top drugs counseling points

amlodipine

instruct patient to report signs/symptoms of low blood pressure or worsen symptoms of angina with initial dosing and dose changes. avoid alcohol while taking drug. report signs/symptoms of peripheral edema, fatigue, hypotension, or hepatic dysfunction. this medicine may cause dizziness. avoid activities that could be dangerous if dizziness occurs at initiation of therapy. dizziness may be worse if too much water is lost from the body due to excessive sweating, diarrhea, or vomiting. avoid grapefruit juice

nifedipine

take Adalat CC on an empty stomach. report signs/symptoms of hypotension, exacerbation of angina, peripheral edema, fatigue, or hypotension. avoid sudden discontinuation of drug as this may cause rebound HTN. may cause dizziness; avoid driving or using hazardous machinery until effects are known. avoid grapefruit juice. may see tablet or shell of dosage form in stool.

amlodipine

instruct patient to report signs/symptoms of low blood pressure or worsen symptoms of angina with initial dosing and dose changes. avoid alcohol while taking drug. report signs/symptoms of peripheral edema, fatigue, hypotension, or hepatic dysfunction. this medicine may cause dizziness. avoid activities that could be dangerous if dizziness occurs at initiation of therapy. dizziness may be worse if too much water is lost from the body due to excessive sweating, diarrhea, or vomiting. avoid grapefruit juice

nifedipine

take Adalat CC on an empty stomach. report signs/symptoms of hypotension, exacerbation of angina, peripheral edema, fatigue, or hypotension. avoid sudden discontinuation of drug as this may cause rebound HTN. may cause dizziness; avoid driving or using hazardous machinery until effects are known. avoid grapefruit juice. may see tablet or shell of dosage form in stool.

benazepril

avoid pregnancy. seek medical attention immediately if you experience any facial swelling. most common adverse effect is dry cough. use potassium supplements (drug causes hyperkalemia) or salt substitutes only under medical supervision. may cause dizziness that may worsen if dehydrated. take at the same time daily.

lisinopril

avoid pregnancy. use potassium supplements (drug causes hyperkalemia) or salt substitutes only under medical supervision. may cause dizziness that may worsen if dehydrated.

chlorthalidone

take in morning w/food. report dyspnea, hypotension, gout, or heart failure. avoid alcohol and NSAIDs. may cause dizziness or blurred vision. avoid operating heavy machinery.

hydrochlorothiazide

may be taken with or without food. take early in the day to avoid nocturia, even if taken more than once/d (eg, bid administration at 8 AM and 2 PM). may cause dizziness. report signs/symptoms of hypotension. eat high-potassium foods during therapy. avoid alcohol and using NSAIDs.

irbesartan

seek medical attention if angioedema (swelling of the face, eyes, lips, tongue, or throat), excessive fluid loss (vomiting, diarrhea, or excessive perspiration), hyperkalemia (confusion, body weakness, uneven heartbeat, or numbness/tingling in hands or feet), reduction in urination, jaundice, or skin rash occurs. avoid pregnancy. avoid abrupt discontinuation. use potassium supplements or salt substitutes only under medical supervision. may cause dizziness. avoid alcohol or driving.

losartan

avoid pregnancy. avoid sudden discontinuation; rebound HTN can occur. use potassium supplements or salt substitutes only under medical supervision. may cause dizziness that may worsen if dehydrated. seek medical attention if angioedema, excessive fluid loss, hyperkalemia, reduction in urination, or jaundice occurs.

olmesartan

avoid pregnancy. use potassium supplements or salt substitutes only under medical supervision. may cause dizziness that may worsen if dehydrated. seek care if angioedema, excessive fluid loss, hyperkalemia, reduction in urination, or jaundice occurs. may cause orthostatic hypotension.

valsartan

do not discontinue abruptly. use potassium supplements or salt substitutes only under medical supervision. this medicine may cause dizziness. avoid driving, using machinery, or doing anything else that could be dangerous if not alert. recommend avoiding alcohol and NSAIDs while taking this drug.

