BBWs/CIs

2024

BBW of Penicllin G benzathine

Not for IV use; IM only

BBW of Aminoglycosides

nephrotoxicity, ototoxicity, neuromuscular blockade

BBW of Quinolones

Tendon inflammation/rupture

Peripheral neuropathy

CNS effects (seizures)

Avoid in myasthenia gravis

BBW of Lipoglycopeptides

Fetal risk; nephrotoxicity

BBW of All GLP-1 Agonists (except Byetta)

Risk of thyroid C-cell Carcinoma

BBW Metformin

lactic acidosis

BBW of Thioamides

Several liver injury and acute liver failure

BBW of Lamotrigine

Serious skin conditions (SJS/TEN)

BBW of Valproate

Hepatic failure; feta harm (neural tube defects)

BBW of Carbamazepine

Serious skin reactions (SJS/TEN)

aplastic anemia

Agranulocytosis

BBW of Phenytoin

IV administration rate should not exceed 50mg/min; if given faster, HoTN and cardiac arrhythmias can occur.

BBW of Benzodiazepines

Use with opioids can cause sedation, respiratory depression and death

BBW of Metoclopramide

tardive dyskinesia

BBW of Misoprostol

abortifacient

BBW of Iron supplements

leading cause of fatal accidental poisoning of children

BBW of Iron Dextran and Ferumoxytol

Serious and sometimes fatal anaphylactic reactions have occured; all patients receiving iron dextran should be give a test dose

BBW of ESAs

Increase risk of death, MI, stroke, VTE, thrombosis

CKD: increase risk of death when Hgb > 11

Not indicated in cancer when expected outcome is cure.

BBW of Dabigatran, Enoxaparin and Fondaparinux

Patients receiving neuraxial anesthesia (epidural, spinal) are at risk of hemotomas and subsequent paralysis

BBW of Edoxaban

Reduced efficiency in patients with CrCl > 95mL/min

BBW of RAAS inhibitors

Teratogenic, d/c as soon as pregnancy is detected

BBW of Beta Blockers

Do not d/c abruptly; gradually taper

BBW of Clopidogrel

Prodrug; conversion depends on CYP2C19

CI of PDE-5 inhibitors

use with nitrates

All Antidepressants

Increased suicidal thoughts or actions in some children, teenagers and young adults

CI of SSRIs, SNRIs, Tricyclics, DNRI

Do not use with MAO inhibitors,

CI of Bupropion

Seizures

Hx of Anorexia/Bulimia

Use w/:

-Linezolid

-MAO inhibitors

-Methylene Blue

CI of clonazepam and diazepam

Severe liver disease

BBW for stimulants

high potential for abuse and dependence

CI of stimulants

Use of MAOi due to risk of hypertensive crisis

FGAs and SGAs

Elderly patients wtih dementia-related pyschosis

Increased risk of death

CI of Ziprasidone (Geodon)

QT prolongation

CI of direct thrombin hibitors

Tx of patients with mechanical prosthetic heart valves

CI of fondaparinux

severe renal impairment (CrCL <30 )

CI of Metformin

eGFR < 30, metabolic acidosis

CI of Sulfonylureas

sulfa allergy

CI of Penicillin

Type 1 hypersensitivity reaction

If severe renal impairment, do not use Augmentin ER or 875mg

CI of Ceftriaxone

Use in neonates

CI of Clarithromycin and Erythromycin

Simvastatin and Lovastatin

CI of SMX/TMP

Sulfa allergy

CI of linezolid

Use within 2 weeks of MAO inhibitors

BBW of Tigecycline

increased risk of death

CI of Metronidazole

Pregnancy

Use of alcohol

BBW of Febuxostat

cardiovascular death

BBW of pegloticase

anaphylaxis reactions

BBW of Pioglitazone

can cause or exacerbate heart failure;

Do not use with NYHA Class III/IV heart failure

BBW of Methotrexate

hepatotoxicity

myelosuppression

pregnancy - fetal death

mucositis/stomatitis

BBW of Anti-TNF Biologic DMARDs

Serious infections (TB, fungal, viral, bacterial)

Lymphomas and other malignancies

BBW of Rituximab (Rituxan)

infusion-related reactions (usually with first infusion), PML, SJS/TEN, HBV reactivation (screen high risk groups for HBV and HCV

BBW of Natalizumab (Tysabril)

Progressive multifocal leukoencephalopathy (PML); only available through REMS program

BBW of Potassium Sparing Diuretic

Hyperkalemia (more likely in patients with diabetes, renal impairment and elderly)

CI of methyldopa

Concurrent use with MAOI and active liver disease

BBW of minoxidil

potent antihypertensive

CI of Psyllium (Metamucil)

Fecal impaction and GI obstruction

CI of Docusate

Abdominal pain, N/V, use with mineral oil

BBW of Guanylate Cyclase C angonists (Linzess, Trulance)

Do not use in pediatric patients;

High risk of dehydration that can cause death

BBW of PAMORAs (Methylnatrexone, Naloxegol, Alvimopan)

Potential risk of MI with long term use.

CI of Sodium Phosphates (Osmoprep)

Nephropathy

CI of Bismuth Subslicylate (Pepto-Bismol)

Salicylate allergy, GI ulcer, bleeding problems

BBW of Loperamide (Imodium A-D)

Cardiac arrest and sudden death with doses higher than recommended

DO NOT USE in children < 2 years old

BBW for ALL Estrogen containing products

Avoid use in women > 35 years old who SMOKE due to serious CVD risk

BBW of Estrogen + Progestin Transdermal patch

Do not use in women with BMI > 30, increase risk of thromboembolism

BBW of Depo-Provera

Loss of bone mineral density with long term use

Do not use Estrogen if:

Hx of DVT/PE, stroke, CAD

Hx of breast, ovarian, or liver cancer

migraines with aura

CI of ACEi

Hx of angiodema

Use with 36 hours of Entresto

BBW of Vericiguat

Do not use if pregnant; contraceptions required during use and one month after stopping tx

CI of Oral Bisphosphonates

Hypocalcemia;

Inability to stand or sit upright for at least 30 minuts

BBW of Systemic Hormone Therapies for Menopause (ex: Estradiol, Medroxyprogesterone, etc)

Endometrial cancer;

Dementia (women ≥65 years)

Increased risk for VTE and stroke

Breast cancer

CI of finasteride

Women of child-bearing potential; pregnancy

BBW of Tolvaptan

-should be initiated and re-initiated in a hospital setting

-dont rapidly correct > 12 mEq/L in 24 hrs bc ODS

BBW of IV Immunoglobulin

Acute renal dysfunction (rare)

BBW of Nitroprusside

excessive doses delivered at a fast rate may cause cyanide toxicity

CI of Propofol

hypersensitivity to egg or soy products

Cyclosporine

nephrotoxicity

Increased risk for lymphoma

Increased risk of infections

BBW of Mycophenolate

Increased risk of infection

Increased development of lymphoma and skin malignancies

Increased risk of congenital malformations and spontaneous abortions