Neuro/Psych

Citalopram

Celexa

SSRI

MOA: Selective and potent inhibitor of presynaptic reuptake of serotonin

Doses/Dosage Form

• 20 to 40 mg daily

• Max 20 mg daily if >60 yrs

• PO - Tablet, oral solution, capsule

Side Effects (ADE)

• headache

• nausea

• sedation or insomnia

• prolonged QTc

• weight gain

• SD

• BLACK BOX WARNING (BBW): Suicidality

Counsiling Points

• Midly Sedating

• Do not stop abruptly

Escitalopram

Lexapro

SSRI

MOA: Selective and potent inhibitor of presynaptic reuptake of serotonin

Doses/Dosage Form

• 10 - 20 mg daily

• Tablet

Side Effects

• Headache

• Nausea

• sedation or insomnia

• Prolonged QTc

• weight gain

• SD

• BBW; SUICIDALITY

Counsiling Point

• Mildly Sedation

• Do not stop abruptly

Fluoxetine

Prozac, Sarafem

SSRI

MOA: Selective and potent inhibitor of presynaptic reuptake of serotonin

Doses/Dosage Form

• 20 - 80 mg daily

• PO - capsule, DR capsule, tablet, oral solution

SIDE Effects

• headache

• nausea

• sedation or insomnia

• Prolonged QTc

• Weight gain

• SD

• BBW: SUICIDALITY

Counsiling Points

• Activating

• Does not require taper due to long half-life

Paroxetine

Paxil, Paxil CR

SSRI

MOA: Selective and potent inhibitor of presynaptic reuptake of serotonin

Doses/Dosage Forms

• IR: 10 - 60 mg daily

• ER: 12.5 mg - 75 mg daily

• PO - IR tablet, ER tablet, oral solution, capsule

Side Effects

• headache

• nausea

• sedation or insomnia

• prolonged QTc

• weight gain

• SD

• BBW: SUICIDALITY

Counsiling Points

• Sedation

• Do not stop abruptly

• highly anticholinergic

Sertraline

Zoloft

SSRI

MOA: Selective and potent inhibitor of presynaptic reuptake of serotonin

Doses/Dosage Form

• 25 mg - 200 mg daily

• PO - tablet, oral concentration, capsule

Side Effects

• headache

• nausea

• sedation or insomnia

• prolonged QTc

• weight gain

• Sd

• BBW: SUICIDALITY

Counsiling Points

• Moderately activating

• Do not stop abruptly

Desvenlafaxine

Pristiq, Khedezia

Selective Norepinehrine Reuptake Inhibitor (SNRI)

MOA: Potent reuptake inhibitor of serotonin and norepinephrine but lacks effects on muscarinic, alpha-adrenergic and histamine receptor

Doeses/Dosage Forms

• 50 - 100 mg daily

• PO - Er Tablet

Side Effects

• diaphoresis

• dizziness

• headache

• nausea

• xerostomia

• High Blood pressure

• SD

• Nervousness

• BBW: SUICIDALITY

Counsiling Points

• Do not stop abruptly

Venlafaxine

Effexor, Effexor XR

Selective Norepinehrine Reuptake Inhibitor (SNRI)

MOA: Potent reuptake inhibitor of serotonin and norepinephrine but lacks effects on muscarinic, alpha-adrenergic and histamine receptor

Doeses/Dosage Form

• 37.5 - 375 mg daily

• PO - Er capsule, IR Tablet, ER Tablet

Side Effects

• Diaphoresis

• Dizziness

• Headache

• nausea

• xerostomia

• High Blood Pressure

• SD

• Nervousness

• BBW: SUICIDALITY

Counsiling Points

• Do not stop abruptly

• Contents of ER capsules may be sprinkled on food and swallowed without chewing

Duloxetine

Cymbalta

Selective Norepinehrine Reuptake Inhibitor (SNRI)

MOA: Potent reuptake inhibitor of serotonin and norepinephrine but lacks effects on muscarinic, alpha-adrenergic and histamine receptor

