Contraindication(s) & Precaution(s)

Contraindication(s) = DO NOT USE in; Precaution(s) = USE with CAUTION; Generic (Brand)

• Contraindication(s):

  • esophageal abnormalities

  • inability to sit upright/stand for at least 30 min.

  • hypocalcemia

  • CrCl <35mL/min.

  • nursing mothers

• Precaution(s):

  • renal disease

Alendronate Sodium (Fosamax)

• Contraindication(s):

  • may be/may become pregnant (category X)

  • active/past history of venous thromboembolic events

  • during immoble events

Raloxifene HCl (Evista)

• Contraindication(s):

  • hypersensitivities

• Precaution(s):

  • impaired renal/hepatic functions

Antibiotics

• Contraindication(s):

  • macrolide/ketolide hypersensitivities

  • complicated pneumonia/gonorrhea/syphilis treatment

• Precaution(s):

  • prolonged QT interval

  • hypokalemia

  • hypomagnesemia

  • bradycardia

  • arrythmia treatment

Azithromycin Dihydrate (Zithromax & Zmax)

• Contraindication(s):

  • quinoline hypersensitivities

  • children/adolescents/pregnant women (due to permanent lesions in weight-bearing joints

• Precaution(s):

  • known/suspected CNS disorders

Ciprofloxacin (Cipro & Cipro XR)

• Contraindication(s):

  • meningitis treatment

• Precaution(s):

  • elderly

  • GI disease history

  • atopy

Clindamycin HCl (Cleocin)

• Precaution(s):

  • under 8 years of age (during tooth development)

  • lactation

  • impaired renal function

Doxycycline Hyclate (Vibramycin & Doryx)

• Contraindications(s):

  • infection treatment in under 18 years of age

• Precaution(s):

  • known/suspected CNS disorders

  • uncorrected hypokalemia

Levofloxacin (Levaquin)

• Contraindication(s):

  • under 8 years of age (during tooth development)

  • pregnancy

  • lactation

  • impaired renal function

Minocycline HCl (Minocin, Dynacin, & Solodyn ER)

• Contraindication(s):

  • component(s) hypersensitivities

Mupirocin (Bactroban)

• Contraindication(s):

  • ofloxacin/quinolone hypersensitivities

• Precaution(s):

  • pregnancy

  • nursing

Ofloxacin (Ocuflox)

• Contraindication(s):

  • less than 2 months of age

  • pregnancy

  • nursing

  • sulfa allergy

  • megaloblastic anemia

• Precaution(s):

  • impaired renal/hepatic function

Sulfamethoxazole with Trimethoprim (Bactrim & Septra)

• Contraindication(s):

  • hypersensitivity

  • pregnancy

  • pre-menopausal women

Anastrozole (Arimidex)

• Contraindication(s):

  • pregnancy

• Precaution(s):

  • pregnancy (if absolutely necessary)

  • nursing

  • existing leukopenia/thrombocytopenia

Tamoxifen Citrate (Nolvadex)

• Contraindication(s):

  • pregnancy (category X); except neoplastic cases where benefit outweighs risk to fetus

  • getting pregnant during either parents’ treatment

  • nursing

  • psoriasis/RA w/ alcoholism, alcoholic liver disease, other chronic liver diseases, immunodeficiency syndromes, or pre-existing blood dyscrasias

• Precaution(s):

  • undergoing methotrexate therapy & during infections in immunocompromised

Methotrexate (Trexall)

• Contraindication(s):

  • systemic fungal infections

• Precaution(s):

  • pregnancy

  • nursing

  • ocular herpes simplex

  • hypothyroidism

  • cirrhosis

  • ulcerative colitis

  • diverticulitis

  • fresh intestinal anastomoses

  • renal impairment

  • hypertension

  • osteoporosis

  • myasthenia gravis

  • TB

  • peptic ulcers

  • diabetes mellitus

• Dexamethasone (Decadron)

• Methylprednisolone (Medrol)

• Prednisone (Deltasone)

• Contraindication(s):

  • anuria

  • oliguria

  • significantly impaired renal function

  • infants under 1 month of age

• Precaution(s):

  • glucose-6-phosphate deficiency

  • peripheral neuropathy

  • pulmonary disease

Nitrofurantoin (Macrodantin, Macrobid, & Furadantin)

• Contraindication(s):

