NAPLEX – Generic to Brand and Class

Sumatriptan

Brand: Imitrex Class: Triptan — 5-HT1B/1D agonist MOA: 5-HT1B/1D agonist; cranial vasoconstriction and blocks pain transmission; fastest by subcutaneous injection Uses: Acute migraine; oral; nasal; subcutaneous Side effects: Chest tightness; dizziness; tingling; flushing; drowsiness Contraindications: Coronary artery disease; stroke or TIA; uncontrolled hypertension; hemiplegic or basilar migraine; use with ergot or another triptan within 24 h Allergies: Avoid if allergic to sumatriptan or its class; check excipients Interactions: Serotonergic drugs (serotonin syndrome risk); ergot alkaloids; MAO inhibitors Monitoring: Clinical response and adverse effects Dosing: Take early at first sign of pain; subcutaneous has the fastest onset; do not combine with another triptan or ergot within 24 h

Rizatriptan

Brand: Maxalt Class: Triptan — 5-HT1B/1D agonist MOA: 5-HT1B/1D agonist; cranial vasoconstriction and blocks pain transmission Uses: Acute migraine; orally disintegrating tablet Side effects: Chest tightness; dizziness; tingling; flushing; drowsiness Contraindications: Coronary artery disease; stroke or TIA; uncontrolled hypertension; hemiplegic or basilar migraine; use with ergot or another triptan within 24 h Allergies: Avoid if allergic to rizatriptan or its class; check excipients Interactions: Serotonergic drugs (serotonin syndrome risk); ergot alkaloids; MAO inhibitors Monitoring: Clinical response and adverse effects Dosing: Orally disintegrating tablet; take early

Zolmitriptan

Brand: Zomig Class: Triptan — 5-HT1B/1D agonist MOA: 5-HT1B/1D agonist; cranial vasoconstriction and blocks pain transmission Uses: Acute migraine; oral / nasal Side effects: Chest tightness; dizziness; tingling; flushing; drowsiness Contraindications: Coronary artery disease; stroke or TIA; uncontrolled hypertension; hemiplegic or basilar migraine; use with ergot or another triptan within 24 h Allergies: Avoid if allergic to zolmitriptan or its class; check excipients Interactions: Serotonergic drugs (serotonin syndrome risk); ergot alkaloids; MAO inhibitors Monitoring: Clinical response and adverse effects Dosing: Oral or nasal; take early

Eletriptan

Brand: Relpax Class: Triptan — 5-HT1B/1D agonist MOA: 5-HT1B/1D agonist; cranial vasoconstriction and blocks pain transmission Uses: Acute migraine Side effects: Chest tightness; dizziness; tingling; flushing; drowsiness Contraindications: Coronary artery disease; stroke or TIA; uncontrolled hypertension; hemiplegic or basilar migraine; use with ergot or another triptan within 24 h Allergies: Avoid if allergic to eletriptan or its class; check excipients Interactions: Serotonergic drugs (serotonin syndrome risk); ergot alkaloids; MAO inhibitors Monitoring: Clinical response and adverse effects Dosing: Oral; take early

Naratriptan

Brand: Amerge Class: Triptan — 5-HT1B/1D agonist MOA: 5-HT1B/1D agonist; cranial vasoconstriction and blocks pain transmission Uses: Acute migraine; longer half-life; slower onset Side effects: Chest tightness; dizziness; tingling; flushing; drowsiness Contraindications: Coronary artery disease; stroke or TIA; uncontrolled hypertension; hemiplegic or basilar migraine; use with ergot or another triptan within 24 h Allergies: Avoid if allergic to naratriptan or its class; check excipients Interactions: Serotonergic drugs (serotonin syndrome risk); ergot alkaloids; MAO inhibitors Monitoring: Clinical response and adverse effects Dosing: Oral; longer half-life and slower onset

Almotriptan

Brand: Axert Class: Triptan — 5-HT1B/1D agonist MOA: 5-HT1B/1D agonist; cranial vasoconstriction and blocks pain transmission Uses: Acute migraine Side effects: Chest tightness; dizziness; tingling; flushing; drowsiness Contraindications: Coronary artery disease; stroke or TIA; uncontrolled hypertension; hemiplegic or basilar migraine; use with ergot or another triptan within 24 h Allergies: Avoid if allergic to almotriptan or its class; check excipients Interactions: Serotonergic drugs (serotonin syndrome risk); ergot alkaloids; MAO inhibitors Monitoring: Clinical response and adverse effects Dosing: Oral; take early

Frovatriptan

Brand: Frova Class: Triptan — 5-HT1B/1D agonist MOA: 5-HT1B/1D agonist; cranial vasoconstriction and blocks pain transmission Uses: Acute migraine; longest half-life Side effects: Chest tightness; dizziness; tingling; flushing; drowsiness Contraindications: Coronary artery disease; stroke or TIA; uncontrolled hypertension; hemiplegic or basilar migraine; use with ergot or another triptan within 24 h Allergies: Avoid if allergic to frovatriptan or its class; check excipients Interactions: Serotonergic drugs (serotonin syndrome risk); ergot alkaloids; MAO inhibitors Monitoring: Clinical response and adverse effects Dosing: Oral; longest half-life

Rimegepant

Brand: Nurtec ODT Class: Gepant — CGRP receptor antagonist MOA: CGRP receptor antagonist; blocks CGRP without vasoconstriction Uses: Acute migraine (and preventive); no vasoconstriction Side effects: Nausea; drowsiness; dry mouth Contraindications: Few vasoconstriction limits; check liver function and interacting drugs Allergies: Avoid if allergic to rimegepant or its class; check excipients Interactions: Strong CYP3A4 inhibitors and inducers Monitoring: Clinical response and adverse effects Dosing: Orally disintegrating tablet; acute and preventive use

Ubrogepant

Brand: Ubrelvy Class: Gepant — CGRP receptor antagonist MOA: CGRP receptor antagonist; blocks CGRP without vasoconstriction Uses: Acute migraine; no vasoconstriction Side effects: Nausea; drowsiness; dry mouth Contraindications: Few vasoconstriction limits; check liver function and interacting drugs Allergies: Avoid if allergic to ubrogepant or its class; check excipients Interactions: Strong CYP3A4 inhibitors and inducers Monitoring: Clinical response and adverse effects Dosing: Oral; acute migraine

Lasmiditan

Brand: Reyvow Class: Ditan — 5-HT1F agonist MOA: 5-HT1F agonist; blocks pain transmission without vasoconstriction; no driving for 8 hours Uses: Acute migraine; no driving for 8 hours (sedation/dizziness) Side effects: Dizziness; drowsiness; fatigue; paraesthesia; no driving for 8 hours Contraindications: Caution with liver impairment and interacting drugs; no driving for 8 hours Allergies: Avoid if allergic to lasmiditan or its class; check excipients Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: Single dose; no driving for 8 hours after a dose

Ergotamine (+ caffeine)

Brand: Cafergot Class: Ergot alkaloid — vasoconstrictor MOA: Ergot alkaloid; vasoconstriction; many interactions especially strong CYP3A4 inhibitors Uses: Older acute migraine; many interactions; CV/pregnancy contraindications Side effects: Nausea; vomiting; vasoconstriction; ergotism with overuse Contraindications: Coronary artery disease; hypertension; pregnancy; use with strong CYP3A4 inhibitors Allergies: Avoid if allergic to ergotamine (+ caffeine) or its class; check excipients Interactions: Strong CYP3A4 inhibitors; triptans; serotonergic drugs Monitoring: Clinical response and adverse effects Dosing: Use sparingly; avoid in CV disease and pregnancy

Dihydroergotamine

Brand: Migranal / Trudhesa Class: Ergot alkaloid — vasoconstrictor MOA: Ergot alkaloid; vasoconstriction; older migraine therapy Uses: Acute migraine; nasal / IV Side effects: Nausea; vomiting; vasoconstriction; ergotism with overuse Contraindications: Coronary artery disease; hypertension; pregnancy; use with strong CYP3A4 inhibitors Allergies: Avoid if allergic to dihydroergotamine or its class; check excipients Interactions: Strong CYP3A4 inhibitors; triptans; serotonergic drugs Monitoring: Clinical response and adverse effects Dosing: Nasal or IV; older migraine therapy