Doses/ Dosage Forms

• 20 - 120 mg daily

• PO - DR capsules, DR sprinkle Capsule

Side Effects

• Diaphoresis

• dizziness

• headache

• nausea

• xerostomia

• High Blood Pressure

• SD

• Nervousness

• BBW: SUICIDALITY

Counsiling Points

• Do not stop abruptly

Bupropion

Aplenzin, Forfivo, Wellbutrin, Zyban

Norepinephrine Dopamine Reuptake Inhibitor (NDRI)

MOA: Monocyclic antidepressant, dopamine and norepinephrine uptake inhibitor with no direct effect on serotonin receptors or MAO

Doses/Dosage Form

• IR: 100 mg BID - TID (MAX 450 mg daily)

• SR: 150 mg daily - BID (MAX 300 mg BID)

• PO - IR tablets, SR 12 h Tablet, ER 24 h Tablet

Side Effects

• Agitation

• Constipation

• headache

• insomnia

• nausea

• tremor

• hypertension

• anxiety

• BBW: SUICIDALITY, NEUROPSYCHIATRIC REACTIONS

Counsiling Points

• ER Tablets shell may remain visible in the stool

Amitriptyline

Elavil

Tricyclic Antidepressant (TCA)

MOA: Blocks presynaptic reuptake of serotonin and norepinephrine with subsequent downregulation of adrenergic receptors

Doses/Dosage Forms

• Depression: 25 - 300 mg daily

• Neuropathic pain/mirgraine: 10 - 150 mg daily

• PO - Tablet

ADE (Side Effects)

• Sedation

• Blurred visions

• Constipation

• SD

• Urinary Retention

• Weight Gain

• Xerostomia

• BBW: Suicidality

Counsiling Points

• Can cause anticholinergic side effects (BEERs List)

Nortriptyline

Pamelor

Tricyclic Antidepressant (TCA)

MOA: Blocks presynaptic reuptake of serotonin and norepinephrine with subsequent downregulation of adrenergic receptors

Doses/Dosage Forms

• Depression: 25 - 100 mg daily

• Neuropathic Pain: 10 - 100 mg daily

• PO - Capsule, Oral Solution

ADE (Side Effects)

• Sedation

• Blurred visions

• Constipation

• SD

• Urinary Retention

• Weight Gain

• Xerostomia

• BBW: Suicidality

Counsiling Points

• Can cause anticholinergic side effects (BEERs List)

Doxepin

Sinequan, Silenor

Tricyclic Antidepressant (TCA)

MOA: Blocks presynaptic reuptake of serotonin and norepinephrine with subsequent downregulation of adrenergic receptors

Doses/Dosage Forms

• Depression: 25 - 300 mg daily

• Insomnia: 3 - 6 mg daily

• PO - Capsule, Tablet, Oral solution

ADE (Side Effects)

• Sedation

• Blurred visions

• Constipation

• SD

• Urinary Retention

• Weight Gain

• Xerostomia

• BBW: Suicidality

Counsiling Points

• Can cause anticholinergic side effects (BEERs List)

Mirtazapine

Remeron

Noradrenergic and Specific Serotonergic Antidepressant (NaSSA)

MOA: Antagonizes presynaptic alpha-2 adrenergic receptors, antagonist at postsynaptic 5-HT2 and 5-HT3 receptors

Doses/Dosage Forms

• 15 - 45 mg every evening

• PO - Tablet, ODT

ADE (Side Effects)

• Constipation

• Increased Appetite

• Somnolence

• Xerostomia

• weight gain

• BBW: Suicidality

Counsiling Points

• Sedating (Low doses) and Activating (High Doses)

• Avoid Abrupt discontinuation of therapy

Trazodone

Desyrel

Serotonin Antagonsit and Reuptake Inhibitor (SARI)

MOA: Potentiation of serotonergic activity in the CNS by inhibiting reuptake of serotonin; significantly blocks histamine and alpha-1 adrenergic receptors

Doses/Dosage Forms

• 25 - 400 mg daily

• PO - Tablet

ADE (Side Effects)

• Dizziness

• sedation

• headache

• xerostomia

• Blurred visions

• BBW: suicidality

Counsiling Points

• Avoid abruptly discontinuing

Buspirone

BuSpar

Antianxiety

MOA: Selective serotonin 5- HT1A receptor partial agonsit with some effect on dopamine- D2 auto-receptors and can downregulate beta-adrenergic receptors

