3PD Spring Top 200 drugs

Alprazolam brand name

Xanax (XR)

Alprazolam therapeutic class

Benzodiazepine, Short or Intermediate Acting. C-IV

Alprazolam FDA labeled indications

Anxiety: immediate-release, orally disintegrating tablet or solution, 0.25-0.5 mg po tid; max daily dose, 4 mg in divided doses

Panic disorder, with or without agoraphobia: immediate-release or orally disintegrating tablets, 0.5 mg po tid, extended-release 3-6 mg po daily; dose may be increased every 3-4 d by <1 mg/d

Alprazolam MOA

Enhances the postsynaptic effect of the inhibitory neurotransmitter, γ-aminobutyric acid (GABA).

Alprazolam Box Warning

Concurrent use with opioids, abuse potential, withdrawal reactions

Alprazolam common ADRs

Ataxia, lethargy, retrograde amnesia, somnolence, weight gain, change in appetite, constipation, fatigue, cognitive dysfunction, decreased libido

Alprazolam key patient counseling points

May cause drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol. Do not crush or break extended-release product. Oral disintegrating tablet may be divided but are unstable after breaking. May mix solution in liquid or semi-solid food for administration. If only 1/2 tablet taken, discard the other half. Allow oral disintegrating tablet to dissolve on your tongue. Do not self-increase or abruptly discontinue use.

Amitriptyline brand name

Elavil

Amitriptyline therapeutic class

Tricyclic Antidepressant

Amitriptyline FDA labeled indications

Depression: Adults, 75 mg po divided into 1-3 daily doses, titrate to max 300 mg/d; Children ≥12 y of age, 10 mg po tid or 20 mg po daily HS

Amitriptyline MOA

a tricyclic antidepressant that blocks presynaptic reuptake of serotonin and norepinephrine with subsequent downregulation of adrenergic receptors.

Amitriptyline Box Warnings

Suicidality; not approved for children <12 y of age

Amitriptyline common ADRs

Sedation

Amitriptyline key patient counseling points

Avoid activities requiring mental alertness, alcohol, and other CNS depressants. Symptomatic improvement may not be seen for a few weeks. Avoid sudden discontinuation of drug. Do not use alcohol.

Aripiprazole brand name

Abilify

Aripiprazole therapeutic class

Second Generation Antipsychotic

Aripiprazole FDA labeled indications

Bipolar disorder, manic or mixed episodes, acute treatment: Adults, 10-15 mg po daily, may titrate to 15-30 mg po daily; Children >10 y, 2 mg po daily, may titrate to 10 mg po daily

Schizophrenia: Adults, 10-15 mg po daily, may titrate to max 30 mg/d; Children >13 y, 2 mg po daily, may titrate to 10 mg po daily

Depression, adjunctive with antidepressant: 2-4 mg po daily, may titrate to 15 mg po daily

Tourette syndrome: Children ≥6 y of age and <50 kg, 2 mg po daily, may titrate to 5-10 mg po daily; Children ≥6 y of age and ≥50 kg, 2 mg po daily, may titrate to 10-20 mg po daily

Irritability with autistic disorder: Children ≥6 y of age, 2 mg po daily × 7 d, then 5 mg po daily, may titrate to 15 mg/d

Aripiprazole MOA

an atypical antipsychotic agent (quinolinone derivative). It exhibits partial agonist activity at dopamine D2 and D3 receptors and serotonin 5-HT1A receptors and antagonist activity at 5-HT2A receptors.

Aripiprazole Box warnings

Dementia, suicidality

Aripiprazole common ADRs

Akathisia, anxiety, extrapyramidal effects, headache, increased appetite, somnolence, weight gain, hyperglycemia

Aripiprazole key patient counseling points

Avoid activities requiring mental alertness or coordination until drug effects are realized. Drug may impair heat regulation. Drug may also lower seizure threshold. Patients with history of seizures or conditions that lower seizure threshold should report increased seizure activity. Report worsening depression, suicidal ideation, or unusual changes in behavior, especially at initiation of therapy or with dose changes. Children, adolescents, and young adults are at higher risk for these effects during the first few months of therapy. Report signs/symptoms of hyperglycemia, extrapyramidal effects, and neuroleptic malignant syndrome. Avoid sudden discontinuation. Avoid alcohol.

