Abilify® (Aripiprazole)
- Used for Agitation/Psychosis/Depression/Bipolar
- Tablets 2-5-10-15-20-30mg
- ODT (Oral Disintegrating tablets) 10-15mg
- Solution 1mg/mL
- Generally taken once/day
- Not indicated in psychosis with dementia
- Be aware of any suicidal thoughts as most psychotropics have the potential to increase such negative thoughts in some (CALL OUR OFFICE IMMEDIATELY!)
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Side effects to stop the medication and call our office immediately (not common but potentially serious):
- Fever with stiff muscles/rapid heat rate
- Uncontrolled muscle movemetns
- Sudden numbness or weakness
- Severe headache
- Any trouble with vision, speech or balance
HP ACTHAR Gel® (Corticotropin)
- Used to treat an exacerbation of Multiple Sclerosis (has other uses beyond this, as well)
- Gel that is injected either subcutaneously or intramuscularly
- Generally given in 80unit dosing/day over a 5 day course, with 1cc syringe, but can be up to 100units/day
- Should not use if you feel you have an infection - notify our office immediately
- Please stop use and notify our office if you experience any skin reactions to the injection
- Can cause stomach upset, changes in mood - if severe notify our office
- Please report any questionable or concerning side effect you may experience
- Not to be used in combination with any other steroid
- Should not be used in patients with severe high blood pressure
Adderall XR® (Dextroamphetamine/Amphetamine)
- Extended release medication taken in the AM that will last usually through mid afternoon
- Can be used in children as young as 6 and adults
- Extended release capsules available in 5mg, 10mg, 15mg 20mg, 25mg and 30mg
- Used to treat attention deficit (with or without hyperactivity) disorder (ADD/ADHD)
- Can also be used to promote wakefulness in certain patients
- Can cause agitation and anxiety in some patients
- Can lower risk of seizures depending on the setting
- May interfere with normal sleep if taken too late in the day of if it continues to act
- Our office will generally require urine testing to assure compliance with medication use
- This substance is highly controlled and its use is tightly monitored
Aggrenox® (Aspirin/Dipyridamole)
- Taken as prevention for stroke in cases of either stroke or TIA
- Comes as a capsule combination of 25mg immediate release aspirin and 200mg Extended Release Dipyridamole
- Taken as one pill two times a day (at times 1/day if Headache pain begins)
- Risk of bleeding
- Should be avoided in severe renal failure
- Should be avoided in pregnancy
Amerge® (Naratriptan)
- Treatment for acute migraine headaches
- 1mg and 2.5mg tablets
- Longer lasting "triptan" that lasts longer and is indicated for "menstrual migraine"
- Contraindicated in Complex and/or Basilar migraine
- Contraindicated in stroke and/or CAD patients (those with heart disease)
- Stop and notify our office if any tightness in jaw, neck or throat, or chest pain, weakness or numbness in the body or any trouble with speech or vision
Ampyra® (Dalfampridine)
- 10mg ER tabs to be taken Twice a day
- For use in Multiple Sclerosis as novel drug that can improve walking
- NOT a disease modifying therapy
- Contradindicated in seizures and can increase risk of seizures
- Also contraindicated in kidney disease
- Not approved for anyone younger than 18 years of age
Amrix® (Cyclobenzaprine ER)
- 15mg ER tablets to be taken 1 or 2 times a day (30mg once daily only)
- For use for pain acting as a muscle relaxant for pain
- Can cause sedation
- Dry mouth and nausea most common side effects
- Beware of use with SSRI, SNRI, TCA or MAO inhibitors
Aptiom® (Eslicarbazepine acetate)
- For partial onset seizures - availabe in 200, 400, 600 or 800mg tablets (can be crushed)
- Can be used alone or in combination with other anti seizure medication
- Can be used for adults or children as young as 4 years of age
- Best to come off slowly when switching or stopping
- Should be avoided with known allergy to Esclicarbezepine or allergy to Oxcarbezipine
- Report any reactions - itchiness, rash, bloating, stomach upset
Aricept® (Donezapil)
- Used to treat mild to moderate dementia
- Slows progression of disease
- Prevents breakdown of Acetylcholine (more helps memory)
- Can be a problem with anyone with a heart rhythm disorder, enlarged prostate, urination problems, trouble swalloing, stomach ulcers, asthma, seizures or obstructive pulmonary disease