hydrochlorothiazide, losartan

refer to hctz and losartan key points , avoid K+ supplements and k+ sparing

hydrochlorothiazide, lisinopril

refer to hctz and lisinopril key points . avoid K+ supplements and k+ sparing

amlodipine, benazepril

avoid pregnancy, limit alcohol, edema (peripheral, facial), dry cough, fatigue, hypotension, hepatic dysfunction, dizziness (dont get up too fast or excercise for too long). no k+ supp or sparing/salt subs. take at same time dont miss doses.

triamterene, hydrochlorothiazide

may cause dizziness. rise slowly from a sitting or lying position to avoid dizziness. avoid foods that are high in potassium, potassium supplements, or potassium-containing salt substitutes. avoid alcohol and NSAIDs. may cause photosensitivity; use sunscreen. use with caution in patients with sulfonamide allergy.

prazosin

give first dose at bedtime; patients should rise from sitting or lying down slowly to minimize risk of orthostatic hypotension. may be taken with or without food. take exactly as directed by your doctor, not more or less. causes dizziness/drowsiness. limit alcohol, and take breaks when exercising

carvedilol

take w/food or milk, avoid abrupt discontinuation, may cause rebound HTN. avoid use of heavy machinery; diabetic patients monitor blood sugar levels due to hypoglycemia

furosemide

avoid alcohol and NSAIDs. increased risk of sun sensitivity. may cause dizziness, vertigo, or blurred vision. report HPT, decreased urine output or severe skin reactions. eat high-potassium foods.

metoprolol

take on an empty stomach and avoid alcohol. avoid abrupt discontinuation, rebound tachycardia and exacerbations of angina may occur. instruct patients to report signs/symptoms of hypotension, heart failure, or exacerbation of angina with initial dosing and dose changes. advise diabetic patients to carefully follow blood sugar levels as beta-blockers may mask symptoms of hypoglycemia.

atenolol

take on an empty stomach. avoid abrupt discontinuation; rebound tachycardia and exacerbations of angina may occur. report signs/symptoms of bradycardia, hypotension, heart failure, or exacerbation of angina with initial dosing and dose changes. may cause dizziness or drowsiness. diabetic patients to carefully follow blood sugar levels as β-blockers may mask symptoms of hypoglycemia. drug may cause sexual side effects, fatigue, and depression.

propranolol

take immediate-release tablets on an empty stomach; ER can be taken with or without food but consistently. avoid alcohol. avoid abrupt discontinuation; exacerbations of angina may occur. report signs/symptoms of hypotension, CHF, or exacerbation of angina with initial dosing and dose changes. this medicine may cause dizziness. diabetic patients should carefully follow blood glucose as beta-blockers may mask symptoms of hypoglycemia.

spironolactone

may cause dizziness. avoid driving, using machinery, or doing anything else that could be dangerous if not alert. report signs/symptoms of hyperkalemia (muscle weakness, fatigue, bradycardia) and hyponatremia (confusion, dry mouth, thirst, weakness, hypotension, decreased urination). avoid potassium supplements, foods/salt substitutes that are high in potassium. avoid alcohol and NSAIDs.

hydralazine

patient should not drink alcohol while taking drug. advise patient against sudden discontinuation of drug as this may cause rebound HTN. this medicine may cause dizziness. patient should report chest pain, palpitations, signs/symptoms of tachyarrhythmia, hypotension, agranulocytosis, systemic lupus erythematosus, or hepatotoxicity.

clonidine

avoid alcohol, CNS depressants. may cause nausea, vomiting, insomnia, constipation, fatigue, or dry mouth. apply patch to hariless area of upper outer arm or chest. avoid abrupt discontinuation to avoid rebound HTN.

atorvastatin

avoid alcohol & grapefruit/grapefruit juice. unexplained muscle tenderness or weakness may occur.

lovastatin

immediate-release tablets - take with evening meal; ER tablets - take at bedtime & whole; do not chew, crush, or cut; avoid alcohol & grapefruit/grapefruit juice; report symptoms of rhabdomyolysis, jaundice, or renal failure.