Atomoxetine brand name

Strattera

Atomoxetine therapeutic class

Norepinephrine Reuptake Inhibitor, CNS Stimulant

Atomoxetine FDA labeled indications

ADHD: Children >6 y of age and weighing ≤70 kg, 0.5 mg/kg/d po, may titrate to lower of 1.4 mg/kg/d or 100 mg/d; Children >6 y of age and weighing >70 kg, 40 mg/d po, may titrate to 100 mg/d; Adults, 40 mg po daily, may titrate to 100 mg/d

Atomoxetine MOA

a selective norepinephrine reuptake inhibitor that produces therapeutic effects in patients with ADHD. The exact mechanism of how selective inhibition of presynaptic norepinephrine exerts effects in ADHD has not been determined.

Atomoxetine Box Warnings

Suicidality in children and adolescents

Atomoxetine common ADRs

Abdominal pain, headache, insomnia, loss of appetite, nausea, weight loss, xerostomia

Atomoxetine key patient counseling points

Avoid activities requiring mental alertness or coordination until drug effects are realized. Growth rate and weight may need to be monitored more frequently in children. Report new or worsened psychiatric problems, chest pain, palpitations, dyspnea, or signs/symptoms of cardiac dysrhythmias, MI, or cerebrovascular accident. Do not open capsules as atomoxetine is an ocular irritant.

Benztropine brand name

Cogentin

Benztropine therapeutic class

Antiparkinsonian, Anticholinergic

Benztropine FDA labeled indications

Extrapyramidal disease, medication-induced movement disorder: Adults, 1-4 mg po daily or bid; Children ≥3 y of age, 0.02-0.05 mg/kg/dose once or twice daily

Parkinsonism: 1-2 mg/d po, may titrate to range 0.5-6 mg/d po

Benztropine MOA

possesses anticholinergic and antihistamine effects. May inhibit reuptake and storage of dopamine.

Benztropine Box Warning

none

Benztropine common ADRs

Constipation, nausea

Benztropine key patient counseling points

Drug may impair heat regulation. Advise patient to use caution with activities leading to an increased core temperature, such as strenuous exercise, exposure to extreme heat, or dehydration. Patient should avoid activities requiring mental alertness or coordination until drug effects are realized. Instruct patient to report sudden muscle weakness or stiffness, and signs/symptoms of tardive dyskinesia (tongue thrusting, facial grimacing/tics, random movements of extremities). Patient should not drink alcohol while taking this drug.

Bupropion brand name

Wellbutrin (SR, XL), Zyban

Bupropion therapeutic class

Monocyclic Antidepressant

Bupropion FDA labeled indications

Depression: Immediate release, 100 mg po bid × 3 d, increase to 100 mg po tid (max 450 mg/d); Extended release 12 h, 150 mg po daily in the morning × 3 d, then increase to 150 mg po bid (max 200 mg bid); Extended-release hydrochloride 24 h, 150 mg po daily × 3 d, then increase to 300 mg po daily (max 450 mg/d); Extended-release hydrobromide 24 h, 174 mg po daily × 3 d, then increase to 348 mg po daily (max 522 mg/d)

Season affective disorder (SAD): Extended-release hydrochloride 24 h, 150 mg po daily, may titrate to 300 mg po daily; Extended-release hydrobromide 24 h, 174 mg po daily, may titrate to 348 mg po daily

Smoking cessation assistance: Extended release 12 h, 150 mg po daily in the morning × 3 d, then 150 mg po bid (max 300 mg/d) for 7-12 wk; begin treatment 1 wk prior to smoking quit date

Bupropion MOA

is a monocyclic antidepressant, unique as a mild dopamine and norepinephrine uptake inhibitor with no direct effect on serotonin receptors or MAO.