- 5mg, 10mg or 23mg - usually once/day
Artane® (Trihexyphenidyl)
- Used as additional drug for treating Parkinson's disease
- Also used to treat other extrapyamidal movement disorders
- Acute withdrawal can lead to worsening of movement disorder symptoms
- Offered in 2 and 5mg tablets as well as 2mg/5ml elixir
- Can cause dry mouth, blurred vision, dizziness, nausea or nervousness
- Can at times see cognitive dysfunction
- Caution advised with alcohol or other sedatives
- Anyone with glaucoma should be extremely careful with use
- Abrupt withdrawal can lead to Neuroleptic Malignant Syndrome (NMS) which includes hyperpyrexia, muscle rigidity, altered mental status and irregular pulse or blood pressure, increased heart rate
- Cardiac, liver, or kidney disorders or with hypertension should be closely monitored
Aubagio® (Teriflunomide)
- Oral disease modifying therapy for relapsing/remitting Multiple Sclerosis (MS)
- Usually taken as one 14mg tablet per day
- Can cause liver damage
- Contraindicated in pregnant women and can cause birth defects
- Possible side effects include: fever/chills, nausea, stomach pain, itching, loss of appetite, racing heartbeats, numbness or tingling in the hands
- Need to monitor liver enzymes monthly for first 6 months, CBC at least at beginning at use, screen for TB before use of medication, check BP before and periodically while using
Avonex® (Interferon Beta 1a)
- Once weekly intramuscular injection as disease modifying therapy for relapsing/remitting Multiple Sclerosis (MS)
- Can be dangerous if pregnant and cause miscarriages
- Stop using Avonex if you become very depressed
- Avonex may be unsafe for patients with: liver disease, seizures, heart disease, chest pain, bleeding disorder, depression or suicide behavior
- Should be given same day and same time each week
- Use a different place in the body each time you use the injection
Axert® (Almotriptan)
- Used to treat migraine in those 12 or older
- It is not a preventative, but only treats existing headaches
- Not to be used if your headaches seem different from usual
- Seek emergency treatment for any allergic reactions such as hives, trouble breathing or swelling of face, lips, tongue or throat
- Notify doctor if you have any pain or tightness in jaw, neck or throat, chest pain or spreading pain, sudden numbness or weakness, sudden severe headache or confusion, sudden visual trouble, or problems with speech or balance.
- Not to beg used in combination with any other triptan headache medication such as imitrex®
- Must wait two hours before taking another tablet and not to take more than 2 tablets in 24 hours
Baclofen® (Baclofen)
- Both muscle relaxant and anstispasmodic
- 5, 10, 15 and 20mg tablets often taken three times a day as needed
- Can see drowsiness as side effect, but also confusion, insomnia and other changes in mood
- Hallucinations and seizures have occurred on abrupt withdrawal
- Limited benefit in those with stroke
- Can be dangerous in pregnancy
- Given with caution in those with impaired renal function
- Use caution with driving
Banzel® (Rufinamide)
- Indicated in adjunctive treatment of seizures associated with Lennox-Gastaut Syndrome in pediatric patients 1 year of age and older and in adults
- Administer with food
- Oral suspension should be shaken well before administration
- Dosing may need to be adjusted in those getting hemodialysis, those with hepatic disease and those taking Valproate
- Offered in 200mg and 400mg tablets and oral suspension
- Serious adverse reactions can include suicide behavior/ideation, effects on brain, heart rhythm changes, organ reactions and drop of white count
- Most common problems include fatigue, stomach upset and headache as well as dizziness
Betaseron® (Interferon Beta 1b)
- Used as disease modifying therapy for relapsing/remitting multiple sclerosis (MS)
- Should not be used in pregnancy
- Can have serious reactions including trouble breathing, swallowing, swelling of the mouth or tongue, rash, itching or skin bumps
- Not to be used in liver disease, CHF, epilepsy, Bleeding disorder, anemia, low WBC, history of depression/suicide behavior or latex allergies
- Injected under skin (Subcutaneously) every 2 days
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Started as 0.0625mg sq every other day and increased in 25% increments every 2 weeks to maintenance dose of 0.25mg sq every other day.