  • hypersensitivities to nitroimidazoles/derivatives

  • trichomoniasis during 1st trimester of pregnancy

• Precaution(s):

  • organic CNS diseases

  • severe hepatic impairment

Metronidazole (Flagyl)

• Precaution(s):

  • congestive heart failure

  • hepatic impairment

Amlodipine Besylate (Norvasc)

• Contraindication(s):

  • pregnancy

• Precaution(s):

  • impaired renal/hepatic function

  • collagen vascular disease

  • aortic stenosis

  • undergoing surgery/anesthesia

  • congestive heart failure

Amlodipine Besylate with Benazepril HCl (Lotrel)

• Contraindication(s):

  • sick sinus syndrome

  • 2nd/3rd degree AV block (except in presence of functioning ventricular pacemaker & hypotension)

• Precaution(s):

  • pregnancy

  • nursing

  • cardiac conduction defects

  • congestive heart failure

  • hypotension

  • impaired renal/hepatic function

Diltiazem HCl (Cardizem (CD), Cartia, Dilacor, Dilt-XR, Tiazec)

• Contraindication(s):

  • coronary artery disease

  • valvular rheumatic heart disease

• Precaution(s):

  • pregnancy

  • suspected coronary artery disease

  • cerebral vascular accidents

  • impaired renal function

Hydralazine HCl (Apresoline)

• Precaution(s):

  • nursing

• Prazosin HCl (Minipress)

• Terazosin HCl (Hytrin)

• Contraindication(s):

  • hypersensitivities to olopatadine HCl/other components

  • contact lens irritation treatment

• Precaution(s):

  • nursing

Olopatadine HCl (Patanol, Pataday, & Pazeo)

• Contraindication(s):

  • most viral & fungal diseases of the cornea & conjunctiva:

    • epithelial herpes simplex keratitis

    • vaccina

    • varicella

• Precaution(s):

  • chronic use

Prednisolone Acetate (Pred Forte, Pred Mild, & Omnipred)

• Contraindication(s):

  • use without an inhaled corticosteroid in patients with asthma

  • treatment of acute deteriorating COPD or acute episodes of bronchospasms

• Precaution(s):

  • CVD

  • cardiac arrhythmias

  • HTN

  • coronary insufficiency

  • convulsive disorders

Arformoterol (Brovana)

• Contraindication(s):

  • known hypersensitivities to atropine or ipratropium

  • acute attacks

• Precaution(s):

  • narrow-angle glaucoma

  • prostatic hypertrophy

  • bladder-neck obstruction

Ipratropium Bromide (Atrovent)

• Contraindication(s):

  • hypersensitivities to any component

  • history of hypersensitivity to soya lecithin, soybean, or peanuts

• Precaution(s):

  • cardiovascular disorders

  • HTN

  • hyperthyroidism

  • diabetes mellitus

  • nursing

  • pregnancy

  • narrow-angle glaucoma

  • prostatic hypertrophy

  • bladder-neck obstruction

Ipratropium Bromide with Albuterol Sulfate (Combivent & DuoNeb)

• Contraindication(s):

  • known hypersensitivities to atropine or its derivatives

  • initial treatment of acute episodes of bronchospasm

  • emergency use

• Precaution(s):

  • renal impairment

  • narrow-angle glaucoma

  • prostatic hyperplasia

  • bladder-neck obstruction

Tiotropium Bromide (Spiriva)

• Contraindication(s):

  • severe hypersensitivity to milk proteins

  • treatment of acute symptoms

  • initial treatment of rapidly deteriorating episodes of COPD

• Precaution(s):

  • narrow-angle glaucoma manifested by eye pain, blurred vision, or corneal edema

  • urinary retention

Umeclidinium Bromide (Incurse Ellipta)

• Contraindication(s):

  • allergic to milk proteins or any other components

  • initial treatment of acute deteriorating COPD

  • treatment of acute symptoms

  • in combination with other LABA due to risk of OD

• Precaution(s):

  • cardiovascular disorders

  • convulsive disorders

  • thyrotoxicosis

  • diabetes mellitus

  • ketoacidosis

  • narrow-angle glaucoma

  • prostatic hyperplasia

  • bladder-neck obstruction

• Umeclidinium and Vilanterol (Anoro Ellipta)

• Fluticasone Furoate, Umeclidinium Bromide, and Vilanterol (Trelegy Ellipta)

• Contraindication(s):