Bupropion Box Warning

Suicidality; neuropsychiatric reactions

Bupropion common ADRs

Agitation, constipation, dizziness, headache, insomnia, nausea, tachyarrhythmia, tremor, xerostomia

Bupropion key patient counseling points

Avoid alcohol, CNS depressants, and activities requiring mental alertness. Take at the same time each day and at bedtime if possible. If taking the extended-release tablet, the tablet shell may remain intact and be visible in the stool.

Buspirone Brand Name

Buspar

Buspirone Therapeutic Class

Antianxiety Agent

Buspirone FDA Labeled indications

Anxiety: Adults, 5 mg po bid-tid or 7.5 mg po bid, may titrate to 20-30 mg/d in 2-3 divided doses (max 60 mg/d)

Buspirone MOA

is the first of a class of selective serotonin-5-HT1A receptor partial agonists. It also has some effect on dopamine-D2 auto-receptors and, like antidepressants, can downregulate β-adrenergic receptors. Unlike benzodiazepines, it lacks amnestic, anticonvulsant, muscle relaxant, and hypnotic effects. Its exact anxiolytic mechanism of action is complex and not clearly defined.

Buspirone Box Warnings

None

Buspirone Common ADRs

Dizziness

Buspirone Key Patient Counseling Points

Patient should avoid activities requiring mental alertness or coordination until drug effects are realized.

Advise patient that symptomatic improvement may not be seen for a few weeks. Advise patient against sudden discontinuation of drug. Patient may take with or without food but should always take drug consistently.

Patient should not drink alcohol or large amounts of grapefruit juice while taking this drug.

Avoid concomitant use with MAOI.

Carbamazepine Brand Name

Tegretol, Tegretol XR, Carbatrol ER, Equetro ER

Carbamazepine Therapeutic Class

Anticonvulsant

Carbamazepine FDA Labeled Indications

Focal onset and generalized onset seizures: Adults, 200 mg po bid, may titrate to 1200 mg po daily; Children <6 y of age, 10-20 mg/kg/d po in 2-4 divided doses, may titrate to 250-350 mg/d po (or 35 mg/kg/d); Children 6-12 y of age, 100 mg po bid, may titrate to 800 mg po daily

Neuropathic pain: 100 mg po q12h, may titrate to 1200 mg po daily for pain control

Carbamazepine MOA

acts presynaptically to block firing of action potentials, which decreases the release of excitatory neurotransmitters, and postsynaptically by blocking high-frequency repetitive discharge initiated at cell bodies.

Carbamazepine Box Warning

Agranulocytosis; aplastic anemia; dermatological reactions (especially in Asians); screen for HLA-B*15:02

Carbamazepine Common ADRs

Hyponatremia, dizziness, nausea

Carbamazepine Key Patient Counseling Points

May decrease effectiveness of oral contraceptives; use an alternative form of birth control.

Avoid activities requiring mental alertness or coordination until drug effects are realized.

Take with food, but not alcohol, grapefruit, or grapefruit juice.

Avoid abrupt discontinuation.

Carbidopa with Levodopa Brand Name

Sinemet, Sinemet CR, Rytary, Duopa

Carbidopa/Levodopa Therapeutic Class

Antiparkinsonian

Carbidopa/Levodopa FDA Labeled Indications

Parkinson disease: Immediate release, 25 mg/100 mg po tid, increasing dose to therapeutic response; extended release, 50 mg/200 mg po bid, separate doses by at least 6 h; extended-release capsules, 23.75 mg/95 mg po tid × 3 d, then may increase to 36.25 mg/145 mg po tid; patients generally treated with 400-1600 mg of levodopa per d; max 200 mg of carbidopa and 2000 mg of levodopa

Carbidopa/Levodopa MOA

When levodopa is administered orally, it is rapidly decarboxylated to dopamine in extracerebral tissues so that only a small portion of a given dose is transported unchanged to the CNS. For this reason, when given alone, large doses of levodopa are required for adequate therapeutic effect. However, these doses often result in nausea and other adverse reactions.