- Wks 1-2 0.0625mg Wks 3-4 0.125mg Wks 5-6 0.1875mg Wk7+ 02.5mg sq every other day
- Common side effects include headache, insomnia, stomach pain, muscle pain, abnormal liver function, skin rash, flu symptoms or skin reaction at injection site
Botox® (Onabotulinumtoxin A)
- Injection for muscle spasticity, blepharospasm, strabismus, underarm sweating, cervical dystonia, migraine and cosmetics
- Will generally cause paralysis of injected muscles
- Dosing varies depending on use
- Contraindicated in pregnancy
- Can at times spread from site of injection and cause muscle weakness, double vision, eyelid droop, trouble swallowing, breathing difficulty or urinary incontinence.
Buspar® (Buspirone)
- Antianxiety agent
- Not to be used in conjunction with an MAO inhibitor
- May interact with certain other psychotropic drugs
- Generally can take weeks to begin to see an effect
- Common side effects include dizziness, drowsiness and increased nervousness, nausea and headache
- Supplied as 5, 10, 15 and 30mg tablets
- Recommended initial dose is 15mg daily
Calan SR® (Verapamil)
- Used for migraine prevention
- Calcium channel blocker used to treat high blood pressure but very effective for migraine, as well
- Comes in 120, 180 and 240mg capsules
- Side effects include constipation, dizziness, nausea and hypotension
- May interact with simvastatin (HMG-CoA reductase inhibitor) and Beta-Blockers, Digitalis and other anti hypertensives and other agents
- Can cause CHF, Hypotension and elevated liver enzymes
- Caution in patients with liver and/or liver problems, or arrhythmia
Carbatrol® (Carbamezapine)
- Extended release carbamezpine - anti epileptic drug and specific pain killer for trigeminal neuralgia
- Can also be used for migraine prevention
- Comes in 100, 200 and 300mg
- Can cause serious and sometimes fatal dermatologic reactions, aplastic anemia and agranulocytosis (decreased white count)
- Can treat partial/complex seizures, GTC seizures an mixed seizures
- 200mg twice/day to start and then up by 200mg weekly to as high as 1200mg daily
- Can be used alone or in combination
- Contraindicated in HLA-B*1502 patients (testing suggested when family Hx positive)
Cardizem CD® (Diltiazem)
- Blood pressure lowering medication used for migraine prevention
- Calcium channel inhibitor
- Don't use with arrhythmias, hypotension or severe heart problems such as CHF or liver problems
- Caution in pregnancy and not to be used in lactation
- Not for use in pediatrics
- Can results in headache, dizziness, bradycardia and forms of heart block
- Usually started at 180 or 240mg daily - available in 120, 180, 240 400 and 360mg
Catapres® (Clonidine)
- Used in pediatrics for ADHD and Tourette's syndrome
- Available in 0.1mg, 0.2mg and 0.3mg
- Can cause low BP, low heart rate, depression
- Can cause fatigue, headache and abdominal pain
- Caution in pregnancy and lactation
- Caution in patients with heart disease, rhythm disorders, stroke, kidney disease
- Often taken nightly for ADHD, divided doses for Tourette's
Celebrex® (Celecoxib)
- NSAID used for pain control
- Can increase serious and potentially fatal cardiovascular thrombotic events including MI and stroke
- Can increase risk of serious and potentially fatal GI adverse events like bleeding, ulcer and stomach or intestinal perforation
- Available in 50, 100, 200 and 400mg
- Can be used in children down to 2 years old
- Cannot use with Cidofovir, Ketorolac or thioridazine
- Commonly causes headache, stomach upset, URI, diarrhea
- Not to use in pregnancy but appears safe in lactation
- Can be used daily or twice daily
Celexa® (Citalopram)
- Primary used for depression, anxiety and OCD - Obsessive Compulsive disorder)
- Oral SSRI (Selective Serotonin Reuptake Inhibitor)
- Allergic reactions can include rash, hives, trouble breathing, facial swelling including tongue/throat