  • primary treatment of status asthmaticus

  • rapid relief of bronchospasm

• Precaution(s):

  • transfer from systemic corticosteroids

Budesonide (Pulmicort)

• Contraindication(s):

  • primary treatment of status asthmaticus

  • rapid relief of bronchospasm

• Precaution(s):

  • transfer from systemic corticosteroids

  • pregnancy

Fluticasone Propionate (Flovent)

• Contraindication(s):

  • reversal of bronchospasm in acute asthmatic attacks, including status asthmaticus

  • monotherapy for exercise-induced asthma

• Precaution(s):

  • nursing

Montelukast Sodium (Singulair)

• Contraindication(s):

  • primary treatment of status asthmatics

  • rapid relief of bronchospasm

• Precaution(s):

  • transfer from systemic corticosteroids

  • cardiovascular disorders

  • HTN

  • hyperthyroidism

  • diabetes mellitus

  • nursing

  • pregnancy

• Budesonide and Formoterol Fumarate Dihydrate (Symbicort)

• Fluticasone Propionate with Salmeterol Xinafoate (Advair)

• Contraindication(s):

  • primary treatment of status asthmatics

  • acute episodes of COPD

  • hypersensitivity to milk proteins

  • acute symptoms

  • initiation in rapidly deteriorating episodes of COPD

  • rapid relief of bronchospasm

• Precaution(s):

  • transfer from systemic corticosteroids

  • cardiovascular disorders

  • HTN

  • hyperthyroidism

  • diabetes mellitus

  • nursing

  • pregnancy

Fluticasone Furoate and Vilanterol (Breo Ellipta)

• Contraindication(s):

  • hypersensitivity to any component

• Precaution(s):

  • cardiovascular disorders

  • HTN

  • hyperthyroidism

  • diabetes mellitus

  • nursing

  • pregnancy

• Albuterol Sulfate (Proventil, Ventolin, & Proair)

• Albuterol Sulfate (Proventil)

• Contraindication(s):

  • hypersensitivity to any component

  • porphyria

• Precaution(s):

  • increased intracranial pressure

  • head injury

  • severe hepatic or renal impairment

  • Addison’s disease

  • hypothyroidism

  • prostatic hypertrophy

  • urethral stricture

Butalbital, Acetaminophen, and Caffeine (Fioricet)

• Contraindication(s):

  • hypersensitivity to opioids

  • acute intoxication w/ alcohol

  • hypnotics

  • centrally acting analgesics

  • opioids

  • psychotropic drugs

  • past/present history of addiction or dependence on opioids

  • obstetrical preoperative use

  • post-delivery analgesia in nursing mothers

• Precaution(s):

  • epilepsy

  • hx of seizures

  • risk for seizures

Tramadol HCl (Ultram & Ultram ER)

• Contraindication(s):

  • combination with potent CYP3A4 inhibitors

  • moderate to severe hepatic impairment

• Precaution(s):

  • moderate to severe renal impairment

  • acquired or congenital QT prolongation

  • medications which may cause QT prolongation

Alfuzosin HCl (Uroxatral)

• Contraindication(s):

  • women, children, & patients with known hypersensitivity to other 5-Alpha-Recutase Inhibitors

  • women who are or may become pregnant should NOT handle medication since absorption through the skin may cause harm to a male fetus NOR be exposed to semen from a patient who is taking the medication

  • blood donation until at least 6 months after last dose

  • pregnancy (category X)

• Precaution(s):

  • hepatic impairment

• Dutasteride (Avodart)

• Finasteride (Proscar)

• Contraindication(s):

  • known hypersensitivity to medication

  • use with other alpha-adrenergic blocking agents NOR in combination with strong CYP3A4 inhibitors

Tamsulosin HCl (Flomax)

• Contraindication(s):

  • pregnancy

  • aliskiren

• Precaution(s):

  • nursing

  • impaired renal function

  • collagen vascular disease

  • aortic stenosis

  • undergoing surgery or anesthesia

• Benazepril HCl (Lotensin)

• Enalapril Maleate (Vasotec & Epaned)

• Contraindication(s):

  • in combination with a neprilysin inhibitor

  • pregnancy

• Precaution(s):

  • nursing

  • impaired renal function

  • collagen vascular disease

  • aortic stenosis

  • undergoing surgery or anesthesia

• Fosinopril Sodium (Monopril)

• Ramipril (Altace)

• Contraindication(s):

