104 - 134 counseling points

Vimpat, lacosamide

Common Indications: Seizures/epilepsy

Warnings/Precautions: Can prolong PR interval and increase risk of arrhythmias

Side Effects: Dizziness, headache, blurred vision

Drug Interactions: Use caution with other medications that prolong PR interval (digoxin, CCB)

Tegretol, carbamazepine

Common Indications: Seizures/epilepsy

BBW: Serious skin reactions (SJS/TEN), HLA-B*1502 testing prior to use in high risk patients (especially in Asian descent), aplastic anemia, agranulocytosis

Contraindications: Myelosuppression

Warnings/Precautions: Hyponatremia (SIADH), fetal harm

Side Effects: Dizziness, drowsiness

Drug Interactions: Autoinducer (will decrease its own concentrations). Many drug interactions! Example: carbamazepine decreases concentrations of hormonal birth control, so non-hormonal birth control is recommended.

Lamictal

Common Indications: Seizures/epilepsy

BBW: Serious skin reactions (SJS/TEN)

Side Effects: Alopecia, rash

Drug Interactions: Valproic acid increases lamotrigine levels (use lower starting doses of lamotrigine to reduce risk of rash). Carbamazepine, phenytoin, phenobarbital, and other decrease lamotrigine levels.

Notes: Dose needs to be titrated up to reduce risk of severe rash.

Keppra

Common Indications: Seizures/epilepsy

Warnings/Precautions: Psychiatric reactions, somnolence, fatigue, severe skin reactions (SJS/TEN)

Side Effects: Irritability, dizziness

Drug Interactions: No significant drug interactions

Trileptal

Common Indications: Seizures/epilepsy

Warnings/Precautions: Risk of serious skin reaction (SJS/TEN), hyponatremia

Side Effects: Somnolence, dizziness

Drug Interactions: Oxcarbazepine can decrease concentrations of hormonal birth control - non-hormonal birth control is recommended.

Dilantin

Common Indications: Seizures/epilepsy

Warnings/Precautions: Fetal harm. Risk of severe rash.

Side Effects: Dose-dependent: nystagmus, ataxia, diplopia. Chronic: gingival hyperplasia, hair growth, hepatotoxocity

Drug Interactions: Strong inducer of many enzymes - lots of interactions! Can decrease concentrations of hormonal birth control - non-hormonal birth control is recommended.

Sezaby

Common Indications: Seizures/epilepsy

Warnings/Precautions: Habit forming, respiratory depression, fetal harm

Side Effects: Tolerance, hangover effect, somnolence, dizziness

Drug Interactions: Phenobarbital is a strong inducer of many enzymes - lots of interactions! Can decrease hormonal birth control concentrations - non-hormonal birth control is recommended.

Topamax

Common Indications: Seizures/epilepsy, migraine prophylaxis

Warnings/Precautions: Metabolic acidosis, nephrolithiasis, visual problems, fetal harm, hyperammonemia, oligohidrosis (reduced sweating)

Side Effects: Somnolence, weight loss, anorexia, trouble with memory/concentration/attention

Drug Interactions: Can decrease concentrations of hormonal birth control - non-hormonal birth control is recommended.

Depakote

Common Indications: Seizures/epilepsy

Dosage Forms: Capsule, syrup, tablet, ER tablet, sprinkle capsule

BBW: Hepatic failure, fetal harm

Warnings/Precautions: Hyperammonemia, thrombocytopenia

Side Effects: Alopecia, weight gain, nausea/vomiting

Drug Interactions: Increases levels of lamotrigine, phenobarbital, phenytoin, and warfarin

Lithobid

Common Indications: Bipolar disorder

BBW: Serum lithium levels should be monitored to avoid toxicity.

Warnings/Precautions: Serotonin syndrome

Side Effects: GI upset, cognitive effects, cogwheel rigidity, tremor, thirst, polyuria/polydipsia, weight gain, hypothyroidism

Drug Interactions: Lithium levels increase with: ACEi/ARBs, decreased salt intake. Lithium levels decrease with: increased salt intake.

Notes: Avoid in pregnancy/breast-feeding.

Counseling points: Maintain hydration to avoid dehydration, maintain consistent salt intake, take with food to reduce nausea

Neurontin

Common Indications: neuropathic pain/epilepsy
side effects: dizziness, somnolence, peripheral edema/weight gain, mild euphoria

Lyrica

Common Indications: Neuropathic pain/epilepsy, fibromyalgia

Side Effects: Dizziness, somnolence, peripheral edema/weight gain, mild anxiolytic

Buspar

Common Indications: Anxiety

Contraindications: Do not use within 14 days of MAOIs.