Doses/Dosage Forms

• 5 - 30 mg daily - TID (MAX 90 mg daily)

• PO - tablet

ADE (Side Effects)

• dizziness

• confusion

• headache

• nervousness

Counsiling Points

• Avoid alcohol and grapfruit juice

Aripiprazole

Abilify

Second Gen Antipsychotic

MOA: Atypical antipsychotic exhibiting activity at dopamine receptors and serotonin receptors

Doses/Dosage Forms

• 2 - 30 mg daily

• PO - Tablet, ODT, Oral Solution

• IM Injection

ADE (Side Effects)

• Akathisia

• Extrapyramidal Effects

• Somnolence

• Metabolic Effects

• QTc Prolongation

• BBW: Increased mortality in dementia and Suicidality

Counsiling Points

• Potential to cause compulsive behaviors

Lurasidone

Latuda

Second Gen Antipscyhotic

MOA: Atypical antipsychotic exhibiting activity at dopamine receptors and serotonin receptors

Doses/Dosage Forms

• 20 - 160 mg daily

• PO - Tablet

ADE (Side Effects)

• Akathisia

• Extrapyramidal Effects

• Somnolence

• Metabolic Effects

• QTc Prolongation

• BBW: Increased mortality in dementia and Suicidality

Counsiling Points

• Should take with at least 350 calories

Olanzapine

Zyprexa

Second Gen Antipsychotic

MOA: Atypical antipsychotic exhibiting activity at dopamine receptors and serotonin receptors

Doses/Dosage Forms

• 2.5 - 20 mg daily

• PO - Tablet, ODT

• IM Injection

ADE (Side Effects)

• Akathisia

• Extrapyramidal Effects

• Somnolence '

• Metabolic effects

• QTc prolongation

• Increased Prolactin levels

• BBW: Increased mortality in dementia

Counsiling Points

• the IM Injection (Zyprexa Relprev) has REMS program

Risperidone

Risperdal

Second Gen Antipsychotic

MOA: Atypical antipsychotic exhibiting activity at dopamine receptors and serotonin receptors

Doses/Dosage Forms

• 0.25 - 8 mg daily

• PO - Tablet, Dispersible Tablet, Oral Solution

• IM and SUBC injection

ADE (Side Effects)

• Akathisia

• Extrapyramidal Effects

• Somnolence '

• Metabolic effects

• QTc prolongation

• Increased Prolactin levels

• BBW: Increased mortality in dementia

Counsiling Points

• Take w/food

• Oral solution may be mixed with water, coffee, orange juice, or low-fat milk

Ziprasidone

Geodon

Second Gen Antipsychotic

MOA: Atypical antipsychotic exhibiting activity at dopamine receptors and serotonin receptors

Doses/Dosage Forms

• 20 - 80 mg BID

• PO - Capsule

• IM Injection

• ADE (Side Effects)

  • Akathisia

  • Extrapyramidal Effects

  • Somnolence '

  • Metabolic effects

  • QTc prolongation

  • Increased Prolactin levels

  • BBW: Increased mortality in dementia

  Counsiling Points

• Take w/food

Quetiapine

Seroquel, Seroquel XR

Second Gen Antipsychotic

MOA: Atypical antipsychotic exhibiting activity at dopamine receptors and serotonin receptors

Doses/Dosage Forms

• 50 - 800 mg daily

• PO - IR tablet and ER Tablet

ADE (Side Effects)

• Akathisia

• Extrapyramidal Effects

• Somnolence '

• Metabolic effects

• QTc prolongation

• Increased Prolactin levels

• BBW: Increased mortality in dementia, suicidality

Counsiling Points

• Take with Food

Lithium

Eskalith, Eskalith CR, Lithobid

Antimanic

MOA: Alters cation transport across cell membrane in nerve and muscle cells and influences reuptake of serotonin and/or norepinehrine altering second-messenger systems (adenylate cyclase and phosphoinositol)

Doses/Dosage Forms

• 300 - 1800 mg daily in 2 - 3 divided doses

• PO - capsule, tablet, ER tablet, Oral Solution

ADE (Side Effects)