pravastatin

avoid alcohol. take in evening

rosuvastatin

avoid alcohol. may be taken without regard for food

simvastatin

avoid alcohol

insulin aspart

do not take in a hypoglycemic episode, side effects may include hypoglycemia, hypokalemia, lipodystrophy, weight gain, heart failure

insulin lispro

do not take in a hypoglycemic episode, side effects may include hypoglycemia, hypokalemia, lipodystrophy, weight gain, heart failure

insulin human (isophane human)

do not take in hypoglycemic episode, avoid alcohol, driving or using machinery; side effects include hypoglycemia, hypokalemia, lipodystrophy, weight gain, edema

insulin degludec

not for those with diabetic ketoacidosis, dont take in hypoglycemic episode; side effects may include hypokalemia, hypoglycemia symptoms, heart failure; test blood sugar

insulin glargine

not for those with diabetic ketoacidosis, dont take in hypoglycemic episode; side effects may include hypokalemia, hypoglycemia symptoms, heart failure; test blood sugar

dulaglutide

admin into upper arm/thigh/abdomen; use different injection site each wk. once weekly w/o regard to meals or time of day. dont mix w/ insulin; may inject in same body region as insulin, but do not admin both adjacently. keep refrigerated. be aware of thyroid cancer symptoms (lump in neck, trouble breathing/swallowing) & kidney problems (decreased urination, blood in urine)

liraglutide

monitor blood glucose. admin into upper arm/thigh/abdomen. change needle for each injection. if also using insulin, admin with separate injection in nonadjacent area. can be injected without regard to meals

semaglutide

can cause thyroid tumors; side effects may include pancreatitis, changes in vision, hypoglycemia, kidney problems

fenofibrate

fenoglide tablets & lipofen R capsules should be given with food; others can be taken without food; take 1 h before or 4-6h after a bile acid binding resin; products not interchangeable. do not use in kidney disease or liver disease

gemfibrozil

take 30 mins before breakfast & dinner. report symptoms of rhabdomyolysis, jaundice, or renal failure

dapagliflozin

take before first meal of the day to reduce post-meal hyperglycemia. dehydration symptoms (dizziness, low BP, decreased urination) and urinary tract infections may occur

empagliflozin

can cause ketoacidosis (increased ketones in blood/urine). possible side effects - dehydration, UTI, yeast infections

glimepiride

monitor blood glucose frequently. take with food/milk in the morning. use sunscreen and avoid alcohol; may cause a disulfiram reaction. risk of hypoglycemia

glipizide

monitor blood glucose frequently. take with food/milk in the morning. use sunscreen and avoid alcohol; may cause a disulfiram reaction. risk of hypoglycemia

ezetimibe

take with/without food. may be taken at the same time as a concurrent statin. in patients receiving bile acid sequestrant concurrently, ezetimibe should be taken at least 2h before or 4h after bile acid sequestrant is taken

pioglitazone

monitor blood glucose frequently. take with/without food. may require several weeks for maximum effect. bone and eye pain, jaundice, shortness of breath may occur. edema may occur

metformin

take with meals. drink plenty of liquids to improve elimination of metformin. avoid alcohol

sitagliptin

monitor blood glucose frequently. take with morning meal if once-daily dosing. take with morning and evening meal if twice a day dosing. when used in combo with insulin or sulfonylureas, risk of hypoglycemia may be increased

metformin, sitagliptin

can cause lactic acidosis, pancreatitis; side effects include hypoglycemia, kidney problems, joint pain

calcium phosphate; cholecalciferol

report nausea, constipation, kidney stones, vomiting; avoid use with thiazide diuretics?; may cause toxicity if high amounts

cholecalciferol

warn patient to report symptoms of hypercalcemia. side effects with excessive use may include nausea, anorexia, weight loss, constipation, polyuria, polydipsia, hypertension, weakness, and muscle aches or stiffness. instruct patient to maintain adequate intake of calcium with drug. advise patient to avoid additional vitamin D supplements

cyanocobalamin

may require several weeks for maximum effect. take extended-release products with food. avoid alcohol as it inhibits the absorption of B12

