Trade Name Code



Common Medications Handbook

For

School Counselors

Compiled by the joint practicum classes Big Sandy Center in Prestonsburg, KY Spring and Fall Semesters of 2012

Table of Contents

Medication Page

Abilify (aripirazole) 3

Adderall (amphetamine) 5

Anafranil (clomipramine) 12

Celexa (citalopram Hydrobomide) 13

Clonidine (catapres) 15

Concerta (methylphenidate HCl) 17

Depakote (divalprocx Sodium) 18

Desyrel (Trazadone) 19

Focalin (dexmethylphenidate HCL) 21

Haldol (haloperidol) 22

Keppra (levetiracetam) 23

Lamictal (lamotrigene) 26

Lexapro (escitalopram) 28

Reglan (metoclopramide) 32

Remeron (mirtazapine) 33

Risperdal (risperidone) 34

Ritalin (methylphenidate HCL) 36

Strattera (atomoxetine) 37

Tegretol (carbamazepine) 38

Topamax (topiramate) 40

Vyvanse (Lisdexamfetamine Dimesylate) 42

Wellbutrin / Zyban (buproprion) 43

Zoloft (Sertraline Hydrocloride) 45

Caution: The information contained in this document is compiled from a variety of online medication sources and is intended as general information only and must be considered as such. Counselors are cautioned to consult qualified medical practitioners when planning interventions with specific clients.

Trade Name: Abilify

Generic Equivalent: Aripirazole

Primary Reason for prescription:

Aripiprazole is used to treat schizophrenia, bipolar mania and mixed manic/depressive episodes (as sole or adjunctive therapy) and as adjunctive (add-on) therapy for major depressive disorder.

Common Indications:

People with Bipolar Disorder experience extreme mood swings that can take three different forms: manic, depressive, and mixed episodes. Symptoms can include both a lowering of mood (depression) and an exaggerated elevation of mood (mania).

Dosage and Administration:

Aripiprazole usually is taken once a day. The usual starting dose is 10 or 15 mg once daily. The dose may be increased over time to achieve the desired effect. Aripiprazole can be taken with or without food.

Side-effects:

Some of the most common side effects associated with aripiprazole are anxiety, blurred vision, constipation, cough, headache, insomnia, lightheadedness, nausea, rash, restlessness, runny nose, sleepiness, tremors, vomiting, weakness, and weight gain. As with other anti-psychotics, long-term use of aripiprazole may lead to a potentially irreversible condition called tardive dyskinesia (involuntary movements of the jaw, lips, and tongue). A potentially fatal complex referred to as neuroleptic malignant syndrome has been reported with anti-psychotic drugs, including aripiprazole. Patients who develop this syndrome may have high fevers, muscle rigidity, altered mental status, irregular pulse or blood pressure, rapid heart rate, excessive sweating, and heart arrhythmias. Although there is no clear link between aripiprazole and diabetes, patients should be tested during treatment for elevated blood-sugars. Additionally, persons with risk factors for diabetes, including obesity or a family history of diabetes, should have their fasting levels of blood sugar tested before starting treatment and periodically throughout treatment to detect the onset of diabetes. Any patient developing symptoms that suggest diabetes during treatment should be tested for diabetes.

Warnings and Precautions:

Before taking aripiprazole, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart disease (e.g., history of heart attacks or chest pain, heart failure, irregular heart rhythm), history of stroke, dehydration, seizures, Alzheimer's disease, swallowing problems (e.g., history of aspiration), diabetes (or family history), obesity. To minimize dizziness or fainting, get up slowly from a lying or seated position (especially when you first start using this drug or if your doctor changes your dose). This medication can reduce sweating, which makes overheating more likely to occur. Avoid activities that might cause you to overheat (e.g., doing strenuous work, exercising in hot weather, or using hot tubs). Drink plenty of fluids to avoid becoming dehydrated. This drug may make you dizzy or drowsy; use caution engaging in activities requiring alertness such as driving or using machinery. Avoid alcoholic beverages. Caution is advised when using this drug in the elderly because they may be more sensitive to its side effects. This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. It is not known whether this drug passes into breast milk. Breast-feeding is not recommended while using this drug.

