CNS DRUGS: Safety, Tolerability, Special Considerations

Buproprion

Safety: seizure risk, increased risk of suicide in pediatrics and young adults

Tolerability: dry mouth, insomnia, anorexia

Special: titrate the dose to reduce seizure risk, start 1 week before quitting smoking

Citalopram

Safety: increased risk of suicide in pediatrics and young adults; cardiac arrythmia (QTc prolonged)

Tolerability: diarrhea, sleep disturbances, nausea

Special: may take 6 weeks for notable improvement in depression, 8 weeks for anxiety

Escitalopram

Safety: increased risk of suicide in pediatrics and young adults; cardiac arrythmia (QTc prolonged)

Tolerability: diarrhea, sleep disturbances, nausea

Special: may take 6 weeks for notable improvement in depression, 8 weeks for anxiety

Fluoxetine

Safety: increased risk of suicide in pediatrics and young adults; cardiac arrythmia (QTc prolonged)

Tolerability: diarrhea, sleep disturbances, nausea

Special: may take 6 weeks for notable improvement in depression, 8 weeks for anxiety

Paroxetine

Safety: increased risk of suicide in pediatrics and young adults; cardiac arrythmia (QTc prolonged)

Tolerability: diarrhea, sleep disturbances, nausea

Special: may take 6 weeks for notable improvement in depression, 8 weeks for anxiety

Sertraline

Safety: increased risk of suicide in pediatrics and young adults; cardiac arrythmia (QTc prolonged)

Tolerability: diarrhea, sleep disturbances, nausea

Special: may take 6 weeks for notable improvement in depression, 8 weeks for anxiety

Desvenlafaxine

Safety: increased risk of suicide in pediatrics and young adults,

Tolerability: constipation, sleep disturbances, nausea, hypertension

Special: may take 6 weeks for notable improvement in depression, 8 weeks for anxiety

Duloxetine

Safety: increased risk of suicide in pediatrics and young adults,

Tolerability: constipation, sleep disturbances, nausea, hypertension

Special: may take 6 weeks for notable improvement in depression, 8 weeks for anxiety

Venlafaxine

Safety: increased risk of suicide in pediatrics and young adults,

Tolerability: constipation, sleep disturbances, nausea, hypertension

Special: may take 6 weeks for notable improvement in depression, 8 weeks for anxiety

Amitriptyline

Safety: increased risk of suicide in pediatrics and young adults; cardiac arrythmia (QTc prolonged)

Tolerability: diarrhea, sleep disturbances, nausea, hypertension

Special: may take 6 weeks for notable improvement in depression, 8 weeks for anxiety

Doxepin

Safety: increased risk of suicide in pediatrics and young adults; cardiac arrythmia (QTc prolonged)

Tolerability: diarrhea, sleep disturbances, nausea, hypertension

Special: may take 6 weeks for notable improvement in depression, 8 weeks for anxiety

Nortriptyline

Safety: increased risk of suicide in pediatrics and young adults; cardiac arrythmia (QTc prolonged)

Tolerability: diarrhea, sleep disturbances, nausea, hypertension

Special: may take 6 weeks for notable improvement in depression, 8 weeks for anxiety

Mirtazepine

Safety: increased risk of suicide in pediatric and young adults, cardiac arrhythmia (QTc prolonged)

Tolerability: sedation/ drowsiness, increased appetite, constipation

Special: may take 6 weeks for notable improvement in depression

Trazadone

Safety: increased risk of suicide in pediatric and young adults, priapism in men

Tolerability: sedation/ drowsiness, hypotension

Special: almost never used for depression now

Atomoxetine

Safety: increased risk of suicide ideation in pediatrics and young adults

Tolerability: dry mouth, fatigue, mood swings, decreased appetite

Amphetamine-dextroamphetamine

Safety: high risk of abuse and physical dependence

Tolerability: decreased appetite, weight loss, insomnia, nervousness

Special: class II controlled substance

Dexmethylphedinate

Safety: high risk of abuse and physical dependence

Tolerability: decreased appetite, weight loss, insomnia, nervousness

Special: class II controlled substance

Lisdexamfetamine

Safety: high risk of abuse and physical dependence

Tolerability: decreased appetite, weight loss, insomnia, nervousness

Special: class II controlled substance

Methylphedinate

Safety: high risk of abuse and physical dependence

Tolerability: decreased appetite, weight loss, insomnia, nervousness

Special: class II controlled substance

Modanifil

Safety: skin rash, may progress to Stevens-Johnson Syndrome

Tolerability: anxiety, insomnia, nausea, headache

Special: class IV controlled substance

Phentermine

Safety: pulmonary hypertension (rare)

Tolerability: insomnia, dry mouth, disturbances, tremors

Special: class IV controlled substance

Buspirone

Tolerability: nausea, dizziness, excitation, headache

Alprazolam

Safety: high risk of sedation, respiratory depression, death when taken with opioid or alcohol, physical dependence and abuse

Tolerability: drowsiness, sedation, ataxia

Special: class IV controlled substance

Clonazepam

Safety: high risk of sedation, respiratory depression, death when taken with opioid or alcohol, physical dependence and abuse

Tolerability: drowsiness, sedation, ataxia

Special: class IV controlled substance

Diazepam

Safety: high risk of sedation, respiratory depression, death when taken with opioid or alcohol, physical dependence and abuse

Tolerability: drowsiness, sedation, ataxia

Special: class IV controlled substance

Lorazepam

Safety: high risk of sedation, respiratory depression, death when taken with opioid or alcohol, physical dependence and abuse