desogestrel; ethinyl estradiol

report upcoming elective surgeries, prolonged periods of immobilization, or recent childbirth as this may increase the risk of blood clots. side effects include nausea, vomiting, breakthrough bleeding, weight gain, breast tenderness, headache, migraine, persistent bleeding, blood clots, liver tumors, high BP, changes in vision, fluid retention. take drug at same time every day and do not allow more than 24 hours between doses. use non-hormonal backup form of contraception for the first 7 days. no smoking during
therapy. if a single dose is missed, take the tablet as soon as possible and resume normal schedule. if more than one active does is missed, contact physician for instructions

drospirenone; ethinyl estradiol

no smoking, as it increases the risk of serious cardiovascular side effects. practice safe sex. drug does not prevent disease transmission. potential long-term adverse effects include myocardial infarction, stroke, thrombophlebitis, dementia, venous thromboembolism (VTE), pulmonary embolism, and breast cancer. risk of VTE is greatest after initially starting therapy or restarting therapy after a 4-week or greater pill-free interval. may cause premenstrual syndrome, headache/migraine, breast pain/tenderness/discomfort, nausea/vomiting, fatigue, abdominal pain/tenderness/discomfort, weight gain, and mood changes. report signs/symptoms of serious cardiovascular events, such as myocardial infarction, stroke, and arterial or venous thrombosis. report new headaches that are persistent, severe, or recurrent, abnormal vaginal bleeding, amenorrhea of 2 or more consecutive cycles, or jaundice. report any unexplained partial or complete loss of vision. report visual changes or changes in lens tolerance if patient wears contacts. drug should be taken every day, at the same time each day, in the exact order noted on the packaging. use a nonhormonal back-up form of contraception for the first 7 days if a Sunday-start regimen is initiated or if drug is started postpartum but before menstruation resumes. certain drugs may cause oral contraceptives to be less effective and backup contraception may be necessary. consult healthcare professional prior to new drug use. review procedure for handling missed doses. patient must follow missed-dose instructions carefully for particular brand or formulation prescribed to prevent pregnancy

ergocalciferol

report symptoms of hypercalcemia; side effects include nausea, anorexia, weight loss, constipation, polyuria, polydipsia, hypertension, weakness, and muscle stiffness and aches; maintain adequate intake of calcium with drug; avoid additional vitamin D supplements

estradiol (oral and patch)

report abnormal vaginal bleeding or signs/symptoms of a thromboembolic disorder. do not smoke during therapy, as this increases the risk of themoboembolic events

ethinyl estradiol; etonogestrel

if vaginal ring is inadvertently expelled or removed, it may be rinsed in cool to lukewarm water and reinserted as soon as possible, at the latest within 3h. if the ring-free interval has been extended beyond 7d of if the vaginal ring has been left in place for >4 wk, an additional form of contraception must be used until the vaginal ring has been used continuously for 7d

ethinyl estradiol; levonorgestrel

inform patient of serious long-term adverse effects of hormone therapy including myocardial infarction, stroke, deep vein thrombosis, pulmonary embolism, dementia, and breast or endometrial cancer. advise patient to report symptoms of pregnancy, including amenorrhea that occurs in 2 or more consecutive cycles, and to discontinue use if pregnancy is confirmed. oral side effects may include elevated blood pressure, headache, migraines, enlarged or tender breasts, dizziness, mood changes, nausea and pancreatitis. transdermal side effects may include application site disorders, nausea, headache, dysmenorrhea, and increased weight. tell patient to report persistent or prolonged vaginal bleeding. instruct patient to report any unexplained partial or complete loss of vision and patient who wears contact lenses to report visual changes or changes in lens tolerance. advise patient to use a non-hormonal backup form of contraception for the first 7 days of use. counsel patient to take oral tablets at the same time each day. instruct patient using transdermal patch to avoid frequent or prolonged water exposure and large amounts of body lotions or oils and to check for partial or complete detachment once daily and also after water exposure. tell patient to avoid smoking cigarettes during therapy. instruct patient to avoid St. John's Wort during therapy. instruct patient that if a single active dose is missed, including vomiting or diarrhea the same day, do not take an extra dose that day but resume usual dose schedule. if vomiting or diarrhea continue for more than 48 hours, contact a physician for instructions. use of backup or additional methods of contraception may be necessary until active tablets have been taken 7 consecutive days after vomiting and diarrhea have resolved