• Cardiac dysrhythmias

• Fine Tremor

• Hypothyroidism

• Leukocytosis

• Xerostomia

• BBW: Lithium level monitoring required

Counsiling Points

• Medication guide MUST be dispensed with medication

• Maintain adequate fluid intake and normal salt intake

Clonazepam

Klonopin

Benzodiazepines: Controlled Substances C-IV

MOA: Enhanced postsynaptic effects of neurotransmitter GABA

Doses/Dosage Forms

• 0.25 - 20 mg daily in divided doses

• PO - Tablet, ODT

ADE (Side Effects)

• Ataxia

• Lethargy

• Cognitive Dysfunction

• Decreased libido

• BBW: Concurrent use with opioids, Abuse potential, Withdrawl

Counsiling Points

• Medication guide required when dispensing

• Higher abuse potential compared to other benzos

• Do not abruptly discontinue, may cause seizures

Diazepam

Valium

Benzodiazepines: Controlled Substances C-IV

MOA: Enhanced postsynaptic effects of neurotransmitter GABA

Doses/Dosage Forms

• 2 - 10 mg BID -QID

• PO - Tablet, Oral solution

• Rectal Gel

• Nasal Spray

• injection

ADE (Side Effects)

• Ataxia

• Lethargy

• Cognitive Dysfunction

• Decreased libido

• BBW: Concurrent use with opioids, Abuse potential, Withdrawl

Counsiling Points

• Do not abruptly discontinue, may cause seizure

Temazepam

Restoril

Benzodiazepines: Controlled Substances C-IV

MOA: Enhanced postsynaptic effects of neurotransmitter GABA

Doses/Dosage Forms

• 7.5 - 30 mg daily

• PO - Capsule

ADE (Side Effects)

• Ataxia

• Lethargy

• Cognitive Dysfunction

• Decreased libido

• BBW: Concurrent use with opioids, Abuse potential, Withdrawl

Counsiling Points

• Take 30 minutes prior to bedtime

Lorazepam

Ativan

Benzodiazepines: Controlled Substances C-IV

MOA: Enhanced postsynaptic effects of neurotransmitter GABA

Doses/Dosage Forms

• Anxiety: 1 mg BID - TID

• Insomnia: 2 - 4 mg Qpm

• PO - Tablet, ER capsule, Oral Solution

ADE (Side Effects)

• Ataxia

• Lethargy

• Cognitive dysfunction

• Decreased libido

• Retrograde amnesia

• BBW: Concurrent use with opioids, Abuse potential, withdrawl

Counsiling points

• Do not stop abruptly may cause seizures

Alprazolam

Xanax

Benzodiazepines: Controlled Substances C-IV

MOA: Enhanced postsynaptic effects of neurotransmitter GABA

Doses/Dosage Forms

• IR: 0.25 - 4 mg daily in divided doses

• ER: 3 - 6 mg daily

• PO - IR tablet, ODT, ER tablet, solution

ADE (Side Effects)

• Ataxia

• Lethargy

• Cognitive dysfunction

• Decreased libido

• Retrograde amnesia

• BBW: Concurrent use with opioids, Abuse potential, withdrawl

Counsiling points

• Do not stop abruptly may cause seizures

Amphetamine/Dextroamphetamine

Adderall

ADHD Agent: Controlled Subtance C - II

MOA: Stimulant that increases CNS activity by inhibiting reuptake of norepinehrine and dopamine and increasing neuronal firing rate and stimulating cereberal cortex and subcortical

Doses/Dosage Forms

• IR: 5 - 40 mg daily in divided doses

• ER: 10 - 40 mg daily

• PO - IR capsules, ER capsules

ADE (Side Effects)

• Weight Loss

• loss of appetite

• Headache

• insomnia

• anxiety

• BBW: Abuse and dependence

Counsiling Points

• ER capsules may be opened and added to applesauce

Dexmethylphenidate

Focalin

ADHD Agent: Controlled Subtance C - II

MOA: Stimulant that increases CNS activity by inhibiting reuptake of norepinehrine and dopamine and increasing neuronal firing rate and stimulating cereberal cortex and subcortical

