Top 200 3PD Fall

Acetaminophen; Hydrocodone Bitartrate brand name(s)

Norco, Vicodin, Lortab

Acetaminophen; Hydrocodone Bitartrate class

Opioid Analgesic

Acetaminophen; Hydrocodone Bitartrate FDA indications

Pain, severe

Acetaminophen; Hydrocodone Bitartrate mechanism of action

Hydrocodone binds to opiate receptors, resulting in altered perception of pain

Acetaminophen; Hydrocodone Bitartrate contraindicated in pregnancy

No

Acetaminophen; Hydrocodone Bitartrate box warnings

Addiction, abuse, misuse, REMS, respiratory depression, accidental ingestion, neonatal opioid withdrawal, alcohol, CYP3A4/5 interactions, hepatotoxicity, concurrent use with benzodiazepines

Acetaminophen; Hydrocodone Bitartrate common adverse reactions (>10%)

Constipation, GI distress, somnolence

Acetaminophen; Hydrocodone Bitartrate key patient counseling points

Use a stool softener and/or laxative for preventing constipation with chronic use. May cause drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol and other CNS depressants.

Baclofen brand name(s)

Lioresal

Baclofen class

Muscle Relaxant

Baclofen FDA indications

Spasticity

Baclofen mechanism of action

Baclofen inhibits both monosynaptic and polysynaptic reflexes at the spinal level, possibly by hyperpolarization of afferent terminals, although actions at supraspinal sites may also occur and contribute to its clinical effect. Baclofen is an analogue of γ-aminobutyric acid (GABA), but there is no conclusive evidence that actions on GABA systems are involved in the production of its clinical effects.

Baclofen contraindicated in pregnancy

No

Baclofen box warnings

Avoid abrupt discontinuation of intrathecal product

Baclofen common adverse reactions (>10%)

Nausea, asthenia, dizziness, somnolence, confusion

Baclofen key patient counseling points

Because of the possibility of sedation, patients should be cautioned regarding the operation of motor vehicles or dangerous machinery while taking baclofen. Patients should be cautioned that the CNS effects of baclofen may be additive to those of alcohol and other CNS depressants. Oral packet doses should be taken within 2 h when mixed with food.

Buprenorphine HCl with Naloxone HCl brand name(s)

Suboxone

Buprenorphine HCl with Naloxone HCl class

Opioid Dependence Agent

Buprenorphine HCl with Naloxone HCl FDA indications

Opioid use disorder

Buprenorphine HCl with Naloxone HCl mechanism of action

Buprenorphine is a μ-opioid receptor partial agonist and a -opioid receptor antagonist. Naloxone is a μ-opioid receptor antagonist that causes opioid withdrawal when injected parenterally and is included in the formulation to reduce the risk of abuse.

Buprenorphine HCl with Naloxone HCl contraindicated in pregnancy

No

Buprenorphine HCl with Naloxone HCl box warnings

None

Buprenorphine HCl with Naloxone HCl common adverse reactions (>10%)

Vasodilation, sweating, headaches, insomnia, constipation, GI distress, opioid withdrawal, dizziness

Buprenorphine HCl with Naloxone HCl key patient counseling points

Use a stool softener and/or laxative to prevent constipation. May cause drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol and other CNS depressants. Do not crush or swallow the sublingual tablet. Place the tablet under the tongue until it is dissolved. If you take ≥2 tablets at a time, place all of the tablets under the tongue together. If this is uncomfortable, place 2 tablets at a time under the tongue and repeat the process until all tablets have been taken. If you are using the sublingual film, place the film under the tongue until it is dissolved. If you need to take an additional film, place the new film on the opposite side from the first film. Do not chew, swallow, or move the film after placing it under the tongue. After the tablet/film has dissolved, swish and swallow water. Do not brush teeth until 1 h after tablet/film administration.

Carisoprodol brand name(s)

Soma

Carisoprodol class

Muscle Relaxant

Carisoprodol FDA indications

Disorder of musculoskeletal system

Carisoprodol mechanism of action

Carisoprodol blocks interneuronal activity in descending reticular formation and spinal cord, resulting in muscle relaxation.

Carisoprodol contraindicated in pregnancy

No

Carisoprodol box warnings

None

Carisoprodol common adverse reactions (>10%)

Drowsiness

Carisoprodol key patient counseling points

Patients should avoid drinking alcohol. Patients should avoid activities requiring mental alertness or coordination until drug effects are known, as drug may cause dizziness or sedative effects. Patients withdrawing from prolonged therapy should be monitored carefully for withdrawal symptoms, including seizures.