Metoclopramide

Brand: Reglan Class: Antiemetic — dopamine antagonist / prokinetic MOA: Dopamine antagonist and prokinetic; blocks nausea and speeds stomach emptying Uses: Migraine-associated nausea; aids absorption Side effects: See Notes for the key adverse effects Contraindications: Caution in renal and hepatic impairment; see Notes Allergies: Avoid if allergic to metoclopramide or its class; check excipients Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: Give for migraine-associated nausea; aids absorption

Prochlorperazine

Brand: Compazine Class: Antiemetic — phenothiazine dopamine antagonist MOA: Dopamine antagonist; blocks nausea signals Uses: Migraine-associated nausea Side effects: See Notes for the key adverse effects Contraindications: Caution in renal and hepatic impairment; see Notes Allergies: Avoid if allergic to prochlorperazine or its class; check excipients Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: Give for migraine-associated nausea

Acetaminophen + aspirin + caffeine

Brand: Excedrin Migraine Class: Analgesic combination MOA: Combination analgesic for mild to moderate migraine Uses: Mild–moderate migraine Side effects: See Notes for the key adverse effects Contraindications: Caution in renal and hepatic impairment; see Notes Allergies: Avoid if allergic to acetaminophen + aspirin + caffeine or its class; check excipients Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: For mild to moderate migraine; take early

Topiramate

Brand: Topamax Class: Antiseizure — migraine preventive MOA: Blocks sodium channels and enhances GABA; also blocks carbonic anhydrase Uses: Weight loss; paraesthesia; kidney stones; cognitive slowing; teratogenic Side effects: Weight loss; paraesthesia; kidney stones; cognitive slowing; teratogenic Contraindications: Pregnancy (valproate and topiramate — teratogenic); liver disease (valproate) Allergies: Avoid if allergic to topiramate or its class; check excipients Interactions: CYP inducers and inhibitors; valproate raises lamotrigine levels; carbamazepine induces its own metabolism Monitoring: Drug level where indicated; liver tests; blood counts; pregnancy test (valproate; topiramate) Dosing: Titrate slowly; judge migraine benefit after 4 to 8 weeks; teratogenic

Valproate / valproic acid

Brand: Depakote Class: Antiseizure — migraine preventive MOA: Blocks sodium channels and enhances GABA; also blocks histone deacetylase Uses: Weight gain; tremor; teratogenic — avoid in pregnancy when possible Side effects: Weight gain; tremor; hepatotoxicity; teratogenic Contraindications: Pregnancy (valproate and topiramate — teratogenic); liver disease (valproate) Allergies: Avoid if allergic to valproate / valproic acid or its class; check excipients Interactions: CYP inducers and inhibitors; valproate raises lamotrigine levels; carbamazepine induces its own metabolism Monitoring: Drug level where indicated; liver tests; blood counts; pregnancy test (valproate; topiramate) Dosing: Titrate slowly; monitor levels where indicated; do not stop abruptly

Propranolol

Brand: Inderal Class: Beta-blocker — migraine preventive MOA: Beta-blocker; lowers heart rate and blood pressure; used for migraine prevention Uses: Also for hypertension / tremor; avoid in asthma; bradycardia Side effects: See Notes for the key adverse effects Contraindications: Caution in renal and hepatic impairment; see Notes Allergies: Avoid if allergic to propranolol or its class; check excipients Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: Titrate to heart rate and blood pressure; avoid in asthma and bradycardia

Metoprolol

Brand: Lopressor / Toprol XL Class: Beta-blocker (beta-1 selective) — migraine preventive MOA: Beta-1 selective beta-blocker; used for migraine prevention Uses: Migraine prevention; dose and heart-rate limits apply Side effects: See Notes for the key adverse effects Contraindications: Caution in renal and hepatic impairment; see Notes Allergies: Avoid if allergic to metoprolol or its class; check excipients Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: Titrate to heart rate and blood pressure; dose and heart-rate limits apply

Amitriptyline

Brand: Elavil Class: Tricyclic antidepressant — migraine preventive MOA: Blocks reuptake of serotonin and norepinephrine; also blocks histamine; muscarinic and alpha receptors Uses: Also neuropathic pain; anticholinergic; sedating Side effects: Anticholinergic effects (dry mouth; constipation; urinary retention; blurred vision); sedation; weight gain; QT prolongation; cardiotoxic in overdose Contraindications: Recent MI; conduction disease; narrow-angle glaucoma; urinary retention Allergies: Avoid if allergic to amitriptyline or its class; check excipients Interactions: MAO inhibitors; serotonergic drugs; QT-prolonging drugs; CYP2D6 inhibitors Monitoring: ECG (QT); blood pressure; anticholinergic effects Dosing: Start low; titrate; anticholinergic and sedating

Venlafaxine

Brand: Effexor XR Class: SNRI — migraine preventive MOA: Blocks reuptake of serotonin and norepinephrine; used for migraine prevention and neuropathic pain Uses: Also depression / anxiety / neuropathic pain Side effects: Nausea; dizziness; insomnia; sweating; raised blood pressure; withdrawal on stopping Contraindications: Uncontrolled narrow-angle glaucoma; use with MAO inhibitors Allergies: Avoid if allergic to venlafaxine or its class; check excipients Interactions: MAO inhibitors; serotonergic drugs; QT-prolonging drugs; CYP2D6 inhibitors Monitoring: Blood pressure; mood; withdrawal symptoms Dosing: Titrate; do not stop abruptly

Erenumab

Brand: Aimovig Class: CGRP monoclonal antibody — preventive MOA: Monoclonal antibody that blocks the CGRP receptor; monthly injection for migraine prevention Uses: Monthly subcutaneous injection; constipation; injection-site reactions Side effects: Injection-site reactions; constipation Contraindications: Hypersensitivity to the antibody Allergies: Avoid if allergic to the specific monoclonal antibody Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: Monthly subcutaneous injection; constipation and injection-site reactions

Fremanezumab

Brand: Ajovy Class: CGRP monoclonal antibody — preventive MOA: Monoclonal antibody that blocks CGRP; monthly or quarterly injection for migraine prevention Uses: Monthly or quarterly subcutaneous injection Side effects: Injection-site reactions; constipation Contraindications: Hypersensitivity to the antibody Allergies: Avoid if allergic to the specific monoclonal antibody Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: Monthly or quarterly subcutaneous injection

Galcanezumab

Brand: Emgality Class: CGRP monoclonal antibody — preventive MOA: Monoclonal antibody that blocks CGRP; monthly injection for migraine prevention Uses: Monthly subcutaneous injection; also cluster headache Side effects: Injection-site reactions; constipation Contraindications: Hypersensitivity to the antibody Allergies: Avoid if allergic to the specific monoclonal antibody Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: Monthly subcutaneous injection; also cluster headache

Eptinezumab

Brand: Vyepti Class: CGRP monoclonal antibody — preventive MOA: Monoclonal antibody that blocks CGRP; IV infusion every 3 months for migraine prevention Uses: IV infusion every 3 months Side effects: Injection-site reactions; constipation Contraindications: Hypersensitivity to the antibody Allergies: Avoid if allergic to the specific monoclonal antibody Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: IV infusion every 3 months

Atogepant

Brand: Qulipta Class: Gepant — CGRP receptor antagonist MOA: CGRP receptor antagonist; daily oral migraine prevention Uses: Daily oral migraine prevention Side effects: Nausea; drowsiness; dry mouth Contraindications: Few vasoconstriction limits; check liver function and interacting drugs Allergies: Avoid if allergic to atogepant or its class; check excipients Interactions: Strong CYP3A4 inhibitors and inducers Monitoring: Clinical response and adverse effects Dosing: Daily oral migraine prevention

Colchicine

Brand: Colcrys Class: Anti-inflammatory — microtubule inhibitor MOA: Binds tubulin; blocks microtubule formation and neutrophil migration Uses: Acute gout flare; renal dose limits; narrow therapeutic index Side effects: GI upset and diarrhoea; myelosuppression with overuse; narrow therapeutic index Contraindications: Severe renal or hepatic impairment without dose reduction; use with strong CYP3A4 or P-gp inhibitors Allergies: Avoid if allergic to colchicine or its class; check excipients Interactions: Strong CYP3A4 and P-gp inhibitors; statins (muscle toxicity) Monitoring: Renal and hepatic function; blood counts Dosing: Low dose for acute flare; reduce dose in renal impairment; narrow therapeutic index