ethinyl estradiol; norethindrone

advise patient to practice safe sex. drug does not prevent disease transmission. discuss potential long-term adverse effects of hormone therapy including myocardial infarction, stroke, thrombophlebitis, dementia, pulmonary embolism, or breast cancer. this drug may cause chloasma, change in weight, bloating, nausea, stomach cramps, vomiting, migraine, depression, amenorrhea, breakthrough bleeding, breast tenderness or swelling, or nipple discharge. tell patient to report persistent/recurrent abnormal vaginal bleeding. patients should report any unexplained partial or complete loss of vision. In addition, patients who wear contact lenses should report visual changes or changes in lens tolerance. this drug should be taken every day, at the same time each day with not more than 24 h between doses. advise patient to use a non-hormonal backup form of contraception for the first 7 days if a Sunday-start regimen is initiated. patients should not smoke during therapy, as this increases the risk of serious cardiovascular side effects. review with the patient the procedure for handling missed doses. it is very important that the patient follow carefully missed-dose instructions for the particular brand or formulation prescribed in order to prevent pregnancy. in many cases, this will necessitate the use of a back-up method of contraception until the regular schedule has been reestablished. if patient is still unsure of what to do in the event of a missed dose, patient should use a back-up form of contraception and contact healthcare professional for instructions.

ethinyl estradiol; norgestimate

warn patient to report symptoms of venous or arterial thrombosis. instruct patient to report symptoms of gallbladder disease or jaundice. counsel patient to report any irregularities in vaginal bleeding. side effects may include headache, migraine, abdominal pain, flatulence, vaginal infection, genital discharge, breast discharge, breast pain or enlargement, mood disorders, nervousness, chloasma, and weight changes. advise patient to take tablet at the same time every day. instruct patient that if a single active dose is missed, including vomiting or diarrhea within 3 to 4 hours after the active dose, take the tablet as soon as possible and resume a normal schedule. if more than one active dose is missed, contact a physician for instructions. use of additional nonhormonal methods of contraception may be necessary

ferrous sulfate

may require several weeks for maximum effect. stools will turn black. take on empty stomach, if possible, to maximize absorption. may take with food if significant nausea occurs. avoid calcium-containing food and antacids as this decreases iron absorption. should be separated by 2-12 h from many medications to avoid interfering with absorption, including tetracycline antibiotics. keep out of reach of children; accidental ingestion may be fatal. do not crush or chew any formulations.

folic acid

may require several weeks for maximum effect. avoid alcohol as it inhibits the absorption of folic acid.

levothyroxine

may require 6-8 wk for symptomatic improvement. avoid abrupt discontinuation. take on an empty stomach, with water at least 30 min before food. avoid antacids and iron within 4 h of dose.

liothyronine

notify healthcare provider or dentist prior to any surgery as drug may need to be temporarily discontinued. partial hair loss, usually temporary, may occur rarely during the first few months of therapy. IV side effects may include arrhythmia, tachycardia, cardiopulmonary arrest, hypotension, and myocardial infarction. oral side effects may include arrhythmias, myocardial infarction, dyspnea, headache, nervousness, irritability, insomnia, tremors, muscle weakness, increased appetite, weight loss, diarrhea, heat intolerance, menstrual irregularities, and skin rash.

norethindrone

side effects may include nausea, dizziness, headache, breast tenderness, or irregular periods. tell patient to report persistent or recurrent abnormal vaginal bleeding, amenorrhea, or severe abdominal pain. advise patient to take drug every day, at the same time of day, with no more than 24 hours between doses, including during bleeding episodes. tell patient to avoid smoking during therapy as this increases the risk of heart attack or stroke. counsel patient to use an alternative non-hormonal or back-up method of contraception while taking St. John's wort and for 28 days after discontinuing St. John's wort. instruct patient that if a dose is missed by 3 hours or more, take the missed pill as soon as remembered, then resume normal schedule, and use a backup method (eg, condom and spermicide) for 48 hours

potassium chloride

take with food. take the powder, granule, or oral liquid only after mixing in 4 oz of water or juice. crush or break only specifically designed extended-release formulations. capsules may be opened, sprinkled on apple sauce, and ingested immediately. completely dissolve effervescent tablets in liquid and sip slowly over a 5-10 min period.