Information Source:







Trade Name: Adderall

Generic Equivalent:

• Amphetamine and Dextroamphetamine 5 mg tablets

• Amphetamine and Dextroamphetamine 7.5 mg tablets

• Amphetamine and Dextroamphetamine 10 mg tablets

• Amphetamine and Dextroamphetamine 12.5 mg tablets

• Amphetamine and Dextroamphetamine 15 mg tablets

• Amphetamine and Dextroamphetamine 20 mg tablets

• Amphetamine and Dextroamphetamine 30 mg tablets.

Primary Reason for prescription:

ADDERALL® is indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) and Narcolepsy.

Common Indications:

A diagnosis of Attention Deficit Hyperactivity Disorder (ADHD; DSM-IV®) implies the presence of hyperactive-impulsive or inattentive symptoms that caused impairment and were present before age 7 years. The symptoms must cause clinically significant impairment, e.g., in social, academic, or occupational functioning, and be present in two or more settings, e.g., school (or work) and at home. The symptoms must not be better accounted for by another mental disorder. For the Inattentive Type, at least six of the following symptoms must have persisted for at least 6 months: lack of attention to details/careless mistakes; lack of sustained attention; poor listener; failure to follow through on tasks; poor organization; avoids tasks requiring sustained mental effort; loses things; easily distracted; forgetful. For the Hyperactive-Impulsive Type, at least six of the following symptoms must have persisted for at least 6 months: fidgeting/squirming; leaving seat; inappropriate running/climbing; difficulty with quiet activities; "on the go;" excessive talking; blurting answers; can't wait turn; intrusive. The Combined Type requires both inattentive and hyperactive-impulsive criteria to be met.

Special Diagnostic Considerations:

Specific etiology of this syndrome is unknown, and there is no single diagnostic test. Adequate diagnosis requires the use not only of medical but of special psychological, educational, and social resources. Learning may or may not be impaired. The diagnosis must be based upon a complete history and evaluation of the child and not solely on the presence of the required number of DSM-IV® characteristics.

Need for Comprehensive Treatment Program:

ADDERALL® is indicated as an integral part of a total treatment program for ADHD that may include other measures (psychological, educational, social) for patients with this syndrome. Drug treatment may not be indicated for all children with this syndrome. Stimulants are not intended for use in the child who exhibits symptoms secondary to environmental factors and/or other primary psychiatric disorders, including psychosis. Appropriate educational placement is essential and psychosocial intervention is often helpful. When remedial measures alone are insufficient, the decision to prescribe stimulant medication will depend upon the physician's assessment of the chronicity and severity of the child's symptoms.

Dosage and Administration:

Regardless of indication, amphetamines should be administered at the lowest effective dosage and dosage should be individually adjusted according to the therapeutic needs and response of the patient. Late evening doses should be avoided because of the resulting insomnia.

Attention Deficit Hyperactivity Disorder:

Not recommended for children under 3 years of age. In children from 3 to 5 years of age, start with 2.5 mg daily; daily dosage may be raised in increments of 2.5 mg at weekly intervals until optimal response is obtained.

In children 6 years of age and older, start with 5 mg once or twice daily; daily dosage may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40 mg per day. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours.

Where possible, drug administration should be interrupted occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy.

Narcolepsy:

Usual dose 5 mg to 60 mg per day in divided doses, depending on the individual patient response.

Narcolepsy seldom occurs in children under 12 years of age; however, when it does, dextroamphetamine sulfate may be used. The suggested initial dose for patients aged 6-12 is 5 mg daily; daily dose may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. In patients 12 years of age and older, start with 10 mg daily; daily dosage may be raised in increments of 10 mg at weekly intervals until optimal response is obtained. If bothersome adverse reactions appear (e.g., insomnia or anorexia), dosage should be reduced. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours.

Side-effects:

Cardiovascular:

Palpitations, tachycardia, elevation of blood pressure, sudden death, myocardial infarction. There have been isolated reports of cardiomyopathy associated with chronic amphetamine use.

Central Nervous System:

Psychotic episodes at recommended doses, overstimulation, restlessness, dizziness, insomnia, euphoria, dyskinesia, dysphoria, depression, tremor, headache, exacerbation of motor and phonic tics and Tourette's syndrome, seizures, stroke.

Gastrointestinal:

Dryness of the mouth, unpleasant taste, diarrhea, constipation, other gastrointestinal disturbances. Anorexia and weight loss may occur as undesirable effects.