Indomethacin

Brand: Indocin Class: NSAID MOA: Blocks COX enzymes; classic acute gout flare therapy; GI; renal and CV risk Uses: Acute gout flare (classic exam answer); GI/renal/CV risk Side effects: See Notes for the key adverse effects Contraindications: Caution in renal and hepatic impairment; see Notes Allergies: Avoid if allergic to indomethacin or its class; check excipients Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: Lowest effective dose; classic acute gout flare therapy

Prednisone

Brand: Deltasone Class: Glucocorticoid MOA: Binds glucocorticoid receptors; suppresses inflammation; acute gout flare when NSAID or colchicine is unsafe Uses: Acute gout flare when NSAID/colchicine unsafe; taper Side effects: Hyperglycaemia; insomnia; weight gain; immunosuppression; bone loss with long use Contraindications: Systemic fungal infection; live vaccines while immunosuppressed Allergies: Avoid if allergic to prednisone or its class; check excipients Interactions: CYP inducers lower levels; live vaccines while immunosuppressed Monitoring: Blood glucose; blood pressure; weight; bone health with long use Dosing: Taper after acute gout flare

Methylprednisolone

Brand: Medrol Class: Glucocorticoid MOA: Binds glucocorticoid receptors; suppresses inflammation; acute gout flare Uses: Acute gout flare; oral taper or intra-articular Side effects: Hyperglycaemia; insomnia; weight gain; immunosuppression; bone loss with long use Contraindications: Systemic fungal infection; live vaccines while immunosuppressed Allergies: Avoid if allergic to methylprednisolone or its class; check excipients Interactions: CYP inducers lower levels; live vaccines while immunosuppressed Monitoring: Blood glucose; blood pressure; weight; bone health with long use Dosing: Oral taper or intra-articular injection for acute gout flare

Allopurinol

Brand: Zyloprim Class: Xanthine oxidase inhibitor — urate lowering MOA: Blocks xanthine oxidase; lowers uric acid production Uses: Chronic gout; start low; flare prophylaxis 3–6 months; target urate <6 mg/dL Side effects: Rash (including severe skin reactions); gout flare when starting; liver enzyme changes Contraindications: Caution in severe renal impairment; CV caution on the febuxostat label Allergies: Avoid if allergic to allopurinol or its class; check excipients Interactions: Azathioprine and mercaptopurine (allopurinol blocks their breakdown) Monitoring: Serum urate; liver tests; rash Dosing: Start low; titrate to serum urate below 6 mg/dL; flare prophylaxis 3 to 6 months

Febuxostat

Brand: Uloric Class: Xanthine oxidase inhibitor — urate lowering MOA: Blocks xanthine oxidase; lowers uric acid production Uses: Chronic gout; CV caution on the label Side effects: Rash; GI upset; liver enzyme changes; gout flare when starting Contraindications: Caution in severe renal impairment; CV caution on the febuxostat label Allergies: Avoid if allergic to febuxostat or its class; check excipients Interactions: Azathioprine and mercaptopurine (allopurinol blocks their breakdown) Monitoring: Serum urate; liver tests; rash Dosing: Daily; CV caution on the label

Probenecid

Brand: Benemid Class: Uricosuric MOA: Blocks urate reabsorption in the kidney; increases uric acid excretion Uses: Chronic gout; needs good renal function; hydration; kidney-stone risk Side effects: Rash; GI upset; kidney stones Contraindications: Kidney stones; severe renal impairment Allergies: Avoid if allergic to probenecid or its class; check excipients Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Renal function; kidney stones Dosing: Needs good renal function; hydrate well

Pegloticase

Brand: Krystexxa Class: Uricase (enzyme) — urate lowering MOA: Enzyme that breaks uric acid down to allantoin; lowers uric acid fast Uses: Refractory chronic gout; IV; G6PD caution; infusion reactions Side effects: Infusion reactions; gout flare; haemolysis in G6PD deficiency Contraindications: G6PD deficiency Allergies: Avoid if allergic to pegloticase; G6PD deficiency is a contraindication not an allergy Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: IV infusion; G6PD caution; infusion reactions

Lesinurad

Brand: Zurampic Class: Uricosuric MOA: Blocks urate reabsorption in the kidney; add-on urate lowering Uses: Add-on urate lowering with a xanthine oxidase inhibitor Side effects: Rash; GI upset; kidney stones Contraindications: Kidney stones; severe renal impairment Allergies: Avoid if allergic to lesinurad or its class; check excipients Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Renal function; kidney stones Dosing: Add-on with a xanthine oxidase inhibitor

Ibuprofen

Brand: Advil / Motrin Class: NSAID — non-selective COX inhibitor MOA: Blocks COX enzymes; lowers pain; inflammation and fever; GI; renal; CV and bleeding risk Uses: Pain; inflammation; fever; GI; renal; CV; bleeding risk Side effects: GI upset and bleeding; renal injury; fluid retention; CV events; rash Contraindications: Active GI bleed or ulcer; severe renal or heart failure; CABG surgery; third trimester of pregnancy Allergies: Avoid if allergic to aspirin or NSAIDs; caution in aspirin-exacerbated respiratory disease Interactions: Anticoagulants and antiplatelets (bleeding); ACE inhibitors; ARBs and diuretics (triple whammy); lithium; methotrexate Monitoring: Clinical response and adverse effects Dosing: Lowest effective dose for the shortest time; take with food

Naproxen

Brand: Aleve / Naprosyn Class: NSAID — non-selective COX inhibitor MOA: Blocks COX enzymes; longest half-life of the common NSAIDs Uses: Pain/inflammation; longest half-life of the common NSAIDs Side effects: GI upset and bleeding; renal injury; fluid retention; CV events; rash Contraindications: Active GI bleed or ulcer; severe renal or heart failure; CABG surgery; third trimester of pregnancy Allergies: Avoid if allergic to aspirin or NSAIDs; caution in aspirin-exacerbated respiratory disease Interactions: Anticoagulants and antiplatelets (bleeding); ACE inhibitors; ARBs and diuretics (triple whammy); lithium; methotrexate Monitoring: Clinical response and adverse effects Dosing: Lowest effective dose; longest half-life of the common NSAIDs

Diclofenac

Brand: Voltaren (oral / topical gel) Class: NSAID — non-selective COX inhibitor MOA: Blocks COX enzymes; oral and topical; topical preferred when systemic risk is high Uses: Oral and topical; topical preferred when systemic risk is high Side effects: GI upset and bleeding; renal injury; fluid retention; CV events; rash Contraindications: Active GI bleed or ulcer; severe renal or heart failure; CABG surgery; third trimester of pregnancy Allergies: Avoid if allergic to aspirin or NSAIDs; caution in aspirin-exacerbated respiratory disease Interactions: Anticoagulants and antiplatelets (bleeding); ACE inhibitors; ARBs and diuretics (triple whammy); lithium; methotrexate Monitoring: Clinical response and adverse effects Dosing: Oral and topical; topical preferred when systemic risk is high

Celecoxib

Brand: Celebrex Class: NSAID — COX-2 selective MOA: Selectively blocks COX-2; lower GI risk than non-selective NSAIDs; still CV and renal risk; sulfa Uses: Lower GI risk than non-selective NSAIDs; still CV/renal risk; sulfa Side effects: GI upset (less than non-selective NSAIDs); renal injury; CV events; sulfa allergy Contraindications: Active GI bleed or ulcer; severe renal or heart failure; CABG surgery; third trimester of pregnancy; sulfa allergy Allergies: Avoid if allergic to sulfonamides; caution in aspirin-exacerbated respiratory disease Interactions: Anticoagulants and antiplatelets (bleeding); ACE inhibitors; ARBs and diuretics (triple whammy); lithium Monitoring: Clinical response and adverse effects Dosing: Lowest effective dose; still CV and renal risk; sulfa

Meloxicam

Brand: Mobic Class: NSAID — preferential COX-2 MOA: Preferentially blocks COX-2; once-daily NSAID; GI; renal and CV risk remains Uses: Once-daily NSAID; GI/renal/CV risk remains Side effects: See Notes for the key adverse effects Contraindications: Caution in renal and hepatic impairment; see Notes Allergies: Avoid if allergic to meloxicam or its class; check excipients Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: Once daily; GI; renal and CV risk remains