Carbidopa inhibits decarboxylation of circulating levodopa, preventing nausea and allowing more levodopa to reach the CNS. Carbidopa does not cross the blood-brain barrier and does not affect the metabolism of levodopa within the CNS.

Carbidopa/Levodopa Box Warning

None

Carbidopa/Levodopa Common ADRs

Dyskinesia

Carbidopa/Levodopa Key Patient Counseling Points

If you are using the oral disintegrating tablets, place on top of the tongue; does not require water or swallowing.

Citalopram Brand Name

Celexa

Citalopram Therapeutic Class

SSRI Antidepressant

Citalopram FDA Labeled indications

Depression: 20 mg po daily, may titrate to 40 mg po daily

Citalopram MOA

a bicyclic antidepressant that is a selective and potent inhibitor of presynaptic reuptake of serotonin (an SSRI). It does not affect reuptake of norepinephrine or dopamine and has a relative lack of affinity for muscarinic, histamine, α1- and α2-adrenergic, and serotonin receptors.

Citalopram Box Warning

Suicidal ideation; not approved for use in children

Citalopram Common ADRs

Constipation, dizziness, headache, insomnia, nausea, sedation, xerostomia

Citalopram Key Patient Counseling Points

Avoid activities requiring mental alertness or coordination until drug effects are realized. Symptomatic improvement may not be seen for several weeks.

Report worsening depression, suicidal ideation, unusual changes in behavior, or unusual bleeding.

Avoid abrupt discontinuation, may precipitate withdrawal symptoms.

Do not drink alcohol or use NSAIDs or aspirin while taking this drug.

Clonazepam Brand Name

Klonopin

Clonazepam Therapeutic Class

Benzodiazepine Antianxiety Agent. C-IV

Clonazepam FDA Labeled Indications

Seizure: Infants, Children <10 y of age or <30 kg, 0.01-0.03 mg/kg/d po divided into 2-3 daily doses, may titrate by 0.25-0.5 mg po every 3 d to max of 0.1-0.2 mg/kg/d (divided into 3 daily doses); Children ≥10 y of age or ≥30 kg, 0.5 mg po tid, may titrate by 0.125-0.25 mg po bid every 3 d to a max of 1-4 mg/d (divided into 2-3 daily doses); Adults, 2-8 mg/d in 1-2 divided doses, may titrate to max 20 mg/d

Clonazepam MOA

Enhances the postsynaptic effect of the inhibitory neurotransmitter, γ-aminobutyric acid (GABA).

Clonazepam Box Warning

Concurrent use with opioids, abuse, misuse, and addiction, dependence and withdrawal reactions

Clonazepam Common ADRs

Ataxia, lethargy, somnolence, weight gain

Clonazepam Key Patient Counseling Points

May cause drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol. Allow orally disintegrating tablet to dissolve on your tongue.

Dexmethylphenidate Brand Name

Focalin

Dexmethylphenidate Therapeutic Class

ADHD Agent, CNS Stimulant. C-II

Dexmethylphenidate FDA Labeled Indications

ADHD, methylphenidate-naive patients: Adults, immediate-release 2.5 mg po bid (max 20 mg po daily) or extended-release 10 mg po daily (max 40 mg/d); Children ≥6 y of age, immediate-release 2.5 mg po bid (max 20 mg po daily) or extended-release 5 mg po daily (max 30 mg/d)

ADHD, currently using methylphenidate: Adults and Children ≥6 y of age, one-half the total daily dose of extended-release racemic methylphenidate; patients currently using dexmethylphenidate immediate release may be switched to the same daily dose of dexmethylphenidate extended release

Dexmethylphenidate MOA

is a stimulant that increases CNS activity by inhibiting reuptake of norepinephrine and dopamine, increasing neuronal firing rate and stimulating the cerebral cortex and subcortical structures.