Doses/Dosage Forms

• IR: 2.5 mg BID (MAX 20 mg daily)

• ER: 5 - 10 mg daily (MAX 40 mg daily)

• PO - Tablet, ER Capsules

ADE (Side Effects)

• Weight Loss

• loss of appetite

• Headache

• insomnia

• anxiety

• BBW: Abuse and dependence

Counsiling Points

• ER capsules may be opened and added to applesauce

Methylphenidate

Retalin, Concerta

ADHD Agent: Controlled Subtance C - II

MOA: Stimulant that increases CNS activity by inhibiting reuptake of norepinehrine and dopamine and increasing neuronal firing rate and stimulating cereberal cortex and subcortical

Doses/Dosage Forms

• IR: 10 - 60 mg daily in divided doses

• ER: 20 - 60 mg daily

• PO - IR tablet, Chewable tablet, ER Chewable tablet, ER tablet, ER ODT, ER capsules, Oral solution, Oral suspension,

• Transdermal Patch

ADE (Side Effects)

• Weight Loss

• loss of appetite

• Headache

• insomnia

• anxiety

• BBW: Abuse and dependence

Counsiling Points

• ER capsules may be opened and added to applesauce

Lisdexamfetamine

Vyvanse

ADHD Agent: Controlled Subtance C - II

MOA: Prodrug converted to dextroamephetamine causing the release of dopamine and norepinephrine at presynaptic nerve terminals and blocking reuptake of norepinephrine and dopamine by competative inhibition

Doses/Dosage Forms

• 30 - 70 mg daily

• PO - capsules, chewable tablets

ADE (Side Effects)

• insomnia

• irritability

• Loss of appetite

• anxiety

• xerostomia

• BBW: Abuse, misuse, diversion

Counsiling Points

• Capsules may be opened and dissolved in water

Atomoxetine

Strattera

ADHD Agent

MOA: CNS Stimulant, selective norepinephrine reuptake inhibitor

Doses/Dosage Form

• 40 - 100 mg daily

• PO - Capsule

ADE (Side Effects)

• Abdominal Pain

• headache

• insomnia

• loss of appetitie

• weight loss

• xerostomia

• BBW: suicidality in children and adolescents

Counsiling Points

• DO NOT OPEN CAPSULES

Modafinil

Provigil

Miscellaneous Agent: Controlled Substance C - IV

MOA: Mechanism not fully understood, “wake-fulness promoting agent” chemically and pharmacologically unrelated to CNS stimulants

Doses/Dosage

• 200 mg Daily (MAX 400 mg daily)

• PO - tablet

ADE (Side Effects)

• Anxiety

• Headache

• Insomnia

• Nausea

Counsiling Points

• Medication guide required at dispensing

• Several off -label uses for fatigue

• May decrease effectiveness of birth controlled, recommened back up contraceptive

Carbamazepine

Tegretol

Anticonvulsants

MOA: Blocks firing of action potentials which decreases release of excitatory neurotransmitters and blocks high-frequency repetitive discharge intiated at cell bodies

Doses/Dosage Forms

• 100 - 200 mg BID (May titrate up to 1200 mg daily)

• PO - IR and ER tablet, chewable tablet, oral suspension, ER capsule

ADE (Side Effects)

• Hyponatremia

• Dizziness

• Nausea

• Somnolence

• BBW:

  • Agranuocytosis

  • Aplastic anemia

  • Dermatological reactions especially in Asians (HLA - B * 15:02)

Counsiling Points

• May decrease effectivness of birth control

• Many drug interactions

• Take with food

• Avoid abrupt D/C

• Avoid Grapefruit

• HLA B* 15:02 and HLA A*31:01 testing should be perfromed in asian patients

Oxcarbazepine

Trilepta

Anticonvulsant

MOA: 10 - keto analogue of carbamazepine

Doses/Dosage Form

• 300 mg BID (May titrate to 2,400 mg daily)

• PO - IR and Er Tablets, Oral suspension

ADE (Side Effects)