Tolerability: drowsiness, sedation, ataxia

Special: class IV controlled substance

Hydroxyzine

Safety: increased risks cardiac arrythmia (QTc prolonged)

Tolerability: drowsiness, sedation, dry mouth

Special: more sedation than anti-anxiety

Haloperidol

Safety: cardiac arrhythmia (QTc prolonged), dementia-related death in elderly patients

Tolerability: movement disorder, dry mouth, sedation, blurred vision

Lurasidone

Safety: cardiac arrhythmia (QTc prolonged), dementia-related death in elderly patients

Tolerability: sedation, weight gain, high blood glucose, cholesterol

Special: take with food

Olanzapine

Safety: cardiac arrhythmia (QTc prolonged), dementia-related death in elderly patients

Tolerability: sedation, weight gain, high blood glucose, cholesterol

Quetiapine

Safety: cardiac arrhythmia (QTc prolonged), dementia-related death in elderly patients

Tolerability: sedation, weight gain, high blood glucose, cholesterol

Risperidone

Safety: cardiac arrhythmia (QTc prolonged), dementia-related death in elderly patients

Tolerability: sedation, weight gain, high blood glucose, cholesterol

Ziprasidone

Safety: cardiac arrhythmia (QTc prolonged), dementia-related death in elderly patients

Tolerability: sedation, weight gain, high blood glucose, cholesterol

Aripiprazole

Safety: cardiac arrhythmia (QTc prolonged), dementia-related death in elderly patients

Tolerability: sedation, weight gain, high blood glucose, cholesterol

Eszopiclone

Safety: increased risk of unusual sleep behavior (sleep-walking, sleep-driving)

Tolerability: dizziness, sleep disturbances

Special: class IV controlled substance, avoid taking alcohol or opioid at the same time

Zoldipem

Safety: increased risk of unusual sleep behavior (sleep-walking, sleep-driving)

Tolerability: dizziness, sleep disturbances

Special: class IV controlled substance, avoid taking alcohol or opioid at the same time

Temazepam

Safety: increased risk of unusual sleep behavior (sleep-walking, sleep-driving)

Tolerability: dizziness, sleep disturbances

Special: class IV controlled substance, avoid taking alcohol or opioid at the same time

Levetiracetam

Tolerability: depression, drowsiness, asthenia (weakness)

Divalproex sodium

Safety: suicide ideation, liver toxicity, pancreatitis, allergic reaction (hypersensitivity)

Tolerability: drowsiness, nausea, hair loss, weight gain, bone loss

Special: obtain blood level to check for efficacy and safety

Gabapentin

Tolerability: drowsiness, ataxia

Special: class V controlled substance in SOME states (NOT TEXAS)

Pregabalin

Tolerability: drowsiness, ataxia

Special: class V controlled substance in SOME states (NOT TEXAS)

Carbamazepine

Safety: skin rash, may progress to Steven-Johnsort Syndrome, death

Tolerability: dizziness, drowsiness, ataxia, nausea, vomiting

Special: titrate dose of complicated drug kinetics, many drug interactions

Oxcarbazepine

Safety: skin rash, may progress to Steven-Johnsort Syndrome, death, 1/3 may have same as Carbazepine

Tolerability: dizziness, drowsiness, ataxia, nausea, vomiting, low blood sodium

Special: titrate dose of complicated drug kinetics, many drug interactions

Lamotrigine

Safety: skin rash, may progress to Steven-Johnsort Syndrome, death

Tolerability: dizziness, drowsiness, ataxia

Phenytoin

Safety: increased risk of cardiac arrhythmia (QTc prolonged)

Tolerability: drowsiness, ataxia, gingival hyperplasia, osteoporosis

Special: capsule can be taken at bedtime at once, tablet should be taken 3 times daily

Topiramate

Tolerability: stinging/ burning to the eye, blurred vision

Bimatoprost

Tolerability: stinging/ burning to the eye, blurred vision

Special: keep refrigerated

Latanoprost

Tolerability: stinging/ burning to the eye, blurred vision

Travoprost

Tolerability: stinging/ burning to the eye, blurred vision

Timolol

Tolerability: stinging/ burning to the eye, blurred vision

Brimonidine

Tolerability: stinging/ burning to the eye, blurred vision

Dorzolamide-timolol

Tolerability: stinging/ burning to the eye, blurred vision

Lithium carbonate

Tolerability: nausea, thirst, hypotension, diarrhea, vomiting, tremor, ataxia

Special: obtain blood level, watch sodium intake and excretion

Carbidopa-levodopa

Tolerability: nausea, drowsiness, dizziness, confusion, hallucination

Special: immediate release and extended release formulations

Pramipexole

Tolerability: drowsiness, dizziness, hallucination

Ropinirole

Tolerability: drowsiness, dizziness, hallucination

Donepezil

Safety: increased risks cardiac arrythmia (QTc prolonged) AND bradycardia

Tolerability: diarrhea, neausea, vomiting, abdominal discomfort

Special: 1st class of drugs for Alzheimer's

Memantine

Tolerability: confusion, drowsiness, dizziness

Special: 2nd class of drugs for Alzheimer's

Varenicline

Special: agitation, depression, suicidal ideation

Tolerability: nausea, hallucination, constipation, insomnia, headache

Sumatriptan

Safety: increased risk of cardiovascular events (myocardial infarction, stroke)

Tolerability: taste disturbances, oral/ throat discomfort, dizziness

Special: do not overuse due to the risk of rebounding headache