Allergic:

Urticaria, rash, hypersensitivity reactions including angioedema and anaphylaxis. Serious skin rashes, including Stevens Johnson Syndrome and toxic epidermal necrolysis have been reported.

Endocrine:

Impotence, changes in libido.

Drug Abuse and Dependence

ADDERALL® is a Schedule II controlled substance.

Amphetamines have been extensively abused. Tolerance, extreme psychological dependence, and severe social disability have occurred. There are reports of patients who have increased the dosage to levels many times higher than recommended. Abrupt cessation following prolonged high dosage administration results in extreme fatigue and mental depression; changes are also noted on the sleep EEG. Manifestations of chronic intoxication with amphetamines include severe dermatoses, marked insomnia, irritability, hyperactivity, and personality changes. The most severe manifestation of chronic intoxication is psychosis, often clinically indistinguishable from schizophrenia.

Warnings and Precautions:

Serious Cardiovascular Events

Sudden Death and Pre-existing Structural Cardiac Abnormalities or Other Serious Heart Problems

Children and Adolescents

Sudden death has been reported in association with CNS stimulant treatment at usual doses in children and adolescents with structural cardiac abnormalities or other serious heart problems.

Although some structural heart problems alone may carry an increased risk of sudden death, stimulant products generally should not be used in children or adolescents with known structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of a stimulant drug (see CONTRAINDICATIONS).

Adults

Sudden deaths, stroke, and myocardial infarction have been reported in adults taking stimulant drugs at usual doses for ADHD. Although the role of stimulants in these adult cases is also unknown, adults have a greater likelihood than children of having serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems. Adults with such abnormalities should also generally not be treated with stimulant drugs (see CONTRAINDICATIONS).

Hypertension and other Cardiovascular Conditions

Stimulant medications cause a modest increase in average blood pressure (about 2-4 mmHg) and average heart rate (about 3-6 bpm) [see ADVERSE REACTIONS], and individuals may have larger increases. While the mean changes alone would not be expected to have short-term consequences, all patients should be monitored for larger changes in heart rate and blood pressure. Caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate, e.g., those with pre-existing hypertension, heart failure, recent myocardial infarction, or ventricular arrhythmia (see CONTRAINDICATIONS).

Assessing Cardiovascular Status in Patients being Treated with Stimulant Medications

Children, adolescents, or adults who are being considered for treatment with stimulant medications should have a careful history (including assessment for a family history of sudden death or ventricular arrhythmia) and physical exam to assess for the presence of cardiac disease, and should receive further cardiac evaluation if findings suggest such disease (e.g. electrocardiogram and echocardiogram). Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation.

Psychiatric Adverse Events

Pre-Existing Psychosis

Administration of stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with pre-existing psychotic disorder.

Bipolar Illness

Particular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible induction of mixed/manic episode in such patients. Prior to initiating treatment with a stimulant, patients with comorbid depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.

Emergence of New Psychotic or Manic Symptoms

Treatment emergent psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania in children and adolescents without prior history of psychotic illness or mania can be caused by stimulants at usual doses. If such symptoms occur, consideration should be given to a possible causal role of the stimulant, and discontinuation of treatment may be appropriate. In a pooled analysis of multiple short-term, placebo-controlled studies, such symptoms occurred in about 0.1% (4 patients with events out of 3482 exposed to methylphenidate or amphetamine for several weeks at usual doses) of stimulant-treated patients compared to 0 in placebo-treated patients.

Aggression

Aggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported in clinical trials and the postmarketing experience of some medications indicated for the treatment of ADHD. Although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment for ADHD should be monitored for the appearance of or worsening of aggressive behavior or hostility.

Long-Term Suppression of Growth

Careful follow-up of weight and height in children ages 7 to 10 years who were randomized to either methylphenidate or non-medication treatment groups over 14 months, as well as in naturalistic subgroups of newly methylphenidate-treated and non-medication treated children over 36 months (to the ages of 10 to 13 years), suggests that consistently medicated children (i.e., treatment for 7 days per week throughout the year) have a temporary slowing in growth rate (on average, a total of about 2 cm less growth in height and 2.7 kg less growth in weight over 3 years), without evidence of growth rebound during this period of development. Published data are inadequate to determine whether chronic use of amphetamines may cause a similar suppression of growth, however, it is anticipated that they will likely have this effect as well. Therefore, growth should be monitored during treatment with stimulants, and patients who are not growing or gaining weight as expected may need to have their treatment interrupted.