• Hypoatremia

• Dizziness

• Nausea

• Somnolence

• Diplopia

Counsiling Points

• Medication guide required at dispensing

• Avoid abrupt D/C

• Take with food

• avoid grapefruit

Lacosamide

Vimpat

Anticonvulsant Controlled Substance C -V

MOA: Stablizes hyperexcitable neuronal membranes and inhibits neuronal firing

Doses/Dosage Forms

• 100 - 200 mg BID

• PO - Tablet, oral solution

• Injection

ADE (Side Effects)

• Dizziness

• fatigue

• ataxia

• nausea

• tremor

• diplopia

Counsiling Points

• CYP2C9 and CYP3A4/5 inhibitors and inducers

Divalprex

Depakote

Anticonvulsant

MOA: Composed of sodium valproate and valproic acids, valproic acid is carboxylic acid which might increase GABA levels inhibiting by GABA metabolism or enhancing postsynaptic GABA activity and limits repetitive neuronal firing through voltage and usage-dependent sodium chennels

Doses/Dosage Forms

• Seizures: 10 - 15 mg/kg/day

• Bipolar: 25 mg/kg/day

• Migraine: 250 - 500 mg daily - BID

• PO - IR/ER/DR tablet, DR sprinkle, capsules and oral solution

ADE (Side Effects)

• Abdominal pain

• alopecia

• asthenia

• diarrhea

• diplopia

• headache

• nausea/vomiting

• somnolence

• tremor

• BBW:

  • Hepatotoxicity

  • Patients with mitochondrial disease

  • teratogenicity

  • pancreatitis

Counsiling Points

• Therapeutic drug serum monitoring required

• DO NOT STOP ABRPTLY

• Take with food

• Sprinkle capsules can be opened and sprinkled on soft food

Levetiracetam

Keppra, Keppra XR

Anticonvulsant

MOA: Pyrrolidine derivative, thought to exert effect through inhibition of voltage-dependent N-type calcium channel, facilitation of GABA-ergic inhibitory transmission, reduction of delayed rectifier potassium current and/or binding to synaptic proteins

Doses/Dosage Forms

• 500 mg BID (MAX DOSE 3000 mg daily)

• PO. - IR/ER/ODT tablets and oral solution

• Injection

ADE (Side Effects)

• asthenia

• fatigue

• headache

• somnolence

• increase blood pressure

• mood changes

Counsiling Points

• Medication guide required at dispensing

• AVOID ABRUPT DISCONTINUATION

Phenobarbital

Luminal

Anticonvulsants: Controlled Substances C - IV

MOA: Long-Acting barbiturate with sedative, hypnotic, and antiseizure properties

Doses/Dosage Forms

• Seizures: 50 - 100 mg BID -TID

• Sedation: 30 - 400 mg daily in divided doses

• PO - Tablet, Oral elixer, Oral solution,

• injectable depot

ADE (Side Effects)

• Apnea

• Ataxia

• confusion

• dizziness

• hypotension

• hypoventilation

• rash

• somnolence

• syncope

• BBW:

  • Concomitant use with opioids

  • Dependence and withdrawl

  • Abuse

Counsiling Points

• AVOID ABRUPT DISCONTINUATION

• MANY drug interactions

• Therapeutic serum drug monitoring needed

Topiramate

Topamax

Anticonvulsant

MOA: Blocks voltage-dependent sodium channels, augments the activity of GABA at GABA — A receptor, antagonizes the AMP/kainte subtype of glutamate receptor, and inhibits carbonic anhydrase enzyme

Doses/Dosage Forms

• 20 - 200 mg BID

• PO - Oral sprinkle capsules, ER Sprinkle Capsules, ER Capsule, Tablet

ADE (Side Effects)

• Ataxia

• Loss of Appetite

• Impaired Psychomotor performance

• somnolence

• Nystagmus

• low serum bicarbonate

• weight loss

Counsiling Points

• DO NOT ABRUPTLY DISCONTINUE

• Maintain adequate hydration due to risk of kidney stones

• May decrease effectiveness of birth control

Phenytoin

Dilantin

Hydantoin Anticonvulant

MOA: Suppresses the spread of seizure activity by inhibiting synaptic post-tenatic potentiation and blocking propagation of elective discharge, may decrease sodium transport and block calcium channels at the cellular level

Doses/Dosage Forms

• 100 - 200 mg TID

• PO - Capsules, Chewable, Oral Suspension

ADE (Side Effects)

• Gingival Hyperplasia

• Ataxia

• Confusion

• Dizziness

• Hypertrichosis

• Intential Tremor

• Slurred Speech

• BBW:

  • Hypotension

  • Arrhythmias

Key Points

• Highly protein bound

• Injectable formulations available but not for IM use due to risk of Purple Glove Syndrome

• MANY DRUG INTERACTIONS.