Ketorolac

Brand: Toradol Class: NSAID — non-selective COX inhibitor MOA: Blocks COX enzymes; short-term use only (5 days or less); high GI and renal risk Uses: Short-term (≤5 days) moderate–severe pain; high GI/renal risk Side effects: GI upset and bleeding; renal injury; fluid retention; CV events; rash Contraindications: Active GI bleed or ulcer; severe renal or heart failure; CABG surgery; third trimester of pregnancy Allergies: Avoid if allergic to aspirin or NSAIDs; caution in aspirin-exacerbated respiratory disease Interactions: Anticoagulants and antiplatelets (bleeding); ACE inhibitors; ARBs and diuretics (triple whammy); lithium; methotrexate Monitoring: Clinical response and adverse effects Dosing: Short-term use only (5 days or less)

Ketoprofen

Brand: Orudis Class: NSAID — non-selective COX inhibitor MOA: Blocks COX enzymes; pain and inflammation Uses: Pain/inflammation; also topical in some markets Side effects: GI upset and bleeding; renal injury; fluid retention; CV events; rash Contraindications: Active GI bleed or ulcer; severe renal or heart failure; CABG surgery; third trimester of pregnancy Allergies: Avoid if allergic to aspirin or NSAIDs; caution in aspirin-exacerbated respiratory disease Interactions: Anticoagulants and antiplatelets (bleeding); ACE inhibitors; ARBs and diuretics (triple whammy); lithium; methotrexate Monitoring: Clinical response and adverse effects Dosing: Lowest effective dose; also topical in some markets

Aspirin

Brand: Bayer Class: NSAID — irreversible COX inhibitor / antiplatelet MOA: Irreversibly blocks COX-1 in platelets; stops thromboxane A2 and platelet clumping for the life of the platelet Uses: Analgesic/antipyretic; antiplatelet at low dose; Reye syndrome in children with viral illness Side effects: GI bleeding; bruising; Reye syndrome in children with viral illness; tinnitus at high doses Contraindications: Active GI bleed or ulcer; severe renal or heart failure; CABG surgery; third trimester of pregnancy Allergies: Avoid if allergic to aspirin or NSAIDs; caution in aspirin-exacerbated respiratory disease Interactions: Anticoagulants and antiplatelets (bleeding); ACE inhibitors; ARBs and diuretics (triple whammy); lithium; methotrexate Monitoring: Clinical response and adverse effects Dosing: Lowest effective dose for the shortest time; take with food; check GI; renal and CV risk

Acetaminophen

Brand: Tylenol Class: Analgesic / antipyretic (not an NSAID) MOA: Analgesic and antipyretic; exact mechanism not fully settled; thought to act centrally on COX pathways Uses: Pain/fever; hepatotoxicity above the daily ceiling; lower ceiling in liver disease Side effects: Liver injury above the daily ceiling Contraindications: Severe liver disease; use above the daily ceiling Allergies: Avoid if allergic to acetaminophen or its class; check excipients Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: Do not exceed the total daily ceiling across all products; lower ceiling in liver disease

Capsaicin (topical)

Brand: Zostrix Class: Topical — TRPV1 agonist MOA: Activates TRPV1 receptors; depletes substance P with repeated use Uses: Neuropathic / local pain; burning at the application site Side effects: Burning at the application site Contraindications: Caution in renal and hepatic impairment; see Notes Allergies: Avoid if allergic to capsaicin (topical) or its class; check excipients Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: Apply to intact skin; burning at the application site

Lidocaine (topical / patch)

Brand: Lidoderm Class: Topical local anaesthetic MOA: Blocks sodium channels in local nerves; localised neuropathic pain Uses: Localised neuropathic pain (e.g. post-herpetic neuralgia) Side effects: Local irritation; numbness Contraindications: Caution in renal and hepatic impairment; see Notes Allergies: Avoid if allergic to lidocaine (topical / patch) or its class; check excipients Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: Apply to intact skin; localised neuropathic pain

Menthol / methyl salicylate (topical)

Brand: Bengay / Icy Hot Class: Topical counterirritant MOA: Stimulates local skin receptors; local effect with minimal systemic exposure Uses: Musculoskeletal pain; local effect; minimal systemic exposure Side effects: Skin irritation Contraindications: Caution in renal and hepatic impairment; see Notes Allergies: Avoid if allergic to menthol / methyl salicylate (topical) or its class; check excipients Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Clinical response and adverse effects Dosing: Apply to intact skin; local effect

Morphine

Brand: MS Contin / Roxanol Class: Opioid agonist MOA: Agonist at mu-opioid receptors; blocks pain signals and changes pain perception; active metabolite accumulates in renal failure Uses: Reference opioid; active metabolite accumulates in renal failure Side effects: Sedation; constipation; nausea; respiratory depression; active metabolite accumulates in renal failure Contraindications: Severe respiratory depression; acute asthma; paralytic ileus; raised intracranial pressure Allergies: Avoid if allergic to the specific opioid; cross-reactivity within the class is possible Interactions: CNS depressants (benzodiazepines; alcohol); serotonergic drugs (tramadol; meperidine); CYP3A4 and CYP2D6 inhibitors or inducers Monitoring: Pain; sedation; bowel function; respiratory rate Dosing: Lowest effective dose; active metabolite accumulates in renal failure

Oxycodone

Brand: OxyContin / Percocet (with acetaminophen) Class: Opioid agonist MOA: Agonist at mu-opioid receptors; CYP3A4 and CYP2D6 interactions Uses: Moderate–severe pain; CYP3A4/2D6 interactions Side effects: Sedation; constipation; nausea; respiratory depression; tolerance and dependence Contraindications: Severe respiratory depression; acute asthma; paralytic ileus; raised intracranial pressure Allergies: Avoid if allergic to the specific opioid; cross-reactivity within the class is possible Interactions: CNS depressants (benzodiazepines; alcohol); serotonergic drugs (tramadol; meperidine); CYP3A4 and CYP2D6 inhibitors or inducers Monitoring: Pain; sedation; bowel function; respiratory rate Dosing: Lowest effective dose; CYP3A4 and CYP2D6 interactions

Hydromorphone

Brand: Dilaudid Class: Opioid agonist MOA: Agonist at mu-opioid receptors; no active metabolite like morphine Uses: Moderate–severe pain; no active metabolite like morphine's Side effects: Sedation; constipation; nausea; respiratory depression; tolerance and dependence Contraindications: Severe respiratory depression; acute asthma; paralytic ileus; raised intracranial pressure Allergies: Avoid if allergic to the specific opioid; cross-reactivity within the class is possible Interactions: CNS depressants (benzodiazepines; alcohol); serotonergic drugs (tramadol; meperidine); CYP3A4 and CYP2D6 inhibitors or inducers Monitoring: Pain; sedation; bowel function; respiratory rate Dosing: Lowest effective dose; no active metabolite like morphine

Hydrocodone

Brand: Vicodin / Norco (with acetaminophen) Class: Opioid agonist MOA: Agonist at mu-opioid receptors; combination products carry an acetaminophen ceiling Uses: Pain; combination products carry an acetaminophen ceiling Side effects: Sedation; constipation; nausea; respiratory depression; tolerance and dependence Contraindications: Severe respiratory depression; acute asthma; paralytic ileus; raised intracranial pressure Allergies: Avoid if allergic to the specific opioid; cross-reactivity within the class is possible Interactions: CNS depressants (benzodiazepines; alcohol); serotonergic drugs (tramadol; meperidine); CYP3A4 and CYP2D6 inhibitors or inducers Monitoring: Pain; sedation; bowel function; respiratory rate Dosing: Lowest effective dose; combination products carry an acetaminophen ceiling

Fentanyl

Brand: Duragesic (patch) / Sublimaze Class: Opioid agonist — highly potent MOA: Agonist at mu-opioid receptors; highly potent; patch only for opioid-tolerant persistent pain Uses: Patch only for opioid-tolerant persistent pain; heat increases absorption Side effects: Sedation; constipation; respiratory depression; heat increases patch absorption Contraindications: Severe respiratory depression; acute asthma; paralytic ileus; raised intracranial pressure Allergies: Avoid if allergic to the specific opioid; cross-reactivity within the class is possible Interactions: CNS depressants (benzodiazepines; alcohol); serotonergic drugs (tramadol; meperidine); CYP3A4 and CYP2D6 inhibitors or inducers Monitoring: Pain; sedation; bowel function; respiratory rate Dosing: Patch only for opioid-tolerant persistent pain; heat increases absorption