Celecoxib brand name(s)

Celebrex

Celecoxib class

Nonsteroidal Anti-inflammatory

Celecoxib FDA indications

Osteoarthritis, Rheumatoid arthritis, Ankylosing spondylitis, Acute pain, primary dysmenorrhea, Migraine, acute treatment

Celecoxib mechanism of action

Inhibition of the COX-2 enzyme isoform is thought to be responsible for the anti-inflammatory effects of NSAIDs.

Celecoxib contraindicated in pregnancy

No

Celecoxib box warnings

Cardiotoxicity, contraindicated perioperatively for CABG, serious gastrointestinal disorders

Celecoxib common adverse reactions (>10%)

Diarrhea, HTN, headaches, GI distress

Celecoxib key patient counseling points

May take with food or milk to decrease GI upset. May open capsule and pour into a teaspoon of applesauce.

Codeine with Acetaminophen brand name(s)

Tylenol, (with Codeine)

Codeine with Acetaminophen class

Opioid Analgesic

Codeine with Acetaminophen FDA indications

Pain

Codeine with Acetaminophen mechanism of action

Codeine is 3-methylmorphine, a phenanthrene opioid with very low affinity for opioid receptors. Its analgesic activity appears to result from conversion to morphine.

Codeine with Acetaminophen contraindicated in pregnancy

No

Codeine with Acetaminophen box warnings

Abuse, REMs, respiratory depression, accidental ingestion, CYP2D6 in children, neonatal withdrawal syndrome, interactions with CYP3A4/5, 2D6, avoid concomitant benzodiazepines and CNS depressants, risk of medication errors with oral solution

Codeine with Acetaminophen common adverse reactions (>10%)

Nausea, vomiting, constipation, somnolence

Codeine with Acetaminophen key patient counseling points

Take with food to decrease stomach upset and nausea. Avoid grapefruit or grapefruit juice due to risk of increased codeine toxicity. If using chronically, use laxative for preventing constipation. May cause drowsiness; avoid driving or other tasks requiring motor coordination. If using an acetaminophen-containing product, advise patients to avoid other acetaminophen-containing products for pain. Avoid alcohol.

Cyclobenzaprine Hydrochloride brand name(s)

Flexeril, Amrix, Fexmid

Cyclobenzaprine Hydrochloride class

Muscle Relaxant

Cyclobenzaprine Hydrochloride FDA indications

Skeletal muscle spasm

Cyclobenzaprine Hydrochloride mechanism of action

Cyclobenzaprine relieves skeletal muscle spasm of local origin without interfering with muscle function. It is ineffective in muscle spasm due to CNS disease. Evidence suggests that the net effect of cyclobenzaprine is a reduction in tonic motor activity, influencing both gamma (γ) and alpha (α) motor systems.

Cyclobenzaprine Hydrochloride contraindicated in pregnancy

No

Cyclobenzaprine Hydrochloride box warnings

None

Cyclobenzaprine Hydrochloride common adverse reactions (>10%)

Dizziness, drowsiness, xerostomia

Cyclobenzaprine Hydrochloride key patient counseling points

Patients should avoid activities requiring mental alertness or coordination until drug effects are known, as drug may cause dizziness or sedative effects. Take extended-release capsule same time each day. For patients with difficulty swallowing, the extended-release capsules may be opened and granules mixed with applesauce for administration.

Diclofenac Sodium brand name(s)

Voltaren (XR)

Diclofenac Sodium class

Nonsteroidal Anti-inflammatory

Diclofenac Sodium FDA indications

Pain, Dysmenorrhea, Migraine, Osteoarthritis, Rheumatoid arthritis, Ankylosing spondylitis

Diclofenac Sodium mechanism of action

Nonselective inhibitor of cyclo-oxygenase-1 (COX-1) and cyclo-oxygenase-2 (COX-2).

Diclofenac Sodium contraindicated in pregnancy

No

Diclofenac Sodium box warnings

Cardiovascular, GI risk, CABG

Diclofenac Sodium common adverse reactions (>10%)

GI distress, peripheral swelling

Diclofenac Sodium key patient counseling points

Take with food or milk to decrease GI upset. Do not chew, split, or crush the delayed-release and extended-release products.

Fentanyl (transdermal) brand name(s)

Duragesic

Fentanyl (transdermal) class

Opioid Analgesic

Fentanyl (transdermal) FDA indications

Pain, chronic, including cancer pain

Fentanyl (transdermal) mechanism of action

Fentanyl is a phenylpiperidine opioid agonist with predominant effects on the mu-opioid receptor and is about 50-100 times more potent as an analgesic than morphine.