Lamotrigine

Lamictal

Phenyltriazine Anticonvulsant

MOA: Inhibits voltage-dependent sodium channels stablilizing neuronal membranes and reducing the release of excitatory neurotransmitters such as glutamate and aspartate

Doses/Dosage Forms

• 25 - 400 mg daily in divided doses

• PO - chewable tablets, IR/ER Tablets, ODTs

ADE (Side Effects)

• Rash

• ataxia

• somnolence

• headache

• nausea

• insomnia

• BBW: Serious Skin reactions

Drug Interactions

• Enzyme inducers (rifampin, carbamazepine) increase lamotrigine metabolism

• Enzyme inhibitors (valproate) decreases lamotrigine metabolism

Counsiling Points

• Medication guide required at dispensing

• Starter pack available for titration due to risk of serious skin reactions

Gabapentin

Neurotin, Gralise

Anticonvulsant: C-V

Neurotin ONLY controlled substance in some states including WV

MOA: Gamma-aminobutyric Acid (GABA) analog

Doses/Dosage Forms

• 300 mg TID (MAX: 2400 - 3600 mg daily)

• PO - Capsule, Tablet, ER Tablet, Oral Solutions

ADE (Side Effects)

• Dizziness

• Somnolence

• Ataxia

• Peripheral edema

• Headache

Counsiling Points

• Medication guide required at dispensing

• WAIT 2 HRS AFTER ANTIACIDS BEFORE TAKING THIS MEDICATION

Pregablin

Lyrica

Anticonvulsant - C- V

MOA: Gamma-aminobutyric Acid (GABA) analog

Doses/Dosage Form

• 25 - 100 mg BID - TID (MAX 600 mg daily)

• PO - capsules, Er Tablets, oral solution

ADE (Side Effects)

• Dizzines

• Somnolence

• Ataxia

• peripheral edema

• headache

Counsiling Points

• Solution must be used within 45 days of opening

Benztropine

Cogentin

Antiparkinsonian

MOA: Anticholinergic and antihistamine effects, may inhibits reuptake and storage of dopamine

Doses/Dosage Forms

• Extrapyramidal Disease: 1 - 4 mg daily

• Parkinsonian: 1 - 6 mg daily

• PO - Tablet

ADE (Side Effects)

• Constipation

• Nausea

• Blurred Vision

• disorientation

• Urinary retention

• Xerostomia

Counsiling Points

• May impair heat regulation advise caution in activities that increase core temperature

Carbidopa/Levodopa

Rytary, Duopa, Sinemet

Antiparkinsonian

MOA: Carbidopa inhibits decarboxylation of circulating levodopa, allowing more levodopa to reach the CNS

Doses/Dosage Forms

• IR: 25 mg/100 mg TID

• ER: 50 mg/200 mg TID

• Carbidopa Max 200 mg and Levodopa MAX 2000 mg

• PO - IR/ER Tablets, ODT, Oral Solution

ADE (Side Effects)

• Dsykinesia

• Nausea

• Vivid Dreams

• Orthostatic Hypotension

Key Points

• When converting from regular release to ER may need to increase dose by 20 %

Pramipexole

Mirapex, Mirapex ER

Dopamine Agent

MOA: Non- ergot derived dopamine agonist

Doses/Dosage Forms

• IR: 0.125 - 1.5 mg TID (Parkinson Disease), 0.125 - 0.5 mg daily. (RLS)

• ER: 0.375 - 4.5 mg daily (parkinson disease)

• PO - IR/ER Tablet

ADE (Side Effects)

