generic / contraindications

acetaminophen 300mg / codeine 30mg

Postoperative pain management in children undergoing tonsillectomy and/or adenoidectomy

Use with caution in patients with known G6PD deficiency

Hepatotoxicity is usually associated with excessive acetaminophen intake and often involves more than one product that contains acetaminophen

\[BBW] Acetaminophen has been associated with acute liver failure/ at times resulting in liver transplant and death

acetaminophen (APAP)

\[BBW] Acetaminophen has been associated with acute liver failure/ at times resulting in liver transplant and death

Hepatotoxicity is usually associated with excessive acetaminophen intake and often involves more than one product that contains acetaminophen

Use with caution in patients with known G6PD deficiency

acyclovir

Neurotoxicity has been reported- risk may be increased with higher doses and in patients with renal failure

adalimumab

\[BBW] Increased risk for serious infections which may result in hospitalization and/or fatality. Discontinue for serious infection/sepsis

\[BBW] Lymphoma and other malignancies have been reported in children and adolescents receiving TNF-blocking agents

\[BBW] Active tuberculosis/ including reactivation of latent tuberculosis- has been reported. Evaluate patients for TB risk factors and latent TB (with a skin test) prior to and during therapy

albuterol inhaler

Albuterol is a short-acting beta2-agonist (SABA) that should be used as needed for quick relief of asthma. Based on step-wise approach using guidelines/ monotherapy without concurrent use of a long term controller meds should only be reserved for pts with mild/ intermittent forms of asthma without the presence of risk factors

aledronate

Esophageal abnormalities or high risk for adverse esophageal effects

Hypocalcemia

Inability to sit or stand upright for at least 30 minutes

Atypical femur fractures have been reported

allopurinol

Before prescribing- consider testing for HLA-B*58:01 allele in pts at elevated risk for developing severe cutaneous adverse reactions (SCAR)

(including Korean patients with CKD ≥ stage 3 and all pts of Han Chinese or Thai descent)

alprazolam

Benzodiazepines have been associated with anterograde amnesia

\[BBW]:Concomitant use of benzodiazepines and opioids may result in profound sedation/
respiratory depression/ coma/ and death

amiodarone

Hypersensitivity to iodine

\[BBW]: Hepatotoxicity (may be fatal). Obtain baseline and periodic liver transaminases and discontinue or reduce dose if the increase exceeds 3 times normal or doubles in a patient with an elevated baseline

\[BBW]: Amiodarone can exacerbate arrhythmias- initiate therapy in a clinical setting where continuous ECGs and cardiac
resuscitation are available

\[BBW]: Only indicated for patients with life-threatening arrhythmias because of risk of substantial toxicity. Alternative therapies should be tried first

\[BBW]: Pulmonary toxicity has been reported (including fatalities). Prior to initiation- obtain a baseline chest Xray and pulmonary function tests/ including diffusion capacity. Repeat every 3 to 6 months.

amitriptyline

\[BBW]:Antidepressants increase the risk of suicidal thinking and behavior in children/ adolescents and young adults (18 to 24
years of age) with major depressive disorder (MDD) and other psychiatric disorders

Abrupt discontinuation or interruption of antidepressant therapy has been associated with a
discontinuation syndrome

Use with caution in patients with a history of cardiovascular disease- the risk of conduction abnormalities with this agent is high relative to other antidepressants

Use with caution in patients at risk of seizures/ including those with a history of seizures/ head trauma/ brain damage/ alcoholism/ or concurrent therapy with medications which may lower seizure threshold

amlodipine

The most common side effect is peripheral edema- occurs within 2 to 3 weeks of starting therapy

amoxicillin

A high percentage of patients with infectious mononucleosis develop an erythematous rash during amoxicillin therapy- avoid use in these patients

amoxicillin/ potassium clavulanate

Clavulanic acid content: Due to differing content of clavulanic acid

ampicillin / sulbactam

Hepatotoxicity has been reported
Monitor hepatic function at regular intervals

anastrozole

Patients LDL should be monitored and managed with hypercholesterolemia

Decreased bone mineral density

apixaban

\[BBW]: Premature discontinuation of any oral anticoagulant/ including apixaban in the absence of adequate alternative anticoagulation increases the risk of thrombotic events

\[BBW]: Spinal or epidural hematomas resulting in long term or permanent paralysis may occur with neuraxial anesthesia (epidural or spinal anesthesia) or spinal/epidural puncture