Seizures

There is some clinical evidence that stimulants may lower the convulsive threshold in patients with prior history of seizure, in patients with prior EEG abnormalities in absence of seizures, and very rarely, in patients without a history of seizures and no prior EEG evidence of seizures. In the presence of seizures, the drug should be discontinued.

Visual Disturbance

Difficulties with accommodation and blurring of vision have been reported with stimulant treatment.

PRECAUTIONS:

The least amount of amphetamine feasible should be prescribed or dispensed at one time in order to minimize the possibility of overdosage. ADDERALL® should be used with caution in patients who use other sympathomimetic drugs.

Tics:

Amphetamines have been reported to exacerbate motor and phonic tics and Tourette's syndrome. Therefore, clinical evaluation for tics and Tourette's syndrome in children and their families should precede use of stimulant medications.

Information for Patients:

Amphetamines may impair the ability of the patient to engage in potentially hazardous activities such as operating machinery or vehicles; the patient should therefore be cautioned accordingly.

Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with amphetamine or dextroamphetamine and should counsel them in its appropriate use.

The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document.

Pregnancy

Teratogenic Effects:

Pregnancy Category C.

Amphetamine, in the enantiomer ratio present in ADDERALL® (d- to l- ratio of 3:1), had no apparent effects on embryofetal morphological development or survival when orally administered to pregnant rats and rabbits throughout the period of organogenesis at doses of up to 6 and 16 mg/kg/day, respectively. These doses are approximately 1.5 and 8 times, respectively, the maximum recommended human dose of 30 mg/day [child] on a mg/m2 body surface area basis. Fetal malformations and death have been reported in mice following parenteral administration of d-amphetamine doses of 50 mg/kg/day (approximately 6 times that of a human dose of 30 mg/day [child] on a mg/m2 basis) or greater to pregnant animals. Administration of these doses was also associated with severe maternal toxicity.

A number of studies in rodents indicate that prenatal or early postnatal exposure to amphetamine (d- or d,l-), at doses similar to those used clinically, can result in long-term neurochemical and behavioral alterations. Reported behavioral effects include learning and memory deficits, altered locomotor activity, and changes in sexual function.

There are no adequate and well-controlled studies in pregnant women. There has been one report of severe congenital bony deformity, tracheo-esophageal fistula, and anal atresia (vater association) in a baby born to a woman who took dextroamphetamine sulfate with lovastatin during the first trimester of pregnancy. Amphetamines should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nonteratogenic Effects:

Infants born to mothers dependent on amphetamines have an increased risk of premature delivery and low birth weight. Also, these infants may experience symptoms of withdrawal as demonstrated by dysphoria, including agitation, and significant lassitude.

Usage in Nursing Mothers:

Amphetamines are excreted in human milk. Mothers taking amphetamines should be advised to refrain from nursing.

Information Source:



Trade Name: Anafranil

Generic Equivalent: Clomipramine

Primary Reason for prescription: treatment of Obsessive Compulsive Disorder

Common Indications: OCD, major depression, panic disorder, narcolepsy, chronic pain, enuresis, depersonalization disorder, Trichotillomania

Dosage and Administration: At the beginning, take 3 times a day with meals. After several weeks of treatment, take once a day at bedtime

Available as capsules 25, 50, and 75mg.

Side-effects: drowsiness, dry mouth, constipation, dizziness, change in appetite, upset stomach, disturbance in speech, stuffy nose

Warnings and Precautions: Increased risk of suicidal thoughts and actions in some children, teenagers and young adults

Do not take if taking a (MOA) inhibitor

Information Source:

Drugs/DrugSafety/InformationbyDrugClass



Trade Name: Celexa

Generic Equivalent: citalopram hydrobromide

Primary Reason for prescription: Depression

Common Indications:

Celexa (citalopram HBr) is indicated for the treatment of depression.

The efficacy of Celexa in the treatment of depression was established in 4-6 week, controlled trials of outpatients whose diagnosis corresponded most closely to the DSM-III and DSM-III-R category of major depressive disorder (see CLINICAL PHARMACOLOGY).

