranitidine, diltiazem, verapamil increase Cp
Precautions: OHTN common with titrations, may potentiate dyskinesia from levodopa (a decrease in levodopa dosage may be required)
AE: early PD-dizziness, nausea, somnolence or insomnia. Advanced PD- OHTN, dyskinesia, insomnia, dizziness, hallucinations
Pt Consult: take with food to reduce nausea, counsel on OHTN, potential sleep disturbances and possibility of hallucinations
Notes: titrate at weekly intervals; take with food |
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Term
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Definition
ropinirole
Indication: Parkinson's disease, restless leg syndrome
DI: CYP 1A2, cigarette smoking significantly decreases AUC, ciprofloxacin increases AUC, omeprazole decreases Cp
Precautions: sudden initiation of sleep can occur, OHTN common with titrations
AE: nausea, dizziness, somnolence
Pt Consult: take with food to reduce nausea, counsel on OHTN, potential sleep disturbances and possibility of hallucinations
Dosing: Start 0.25 mg tid. Usual 1 mg tid (titrated over 4 wks). Max 24 mg/day
Notes: titrate at weekly intervals; take with food |
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Term
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Definition
carbidopa/levodopa
Indication: Parkinson's disease
Dosing: start 25/100 mg tid. Max 1600 mg/day
CI: narrow angle glaucoma, non-selective MAOI
Precautions: cardiovascular disease
AE: nausea, dystonia/involuntary mvmts, dementia
Pt Consult: food or milk if GI upset
Notes: can titrate every 1-2 days |
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Term
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Definition
carbidopa/levodopa
Indication: Parkinson's disease
Dosing: Start 50/200 mg bid (about 6 hrs apart). Max 1600 mg/day
Notes: can titrate every 3 days; 4-8 hr dosing interval range. Can half CR tabs but do not chew or crush |
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Term
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Definition
carbidopa, levodopa and entacapone combo
Indication: Parkinson's disease
Dosing: individualized. Max 1 tab per dose (up to 8 tabs/day)
Notes: entacapone 200 mg with carbidopa/levodopa (1:4) |
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Definition
amantadine
Indication: Parkinson's disease
Dosing: Start 100 mg bid (monotherapy). Usual 100 mg bid. Max 300-400 mg/day.
Precautions: requires dose reduction in renal impairment and may be needed with CHF, elderly
AE: nausea, dizziness/OHTN, insomnia
Pt Consult: take last dose in the early evening to reduce incidence of insomnia
Notes: 100 mg daily initial dose if on other Parkinson's agents |
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Definition
pregabalin
Indication: neuropathic pain (diabetic neuropathy), postherpetic neuralgia and adjunct txt in certain seizure disorders
Dosing: Start 50 mg tid. Usual 100 mg tid. Max 300 mg/day (100 mg tid)
Precautions: taper gradually over at least 1 wk prior to DC, edema when utilized with glitazone agents, rare reports of myopathy
AE: dizziness, drowsiness, dry mouth, peripheral edema
Pt Consult: Do not DC without MD, report unexplained muscle weakness or pain
Notes: dose reduction for renal dysfunction |
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Definition
divalproex
Indication: seizure disorders
Dosing: Start 15 mg/kg/day. Usual individualized dosing. Max 60 mg/kg/day
DI: all
CI: hepatic disease
-precautions: severe AE (decreased platelet counts and pancreatitis) report
AE: nausea, dyspepsia, somnolence, dizziness, diarrhea
Pt consult: food or milk to avoid GI; do not DC w/o MD< caps can be sprinkled on soft food and swallowed whole, do not crush or chew, contact MD for persistent GI side effects |
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Definition
extended phenytoin
Indication: seizure disorders
Dosing: Start 100 mg tid (adults). Usual individualized doses. Max based on serum levels.
Notes: can dose daily once stabilized
DI: Amiodarone, Cimetidine, Fluconazole, Carbamazepine, Sucralfate, VPA, Theophylline, OC
Precautions: impaired liver fx
AE: dizziness, drowsiness, nausea, gingival hyperplasia**,
-signs of toxicity: ataxia, slurred speech, confusion, rash
Pt consult: take with food, no EtOH w/o MD direction, good oral hygiene, contact MD if rash develops, do not DC w/o MD |
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Definition
lamotrigine
Indication: adjunct in seizure disorders
Dosing: Starting dependent on other seizure agents. Usual 100-500 mg qd.