aripiprazole

\[BBW]: Antidepressants increase the risk of suicidal thinking and behavior in children/ adolescents and young adults (18-24 years of age) with major depressive disorder and other psychiatric disorders

\[BBW]: Elderly patients with dementia- related psychosis treated with antipsychotics are at an increased risk of death compared to placebo

aspirin

Patients with asthmarhinitis/ and nasal polyps

Do not use in children or teenagers for viral infections with or without fever (Reye Syndrome)

atenolol

Severe sinus bradycardia

Uncompensated CHF Beta-blocker therapy should not be withdrawn abruptly

atomoxetine

has been associated with serious cardiovascular events including sudden death in children and adolescents and sudden death/ stroke/ and MI in adult patients with preexisting structural cardiac abnormalities or other serious heart problems

atorvastatin

Contraindicated in pregnancy
Muscle weakness/ myopathy

azelastine

May cause CNS depression/ which may impair physical or mental abilities- patients must be cautioned about performing tasks that require mental alertness

azithromycin

Altered cardiac conduction with potential QT prolongation

Conflicting data on increased cardiovascular mortality

baclofen

\[BBW] Abrupt withdrawal of intrathecal baclofen/ has resulted in sequelae/ multiple organ-system failure/ and death.

Prevention of abrupt
discontinuation requires careful attention to programming and monitoring of infusion system/ refill scheduling and procedures and pump alarms

benazepril

history of angioedema

contraindicated in pregnancy

benzonatate

N/A

bimatoprost

May permanently change/increase brown pigmentation of the iris/ the eyelid skin/ periorbital tissue/ and eyelashes

Remove contact lenses prior to administration and wait 15 minutes before reapplying

bisacodyl

Do not use in pts with ileus/ intestinal obstruction/ acute abdominal conditions including appendicitis/ acute inflammatory bowel diseases and severe abdominal pain associated with nausea and vomiting

bisoprolol

Cardiogenic shock/ cardiac failure/ or first degree heart block/ sinus bradycardia

Beta-blocker therapy should not be withdrawn abruptly

brimonidine

Bacterial keratitis: Inadvertent contamination of multiple-dose ophthalmic solutions

CNS depression

budesonide

May cause hypercortisolism or suppression of hypothalamic pituitary-adrenal (HPA) axis/ particularly in younger children or in patients receiving high doses for prolonged periods

budesonide / formoterol

Adrenal suppression Oropharyngeal Candida infections

bupropion

\[BBW]: Antidepressants increased the risk of suicidal thoughts and behavior

May cause a dose-related risk of seizures.

Use is contraindicated in patients with a history of seizures or certain conditions with high seizure risk

buprenorphine / naloxone

CNS and respiratory depression

Use not recommended in severe hepatic dysfunction

buspirone

Potentially life-threatening serotonin syndrome has occurred with serotonergic agents/ including buspirone/ particularly when used in combination with other
serotonergic agents (eg. triptans/ TCAs/ fentanyl/ lithium/ tramadol/ buspirone/ St John's wort/ tryptophan) or agents that impair metabolism of serotonin (eg. MAOIs/ other MAOIs [ie. linezolid and IV methylene blue])

canagliflozin

Risk of lower limb amputations in pts with type 2 DM who had either established cardiovascular disease or were at risk for CV disease

Lower limb infections/ gangrene/ and diabetic foot ulcers were the most common precipitating factors for amputation

May increase the risk of genital mycotic infections

Cases of necrotizing fasciitis of the perineum

Serious urinary infections including urosepsis and pyelonephritis requiring hospitalization have been reported

carbamazepine

BBW: Dermatologic reactions/ HLA- B*15:02 allele/ aplastic anemia and agranulocytosisIn chronic therapy/ withdraw gradually over 2 to 6 months to minimize the potential of increased seizure frequency

Hepatic enzyme autoinduction/ monitor for dosing increases

carbidopa / levodopa

Narrow angle glaucoma
Dietary protein: Distribute dietary protein throughout the day to avoid fluctuations in levodopa absorption

carisoprodol

Use with caution inpatients with a history of drug abuse or acute alcoholism- potential for drug dependency exists.