  • hx of angioedema related to a previous treatment with an ACE inhibitor

• Precaution(s):

  • impaired renal function

Lisinopril (Prinivil & Zestril)

• Contraindication(s):

  • hx of angioedema related to a previous treatment with an ACE inhibitor

  • anuria

  • hypersensitivity to sulfonamide-derivatives

  • pregnancy

• Precaution(s):

  • cirrhosis

  • gout

  • impaired hepatic function

  • impaired renal function

  • diabetes

  • corticosteroids or ACTH

Lisinopril with HCTZ (Zestoretic & Prinzide)

• Contraindication(s):

  • aliskiren

  • pregnancy

  • nursing

• Precaution(s):

  • renal function dependent on the activity of the renin-angiotensisn-aldosterone system

  • congestive heart failure

Irbesartan (Avapro)

• Contraindication(s):

  • aliskiren

  • pregnancy

• Precaution(s):

  • nursing

• Losartan Potassium (Cozaar)

• Olmesartan Medoxomil (Benicar)

• Contraindication(s):

  • aliskiren

  • pregnancy

  • anuria

  • hypersensitivity to sulfonamide-derivatives

• Precaution(s):

  • nursing

  • impaired hepatic function

  • progressive liver disease

  • impaired renal function

  • gout

  • diabetes

  • corticosteroid or ACTH use

Losartan Potassium with HCTZ (Hyzaar)

• Contraindication(s):

  • pregnancy

• Precaution(s):

  • impaired renal function

Telmisartan (Micardis)

• Contraindication(s):

  • aliskiren

  • pregnancy

• Precaution(s):

  • nursing

  • volume or salt-depletion

  • impaired hepatic function

  • impaired renal function

Valsartan (Diovan)

• Contraindication(s):

  • women with cancer of the breast, estrogen-dependent neoplasia, undiagnosed genital bleeding, active thromboembolic disorders or a past history of thromboembolic disorders, or during pregnancy (category X)

• Precaution(s):

  • women with a family history of breast cancer or who have breast nodules, fibrocystic disease, or abnormal mammograms

  • history of depression

  • nursing

  • liver, cardiac, or kidney dysfunction

  • epilepsy

• Estradiol (Vivelle-Dot, Alora, Climara, Estrace, Divigel, Femring, Estring, & Vagifem)

• Estradiol (Estrace)

• Contraindication(s):

  • known or suspected breast cancer EXCEPT in selected patients being treated for metastatic disease

  • known or suspected estrogen-dependent neoplasia

  • known or suspected pregnancy (category X)

  • undiagnosed abnormal genital bleeding

  • thrombophlebitis, thrombosis, or thromboembolic disorders EXCEPT when used in treatment of breast or prostatic malignancy

  • nursing

• Precaution(s):

  • HTN

  • asthma

  • epilepsy

  • migraine

  • cardiac or renal dysfunction

  • hx of jaundice during pregnancy

  • diabetes

  • impaired liver function

  • metabolic bone disorders

Estrogens, Conjugated (Premarin)

• Contraindication(s):

  • uncorrected adrenal cortical insufficiency

  • untreated thyrotoxicosis

  • acute MI

  • treatment of obesity or for weight loss

• Precaution(s):

  • nursing

  • CVD

  • hypopituitarism

  • diabetes

  • oral anticoagulants

• Levothyroxine Sodium (Synthroid, Levoxyl, & Levothroid)

• Liothyronine Sodium (Cytomel & Triostat)

• Contraindication(s):

  • hx of thrombophlebitis, thromboembolic disorders, cerebral apoplexy

  • liver impairment

  • known or suspected malignancy of breast or genital organs

  • undiagnosed vaginal bleeding

  • in a missed abortion

  • use as a diagnostic test for pregnancy

• Precaution(s):

  • nursing

  • epilepsy

  • migraine

  • asthma

  • cardiac or renal dysfunction

  • psychic depression

  • diabetes

Medroxyprogesterone Acetate (Provera)

• Contraindication(s):

  • peanut allergy

  • known or suspected pregnancy

  • hx of thrombophlebitis, thromboembolic disorders, cerebral apoplexy

  • severe liver dysfunction or disease

  • known or suspected malignancy of breast or genital organs

  • undiagnosed vaginal bleeding

  • in missed abortion

  • use as a diagnostic test for pregnancy

• Precaution(s):