Notes: dosage highly influenced by enzyme induced antiepileptic drugs and valproate
PK: t1/2 dependent on concomitant agents
DI: PHY, carbamazepine, phenobarb decrease Cp; VPA increases Cp
Precautions: serious rashes - w/in weeks of initiation & more common in children/VPA; *hypersensitivity/fever; *ophthalmic effects
Pt consult: report fever/rash; chewable tabs can be dispersed in small amt of liquid |
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Definition
zonisamide
Indication: adjunct in seizure disorders
Dosing: Start 100 mg qd. Usual 100-400 mg, given daily or bid. Max 400 mg/day
Notes: dosage increases up to 100 mg every 2 wks
PK: long t1/2 (may be shortened by enzyme inducers)
DI: PHY, carbamazepine, phenobarb
CI: h/o sulfonamide allergy
-D/C in pt who develops impaired renal fx (should not be used <50ml/min)
Precautions: risk of rare derm rashes
AE: drowsiness; *rare rash & kidney stones*
Pt consult: report rash or painful urination/blood in urine |
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Definition
gabapentin
Indication: adjunct in seizure disorders
Dosing: Start 300 mg q hs. Usual 900-1800 mg divided tid. Max 2400 mg/day
Notes: titrate by 300 mg/day until 300 mg tid; renal adjustment
PK: renally excreted unchanged
DI: antacids
Precautions: abrupt w/d; high renal excretion
AE: somnolence*, dizziness
Pt consult: drowsiness, avoid alcohol, avoid concomitant antacids |
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Term
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Definition
phenobarbital
Indication: seizure disorders
Dosing: 50-100 mg bid-tid
PK: enzyme induction, long t1/2
DI: enzyme induction - warfarin, BB, quinidine, theo; CNS depressants
Precaution: elderly, impaired liver fx
AE: all (..?)
Pt consult: drowsiness and alcohol use |
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Term
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Definition
carbamazepine
Indication: seizure disorders
Dosing: Start 200 mg bid (>= 12 y/o). Usual 800-1200 mg divided bid-tid. Max 1000-1200 mg (age dependent).
Notes: Tegretol ER frequency is generally bid
DI: warfarin, VPA, cimetidine, diltiazem, fluoxetine, propoxyphene, verapamil, macrolides, PHY
CI: bone marrow depression
Precaution: cardiac, renal or hepatic disorder; rare cases of aplastic anemia and agranulocytosis
AE: all
Pt consult: take w/ food or milk, avoid alcohol, follow chewable tabs w/ water, bone marrow suppression (rare) counsel precautions |
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Term
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Definition
oxcarbazepine
Indication: seizure disorders
Dosing: Start 300 mg bid (> 16 y/o). Usual 600 mg bid.
Precautions: hyponatremia*, renal dysfx, Steven Johnson syndrome
DI: 3A4 inducer
AE: nausea, dizziness, somnolence, ataxia, abnormal vision
Pt consult: surveillance for derm changes and AE, maintain adequate hydration |
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Definition
topiramate
Indication: seizure adjunctive therapy
Dosing: Start 25-50 mg daily. Usual 200-400 mg divided bid. Max 400 mg
PK: weak carbonic anhydrase inhibitor, primarily excreted unchanged in urine, shifts to hepatic CL when used w/ other inducers
DI: CNS depressants, metformin, PHY, carbamazepine
Precautions: myopia/secondary angle closure glaucoma, kidney stones
AE: not DR - drowsiness, dizziness; DR - fatigue, nervousness, anorexia/wt. loss
Pt consult: avoid alcohol, maintain hydration
renal adjust < 70ml/min* |
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Term
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Definition
levetiracetam
Indication: adjunct in seizure disorders
Dosing: Start 500 mg bid. Usual 3000 mg/day divided bid. Max 3000 mg/day
Notes: dosing increments given every 2 wks (1000 mg/day)
PK: renal clearance
DI: none known
Precautions: impaired renal fx, adjustment req'd
AE: drowsiness, nausea |
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Term
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Definition
lithium carbonate
Indication: mania associated with bipolar disorder
Dosing: 900-2400 mg divided bid-qid. Max based on serum levels
Notes: regular release tid-qid; sustained release bid
PK: renal elim
DI: NSAIDs, ACE-i's, thiazides increase serum conc.
CI/precautions: renal or CV disease, dehydration or Na depletion
AE: tremor, nausea, thirst
PT consult: maintain consistent fluid and dietary Na intake, avoid dehydration |
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Term
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Definition
phenelzine
Indication: depression
Dosing: Start 15 mg tid. Titrate to response. Max 90 mg/day
Notes: avoid drug interactions and tyramine-containing foods
MAOI inhibitors, non-selective
CI: CHF, h/o hepatic disease, renal disease, concurrent use of many agents (sympathomimetics, cns depressants, flexeril, dextromethorphan, ethanol, meperidine, bupropion, buspirone, SSRI)
Pt consult: DI, avoid caffeine, alcohol and OTC meds, avoid tyramine-containing foods |
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Term
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Definition
tranylcypromine
Indication: depression
Dosing: Start 10 mg bid. Usual 30 mg in divided doses. Max 60 mg/day
Notes: avoid drug interactions and tyramine-containing foods
MAOI inhibitors, non-selective
CI: CHF, h/o hepatic disease, renal disease, concurrent use of many agents (sympathomimetics, cns depressants, flexeril, dextromethorphan, ethanol, meperidine, bupropion, buspirone, SSRI)
Pt consult: DI, avoid caffeine, alcohol and OTC meds, avoid tyramine-containing foods |
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