• Asthenia

• dream disorder

• dyskinesia

• Extrapyramidal movements

• nausea

• somnolence

• hallucinations

Counsiling Points

• DO NOT STOP ABRUPTLY

Ropinirole

Requip. Requip XL

Dopamine Agent

MOA: Non- ergot derived dopamine agonist

Doses/Dosage Forms

• IR: 0.25 - 1 mg TID (Parkinson disease), 0.25 - 4 mg daily (RLS)

• ER: 2 - 24 mg daily (Parkinson Disease)

• PO - IR/ER Tablet

ADE (Side Effects)

• Asthenia

• dream disorder

• dyskinesia

• Extrapyramidal movements

• nausea

• somnolence

• hallucinations

Counsiling Points

• DO NOT STOP ABRUPTLY

Donepezil

Aricept

Central Cholinesterase Inhibitor

MOA: Enhances action of acetylcholine by reversibly inhibiting acetylcholinesterase

Doses/Dosage Forms

• 55 - 10 mg Daily

• PO - Tablet, ODT

• Transdermal Patch

ADE (Side Effects0

• Asthenia

• Diarrhea

• Dizziness

• nausea

• weight loss

Counsiling Points

• Take at bedtime (qhs)

Memantine

Namenda

N-Methyl-D-Aspartate (NMDA) Receptor Antagonist

MOA: Uncompetitive NMDA receptor antagonist that binds preferentially to NMDA-receptor-operated cation channels

Doses/Dosage Forms

• IR: 5 - 10 mg daily - BID

• ER: 7-28 mg Daily

• PO - oral solution, tablet, ER capsules

ADE (Side Effects)

• hypo or hypertension

• Syncope

• Dizziness

• Consitpation

• headache

• nausea

Counsiling Points

• Oral solution is packaged with dosing device

Eszopiclone

Lunesta

Nonbarbiturate Hypnotic (Z Drug) : C-IV

MOA: Exact mechanism unknown, sedative and hypnotic effects due to increased chloride conductance, neuronal hyperpolarization, inhibition of action potential and decreased in neuronal excitability

Doses/Dosage Forms

• 1 mg before hs (MAX 3 mg daily)

• PO - Tablets

ADE (Side Effects)

• Headache

• Abnormal Behavior or thinking

• Confusion

• dizziness

• nausea

• Diarrhea

• BBW: Complex sleep behaviors

Counsiling Points

• Take immediately before bedtime

• Do not take with a high fat meal

• Medication guide required at dispensing

Zolpidem

Ambien, Intermezzo, Zolpimist

Nonbarbiturate Hypnotic (Z Drug) : C-IV

MOA: Exact mechanism unknown, sedative and hypnotic effects due to increased chloride conductance, neuronal hyperpolarization, inhibition of action potential and decreased in neuronal excitability

Doses/Dosage Forms

• IR: 1.75 - 5 mg (Females) 3.5 - 10 mg (Males)

• ER: 6.25 mg (Females), 6.25 - 12.5 mg (Males)

• PO - Tablet, ER tablet, sublingual tablets, Oro-mucosal,

• Spray

ADE (Side Effects)

• Headache

• Abnormal Behavior or thinking

• Confusion

• dizziness

• nausea

• Diarrhea

• BBW: Complex sleep behaviors

Counsiling Points

• Take immediately before hs

  • Take on an empty stomach

Sumatriptan

Imitrex, Onzetra, Sumavel, Tosymra, Zembrace

Antimigraine Serotonin Receptor Agonist

MOA: Binds to 5-HT subtypes 1B, 1D, and 1F receptors and believed to be effective in migraine through vasoconstriction or activation of 5-HT1 receptors on sensory nerve ending in the trigminal system resulting in inhibition of proinflammatory neuropeptide release

Doses/Dosage Forms

• oral (Tablet): 25 - 100 mg at onset of migraine may repeat after 2 hrs (Max 200 mg daily)

• nasal (Nasal Solution/Nasal exhaler powder): 5 -20 mg in one nostril, may repeat after 2 hrs (MAX 40 mg daily)

• SUBC(Q): 6 mg once (MAX 12 mg daily)

ADE (Side Effects)

• nausea

• Asthenia

• Somnolence

• Dizziness

Counsiling Points

• Not for prophalaxis ONLY FOR. TREATMENT OF MIGRAINE