- Available in 10, 20 and 40mg once/daily tablets
- Can be used in children down to 7 years old
- As in almost all similar medications, must watch for paradoxical worsening depression or suicide thoughts
- More common side effects include nausea, fatigue, stomach upset
- Caution advised in pregnancy and lactation
Cogentin® (Benztropine)
- Available as 0.5mg, 1mg and 2mg tabs or 1mg/ml injections
- Useful in parkinsonism, extrapyramidal symptoms, dystonic reactions
- Contraindicated with many potassium products
- Caution advised in pregnancy and lactation
- Serious side effects include tachycardia, psychosis and heat stroke
- Can cause constipation, sedation, nausea, vomiting
Compazine® (Prochlorperazine Maleate)
- Available in 5mg and 10mg tabs
- Contraindicated in dementia-related psychosis
- Indicated for nausea, vomiting, anxiety and schizophrenia
- Can be used for children down to 2 years of age
- Can cause tardive dyskinesia, neuroleptic malignant syndrome, various forms of anemia, movement disorders and EKG abnormalities
- Can cause drowsiness, dizziness, blurred vision, agitation, nausea and headache
- Caution advised in pregnancy and lactation
Concerta® (Methylphenidate)
- Used for ADD/ADHD
- Available as 18, 27, 36 and 54mg ER tablets (ER methylphenidate)
- Indicated in adults and children down to 6
- Not indicated in glaucoma, tourette's or severe anxiety
- Can cause sleep trouble, aggressive behavior, HTN
- Common reactions are nervousness, insomnia, abdominal pain, weight loss
- Caution in pregnancy and lactation
Corgard® (Nadolol)
- Used in neurology for migraine prevention
- Also can care for HTN, Angina, ventricular arrhythmias
- Available in 20, 40, 80, 120 and 160mg daily
- Avoid abrupt cessation
- Can cause CHF, severe bradycardia, heart block, angina
- Can cause fatigue, dizziness, nausea and vomiting
- Caution advised in pregnancy and probably unsafe in lactation
- Caution advised in asthma, COPD, serious heart conditions, very low blood pressure
Copaxone® (Glatiramer Acetate)
- Used in Relapsing Remitting Multiple Sclerosis (MS) for disease modifying therapy
- 20mg subcutaneous injection every day
- Can cause syncope, angioedema, anaphylaxis
- Can cause local site reactions at injection sites
- Can cause flushing, rash, nausea, vomiting
- May be used during pregnancy, but caution with lactation
Cymbalta® (Duloxetine)
- Given for depression, anxiety, neuropathic pain, fibromyalgia and chronic musculoskeletal pain
- Available in 20, 30 and 60mg delayed release capsules
- Can be used in children as young as 7 years of age
- Usual suicidality risk of entire group - including possible depression exacerbation
- Can see nausea, headache, abdominal pain, fatigue, elevated BP
- Caution in pregnancy but likely safe in lactation
- SNRI - Serotonin Norepineprhine Reuptake Inhibitor
Daypro® (Oxaprozin)
- Warning as an NSAID for thrombotic events and GI risk
- 600mg tabs
- Indicated for osteoarthritis, rheumatoid arthritis, acute gout, inflammation, mild to moderate pain
- Can be used in children down to 6
- Serious problems including GI bleed, HTN, CHF, liver damage, skin reactions
- Often see nausea, abdominal pain, headache, dizziness
- Caution advised in both pregnancy and lactation
Daytrana® (Methylphenidate Transdermal)
- Used for ADD/ADHD
- Patch form of 10, 15, 20 or 30mg per 9hour
- Indicated for children 6 years and older
- Serious reactions include dependency, psychosis, hallucinations, growth suppression, liver damage, anemia
- Common reactions include headache, insomnia, weight loss, stomach upset, rash
- Caution advised in pregnancy and lactation
Depakote® (Valproic Acid)
- Medication for seizures, migraine, bipolar (can be used as a calming agent)
- Available as 125mg, 250mg or 500mg delayed release capsules