A major depressive episode (DSM-IV) implies a prominent and relatively persistent (nearly every day for at least 2 weeks) depressed or dysphoric mood that usually interferes with daily functioning, and includes at least five of the following nine symptoms: depressed mood, loss of interest in usual activities, significant change in weight and/or appetite, insomnia or hypersomnia, psychomotor agitation or retardation, increased fatigue, feelings of guilt or worthlessness, slowed thinking or impaired concentration, a suicide attempt or suicidal ideation. The antidepressant action of Celexa in hospitalized depressed patients has not been adequately studied.

The efficacy of Celexa in maintaining an antidepressant response for up to 24 weeks following 6 to 8 weeks of acute treatment was demonstrated in two placebo-controlled trials (see CLINICAL PHARMACOLOGY). Nevertheless, the physician who elects to use Celexa for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient.

Dosage and Administration: 40 mg/daily

Side-effects:

The premarketing development program for Celexa included citalopram exposures in patients and/or normal subjects from 3 different groups of studies: 429 normal subjects in clinical pharmacology/pharmacokinetic studies; 4422 exposures from patients in controlled and uncontrolled clinical trials, corresponding to approximately 1370 patient-exposure years. There were, in addition, over 19,000 exposures from mostly open-label, European postmarketing studies. The conditions and duration of treatment with Celexa varied greatly and included (in overlapping categories) open-label and double-blind studies, inpatient and outpatient studies, fixed-dose and dose-titration studies, and short-term and long-term exposure. Adverse reactions were assessed by collecting adverse events, results of physical examinations, vital signs, weights, laboratory analyses, ECGs, and results of ophthalmologic examinations.

Adverse events during exposure were obtained primarily by general inquiry and recorded by clinical investigators using terminology of their own choosing. Consequently, it is not possible to provide a meaningful estimate of the proportion of individuals experiencing adverse events without first grouping similar types of events into a smaller number of standardized event categories. In the tables and tabulations that follow, standard World Health Organization (WHO) terminology has been used to classify reported adverse events.

The stated frequencies of adverse events represent the proportion of individuals who experienced, at least once, a treatment-emergent adverse event of the type listed. An event was considered treatment-emergent if it occurred for the first time or worsened while receiving therapy following baseline evaluation

Warnings and Precautions:

Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. There has been a long-standing concern, however, that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment.

Information Source:



Trade Name: Clonidine

Generic Equivalent: Catapres

Primary Reason for prescription:

Clonidine (Catapres") belongs to a class of medications known as antihypertensives. It is used for the management of hypertension (high blood pressure). It can be used in children for a condition known as Attention Deficit Hyperactivity Disorder (ADHD). It may also be used in combination with other pain medication for treating certain kinds of pain. It is available as a tablet, as a patch applied to the skin or your pharmacist may be able to make a liquid.

Common Indications:

▪ Give this medication as directed, and do not stop taking unless directed to stop by your child's doctor.

▪ Notify your child's doctor of any other medications your child is taking.

▪ Let your child's doctor know if your child has a heart condition or kidney disorder prior to giving this medicine.

▪ It is best to avoid alcohol or over the counter medications that contain alcohol while taking this medication.

▪ The patches should be applied at bedtime to a clean, hairless area of the upper arms or chest.

▪ Rotate where the patch is applied weekly. Do not cut the patches.

▪ Do not use after the expiration date on the bottle/package.

▪ If too much medication is taken by accident, call the Drug and Poison Information Center (DPIC), 513-636-5111 or 1-800-222-1222, or call your child's doctor immediately.

▪ Keep this medication out of the reach of children

Dosage and Administration:

Dosages of 0.4–0.6 mg have been used for the treatment of alcohol withdrawal. Total daily dosage for the treatment of opiate withdrawal range between 0.5 and 1.4 mg, depending on the stage as well as the severity of withdrawal symptoms. If the clonidine patch is used to treat nicotine withdrawal symptoms, dosages that deliver 0.1–.2 mg daily are used. For oral therapy (tablets), a total dosage of 0.2–0.4 mg daily is taken in divided doses.