Warnings/Precautions: Risk of serotonin syndrome

Side Effects: dizziness, drowsiness, nausea

Drug Interactions: Increased risk of serotonin syndrome when used with other serotonergic drugs

Notes: No potential for abuse

Atarax

Common Indications: Anxiety, pruritus, urticaria (hives)

Side Effects: Anticholinergic effects (sedation, dry mouth), QT prolongation

Notes: Atarax (brand name) is not marketed in US (only Canada).

Vistaril

Common Indications: Anxiety, hives

Side Effects: Anticholinergic effects (sedation, dry mouth), QT prolongation

Notes: Typically for short-term use

Cogentin

Common Indications: Parkinson disease

Side Effects: Anticholinergic effects (dry mouth, constipation, urinary retention, blurred vision, mydriasis, somnolence, confusion)

Notes: Increased risk of irregular movements

Sinemet

Common Indications: Parkinson disease

Contraindications: Do not use within 14 days of MAOIs.

Side Effects: Nausea, dizziness, orthostasis, dyskinesias, hallucinations, psychosis, dark urine, unusual sexual urges, priapism

Drug Interactions: Iron and protein can decrease absorption.

Notes: Do not discontinue abruptly.

pramipexole

Common Indications: Parkinson disease, restless leg sydrome

Warnings/Precautions: Somnolence (daytime sleep attacks), orthostasis, hallucinations, dyskinesias

Side Effects: Nausea, dizziness, vomiting, dry mouth

Notes: Do not discontinue abruptly.

Requip

See counseling points for pramipexole.

Zyprexa

Common Indications: Schizophrenia, bipolar disorder

Side Effects: Somnolence, metabolic syndrome (weight gain, hyperglycemia, hyperlipidemia)

Notes: Smoking reduces drug levels.

Seroquel

Common Indications: Schizophrenia, bipolar disorder

Side Effects: Somnolence, metabolic syndrome (weight gain, hyperglycemia, hyperlipidemia)

Notes: Low EPS risk

Counseling point: XR formulation should be taken at night without food or with a meal <= 300kcal.

Risperdal

Common Indications: Schizophrenia, bipolar disorder

Side Effects: Hyperprolactinemia, extrapyramidal symptoms (especially at higher doses), metabolic syndrome (weight gain, hyperglycemia, hyperlipidemia)

Compro

Common Indications: Nausea/Vomiting

BBW: Increased mortality in elderly patients with dementia-related psychosis

Warnings/Precautions: Can exacerbate symptoms of Parkinson disease

Side Effects: Acute EPS, sedation, lethargy

Geodon

Common Indications: Schizophrenia, bipolar disorder

Contraindications: Can cause QT prolongation. Do not use in high risk patients.

Side Effects: Somnolence, EPS, dizziness, nausea

Latuda

Common Indications: Schizoprenia, bipolar disorder

Side Effects: Somnolence, EPS (dystonias), nausea, metabolic syndrome (lower risk than other SGAs)

Abilify

Common Indications: Schizophrenia, bipolar disorder

Side Effects: Akathisia, can be activating or sedating, weight gain (lower risk)

Xanax, alprazolam

Common Indications: Anxiety

BBW: Increased risk of sedation, respiratory depression, coma and death with opioid use. Risk for abuse. Withdrawal symptoms with abrupt discontinuation.

Contraindications: Acute narrow-angle glaucoma

Warnings/Precautions: CNS depression, anterograde amnesia, abuse potential, safety risk in patients 65 years and older (impaired cognition, delirium, falls and fractures)

Side Effects: Somnolence, dizziness, ataxia

Drug Interactions: Caution with other CNS depressants (additive effect)

Counseling point: Do not use with alcohol.

Klonopin

See counseling points for alprazolam. Exception - contraindicated in severe liver disease

Valium

See counseling points for alprazolam. Exception - contraindicated in severe liver disease

Ativan

See counseling points for alprazolam

Restoril

See counseling points for alprazolam. Exceptions-

Common Indications: Sleep disorders

Warnings/Precautions: Complex sleep behaviors

Side Effects: Dizziness, drowsiness/increased fall risk, cognitive impairment