  • epilepsy

  • migraine

  • asthma

  • cardiac or renal dysfunction

  • psychic depression

  • diabetes

Progesterone (Prometrium)

• Contraindication(s):

  • males with carcinoma of the breast or prostate

  • women (pregnancy category X)

• Precaution(s):

  • congestive HF

  • hyperlipidemia

Testosterone Gel (Androgel, Fortesta, & Testim)

• Contraindication(s):

  • dx, but as of yet, uncorrected adrenal insufficiency

  • untreated thyrotoxicosis

  • hypersensitive to any ingredient

• Precaution(s):

  • nursing

  • CV disorders

  • diabetes

  • currently taking oral anticoagulants

Thyroid (Armour Thyroid)

• Contraindication(s):

  • cardiogenic shock, marked sinus bradycardia, & 2nd or 3rd degree AV block unless a functioning pacemaker is available

  • nursing

Amiodarone (Cordarone, Pacerone, & Nexterone)

• Contraindication(s):

  • congenital or acquired long QT syndromes

  • severe renal impairment

  • use with verapamil, cimetidine, trimethoprim, or ketoconazole

  • pregnancy unless absolutely needed

Dofetilide (Tikosyn)

• Contraindication(s):

  • cardiogenic shock

  • pre-existing 2nd or 3rd degree AV block

  • right bundle branch block when associated with a left hemiblock if no pacemaker is present

  • recent cardiac arrest

  • CHF

• Precaution(s):

  • sick sinus syndrome

  • severe hepatic or renal impairment

Flecainide (Tambocor)

• Contraindication(s):

  • bronchial asthma

  • sinus bradycardia

  • 2nd or 3rd degree AV block

  • congenital or acquired long QT syndromes

  • cardiogenic shock

  • uncontrolled CHF

• Precaution(s):

  • CHF treatment

  • hx of sustained ventricular tachycardia/fibrillation

  • diabetes

  • renal impairment

Sotalol HCl (Betapace)

• Contraindication(s):

  • ventricular fibrillation

• Precaution(s):

  • pregnancy

  • nursing

  • severe carditis

  • HF accompanying acute glomerulonephritis

  • renal impairment

  • hypokalemia

  • acute MI

  • pulmonary disease

  • incomplete AV block

  • sinus node defects

  • idiopathic hypertrophic subaortic stenosis

Digoxin (Lanoxin & Digitek)

• Contraindication(s):

  • under the age of 6 y.o. unless recommended by a dentist or physician

Sodium Fluoride Paste (SF 5000 Plus)

• Contraindication(s):

  • previously experienced an episode of complex sleep behavior with eszopiclone, zaleplon, or zolpidem

• Precaution(s):

  • elderly

  • debilitated

  • hepatic impairment

  • diseases/conditions that affect metabolism or hemodynamic responses

  • exhibiting signs or symptoms of depression

• Eszopiclone (Lunesta)

• Zolpidem Tartrate (Ambien (CR) & Intermezzo)

• Zaleplon (Sonata)

• Contraindication(s):

  • hypersensitivity to benzodiazepines

  • pregnancy

• Precaution(s):

  • impaired renal or hepatic function

  • depression

  • nursing

Temazepam (Restoril)

• Contraindication(s):

  • with aliskiren in diabetic patients

  • hx of angioedema related to ACE inhibitor or ARB therapy

  • pregnancy

  • nursing mothers

• Precaution(s):

  • volume or salt-depleted patients dur to excessive hypotension

  • moderately impaired hepatic or renal function

Sacubitril and Valsartan (Entresto)

• Contraindication(s):

  • pregnancy (category X)

  • lactation

  • active liver disease or unexplained persistent elevations of serum transaminases

  • hypersensitive to any component

  • taking strong CYP3A4 inhibitors, gemfibrozil, cyclosporine, or danazol

• Precaution(s):

  • any amount of liver dysfunction

  • those who consume large/substantial amounts of alcohol

• Atorvastatin Calcium (Lipitor)

• Lovastatin (Mevacor)

• Pravastatin Sodium (Pravachol)

• Rosuvastatin Calcium (Crestor)

• Simvastatin (Zocor)

• Contraindication(s):

  • hypersensitive to nitrates

  • acute phase of MI

  • CHF

• Precaution(s):

  • hypotension

  • volume depletion

Isosorbide Mononitrate (Imdur)

• Contraindication(s):