progesterone

if using for amenorrhea, menstrual bleeding should occur 3-7 d after last oral dose. report if menstruation does not occur within 7 d after last dose. for vaginal formulation, avoid using other vaginal drugs within 6 h before or 6 h after using progesterone.

testosterone

gel to be applied to clean, dry, intact skin of the shoulders and upper arms and/or abdomen but should not be applied to genitals. gel should be allowed to dry well; swimming and showering should be avoided for 5-6 h after application. patients should keep application site covered, as direct skin contact can transfer drug to others. virilization has been reported in children who were secondarily exposed to testosterone gel (coming in contact with bare skin around gel application site). male patients should report too frequent or persistent erections. female sexual partners of patients using drug should report male-like changes. do not use higher doses than you have been prescribed, or combine with other anabolic steroids, serious adverse effects can occur. seek medical attention if chest pain, shortness of breath, signs of stroke, or behavioral changes.

thyroid

may require 6-8 wk before symptoms improve. do not stop using this medicine suddenly without asking your doctor; may need to slowly decrease dose before stopping it completely. take on an empty stomach, with water.

acyclovir

complete full course of therapy; ensure adequate hydration; symptoms should improve within 2-3 days

amiodarone

use sunscreen; may cause cardiac arrhythmias, pulmonary toxicity, or liver toxicity; multiple drug interactions; avoid interactions; avoid grapefruit/grapefruit juice

amoxicillin

shake well and store in the refrigerator; not short expiration after reconstitution; can take with food. if causes upset stomach; avoid mixing suspension with food or beverages and use with measuring device that comes with prescription; symptoms should improve within 2-3 days; may decrease effectiveness of oral contraceptives

amoxicillin/clavulanate

take dose with food to ensure proper absorption; for the suspension, shake well and store in the refrigerator; short expiration after reconstitution of 10 days; avoid mixing suspension with food or beverages; symptoms should improve within 2-3 days; may decrease effectiveness of oral contraceptives

apixaban

may cause unexpected bleeding or trouble breathing; take with or without food; do not stop taking apixaban without talking with your HCP; stopping early may increase the risk of stroke especially in patients with atrial fibrillation; apixaban should be interrupted 24-48h prior to dental and surgical procedures and restarted after hemostasis; avoid OTC NSAIDs and high-dose aspirin as then may increase the risk of bleeding

aspirin

avoid additional aspirin, NSAIDs, or aspirin-containing products during use, unless recommended by HCP, particularly if history of GI disease. avoid ≥3 alcoholic drinks/d, as risk of GI bleeds increases. use should be discontinued temporarily in advance of dental procedures.

azithromycin

complete full course of therapy; take tablets with or without food (some pts report increased tolerability when taken with food); avoid mixing suspension with food or beverages, but food can be taken after; symptoms should improve within 2-3d, if worse, follow up with HCP

cefdinir

complete full course of therapy; for the suspension, shake well and can be stored at room temp; note 10 day expiration after reconstitution; avoid mixing suspension with food or beverages, but food can be taken after; symptoms should improve within 2-3 days; if they worsen, follow up with HCP; separate admin of antacids, iron, and vitamins by 2h

cephalexin

seek medical attention if rash develops; complete full course of therapy; for the suspension, shake well and store in the refrigerator; note short expiration after reconstitution; avoid mixing suspension with food or beverages, but food can be taken afterward; symptoms should improve within 2-3 days

ciprofloxacin (PO, otic)

PO: seek medical attention if decreased urination, yellowing of eyes, blistering skin rash or extreme fatigue, unusual bruising or bleeding, SOB or chest pain, tendon pain, muscle weakness, "pins and needles" tingling or pricking sensation, numbness in arms or legs, confusion of hallucinations; take with or without food but not with milk or other dairy products; take at least 2h before or 6h after antacids, sucralfate, or mineral supplements and multivitamins and calcium, iron, or zinc; if using suspension, shake well before use; suspension can be stored at room temperature
otic: warm solution by holding container in hands for at least 1 min before administering; patient should lie with affected ear upward; position should be maintained for at least 1 min after instillation; repeat in opposite ear if necessary

clindamycin (PO, topical)