Tolerance/ psychological and physical dependence to carisoprodol (and its metabolite/ meprobamate) may occur with prolonged use

Limit use to 2 to 3 weeks

carvedilol

Beta-blocker therapy should not be withdrawn abruptly (particularly in patients with CAD)/ but gradually tapered

cefazolin

Caution in patients with a history of seizure disorder- high levels/ particularly in renal impairment/ may increase risk of seizures

cefdinir

Cases of reddish stools have been reported with cefdinir with iron-containing products due to the formation of a nonabsorbable complex in the GI tract

cefepime

Neurotoxicity: Severe neurological reactions reported/ including seizures and nonconvulsive status epilepticus.

Risk may be increased with renal impairment- ensure dose adjusted for renal function and discontinue therapy if neurotoxicity develops

cefoxitin

Pediatric ≥3 months of age- higher doses have been associated with an increased incidence of eosinophilia and elevated AST

ceftriaxone

Hyperbilirubinemic neonates

Concurrent use with IV calcium containing solutions in neonates

cefuroxime

Tablets and oral suspension are not bioequivalent- do not substitute on a mg-per- mg basis

celecoxib

\[BBW]: NSAIDs cause an increased risk of serious adverse cardiovascular thrombotic events including MI and stroke. Risk may occur early during treatment and may increase with
duration of use

\[BBW]: NSAIDs cause an increased risk of serious GI inflammation/ ulceration/ bleeding/ and perforation- elderly patients and patients with history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events. These events may occur at any time during therapy and without warning

cephalexin

Positive direct Coombs tests and acute intravascular hemolysis have been reported. If anemia develops/ discontinue use and work up for drug induced hemolytic anemia

cetirizine

May cause CNS depression which may impair physical or mental abilities

chlorhexidine

staining of oral surfaces

ciprofloxacin

\[BBW]: Fluoroquinolones are associated with disabling and potentially irreversible serious adverse reactions that may occur together/ including tendonitis and tendon rupture/ peripheral neuropathy and CNS effects.

Discontinue ciprofloxacin immediately

citalopram

\[BBW]: Antidepressants increase the risk of suicidal thinking and behavior in children/ adolescents and young adults

Potentially life-threatening serotonin syndrome (SS) has occurred with serotonergic agents

Avoid use in CYP2C19 poor metabolizers

clarithromycin

Potentially significant interactions may exist with CYP3A4 metabolism including some statins

History of QT prolongation or ventricular arrhythmia

clinamycin

\[BBW]: Can cause severe and possibly fatal colitis. Should be reserved for serious infections where less toxic antimicrobial agents are inappropriate. It should not be used in patients with nonbacterial infections such as most upper respiratory tract infections. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality/ as these infections can be refractory to
antimicrobial therapy and may require colectomy. C. difficile associated diarrhea (CDAD) must be considered in all patients who present with diarrhea following antibiotic use. CDAD has been observed \>2 months post-antibiotic treatment. If CDAD is
suspected or confirmed

clonazepam

\[BBW]: Concomitant use of benzodiazepines and opioids may result in profound sedation/ respiratory depression/ coma and death

Anterograde amnesia

CNS depression

Potential for abuse

clonidine

Do not discontinue therapy abruptly. When discontinuing- taper gradually to decrease risk of rebound hypertension

clopidogrel

Active bleeding

Premature interruption of therapy may result in stent thrombosis with subsequent MI

\[BBW]: Effectiveness results from antiplatelet activity/ which is dependent on conversion to an active metabolite by CYP- 450/ principally CYP2C19. In pts who are homozygous for nonfunctional alleles (CYP2C19 poormetabolizers)/ clopidogrel has reduced effect on platelet activity

clozapine

\[BBW]: Orthostatic hypotension/ bradycardia/ syncope/ and cardiac arrest have been reported

\[BBW] Fatalities due tomyocarditis and cardiomyopathy Severe/ life-threatening and sometimes fatal hepatotoxicity

\[BBW]: Severe neutropenia/ defined as absolute neutrophil count (ANC) less than 500/mm3. Pts must have regular monitoring

\[BBW] Seizures have been associated with clozapine use in a dose-dependent manner

\[BBW]: Elderly patients with dementia- related psychosis treated with antipsychotics are at an increased risk of death compared to placebo

colchicine

Myelosuppression and aplastic anemia have been reported

Myotoxicity (including rhabdomyolysis) has been reported

colesevelam

History of bowel obstruction

Serum triglycerides concentrations \>500 mg/dl

conjugated estrogens

\[BBW\]: Based on data from the Women’s Health Initiative studies, an increased risk of invasive breast cancer was observed in postmenopausal women using conjugated estrogens in combination with medroxyprogesterone acetate

\[BBW\]: Estrogens with or without progestin should not be used to prevent dementia.