- Serious black black warnings include liver damage, fetal risk in pregnancy and possible pancreatitis
- Safe in children down to 10
- Can also cause SIADH, decreased platelets, anemia, severe rash
- Can cause headache, nausea, tremor, constipation, insomnia
- Contraindicated in pregnancy and caution advised in lactation
- Normal blood levels: Epilepsy: 50-100 mcg/mL (valproic acid); Mania: 50-125 mcg/mL (valproic acid); Toxic Levels: >175 mcg/mL; 2-4 days to steady state
Diamox® (Acetazolamide)
- Used in neurology to treat Pseudotumor cerebri/Benign Intracranial Hypertension
- Can be used to treat seizure disorder and altitude sickness treatment
- Available in 125mg, 250mg and injections
- Can cause metabolic acidosis, serious rash, anemia, seizures
- Can cause fatigue, nausea, vomiting, confusion, bleeding from gut or urinary tract
- Safe in pregnancy and lactation
Dilantin® (Phenytoin)
- Seizure prophylaxis and treatment of status epilepticus
- Available as 100, 200 and 300mg ER caps, 50mg chewable and 25mg per mil suspension and various injections
- Can even be used in infants
- IV use can cause VFib, severe hypotension, cardiovascular collapse and AV conduction disturbance
- Can cause liver damage, decrease platelets, white count, anemia, severe rash
- Can cause nausea, vomiting, rash, slurred speech, dizziness, tremor
- Usually test for drug leves between 10-2 mcg/ml (total) - 1-2 mcg/ml (free) - Toxic levels > 20 mcg/ml (total) or >2mcg/ml (free) - 7-10 days to steady state
- Monitor closely in pregnancy and lactation
Effexor XR® (Venlafaxine XR)
- Used for depression, anxiety, panic disorder, cataplexy, migraine headache prophylaxis and post traumatic stress disorder
- Available in 37.5mg, 75mg and 150mg extended release capsules
- Has category black box warning of suicidality (found in all SSRI/SNRI drugs)
- Indicated in children as low as age 5 for cateplexy
- Can cause worsening depression, bleeding problems, rash, seizures, HTN
- Can cause headache, nausea, insomnia, dizziness, weight loss, tremor, anxiety
- Caustion advised in both pregnancy and lactation
Elavil® (Amitriptyline)
- Used for depression, neuropathic pain, post-herpetic neuralgia, migraine headache prophylaxis and fibromyalgia
- Comes in 10, 25, 50, 75, 100 and 150mg dosage forms
- Usual category suicidality risks
- Can be used in children down to 9
- Serious adverse reactions include hypotension, HTN, syncope, arrhythmias, seizures, glaucoma, SIADH, hepatitis, anemia, decreased white count
- Can cause drowsiness, dizziness, blurred vision, palpitations, impaired coordination, tremor, insomnia
- Caution advised in 3rd trimester pregnancy, may be used during lactation
Eldepryl® (Selegeline)
- Used to treat Parkinson's disease
- 5mg capsules and 5mg tablets
- Only for adult use
- Can cause hypertensive crisis, sudden sleep, hypotension, change in MS, extrapyramidal syndrome
- Can cause dizziness, nausea, headache, back pain, confusion
- To avoid during pregnancy or lactation
Evekoeo® (Amphetamine)
- To treat ADHD, ADD, Narcolepsy, obesity (short term treatment)
- 5mg and 10mg tabs
- Can be used in adults and children down to 3 years of age
- Can cause dependency, psychosis, mania, aggressive behavior, HTN, seizures, rhabdomyolysis
- Can cause weight loss, insomnia, headache, dizziness, restlessness, change in libido
- Avoid in pregnancy and lactation
Exelon® (Rivastigmine)
- Indicated in mild to moderate Alzheimer's and Parkinson dementia
- Available in 1.5, 3, 4.5 and 6mg capsules
- Serious reactions include rash, seizures, syncope, GI bleed, depression
- Can cause nausea, abdominal pain, dizziness, fatigue, tremor, confusion, anxiety
- Caution advised during pregnancy or lactation (unlikely to come up in indication)
Extavia® (Interferon Beta 1b)
- Indicated for disease modifying therapy for multiple sclerosis (MS)