  • intolerance to organic nitrates

  • severe anemias

  • closed-angle glaucoma

  • postural hypotension

  • increased IOP

  • during early MI

  • uncorrected hypovolemia

  • constrictive pericarditis or pericardial tamponade

• Precaution(s):

  • pregnancy

  • nursing

  • increased IOP

  • CHF acute MI

  • severe renal or hepatic disease

Nitroglycerin (Nitrostat & Nitroquick)

• Contraindication(s):

  • liver cirrhosis

  • use with strong CYP3A4 inhibitors nor inducers

• Precaution(s):

  • moderate to severe renal impairment

Ranolazine (Ranexa)

• Contraindication(s):

  • active pathological bleeding

  • severe hypertensive reactions to any component

• Precaution(s):

  • renal impairment

  • severe hepatic impairment

Rivaroxaban (Xarelto)

• Contraindication(s):

  • pregnancy (category X)

  • hemorrhagic tendencies

  • blood dyscrasias

  • recent or contemplated surgeries

  • bleeding tendencies associated with active ulceration

  • overt bleeding of any major organ or organ system

  • eclampsia or preeclampsia

  • inadequate mental state

  • spinal puncture

  • lumbar block anesthesia

  • malignant HTN

• Precaution(s):

  • nursing

  • hepatic or renal impairment

  • infections

  • sprue

  • indwelling catheters

  • moderate to severe HTN

  • CHF

  • polycythemia vera

  • vasculitis

  • severe diabetes

  • severe allergic or anaphylactic disorders

  • situation or physical condition adds the risk of hemorrhage

Warfarin Sodium (Coumadin & Jantoven)

• Contraindication(s):

  • severe organic heart disease

  • acute renal disease

  • urinary retention

  • pheochromocytoma

  • thyrotoxicosis

• Precaution(s):

  • renal impairment

  • urinary retention

Midodrine (Proamatine)

• Precaution(s):

  • impaired renal or hepatic function

Allopurinol (Zyloprim)

• Contraindication(s):

  • hypersensitive to any component

  • serious GI, renal, hepatic, blood, or cardiac disorders

• Precaution(s):

  • elderly

  • debilitated

  • early signs of GI, renal, hepatic, cardiac, or hematological disorders

Colchicine (Colcrys)

• Contraindication(s):

  • active ocular infections

  • known or suspected hypersensitivity to any ingredient

Cyclosporine Emulsion (Restasis)

• Contraindication(s):

  • sinus bradycardia

  • heart block greater than 1st degree

  • cardiogenic shock

  • overt cardiac failure

• Precaution(s):

  • bronchial asthma

  • CHF

  • diabetes mellitus

  • hyperthyroidism

  • impaired renal function

• use during pregnancy & nursing may increase the risk of neonatal hypoglycemia & bradycardia (Category D)

Atenolol (Tenormin)

• Contraindication(s):

  • NYHA class IV decompensated cardiac failure requiring IV inotropic therapy

  • bronchial asthma or related bronchospastic conditions

  • 2nd or 3rd-degree AV block

  • sick sinus syndrome

  • cardiogenic shock or severe bradycardia

• Precaution(s):

  • hepatic impairment

  • peripheral vascular disease (can aggravate symptoms)

  • diabetics (can mask hypoglycemia)

  • thyrotoxicosis (can mask hyperthyroidism)

  • during anesthesia (due to bradycardia)

• D/C use at the 1st sign of hepatic dysfunction (e.g., pruritis, dark urine, anorexia, jaundice, right upper quadrant tenderness, or unexplained flu-like symptoms)

Carvedilol (Coreg & Coreg CR)

• Contraindication(s):

  • sinus bradycardia

  • heart block greater than 1st degree

  • cardiogenic shock

  • decompensated HF

  • sick sinus syndrome

• Precaution(s):

  • pregnancy

  • bronchospastic diseases

  • diabetes

  • thyrotoxicosis

  • impaired hepatic function

• when stopping chronically administered therapy, doses should be gradually decreased over 1-2 week period to avoid angina pectoris/MI

Metoprolol Succinate (Toprol-XL & Kapspargo)

• Contraindication(s):

  • sinus bradycardia

  • heart block greater than 1st degree

  • cardiogenic shock

  • CHF

  • overt cardiac failure

  • HR < 45 BPM

  • systolic BP < 100 mmHg

  • moderate to severe cardiac failure

• Precaution(s)b:

  • pregnancy

  • bronchospastic disease

  • diabetes

  • thyrotoxicosis

  • impaired hepatic function

Metoprolol Tartrate (Lopressor)

• Contraindication(s):

  • bronchial asthma

  • overt cardiac failure

  • heart block greater than 1st degree

  • cardiogenic shock

  • severe bradycardia

• Precaution(s):

  • pheochromocytoma

  • diabetes mellitus

  • jaundice

  • hepatic dysfunction

• abrupt withdrawal of therapy may exacerbate ischemic heart disease & HTN

Labetalol HCl (Normodyne & Trandate)

• Contraindication(s):

  • severe bradycardia

  • heart block greater than 1st degree

  • cardiogenic shock

  • decompensated cardiac failure

  • sick sinus syndrome (w/o a pacemaker)

  • severe hepatic impairment

  • hypersensitivity to any component

• Precaution(s):

  • bronchospastic diseases

• abruptly discontinuing therapy may exacerbate angina, MI, & ventricular arrythmias

• may mask symptoms of hypoglycemia in diabetes

Nebivolol HCl (Bystolic)

• Contraindication(s):

  • cardiogenic shock

  • bronchial asthma

  • sinus bradycardia

  • heart block greater than 1st degree

  • CHF, unless secondary to tachyarrhythmia, then treatable

• Precaution(s):

  • pregnancy

  • nursing

  • impaired renal or hepatic function

  • bronchospastic diseases

  • diabetes mellitus

  • thyrotoxicosis

Propranolol HCl (Inderal (LA) & Innopran XL)

• Precaution(s):

  • severe coronary insufficiency

  • recent MI

  • cerebrovascular disease

  • chronic renal failure

• sudden cessation of therapy may produce severe HTN

Clonidine HCl (Catapres, Nexiclon XR, & Kapvay)

• Precaution(s):

  • severe coronary insufficiency

  • recent MI

  • cerebrovascular disease

  • chronic renal or hepatic failure

• drowsiness is pronounced during initiation of therapy

Guanfacine HCl (Tenex & Intuniv)

• Precaution(s):

  • significant liver impairment

  • administration when nursing

• episodes of syncope have occurred during therapy, especially during the 1st few doses of therapy or after missing a few doses of maintenance therapy

• to decrease the chance of syncope, all patients should be started with 1 mg tablets given HS

• if syncope occurs, the patient should be placed in a recumbent position & treated supportively as necessary

Doxazosin Mesylate (Cardura & Cardura XL)

• Precaution(s):

  • undergoing surgery where fentanyl is used

  • recently discontinuing beta-adrenergic blocker therapy

  • tight aortic stenosis

  • hepatic impariment

  • CHF

• may cause rare increase in angina or MI on starting therapy or increasing dose

Nifedipine (Procardia, Nifedical XL, & Adalat CC)

• Contraindication(s):

  • severe left ventricular dysfunction

  • hypotension (systolic BP < 90 mmHg)

  • cardiogenic shock

  • sick sinus syndrome (except in pts with a functioning artificial ventricular pacemaker)

  • 2nd or 3rd-degree AV block

  • severe CHF (unless secondary to a SVT amenable to therapy)

• Precaution(s):

  • HF

  • hypotension

  • renal or hepatic impairment

  • Afib/flutter with accessory bypass tract

  • atrioventricular block

  • hypertrophic cardiomyopathy

Verapamil HCl (Isoptin, Calan, & Verelan)

• Contraindication(s):

  • known hypersensitivity to donepezil or piperidine derivatives

• it may be beneficial to D/C usage prior to known anesthesia

• Precaution(s):

  • sick sinus syndrome (may cause vagotonic effects on the heart)

  • prone to ulcers or GI bleeding (may cause gastric acid secretion)

  • asthma or obstructive pulmonary disease

Donepezil HCl (Aricept)

• Contraindication(s):

  • hypersensitive to any component of this drug

• Precaution(s):

  • mild, moderate, or severe renal impairment

• daily doses above 5 mg should be given BID & dose increase should NOT be made sooner than once a week

Memantine HCl (Namenda)

• Contraindication(s):

  • allergic to any component of any formulation

• Precaution(s):

  • renal or hepatic impairment (use a lower dose)

  • risk for seizures

  • COPD

  • hx of stomach ulcers

  • nursing

Rivastigmine (Exelon)