\[BBW\]: The use of unopposed estrogen in women with a uterus is associated with an increased risk of endometrial cancer

\[BBW\]: Estrogens with or without progestin should not be used to prevent cardiovascular disease DVT or PE (current or history); active or history of arterial thromboembolic disease (eg, stroke, MI); breast cancer (except in pts being treated for metastatic disease); estrogen-dependent tumor; hepatic impairment or disease; known protein C, protein S, antithrombin deficiency or other known thrombophilic disorders; pregnancy

cyanocobalamin

N/A

cyclobenzaprine

Concurrent use of MAOI

CHF

Heart block

Arrhythmias

Acute recovery after MI

Hyperthyroidism

cyclosporine (ophthalmic)

Active ocular infections

Remove contact lens prior to administration and wait 15 minutes

dabigatran

BBW]: Upon premature discontinuation/ the risk of thrombotic events is increased. If dabigatran must be discontinued for a reason other than pathological bleeding or completion of a course of therapy- consider the use of another anticoagulant during the time of interruption

darbepoetin

\[BBW]: Erythropoiesis stimulating agents increased the risk of serious cardiovascular events/ and mortality in clinical studies when administered to target hemoglobin levels \>11 g/dL

\[BBW]: A shortened overall survival and/or increased risk of time to tumor progression or recurrence has been reported in studies

desvenlafaxine

\[BBW]: suicidal thoughts and behavior Serotonin syndrome

dexamethasone

Systemic fungal infection

Administration of live virus vaccines

Suppression of hypothalamic pituitary- adrenal (HPA) axis

Immunosuppression

Psychiatric disturbances

dexlansoprazole

Increased incidence ofosteoporosis-related bone fractures of the hip/ spine or wrist may occur with PPI therapy

PPIs may diminish the therapeutic effect of clopidogrel

Increase risk of Clostridium difficile

dexmedetomidine

Episodes of bradycardia/ hypotension and sinus arrest have been associated with rapid IV administration

dexmethylphenidate

\[BBW]: possible abuse and dependence

\[BBW] CNS stimulant treatment has been associated with sudden death in children and adolescents with preexisting structural cardiac abnormalities

dextroamphetamine / amphetamine

Caution in CV disease

Hyperthyroidism

Glaucoma

Agitated states

History of drug abuse

Concurrent use of MAOI

diazepam

Anterograde amnesia

Drug abuse potential

diclofenac

\[BBW]: NSAIDs cause an increased risk of serious adverse cardiovascular thrombotic events/ including MI and stroke. Risk may occur early during treatment and may increase with duration of use

\[BBW]: NSAIDs cause an increased risk of serious gastrointestinal inflammation/ ulceration/ bleeding and
perforation- elderly patients and patients with history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events.

These events may occur at any time during therapy and without warning

dicyclomine

Due to anticholinergic effects avoid in: obstructive diseases of the GI tract/
severe ulcerative colitis/
unstable cardiovascular disease/
obstructive uropathy/ glaucoma/
myastheniagravis

digoxin

Correct electrolyte disturbances/ especially hypokalemia or hypomagnesemia/ prior to use and throughout therapy

diltiazem

Due to its negative inotropic and chronotropic effects/ use is generally avoided in patients taking a beta-blocker or who have heart failure with reduced ejection fraction.

Unless a functioning pacemaker has been placed/ avoid use in patients with sinus node dysfunction or second- or third-degree atrioventricular block

diphenoxylate / atropine

Obstructive jaundice- diarrhea associated with pseudomembranous enterocolitis

docusate (sodium/ calcium)

Do not use OTC for longer than 7 days

Do not use with mineral oil

donepezil

N/A

doxazosin

Do not use in severe hepatic impairment (Child-Pugh class C)

May cause orthostatic hypotension and syncope within a few hours after dosing but may occur later- anticipate a similar effect if therapy is interrupted for a few days/ if dosage is increased or if another antihypertensive drug/ PDE-5 inhibitor or nitrates are introduced.