Methadone

Brand: Dolophine / Methadose Class: Opioid agonist — long half-life MOA: Agonist at mu-opioid receptors with a long half-life; also blocks NMDA receptors Uses: Pain and opioid use disorder; QT prolongation; many interactions Side effects: QT prolongation; sedation; constipation; respiratory depression Contraindications: Severe respiratory depression; acute asthma; paralytic ileus; raised intracranial pressure Allergies: Avoid if allergic to the specific opioid; cross-reactivity within the class is possible Interactions: CNS depressants (benzodiazepines; alcohol); serotonergic drugs (tramadol; meperidine); CYP3A4 and CYP2D6 inhibitors or inducers Monitoring: Pain; sedation; bowel function; respiratory rate Dosing: Long half-life; QT check at baseline and with dose changes

Buprenorphine

Brand: Subutex / Butrans / Belbuca Class: Opioid partial agonist MOA: Partial agonist at mu-opioid receptors; ceiling on respiratory depression Uses: Pain and opioid use disorder; ceiling on respiratory depression Side effects: Sedation; constipation; nausea; precipitated withdrawal if started too early Contraindications: Severe respiratory depression; use before withdrawal has started Allergies: Avoid if allergic to buprenorphine Interactions: CNS depressants; CYP3A4 inhibitors and inducers Monitoring: Clinical response and adverse effects Dosing: Start in mild to moderate withdrawal; taper; do not stop abruptly

Buprenorphine / naloxone

Brand: Suboxone Class: Opioid partial agonist + antagonist MOA: Partial agonist plus antagonist; start in mild to moderate withdrawal or it precipitates withdrawal Uses: Opioid use disorder; start in mild–moderate withdrawal or it precipitates withdrawal Side effects: Sedation; constipation; nausea; precipitated withdrawal if started too early Contraindications: Severe respiratory depression; use before withdrawal has started Allergies: Avoid if allergic to buprenorphine Interactions: CNS depressants; CYP3A4 inhibitors and inducers Monitoring: Clinical response and adverse effects Dosing: Start in mild to moderate withdrawal or it precipitates withdrawal

Tramadol

Brand: Ultram Class: Opioid agonist (prodrug) + SNRI-like effects MOA: Opioid agonist plus SNRI-like effects; needs CYP2D6 to form its active metabolite Uses: Needs CYP2D6 activation; seizure and serotonin risk Side effects: Seizure risk; serotonin syndrome risk; nausea; dizziness Contraindications: Severe respiratory depression; acute asthma; paralytic ileus; raised intracranial pressure Allergies: Avoid if allergic to the specific opioid; cross-reactivity within the class is possible Interactions: CNS depressants (benzodiazepines; alcohol); serotonergic drugs (tramadol; meperidine); CYP3A4 and CYP2D6 inhibitors or inducers Monitoring: Pain; sedation; bowel function; respiratory rate Dosing: Do not escalate the dose in poor CYP2D6 metabolisers; switch drugs instead

Codeine

Brand: Tylenol #3 (with acetaminophen) Class: Opioid agonist (prodrug) MOA: Opioid prodrug; needs CYP2D6 to form morphine Uses: Needs CYP2D6 activation to morphine; ultra-rapid metabolisers at risk; avoid in breastfeeding/children Side effects: Sedation; constipation; respiratory depression in ultra-rapid metabolisers Contraindications: Severe respiratory depression; acute asthma; paralytic ileus; raised intracranial pressure Allergies: Avoid if allergic to the specific opioid; cross-reactivity within the class is possible Interactions: CNS depressants (benzodiazepines; alcohol); serotonergic drugs (tramadol; meperidine); CYP3A4 and CYP2D6 inhibitors or inducers Monitoring: Pain; sedation; bowel function; respiratory rate Dosing: Avoid in breastfeeding and in children; ultra-rapid metabolisers at risk

Meperidine

Brand: Demerol Class: Opioid agonist MOA: Agonist at mu-opioid receptors; avoid in most settings; neurotoxic metabolite and serotonin risk Uses: Avoid in most settings: neurotoxic metabolite; serotonin risk; poor oral efficacy Side effects: Neurotoxic metabolite (seizures); serotonin syndrome risk; poor oral efficacy Contraindications: Severe respiratory depression; acute asthma; paralytic ileus; raised intracranial pressure Allergies: Avoid if allergic to the specific opioid; cross-reactivity within the class is possible Interactions: CNS depressants (benzodiazepines; alcohol); serotonergic drugs (tramadol; meperidine); CYP3A4 and CYP2D6 inhibitors or inducers Monitoring: Pain; sedation; bowel function; respiratory rate Dosing: Avoid in most settings; neurotoxic metabolite and serotonin risk

Naloxone

Brand: Narcan Class: Opioid antagonist MOA: Blocks opioid receptors; reverses opioid overdose; short half-life so the opioid may outlast it Uses: Overdose reversal; short half-life — opioid may outlast it; repeat every 2–3 min Side effects: Withdrawal symptoms if opioids are present; short half-life so the opioid may outlast it Contraindications: Opioid dependence without an opioid-free interval (naltrexone) Allergies: Avoid if allergic to naloxone or naltrexone Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Withdrawal symptoms; respiratory rate Dosing: Repeat every 2 to 3 min until response; opioid may outlast it; stay until help arrives

Naltrexone

Brand: Vivitrol / ReVia Class: Opioid antagonist MOA: Blocks opioid receptors long-term; used for opioid and alcohol use disorder Uses: Opioid and alcohol use disorder; requires opioid-free interval first Side effects: Withdrawal symptoms if opioids are present; nausea Contraindications: Opioid dependence without an opioid-free interval (naltrexone) Allergies: Avoid if allergic to naloxone or naltrexone Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Withdrawal symptoms; respiratory rate Dosing: Requires an opioid-free interval first

Methylnaltrexone

Brand: Relistor Class: Peripherally acting opioid antagonist MOA: Blocks opioid receptors in the gut only; relieves constipation without reversing pain relief Uses: Opioid-induced constipation without reversing analgesia Side effects: Withdrawal symptoms if opioids are present; nausea Contraindications: Opioid dependence without an opioid-free interval (naltrexone) Allergies: Avoid if allergic to naloxone or naltrexone Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Withdrawal symptoms; respiratory rate Dosing: Oral daily for opioid-induced constipation

Naloxegol

Brand: Movantik Class: Peripherally acting opioid antagonist MOA: Blocks opioid receptors in the gut only; relieves constipation without reversing pain relief Uses: Opioid-induced constipation; CYP3A4 interactions Side effects: Withdrawal symptoms if opioids are present; nausea Contraindications: Opioid dependence without an opioid-free interval (naltrexone) Allergies: Avoid if allergic to naloxone or naltrexone Interactions: Check interacting drugs before prescribing; see Notes Monitoring: Withdrawal symptoms; respiratory rate Dosing: Oral daily for opioid-induced constipation; CYP3A4 interactions

Loperamide

Brand: Imodium
Class: Opioid agonist — peripherally acting
MOA: Opioid agonist that acts in the gut only; slows bowel movement
Uses: Diarrhoea; high doses can cause QT prolongation / arrhythmia
Side effects: Sedation; constipation; nausea; respiratory depression; tolerance and dependence
Contraindications: Severe respiratory depression; acute asthma; paralytic ileus; raised intracranial pressure
Allergies: Avoid if allergic to the specific opioid; cross-reactivity within the class is possible
Interactions: CNS depressants (benzodiazepines; alcohol); serotonergic drugs (tramadol; meperidine); CYP3A4 and CYP2D6 inhibitors or inducers
Monitoring: Pain; sedation; bowel function; respiratory rate
Dosing: Oral; high doses can cause QT prolongation and arrhythmia

Diphenoxylate / atropine

Brand: Lomotil
Class: Opioid agonist + anticholinergic
MOA: Opioid agonist in the gut plus atropine to discourage misuse; slows bowel movement
Uses: Diarrhoea; controlled substance
Side effects: Sedation; constipation; nausea; respiratory depression; tolerance and dependence
Contraindications: Severe respiratory depression; acute asthma; paralytic ileus; raised intracranial pressure
Allergies: Avoid if allergic to the specific opioid; cross-reactivity within the class is possible
Interactions: CNS depressants (benzodiazepines; alcohol); serotonergic drugs (tramadol; meperidine); CYP3A4 and CYP2D6 inhibitors or inducers
Monitoring: Pain; sedation; bowel function; respiratory rate
Dosing: Lowest effective dose for the shortest time; taper; bowel regimen from day one; naloxone at home