Pediatric doses of clonidine are calculated based on the child's body weight. Clonidine dosage for ADHD in children is 5 micrograms per kilogram of body weight per day orally in four divided doses. Children who require a daily dosage of 0.2 mg usually can use the 0.3 mg dermal patch. If ADHD is associated with sleep disturbances, low to moderate doses of clonidine can be taken at bedtime. Oral doses in children with Tourette's syndrome range from 3 to 6 micrograms per kilogram of body weight per day divided into two to four even doses.

Read more:

Side-effects:

Call your child's doctor if the following effects continue or are bothersome:

▪ Drowsiness

▪ Dizziness

▪ Fatigue

▪ Headache

▪ Dry mouth

Warnings and Precautions:

Call your child's doctor immediately if your child develops any of the following:

▪ Trouble breathing

▪ Chest pain

▪ Unusually severe fatigue or drowsiness

▪ Increased heart rate

▪ Tremors

Trade Name: Concerta

Generic Equivalent: methylphenidate HCl

Primary Reason for prescription: It is a central nervous system (CNS) stimulant

Common Indications: It is indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children 6 years of age and older, adolescents, and adults up to the age of 65.

Dosage and Administration:

|Patient Age |Recommended Starting Dose |Dose Range |

|Children 6-12 years of age |18 mg/day |18 mg - 54 mg/day |

|Adolescents 13-17 years of age |18 mg/day |18 mg - 72 mg/day not to |

| | |exceed 2 mg/kg/day |

|Adults 18-65 years of age |18 or 36 mg/day |18 mg - 72 mg/day |

Side-effects: Drug Dependence, Hypersensitivity to Methylphenidate,Agitation,Glaucoma, Tics, Monoamine Oxidase Inhibitors,Serious Cardiovascular Events,Psychiatric Adverse Events, Seizures,Long-Term Suppression of Growth,Visual Disturbance,Potential for Gastrointestinal Obstruction,Hematologic Monitoring

Warnings and Precautions: Sudden death has been reported in association with CNS stimulant treatment.

Sudden deaths, stroke, and myocardial infarction have been reported in adults taking stimulant drugs at usual doses for ADHD.

Retrieved from on 9/25/09

Trade Name: Depakote  

Generic Equivalent:  Divalprocx Sodium  

Primary Reason for prescription: Treatment of manic episodes associated with bipolar disorders.  It is also used for seizures and migraines.

Common Indications: A manic episode is a distinct period of abnormally and persistently elevated, expansive or irritable mood.  It is frequently used in the treatment of patients with complex partial seizures and for migraine headaches. 

Dosage and Administration: An overall average dosage of 50mgs – 125 mgs is most often prescribed by physicians. Average Dosage for children 60 mg per day, Average adult females 110mg. Average adult males 135mg.   

Side-effects:  Hepatotoxicity-Hepatic failure ( less likely in older patients ) vomiting, nausea, somnolence, and dizziness.

 Warnings and Precautions: This drug can be hazardous to a fetus.  Pancreatitis is possible in children and adults.  Other problems include urea cycle disorders, dehydration which is sometimes fatal as well as liver problems. 

 Information Source:



Trade Name: Desyrel

Generic Equivalent: Trazadone

Primary Reason for prescription:

This medication is used to treat depression. This medication may also be used for relief of symptoms of an anxiety disorder (e.g., sleeplessness, tension), or to treat chronic pain.

Common Indications:

Major Depressive Episode implies a prominent and relatively persistent (nearly every day for at least two weeks) depressed or dysphoric mood that usually interferes with daily functioning, and includes at least four of the following eight symptoms: change in appetite, change in sleep, psychomotor agitation or retardation, loss of interest in usual activities or decrease in sexual drive, increased fatigability, feelings of guilt or worthlessness, slowed thinking or impaired concentration, and suicidal ideation or attempts.

Dosage and Administration:

An initial dose of 150 mg/day in divided doses is suggested. The dose may be increased by 50 mg/day every three to four days. The maximum dose for outpatients usually should not exceed 400 mg/day in divided doses. Inpatients (i.e., more severely depressed patients) may be given up to but not in excess of 600 mg/day in divided doses.