Fentanyl (transdermal) contraindicated in pregnancy

No

Fentanyl (transdermal) box warnings

Respiratory depression; addiction, CYP3A4/5 interactions, fatalities in children; formulations not interchangeable; care with disposal; REMS program; concurrent use with benzodiazepines or other CNS depressants, neonatal withdrawal, heat exposure with transdermal patch

Fentanyl (transdermal) common adverse reactions (>10%)

Application site reactions, constipation, GI distress, confusion, headache, urinary retention, fatigue, edema, nausea, vomiting

Fentanyl (transdermal) key patient counseling points

A stimulant laxative should be recommended to prevent constipation. May cause drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol and other CNS depressants. Apply to clean, dry skin. Skin breaks may increase absorption. Remove old patch when new patch applied. Febrile patients may have increased absorption. Patch should be removed prior to MRI scan as it may contain aluminum. Do not cut patch.

Hydrocodone Bitartrate brand name(s)

Norco, Vicodin,etc

Hydrocodone Bitartrate class

Opioid Analgesic

Hydrocodone Bitartrate FDA indications

Pain, severe

Hydrocodone Bitartrate mechanism of action

Hydrocodone binds to opiate receptors, resulting in altered perception of pain.

Hydrocodone Bitartrate contraindicated in pregnancy

No

Hydrocodone Bitartrate box warnings

Addiction, abuse, misuse, REMS, respiratory depression, accidental ingestion, neonatal opioid withdrawal, alcohol, CYP3A4/5 interactions, hepatotoxicity, concurrent use with benzodiazepines

Hydrocodone Bitartrate common adverse reactions (>10%)

Constipation, GI distress, somnolence

Hydrocodone Bitartrate key patient counseling points

Use a stool softener and/or laxative for preventing constipation with chronic use. May cause drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol and other CNS depressants.

Hydrocortisone (rectal) brand name(s)

Anusol-HC, Proctosol-HC

Hydrocortisone (rectal) class

Anti-inflammatory, Topical

Hydrocortisone (rectal) FDA indications

Skin disorders, corticosteroid responsive

Hydrocortisone (rectal) mechanism of action

Hydrocortisone has anti-inflammatory, antipruritic, and vasoconstrictive properties. Corticosteroids are thought to act by the induction of phospholipase A2-inhibitory proteins, lipocortins. It is postulated that these proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor, arachidonic acid. Arachidonic acid is released from membrane phospholipids by phospholipase A2.

Hydrocortisone (rectal) contraindicated in pregnancy

No

Hydrocortisone (rectal) box warnings

None

Hydrocortisone (rectal) common adverse reactions (>10%)

None known

Hydrocortisone (rectal) key patient counseling points

Apply thin layer to affected area of skin. Skin should be clean and intact at site of application. Avoid contact with eyes and do not ingest by mouth. Avoid occlusive dressings or tight-fitting clothes over site of administration. Wash hands after application.

Ibuprofen brand name(s)

Motrin

Ibuprofen class

Nonsteroidal Anti-inflammatory

Ibuprofen FDA indications

Fever, Pain, Osteoarthritis or rheumatoid arthritis, Juvenile rheumatoid arthritis

Ibuprofen mechanism of action

Nonselective inhibitor of cyclo-oxygenase-1 (COX-1) and cyclo-oxygenase-2 (COX-2), and reversibly alters platelet function and prolongs bleeding time.

Ibuprofen contraindicated in pregnancy

No

Ibuprofen box warnings

Cardiovascular events, GI toxicity, CABG

Ibuprofen common adverse reactions (>10%)

None known

Ibuprofen key patient counseling points

Take with food or milk to decrease GI upset. Counsel patients with heart failure to avoid NSAIDs as they may cause fluid retention which can exacerbate heart failure.

Lidocaine (Transdermal) brand name(s)

Lidoderm

Lidocaine (Transdermal) class

Topical Analgesic

Lidocaine (Transdermal) FDA indications

Postherpetic neuralgia and localized pain

Lidocaine (Transdermal) mechanism of action

Lidocaine is an amide-type local anesthetic agent and is suggested to stabilize neuronal membranes by inhibiting the ionic fluxes required for the initiation and conduction of impulses. The penetration of lidocaine in patch form into intact skin is sufficient to produce an analgesic effect but less than the amount necessary to produce a complete sensory block.