- Available as 0.25mg per ml injectable
- Started in titration form - 0.0625qOD x 2wk, then 0.125mg qOD x 2wk, then 0.1875mg qOD x 2wk, then 0.25mg qOD subcutaneously
- Not indicated for children
- Serious reactions include depression, decreased blood counts, hypo or hyper thyroidism, seizures
- Can cause injection site reactions, flu-like symptoms, headache, pain, HTN
- Caution advised during pregnancy, but may be used while breastfeeding
Flector® Patch (Diclofenac Epolamine Topical)
- Acute pain patch
- NSAID class warning of thrombotic events and GI risks
- 1.3% patch to be applied twice daily
- Can cause bronchospasm, rash, HTN, GI bleed, Anemia
- Can cause application site reaction, nausea, dermatitis
- Caution advised in 1st trimester pregnancy but may be used in lactation
Focalin XR® (Dexmethylphenidate)
- Also available as regular release and not extended release
- Indicated for ADHD/ADD
- ER caps available in 5, 10, 15,20, 25, 30, 35 and 40mg
- Indicated in adults and children down to 6
- Serious reactions include dependence, psychosis, mania, aggressive behavior, seizures, rash, liver trouble
- Side effects include weight loss, headache, anxiety, dizziness, insomnia
- Caution advised in pregnancy and lactation
Frova® (Frovatriptan)
- Indicated for acute migraine headache and menstrual migraine headache prevention
- 2.5mg tablets
- Not indicated for children
- Serious reactions include heart problems, arrhythmias, HTN, CVA, worsening headache
- Side effects include dizziness, fatigue, flushing, headache, bone pain
- Use with caution in pregnancy and lactation
Geodon® (Ziprasidone)
- Indicated for agitation (schizophrenic associated), schizophrenia and bipolar I (manic/mixed) as monotherapy or adjunctive therapy
- Available in 20, 40, 50 or 80mg tablets or in 20mg per mL injection
- Indicated in children as low as 7 for Tourette's syndrome
- Serious effects can cause neuroleptic malignant syndrome, extrapyramidal syndrome, tardive dyskinesia, dystonia, seizures, syncope, diabetes, serotonin syndrome, severe rash
- Side effects include headache, dizziness, nausea, rash, weight gain, HTN, menstrual irregularities
- Consider advised in pregnancy, consider alternatives in lactation
Gilenya® (Fingolimod)
- Indicated for relapsing remitting Multiple Sclerosis (MS)
- 0.5mg capsules taken once daily
- Need to be checked and clear of any VZV (chickenpox/post-herpetic neuralgia) prior to beginnings medication
- Not indicated for pediatrics
- Serious reactions include syncope, AV block, infection, PML, posterior reversible encephalopathy syndrome, macular edema and basal cell carcinoma
- Adverse reactions include bradycardia, headache, nausea, cough, infection, HTN, blurred vision, bradycardia
- Avoid use for pregnancy and use alternatives for lactation
Gralise® (Gabapentin)
- Indicated for post-herpetic neuralgia (often used for many types of neuropathic pain)
- Available in 300mg and 600mg ER
- Not indicated in pediatrics
- Serious reactions include depression, suicidality, severe rash, rhabdomyolysis, withdrawal seizures
- Side effects include dizziness, lethargy, ataxia, nystagmus, tremor, double vision, emotional lability, headache, dysarthria, amnesia, back pain, weight gain
- caution advised during pregnancy but may be used during lactation
Horizant® (Gabapentin)
- Indicated for restless legs syndrome, post-herpetic neuralgia and used in many neuropathies
- Available in 300mg and 600mg extended release tablets
- Not indicated in pediatrics
- Serious reactions include depression, suicidality, acute renal failure, rash, thrombocytopenia and possible withdrawal seizures
- Side effects include lethargy, dizziness, headache, nausea, irritability, flatulence, insomnia, weight gain, blurred vision
- Caution advised during pregnancy and may be used during lactation