Gabapentin

Brand: Neurontin
Class: Gabapentinoid — calcium-channel ligand
MOA: Binds the alpha-2-delta subunit of calcium channels; lowers excitatory neurotransmitter release; renally cleared
Uses: Neuropathic pain; renally cleared; taper; sedation/dizziness
Side effects: Sedation; dizziness; ataxia; weight gain; oedema
Contraindications: Caution in renal impairment and in older adults (sedation and falls)
Allergies: Avoid if allergic to gabapentin or its class; check excipients
Interactions: CNS depressants; opioids
Monitoring: Renal function; sedation and falls
Dosing: Renally cleared; reduce dose in kidney disease; taper; dose after dialysis on dialysis days

Pregabalin

Brand: Lyrica
Class: Gabapentinoid — calcium-channel ligand
MOA: Binds the alpha-2-delta subunit of calcium channels; lowers excitatory neurotransmitter release; renally cleared
Uses: Neuropathic pain; fibromyalgia; renally cleared; taper; misuse potential
Side effects: Sedation; dizziness; ataxia; weight gain; oedema; misuse potential
Contraindications: Caution in renal impairment and in older adults (sedation and falls)
Allergies: Avoid if allergic to pregabalin or its class; check excipients
Interactions: CNS depressants; opioids
Monitoring: Renal function; sedation and falls
Dosing: Renally cleared; reduce dose in kidney disease; taper

Duloxetine

Brand: Cymbalta
Class: SNRI
MOA: Blocks reuptake of serotonin and norepinephrine; used for neuropathic pain and fibromyalgia
Uses: Neuropathic pain; fibromyalgia; depression/anxiety; hepatic caution
Side effects: Nausea; dizziness; insomnia; sweating; raised blood pressure; withdrawal on stopping
Contraindications: Uncontrolled narrow-angle glaucoma; use with MAO inhibitors
Allergies: Avoid if allergic to duloxetine or its class; check excipients
Interactions: MAO inhibitors; serotonergic drugs; QT-prolonging drugs; CYP2D6 inhibitors
Monitoring: Blood pressure; mood; withdrawal symptoms
Dosing: Titrate; do not stop abruptly; hepatic caution

Milnacipran

Brand: Savella
Class: SNRI
MOA: Blocks reuptake of serotonin and norepinephrine; used for fibromyalgia
Uses: Fibromyalgia; blood pressure and urinary effects
Side effects: Nausea; dizziness; insomnia; sweating; raised blood pressure; withdrawal on stopping
Contraindications: Uncontrolled narrow-angle glaucoma; use with MAO inhibitors
Allergies: Avoid if allergic to milnacipran or its class; check excipients
Interactions: MAO inhibitors; serotonergic drugs; QT-prolonging drugs; CYP2D6 inhibitors
Monitoring: Blood pressure; mood; withdrawal symptoms
Dosing: Titrate; do not stop abruptly; hepatic caution

Nortriptyline

Brand: Pamelor
Class: Tricyclic antidepressant
MOA: Blocks reuptake of serotonin and norepinephrine; also blocks histamine; muscarinic and alpha receptors
Uses: Neuropathic pain; better tolerated than amitriptyline in older adults
Side effects: Anticholinergic effects (dry mouth; constipation; urinary retention; blurred vision); sedation; weight gain; QT prolongation; cardiotoxic in overdose
Contraindications: Recent MI; conduction disease; narrow-angle glaucoma; urinary retention
Allergies: Avoid if allergic to nortriptyline or its class; check excipients
Interactions: MAO inhibitors; serotonergic drugs; QT-prolonging drugs; CYP2D6 inhibitors
Monitoring: ECG (QT); blood pressure; anticholinergic effects
Dosing: Start low; titrate; better tolerated than amitriptyline in older adults

Desipramine

Brand: Norpramin
Class: Tricyclic antidepressant
MOA: Blocks reuptake of norepinephrine mainly; also blocks muscarinic and alpha receptors
Uses: Neuropathic pain; CYP2D6 substrate
Side effects: Anticholinergic effects (dry mouth; constipation; urinary retention; blurred vision); sedation; weight gain; QT prolongation; cardiotoxic in overdose
Contraindications: Recent MI; conduction disease; narrow-angle glaucoma; urinary retention
Allergies: Avoid if allergic to desipramine or its class; check excipients
Interactions: MAO inhibitors; serotonergic drugs; QT-prolonging drugs; CYP2D6 inhibitors
Monitoring: ECG (QT); blood pressure; anticholinergic effects
Dosing: Start low; titrate; CYP2D6 substrate

Carbamazepine

Brand: Tegretol
Class: Antiseizure — sodium-channel blocker
MOA: Blocks voltage-gated sodium channels; first-line for trigeminal neuralgia
Uses: First-line for trigeminal neuralgia; HLA-B*15:02; CYP inducer; blood dyscrasias
Side effects: Rash (including Stevens-Johnson with HLA-B*15:02); blood dyscrasias; hyponatraemia; liver effects
Contraindications: Caution with cardiac conduction disease; rash history
Allergies: Avoid if allergic to carbamazepine or its class; check excipients
Interactions: CYP inducers and inhibitors; valproate raises lamotrigine levels
Monitoring: Drug level where indicated; liver tests; blood counts; pregnancy test (valproate; topiramate)
Dosing: HLA-B*15:02 screening in Asian ancestry; CYP inducer; monitor blood counts and sodium

Oxcarbazepine

Brand: Trileptal
Class: Antiseizure — sodium-channel blocker
MOA: Blocks sodium channels; hyponatraemia
Uses: Neuropathic pain / seizures; hyponatraemia
Side effects: Dizziness; drowsiness; ataxia; rash
Contraindications: Caution with cardiac conduction disease; rash history
Allergies: Avoid if allergic to oxcarbazepine or its class; check excipients
Interactions: CYP inducers and inhibitors; valproate raises lamotrigine levels
Monitoring: Drug level where indicated; liver tests; blood counts; pregnancy test (valproate; topiramate)
Dosing: Titrate; hyponatraemia

Lamotrigine

Brand: Lamictal
Class: Antiseizure — sodium-channel blocker
MOA: Blocks sodium channels; slow titration because of rash and Stevens-Johnson risk
Uses: Neuropathic pain / seizures; slow titration (rash / Stevens-Johnson)
Side effects: Rash including Stevens-Johnson; dizziness; drowsiness
Contraindications: Caution with cardiac conduction disease; rash history
Allergies: Avoid if allergic to lamotrigine or its class; check excipients
Interactions: CYP inducers and inhibitors; valproate raises lamotrigine levels
Monitoring: Drug level where indicated; liver tests; blood counts; pregnancy test (valproate; topiramate)
Dosing: Slow titration because of rash and Stevens-Johnson risk

Cyclobenzaprine

Brand: Flexeril
Class: Muscle relaxant — centrally acting
MOA: Acts in the central nervous system to reduce muscle spasm; TCA-like structure and effects
Uses: Short-term muscle spasm; sedating; anticholinergic; TCA-like
Side effects: Sedation; dizziness; weakness
Contraindications: Caution in renal and hepatic impairment; see Notes
Allergies: Avoid if allergic to cyclobenzaprine or its class; check excipients
Interactions: Check interacting drugs before prescribing; see Notes
Monitoring: Clinical response and adverse effects
Dosing: Short-term use only; sedating and anticholinergic

Baclofen

Brand: Lioresal
Class: Muscle relaxant — GABA-B agonist
MOA: Agonist at GABA-B receptors; reduces spinal reflexes and muscle spasm
Uses: Spasticity; taper — abrupt stop can cause withdrawal
Side effects: Sedation; dizziness; weakness; withdrawal on abrupt stop
Contraindications: Caution in renal impairment; do not stop abruptly
Allergies: Avoid if allergic to baclofen or its class; check excipients
Interactions: Check interacting drugs before prescribing; see Notes
Monitoring: Clinical response and adverse effects
Dosing: Taper — abrupt stop can cause withdrawal