PO: complete full course of therapy; symptoms should improve within 2-3d; take with full glass of water; remain upright for 30 mins after dose to minimize risk of GI ulceration
topical: wash and dry face prior to application; use on skin only, avoid eyes and mucous membranes, avoid cut or broken skin; shake well before use; liquid is flammable; avoid smoking while applying or exposure to heat or open flame

clopidogrel

report signs/symptoms of bleeding, especially if used concomitantly with anticoagulant therapy; do not stop therapy abruptly without first talking with prescriber to minimize the risk of re-thrombosis particularly after stent placement

dapagliflozin

take before first meal of the day to help reduce post-meal hyperglycemia; report signs/symptoms of dehydration (dizziness, low BP, decreased urination), and UTIs

diltiazem

may cause symptomatic hypotension, bradyarrhythmia, peripheral edema, or syncope; do not drink alcohol while taking this drug; administer at the same time of day, either morning or evening

doxycycline

may take with food that does not contain calcium; complete full course of therapy; symptoms should improve within 2-3d; may cause photosensitivity; discontinue at first sign of skin erythema; wear sunscreen and avoid prolonged exposure to sunlight and ultraviolet light; administer with 240 mL of water

fluconazole

drug-drug interactions; do not take any new medications without consulting your doctor or pharmacist; if taking a weekly dose, take on same day and time each week

isosorbide mononitrate

take on empty stomach with at least half a glass of water; swallow XR tablet whole, do not break, crush or chew it; can cause headaches (sign the medicine is working); acetaminophen may be used to relieve the headache, contact HCP if HA is severe; can cause dizziness, avoid driving, using machinery, or anything that could be dangerous if not alert; stand up slowly if this medicine causes light-headedness from orthostatic hypotension; do not stop suddenly without consulting HCP; dose may need to be slowly decreased before stopping it completely; avoid concomitant use of PDEIs as it may increase severe hypotension; avoid alcohol; scored tablets may be split; doses of immediate release should be taken at least 7h apart

ketoconazole (topical)

apply thin layer to affected area of skin; skin should be intact; do not get into eyes, nose, mouth, or vagina; do not wash areas where you applied to medicine for at least 3 hours after application; cosmetics may be put on the affected areas 20 minutes after application; topical products are alcohol based and flammable immediately after application

metronidazole

avoid alcohol while taking this medicine and for 3 d after, may cause severe disulfiram-like reaction; complete full course of therapy (don't stop even if you feel better); symptoms should improve within 2-3 d, if they worsen, seek follow-up with HCP; may be administered with food to minimize stomach upset

nitrofurantoin

may make urine brown (breakdown product of drug); complete full course of therapy; for the suspension, shake well and store at room temperature, use within 30 d; avoid mixing suspension with food or beverages, but food can be taken afterward; symptoms should improve within 2-3 d; if they worsen, seek follow-up care

nitroglycerin

sit prior to using sublingual tablets, lingual aerosol, or spray; tablet dissolved SL or in buccal pouch at first sign of angina; do not swallow or chew tablet; do not eat or drink after placement of tablets; spray should be sprayed onto or under tongue; do not inhale; do not spit out or rinse mouth after use; rise slowly from a sitting position in order to prevent light-headedness; allow a 10- to 12-h/d drug-free interval to avoid development of nitrate tolerance for both patches and extended-release capsules; avoid concurrent use of alcohol, CNS depressants, antihypertensives, or other drugs that cause hypotension; do not use with PDEIs, which may result in hypotension; the ointment may stain clothing; when treating acute angina, instruct patient to call 911 if symptoms are not resolved by the first dose