Use with caution in patients with symptomatic orthostatic hypotension

doxycycline

May cause tissue hyperpigmentation/ tooth enamel hypoplasia or permanent tooth discoloration (more common with long-term use but observed with repeated/ short courses) when used during tooth development (last half of pregnancy/ infancy and childhood ≤8 years of age

IV form may cause phlebitis

duloxetine

\[BBW]:Antidepressants increase the risk of suicidal thinking and behavior in children/ adolescents and young adults (18 to 24 years of age) with major depressive disorder and other psychiatric disorders

Concurrent use of MAOI/ TCA/ or linezolid

dutasteride

Active ingredient can be absorbed through the skin- women should always use caution whenever handling

Pregnant women or women trying to conceive should not handle product- if contact occurs/ wash area immediately with soap and water- dutasteride may negatively impact fetal development

edoxaban

If CrCl \>95ml/min do not use

\[BBW]: Premature discontinuation of edoxaban/ in the absence of adequate alternative anticoagulation increases the risk of ischemic events

emtricitabine / tenofovir alafenamide

\[BBW]: Safety and efficacy during coinfection of HIV-1 and HBV have not been established- acute exacerbations of HBV have been reported following discontinuation of antiretroviral therapy

Not for treatment of chronic hepatitis B

enalapril enalapilat (IV)

History of angioedema
Do not use in pregnancy

enoxaparin

Thrombocytopenia with positive test for antiplatelet antibodies with enoxaparin use

Hypersensitivity to pork products

Active major bleeding

epinephrine

May precipitate oraggravate angina pectoris or induce cardiac arrhythmias

epoetin

\[BBW]: Erythropoiesis
stimulating agents increased the risk of serious cardiovascular events and mortality in clinical studies when administered to target hemoglobin levels \>11 g/dL

\[BBW]: A shortened overall survival and/or increased risk of time to tumor progression or recurrence has been reported in studies

escitalopram

\[BBW] Antidepressants increase the risk of suicidal thinking and behavior in children/ adolescents and young adults

Potentially life threatening serotonin syndrome has occurred with serotonergic agents

esomeprazole

Increased incidence of osteoporosis-related bone fractures of the hip/ spine/ or wrist may occur

Diminish the therapeutic effect of clopidogrel

Increase risk of C difficile

estradiol

\[BBW]: Increased risk of invasive breast cancer

\[BBW]: Estrogens with or without progestin should not be used to prevent dementia.

\[BBW]: Unopposed estrogen in women with a uterus associated with an increased risk of endometrial cancer

\[BBW]: Do not use to prevent CV disease DVT or PE (current or history of)- active or history stroke/ MI/ breast cancer/ estrogen- dependent tumor- hepatic disease- known protein C/ protein S/ antithrombin deficiency or other known thrombophilic disorders- pregnancy

eszopiclone

Use with caution in pts with a history of drug dependence

Hypnotics/sedatives have been associated with
abnormal thinking and behavior changes including decreased inhibition/ aggression/ bizarre behavior/ agitation/ hallucinations and depersonalization

etanercept

\[BBW]: Patients receiving etanercept are at increased risk for serious infections which may result inhospitalization and/or fatality

\[BBW]: Lymphoma and other malignancies (some fatal) have been reported in children and adolescents receiving TNF-blocking agents- including etanercept.

\[BBW]: Active tuberculosis (disseminated or extrapulmonary) including reactivation of latent tuberculosis/ has been reported in patients receiving etanercept

ethinyl estradiol / etonogestrel

Increased risk of invasive breast and cervical cancer

Combination hormonal contraceptives may adversely affect lipid levels/ including serum
triglycerides

Discontinue use of combination hormonal contraceptives if an arterial or venous thrombotic event occurs

ethinyl estradiol / norethindrone

Current or history of thromboembolic disorders

History of estrogen- or progesterone- dependent neoplasm

evolucumab

The packaging (needle cap of prefilled syringe and autoinjector) may contain dry natural rubber/ which is a derivative of latex

exenatide

Bydureon: [BBW] Thyroid C-cell tumors have developed in animal studies with exenatide ER- it is not known if causes thyroid C-cell tumor/ including medullary thyroidtumors.

Avoid inpatients with a history of thyroid tumors

ezetimibe

Hepatic (avoid in moderate or severe impairment)

Myopathy has been rarely reported with ezetimibe- risk may be increased with use of a statin or fibrate

Elevated hepatic transaminases when combined with statins