Tizanidine

Brand: Zanaflex
Class: Muscle relaxant — alpha-2 agonist
MOA: Agonist at alpha-2 receptors; reduces excitatory signalling and muscle spasm
Uses: Spasticity; CYP1A2 substrate — ciprofloxacin combination is contraindicated
Side effects: Sedation; dry mouth; hypotension; dizziness
Contraindications: Hypotension; use with ciprofloxacin (tizanidine)
Allergies: Avoid if allergic to tizanidine or its class; check excipients
Interactions: Check interacting drugs before prescribing; see Notes
Monitoring: Clinical response and adverse effects
Dosing: CYP1A2 substrate — ciprofloxacin combination is contraindicated

Methocarbamol

Brand: Robaxin
Class: Muscle relaxant — centrally acting
MOA: Acts in the central nervous system to reduce muscle spasm; sedating
Uses: Muscle spasm; sedation; dizziness
Side effects: Sedation; dizziness; weakness
Contraindications: Caution in renal and hepatic impairment; see Notes
Allergies: Avoid if allergic to methocarbamol or its class; check excipients
Interactions: Check interacting drugs before prescribing; see Notes
Monitoring: Clinical response and adverse effects
Dosing: Short-term use; sedation and dizziness

Orphenadrine

Brand: Norflex
Class: Muscle relaxant — anticholinergic
MOA: Anticholinergic muscle relaxant; reduces muscle spasm
Uses: Muscle spasm; anticholinergic burden
Side effects: Dry mouth; constipation; urinary retention; blurred vision; confusion in older adults
Contraindications: Narrow-angle glaucoma; urinary retention; bowel obstruction
Allergies: Avoid if allergic to orphenadrine or its class; check excipients
Interactions: Check interacting drugs before prescribing; see Notes
Monitoring: Confusion and falls in older adults; urinary retention
Dosing: Short-term use; anticholinergic burden

Azithromycin

Brand: Zithromax
Class: Macrolide antibiotic
MOA: Binds the 50S ribosomal subunit; QT prolongation
Uses: Traveler's diarrhoea; respiratory infection; QT prolongation
Side effects: GI upset; QT prolongation; hepatotoxicity
Contraindications: QT prolongation; history of torsades
Allergies: Avoid if allergic to macrolides
Interactions: QT-prolonging drugs; CYP3A4 substrates (statins; calcium-channel blockers)
Monitoring: ECG (QT); liver tests
Dosing: Oral; QT check

Doxycycline

Brand: Vibramycin
Class: Tetracycline antibiotic
MOA: Binds the 30S ribosomal subunit; also malaria prophylaxis; photosensitivity
Uses: Malaria prophylaxis; many infections; photosensitivity; avoid in pregnancy/young children
Side effects: GI upset; photosensitivity; tooth discolouration in children
Contraindications: Pregnancy; children under 8 years; severe liver disease
Allergies: Avoid if allergic to tetracyclines
Interactions: Check interacting drugs before prescribing; see Notes
Monitoring: Clinical response and adverse effects
Dosing: Daily; 4 weeks after leaving; photosensitivity; avoid in pregnancy and young children

Ciprofloxacin

Brand: Cipro
Class: Fluoroquinolone antibiotic
MOA: Blocks bacterial DNA gyrase; strong CYP1A2 inhibitor so tizanidine combination is contraindicated
Uses: Strong CYP1A2 inhibitor — tizanidine interaction; tendon; QT; CNS effects
Side effects: GI upset; tendon pain or rupture; QT prolongation; CNS effects; strong CYP1A2 inhibitor
Contraindications: Tendon disorders; myasthenia gravis; QT prolongation; children and pregnancy (most)
Allergies: Avoid if allergic to fluoroquinolones
Interactions: Antacids; calcium; iron (separate by 2 to 4 h); QT-prolonging drugs; theophylline (ciprofloxacin)
Monitoring: ECG (QT); glucose; tendon pain
Dosing: Separate from antacids; calcium and iron by 2 to 4 hours; strong CYP1A2 inhibitor

Levofloxacin

Brand: Levaquin
Class: Fluoroquinolone antibiotic
MOA: Blocks bacterial DNA gyrase; QT prolongation and tendon effects
Uses: Respiratory / urinary infection; tendon; QT; glucose effects
Side effects: GI upset; tendon pain or rupture; QT prolongation; CNS effects; glucose changes
Contraindications: Tendon disorders; myasthenia gravis; QT prolongation; children and pregnancy (most)
Allergies: Avoid if allergic to fluoroquinolones
Interactions: Antacids; calcium; iron (separate by 2 to 4 h); QT-prolonging drugs; theophylline (ciprofloxacin)
Monitoring: ECG (QT); glucose; tendon pain
Dosing: Separate from antacids; calcium and iron by 2 to 4 hours

Moxifloxacin

Brand: Avelox
Class: Fluoroquinolone antibiotic
MOA: Blocks bacterial DNA gyrase; strongest QT effect among fluoroquinolones
Uses: Respiratory infection; QT prolongation
Side effects: GI upset; tendon pain or rupture; QT prolongation; CNS effects; glucose changes
Contraindications: Tendon disorders; myasthenia gravis; QT prolongation; children and pregnancy (most)
Allergies: Avoid if allergic to fluoroquinolones
Interactions: Antacids; calcium; iron (separate by 2 to 4 h); QT-prolonging drugs; theophylline (ciprofloxacin)
Monitoring: ECG (QT); glucose; tendon pain
Dosing: Separate from antacids; calcium and iron by 2 to 4 hours

Amoxicillin

Brand: Amoxil
Class: Penicillin antibiotic
MOA: Binds penicillin-binding proteins; blocks bacterial cell wall synthesis
Uses: Many infections; rash; allergy — check penicillin history
Side effects: Rash; GI upset; allergy; C. difficile
Contraindications: History of severe allergy to penicillins
Allergies: Avoid if allergic to penicillins; cephalosporins need caution — cross-reactivity is possible
Interactions: Methotrexate; warfarin; oral contraceptives (counselling point)
Monitoring: Clinical response and adverse effects
Dosing: Take as directed; finish the course; allergy check

Amoxicillin / clavulanate

Brand: Augmentin
Class: Penicillin + beta-lactamase inhibitor
MOA: Penicillin plus clavulanate that blocks beta-lactamase enzymes
Uses: Broader cover; GI upset; hepatic caution
Side effects: Rash; GI upset; allergy; C. difficile; liver effects
Contraindications: History of severe allergy to penicillins; cholestatic jaundice history with this combination
Allergies: Avoid if allergic to penicillins; cephalosporins need caution — cross-reactivity is possible
Interactions: Check interacting drugs before prescribing; see Notes
Monitoring: Clinical response and adverse effects
Dosing: Take as directed; finish the course; allergy check

Cephalexin

Brand: Keflex
Class: Cephalosporin (1st generation)
MOA: Binds penicillin-binding proteins; blocks bacterial cell wall synthesis
Uses: Skin / soft-tissue infection; renal dosing
Side effects: Rash; GI upset; allergy; C. difficile
Contraindications: History of severe allergy to cephalosporins
Allergies: Avoid if allergic to cephalosporins; caution if penicillin allergy
Interactions: Warfarin; alcohol (some)
Monitoring: Clinical response and adverse effects
Dosing: Renal dosing; take as directed

Ceftriaxone

Brand: Rocephin
Class: Cephalosporin (3rd generation)
MOA: Binds penicillin-binding proteins; blocks bacterial cell wall synthesis
Uses: Many serious infections; biliary sludging; calcium interaction in neonates
Side effects: Rash; GI upset; allergy; C. difficile
Contraindications: History of severe allergy to cephalosporins
Allergies: Avoid if allergic to cephalosporins; caution if penicillin allergy
Interactions: Warfarin; alcohol (some)
Monitoring: Clinical response and adverse effects
Dosing: Once daily in most uses; biliary sludging

Vancomycin

Brand: Vancocin
Class: Glycopeptide antibiotic
MOA: Binds the D-Ala-D-Ala end of cell wall precursors; nephrotoxic and ototoxic so monitor levels
Uses: MRSA and serious Gram-positive infection; nephro-/ototoxicity; TDM
Side effects: Nephrotoxicity; ototoxicity; red man syndrome with fast infusion
Contraindications: Severe renal impairment without dose adjustment
Allergies: Avoid if allergic to vancomycin; red man syndrome is a rate reaction not an allergy
Interactions: Nephrotoxic drugs (aminoglycosides; contrast)
Monitoring: Drug levels; renal function; hearing
Dosing: Dose by weight and renal function; monitor trough levels; nephrotoxic and ototoxic