Dexmethylphenidate Box Warning

Abuse and dependence

Dexmethylphenidate Common ADRs

Weight loss, loss of appetite, headache, insomnia, restlessness

Dexmethylphenidate Key Patient Counseling Points

Avoid late evening doses due to resulting insomnia.

If you cannot swallow the extended-release capsule, you may open it and pour the medicine into a small amount of soft food such as applesauce.

Stir this mixture well and swallow it without chewing.

Seek medical attention if chest pain, seizures, heart palpitations, change in behavior or personality, or hostility.

Diazepam Brand Name

Valium

Diazepam Therapeutic Class

Benzodiazepine. C-IV

Diazepam FDA labeled indications

Substance abuse withdrawal syndrome: 10 mg po tid-qid in first 24 h, then 5 mg po tid-qid prn

Anxiety: Adults, 2-10 mg po bid-qid; Children, 1-2.5 mg po tid-qid

Seizure, adjunct: Adults, 2-10 mg po bid-qid; Children, 1-2.5 mg po tid-qid

Diazepam MOA

Enhanced postsynaptic effect of the inhibitory neurotransmitter, γ-aminobutyric acid (GABA).

Diazepam Box Warning

Concurrent use with opioids, addiction and dependence and withdrawal reactions

Diazepam common ADRs

Drowsiness, impaired motor coordination

Diazepam key patient counseling points

May cause drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol.

Divalproex brand name

Depakote (ER)

Divalproex therapeutic class

Anticonvulsant/Antipsychotic

Divalproex common FDA labeled indications

Absence seizure, simple and complex: 15 mg/kg/d po, may titrate to 60 mg/kg/d; delayed-release products are dosed bid, extended-release 24 h products are dosed daily

Complex partial epileptic seizure: 10-15 mg/kg/d po, may titrate to 60 mg/kg/d; delayed-release products are dosed bid, extended-release 24 h products are dosed daily

Manic bipolar disorder: 25 mg/kg/d po, may titrate to 60 mg/kg/d; delayed-release products are dosed bid, extended-release 24 h products are dosed daily

Migraine prophylaxis: Extended release 24 h, 500 mg po daily for 1 wk, then 1 g po daily; delayed release 250 mg po bid, increasing to 500 mg po bid

Divalproex MOA

is composed of sodium valproate and valproic acid. Valproic acid is a carboxylic acid compound whose anticonvulsant activity might be mediated by an inhibitory neurotransmitter, GABA. Valproic acid might increase GABA levels by inhibiting GABA metabolism or enhancing postsynaptic GABA activity. Valproic acid also limits repetitive neuronal firing through voltage- and usage-dependent sodium channels.

Divalproex Box Warning

Hepatotoxicity, patients with mitochondrial disease, teratogenicity, pancreatitis

Divalproex common ADRs

Abdominal pain, alopecia, asthenia, diarrhea, diplopia, dizziness, headache, nausea, somnolence, tremor, vomiting

Divalproex key patient counseling points

Avoid activities requiring mental alertness until drug effects are realized; drug may cause somnolence or dizziness.

Seek medical attention for signs and symptoms of liver dysfunction (eg, dark-colored urine, light-colored stools, yellowing of skin or eyes, etc), especially during first 6 mo of therapy.

Take with food to avoid GI irritation.

Do not discontinue drug abruptly, as this may precipitate seizures.

Avoid alcohol.

Sprinkle capsules can be swallowed whole or opened and sprinkled onto soft food; do not chew.

Donepezil brand name

Aricept

Donepezil therapeutic class

Alzheimer's Dementia Agent. Central Cholinesterase Inhibitor