oseltamivir phosphate

complete full course of therapy; symptoms should improve within 2-3 d; if they worsen, seek care; suspension is available in a 6 mg/mL concentration and is packaged with an oral syringe calibrated in milliliters up to a total of 10 mL (instructions for patient based on units); when providing oseltamivir suspension for children <1 y of age, use a lower volume (ie, <10 mL) oral syringe to ensure accurate dosing; if suspension unavailable, open capsules and compound a 6-mg/mL suspension; take with food to minimize GI irritation; take missed dose as soon as possible, if next dose is within 2 h, skip missed dose

rivaroxaban

may cause bleeding and interactions with other anticoagulant or antiplatelet medications, including OTC medications; warn risks of epidural (spinal) anesthesia while taking rivaroxaban; doses > 15 mg should be taken with food; if taking for nonvalvular atrial fibrillation, take with evening meal

sacubitril/valsartan

do not discontinue abruptly; use potassium supplements or salt substitutes only under medical supervision; may cause dizziness; avoid driving, using machinery, or doing anything that could be dangerous if not alert; avoid NSAIDs

torsemide

avoid alcohol and NSAIDs; increased risk of sun sensitivity, use sunscreen and avoid tanning; report signs/symptoms of hypotension or decreased urine output; severe skin reactions; eat high potassium foods; monitor weight daily

trimethoprim/sulfamethoxazole

complete full course of therapy; for the suspension, shake well and store at room temperature and protect from light; symptoms should improve within 2-3 days; may cause photosensitivity; use sunscreen; maintain adequate hydration during therapy to prevent kidney complications; seek medical attention for severe diarrhea, dark urine, yellowing of skin or eye, unusual bruising or bleeding, blistering skin rash, or shortness of breath

valacyclovir

seek medical attention if decreased urination, unusual bruising or bleeding, blistering skin rash, or SOB; symptoms should improve within 2-3 d, if worse, follow up with HCP; if using for prophylaxis, medicine should reduce the number of breakouts; maintain adequate hydration during therapy to prevent renal complications

verapamil

do not crush or chew extended-release product; extended-release capsules may be sprinkled on food and swallowed without chewing, followed by water; report symptomatic hypotension, bradyarrhythmia, peripheral edema, or syncope; avoid sudden discontinuation of drug, as this may precipitate hypertensive rebound/crisis; rise slowly from a sitting or lying position to avoid dizziness; avoid alcohol and grapefruit juice; calcium channel blockers are not drugs of first choice for hypertension, but may be used in combination with other agents in patients with inadequate blood pressure response

warfarin

report signs/symptoms of hemorrhage, skin and tissue necrosis; avoid situations/activities in which cuts, bruising, or injury is likely to occur; many significant drug-drug interactions; consult health-care professional prior to new prescription or OTC use; avoid alcohol, cranberry products, and drastic changes in vitamin K consumption from diet (cruciferous vegetables)

albuterol

contact prescriber if more albuterol is needed to control symptoms than usual as this may indicate acute asthma exacerbation. do not use more frequently than recommended. DPI does not require shaking or priming but does require deep inhalation for use. when inhaling contents, hold breath for at least 10 s, if possible, to allow albuterol to travel deeper into the lungs.

azelastine

avoid spraying in eyes; somnolence has been reported with nasal administration; instruct patient to avoid alcohol use and hazardous activities. review proper instillation technique, including priming the spray with initial use and if not used > 3 days. blow nose prior to using. do not spray into septum of the nose. may cause taste disturbances that are typically transient and temporary.

budesonide

gently swirl nebulizer suspension before use; use entire vial of inhalation suspension immediately after opening to avoid contamination; deliver over 5-15 minutes using a jet nebulizer with mouthpiece or face mask; after administration, rinse mouth with water and spit, and wash face to minimize risk of developing oral candidiasis; provided as a strip of five small plastic containers with sealed caps; each container holds 1 dose; the strip of containers is sealed inside a foil pouch; keep any unused containers inside the pouch; once foil pouch is opened, the containers will only be good for 2 weeks

budesonide/formoterol

advise patient on proper inhalation technique. if >1 inhalation is prescribed, wait 1 min after initial inhalation and shake the inhaler again before the next inhalation. after administration, rinse mouth with water and spit, and wash face to minimize risk of developing oral candidiasis. wash the mouthpiece and air-dry thoroughly at least once a week