Gentamicin / tobramycin

Brand: Garamycin / Nebcin
Class: Aminoglycoside antibiotic
MOA: Binds the 30S ribosomal subunit; nephrotoxic and ototoxic so monitor levels
Uses: Serious Gram-negative infection; nephro-/ototoxicity; TDM; once-daily dosing
Side effects: Nephrotoxicity; ototoxicity; neuromuscular blockade
Contraindications: Severe renal impairment without dose adjustment; myasthenia gravis
Allergies: Avoid if allergic to aminoglycosides
Interactions: Nephrotoxic drugs (vancomycin; contrast; loop diuretics)
Monitoring: Drug levels; renal function; hearing
Dosing: Dose by weight and renal function; once-daily dosing; monitor levels; renal function and hearing

Metronidazole

Brand: Flagyl
Class: Nitroimidazole antibiotic / antiprotozoal
MOA: Damages bacterial and protozoal DNA in anaerobic cells; disulfiram-like reaction with alcohol
Uses: Anaerobic infection; disulfiram-like reaction with alcohol
Side effects: Metallic taste; GI upset; neuropathy with long use
Contraindications: Alcohol use during and after treatment
Allergies: Avoid if allergic to metronidazole or its class; check excipients
Interactions: Check interacting drugs before prescribing; see Notes
Monitoring: Clinical response and adverse effects
Dosing: Avoid alcohol during and after treatment

Trimethoprim / sulfamethoxazole

Brand: Bactrim
Class: Folate antagonist combination
MOA: Blocks two steps of bacterial folate synthesis; hyperkalaemia and renal risk
Uses: UTI and others; hyperkalaemia; renal; sulfa allergy; warfarin interaction
Side effects: Hyperkalaemia; renal injury; rash; myelosuppression
Contraindications: Severe renal or hepatic impairment; sulfa allergy; pregnancy (first trimester caution)
Allergies: Avoid if allergic to sulfonamides
Interactions: Warfarin; ACE inhibitors (hyperkalaemia); methotrexate
Monitoring: Potassium; renal function; blood counts
Dosing: Hydrate; renal dosing; hyperkalaemia check

Nitrofurantoin

Brand: Macrobid
Class: Urinary antibiotic
MOA: Damages bacterial DNA; concentrates in urine; avoid in renal impairment and in G6PD deficiency
Uses: Uncomplicated cystitis; avoid in renal impairment and near term
Side effects: GI upset; headache; lung effects with long use
Contraindications: Renal impairment; near term in pregnancy; G6PD deficiency
Allergies: Avoid if allergic to nitrofurantoin or its class; check excipients
Interactions: Check interacting drugs before prescribing; see Notes
Monitoring: Clinical response and adverse effects
Dosing: Take as directed; avoid in renal impairment and near term

Linezolid

Brand: Zyvox
Class: Oxazolidinone antibiotic
MOA: Binds the 50S ribosomal subunit; also a reversible MAOI so serotonergic combinations are a risk
Uses: MRSA / VRE; serotonergic; myelosuppression; optic neuropathy
Side effects: Myelosuppression; optic neuropathy; serotonin syndrome risk
Contraindications: Uncontrolled hypertension; use with serotonergic drugs or tyramine foods
Allergies: Avoid if allergic to linezolid or its class; check excipients
Interactions: Serotonergic drugs (MAOI); tyramine foods; sympathomimetics
Monitoring: Blood counts; blood pressure; vision with long use
Dosing: Check the serotonergic drug list first; reversible MAOI

Isoniazid

Brand: Nydrazid
Class: Antituberculous
MOA: Blocks mycolic acid synthesis in tuberculosis; hepatotoxicity and neuropathy (give pyridoxine)
Uses: Tuberculosis; hepatotoxicity; peripheral neuropathy (give pyridoxine)
Side effects: Hepatotoxicity; peripheral neuropathy (give pyridoxine)
Contraindications: Severe liver disease; alcohol use
Allergies: Avoid if allergic to the specific drug
Interactions: Rifampin is a strong CYP inducer — lowers levels of many drugs
Monitoring: Liver tests; blood counts; vision (ethambutol is not in this set)
Dosing: Daily; give pyridoxine for neuropathy; monitor liver tests

Rifampin

Brand: Rifadin
Class: Antituberculous — strong CYP inducer
MOA: Blocks bacterial RNA polymerase; strong CYP inducer so many drugs lose effect
Uses: Tuberculosis; induces CYP3A4/2C9/2C19; P-gp — many interactions; orange urine
Side effects: Hepatotoxicity; orange urine; flu-like symptoms; strong CYP inducer
Contraindications: Severe liver disease; alcohol use
Allergies: Avoid if allergic to the specific drug
Interactions: Rifampin is a strong CYP inducer — lowers levels of many drugs
Monitoring: Liver tests; blood counts; vision (ethambutol is not in this set)
Dosing: Daily; strong CYP inducer; orange urine; many interactions

Atovaquone / proguanil

Brand: Malarone
Class: Antimalarial combination
MOA: Blocks malaria parasite growth in blood and liver stages; 7 days after leaving the area
Uses: Malaria prophylaxis/treatment; start 1–2 days before; 7 days after
Side effects: GI upset; headache
Contraindications: Use where resistance is known; QT prolongation (chloroquine)
Allergies: Avoid if allergic to atovaquone / proguanil or its class; check excipients
Interactions: QT-prolonging drugs; CYP inhibitors and inducers
Monitoring: Clinical response and adverse effects
Dosing: Start 1 to 2 days before travel; daily; 7 days after leaving

Mefloquine

Brand: Lariam
Class: Antimalarial
MOA: Kills malaria parasites in blood; weekly dosing; neuropsychiatric cautions
Uses: Weekly malaria prophylaxis; neuropsychiatric cautions
Side effects: GI upset; QT prolongation (some); neuropsychiatric effects (mefloquine)
Contraindications: Use where resistance is known; QT prolongation (chloroquine)
Allergies: Avoid if allergic to mefloquine or its class; check excipients
Interactions: QT-prolonging drugs; CYP inhibitors and inducers
Monitoring: Clinical response and adverse effects
Dosing: Weekly; neuropsychiatric cautions

Chloroquine

Brand: Aralen
Class: Antimalarial
MOA: Kills malaria parasites in blood; only where sensitive; QT and retinal toxicity
Uses: Only where sensitive; QT; retinal toxicity with long use
Side effects: GI upset; QT prolongation (some); neuropsychiatric effects (mefloquine)
Contraindications: Use where resistance is known; QT prolongation (chloroquine)
Allergies: Avoid if allergic to chloroquine or its class; check excipients
Interactions: QT-prolonging drugs; CYP inhibitors and inducers
Monitoring: Clinical response and adverse effects
Dosing: Only where sensitive; QT and retinal toxicity with long use

Primaquine

Brand: Primaquine
Class: Antimalarial (8-aminoquinoline)
MOA: Kills liver stages of Plasmodium vivax and ovale; haemolysis in G6PD deficiency
Uses: Radical cure of vivax/ovale; haemolysis in G6PD deficiency — quantitative G6PD test first
Side effects: GI upset; haemolysis in G6PD deficiency
Contraindications: G6PD deficiency; pregnancy (primaquine)
Allergies: Avoid if allergic to 8-aminoquinolines; G6PD deficiency is a contraindication not an allergy
Interactions: QT-prolonging drugs; CYP inhibitors and inducers
Monitoring: G6PD status before treatment; haemolysis signs
Dosing: Quantitative G6PD test first; do not give if deficient

Tafenoquine

Brand: Krintafel / Arakoda
Class: Antimalarial (8-aminoquinoline)
MOA: Kills liver stages of Plasmodium vivax and ovale; haemolysis in G6PD deficiency
Uses: Vivax radical cure / prophylaxis; G6PD testing required
Side effects: GI upset; haemolysis in G6PD deficiency
Contraindications: G6PD deficiency; pregnancy (primaquine)
Allergies: Avoid if allergic to 8-aminoquinolines; G6PD deficiency is a contraindication not an allergy
Interactions: QT-prolonging drugs; CYP inhibitors and inducers
Monitoring: G6PD status before treatment; haemolysis signs
Dosing: Quantitative G6PD test first; do not give if deficient