CMS: High-Risk Meds =

Amphetamines

  • High risk agents to avoid/ (H) considered Highest-Risk =

    • amphetamine and dextroamphetamine (H) (adderall/xr)

    • benzphetamine (H) (DIDREX)

    • dexmethylphenidate (H) (FOCALIN/XR)

    • dextroamphetamine (H) (DEXADRINE, DEXTROSTAT)

    • diethylpropin (H) (DURAD, TENUATE, TEPANIL)

    • INTUNIV (H)

    • methamphetamine (H) (RITALIN/LA,CONCERTA, DAYTRANA< METADATE CD)

    • phendimetrazine (H) (BONTRIL)

    • phentermine (H) (ADIPEX-P)

  • REASONS FOR RISK:

    • stimulation

    • agitation

    • insomnia

    • hypertension

    • myocardial ischemia

    • dependence

    • appetite suppresion

  • CONSIDER DISCONTINUING

  • TIER:

    • N/a

ANALGESICS:

  • HIGH RISK AGENTS TO AVOID:

    • indomethacin (INDOCIN)

    • ketorolac (H) (TORADOL)

  • REASONS FOR RISK

    • ketrorolac: gastrointestinal bleeding risk in elderly

    • indomethacin: GI bleeding/peptic ulcer in high-risk patients. this medications has more adverse effects than other NSAIDs. EDEMA may worsen heart failure.

non high risk alts for analgesics:

  • mild pain:

    • APAP (not covered)

    • ibuprofen (T1)

    • naproxen (T1)

    • meloxicam (T1)

  • moderate/severe pain

    • tramadol (T2)

    • morphine sulfate (MS CONTIN) (T2)

    • hydrocodone/APAP (VICODIN, etc) (T2)

    • oxycodone (OXYIR) (T2)

    • oxycodone/APAP (PERCOCET) (T2)

    • fentanyl patch (DURAGESIC) (T2)

    • OXYCONTIN = T5/T5

    • AVINZA = T5 (ST)

ANTI-ADRENERGICS:

  • HIGH RISK AGENTS:

    • guanabenz

    • guanfacine (TENEX)

    • methyldopa (ALDOMET)

    • METHYLDOPA/HCTZ (ALCOLOR, ALDORIL)

  • REASONS FOR RISK:

    • orthostatic hypotension

    • bradycardia

    • CNS adverse effects

non high risk for anti-adrenergics:

  • HCTZ (T1)

  • lisinopril (T1)

  • enalapril (T1)

  • losartan (T1)

  • metoprolol (T1)

ANTI-ANXIETY:

  • HIGH RISK AGENTS:

    • meprobamate (H) (EQUINIL)

    • aspirin/meprobamate (H) (EQUAGESIC)

  • REASONS FOR RISK:

    • dependence of sedation, depression, confusion, falls, fractures, respiratory depression (especially if in COPD).

non high risk for ANTI-ANXIETY:

  • anxiety: buspirone (BUSPAR) (T2)

  • sleep: ROZEREM (T5)

ANTI-EMETICS:

  • HIGH RISK AGENTS:

    • trimethobenzamide (H) (TIGAN)

    • promethazine (H) (PHENERGAN)

  • REASONS FOR RISK:

    • anticholinergic side effects: worsened cognition, and behavioral problems (usually in dementia); urinary retention or incotinence; questionable efficacy

non high risk for ANTI-EMETICS:

  • Levocetirizine (XYZAL) (T2)

  • CLARINEX (T5 with ST)

ANTIHISTAMINES:

  • HIGH RISK AGENTS:

    • APAP/dextromethorpha/diphenhydramine (H)

    • APAP/diphenhydramine/ PHENYLEPHRINE (H)

    • APA/diphenhydramine/ PSE (H)

    • APAP & diphenhydramine (H)

    • Brompheniramine/ combination products (H)

    • carbetapentane. diphenhydramine/phenylephrine (H)