Side-effects:

This drug may cause drowsiness, dizziness, blurred vision, loss of appetite, dry mouth, strange taste in mouth, anxiety, restlessness or sweating. If these effects persist or worsen, notify your doctor promptly. Notify your doctor promptly if you develop: chest pain, rapid heart rate, shortness of breath, difficulty urinating, blood in the urine, nightmares, uncoordinated movements. Tell your doctor immediately if any of these unlikely but serious side effects occur: black stools, "coffee ground" vomit, easy bruising/bleeding. Males - if you experience painful and prolonged erections, stop using this drug and seek immediate medical attention. In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention. Symptoms of an allergic reaction include: rash, itching, swelling, severe dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.

Warnings and Precautions:

Tell your doctor your medical history, especially if you have: heart disease, liver disease, kidney disease, blood pressure problems, any allergies (including nefazodone). Use caution performing tasks requiring alertness such as driving or using machinery. To avoid dizziness and lightheadedness when rising from a seated or lying position, get up slowly. Alcoholic beverages can add to the drowsiness caused by this drug. Limit alcohol intake. Though uncommon, depression itself can lead to thoughts or attempts of suicide. Tell your doctor immediately if you have any suicidal thoughts, or other mental/mood changes. Keep all medical appointments so your doctor can monitor your progress closely. Elderly patients may be more sensitive to the effects of trazodone. Use cautiously. Trazodone should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. Trazodone is excreted into breast milk. Though to date, no problems have been reported to nursing infants, consult your doctor before breast-feeding.

Information Source:





Trade Name: Focalin

Generic Equivalent: Dexmethylphenidate Hydrochloride

Primary Reason for prescription:

Focalin is indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Focalin is a central nervous system (CNS) stimulant, available in three tablet strengths. Each tablet contains dexmethylphenidate hydrochloride 2.5, 5, or 10 mg for oral administration.

Common Indications:

May interact with other medications

Dosage and Administration:

Focalin is administered twice daily, at least 4 hours apart. Focalin may be administered with or without food. Dosage should be individualized according to the needs and responses of the patient.

Side-effects:

Nausea, stomach pain, a loss of appetite, and a fever

Warnings and Precautions:

Speak to your doctor if you have a heart condition, high blood pressure, seizures or epilepsy, bipolar disorder, any allergies including food and dyes, or history of drug or alcohol abuse.

Trade Name: Haldol

Generic Equivalent: haloperidol

Primary Reason for prescription: Treat symptoms of Tourette’s Syndrome

Schizophrenia

Common Indications: Tourette’s disorder, schizoaffective disorders,mood disorders, severe behavior disorders, prevention of nausea and vomiting due to cancer treatment

Dosage and Administration: single doses of 1 to 5 mg. (up to 10mg.) oral or IM , usually repeated every four to six hours, not to exceed an oral dose of 100 mg. daily. May be taken with or without food.

Side-effects: dizziness,drowsiness, difficulty urinating, sleep disturbances, headaches, anxiety, muscle spasms.

Warnings and Precautions: increase risk of pneumonia, heart failure in older adults with demintia

Information Source:



Drugs/DrugSafety/Information by DrugClass/UCMO96273

Trade Name: Keppra

Generic Equivalent: Levetiracetam

Primary Reason for prescription:

Levetiracetam (Keppra) may be used to help control partial seizures in adults. It is usually used with, not instead of, other antiepileptic medicines (add-on, or adjunctive, therapy).

Levetiracetam may also be used alone or in combination with other epilepsy drugs to treat seizures that affect the entire brain (generalized) in adults. Or it may be used alone or in combination with other epilepsy medicines in children who have Lennox-Gastaut syndrome or absence seizures.

Common Indications:

KEPPRA is indicated as adjunctive therapy in the treatment of partial onset seizures in patient’s ≥16 years of age with epilepsy.

Dosage and Administration:

Oral Initially, 500 mg twice daily.

If response is inadequate, dosage may be increased by 1 g daily at 2-week intervals. Some clinicians reportedly initiate therapy with dosages of 2–4 g daily. Dosages >3 g daily may not be associated with increased therapeutic benefit.

Do not discontinue abruptly; withdraw gradually by reducing dosage by 1 g daily at 2-week intervals. (See Discontinuance of Levetiracetam under Cautions.)

Side-effects:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue

• breathing problems

• dark urine

• general ill feeling or flu-like symptoms

• problems with balance, talking, walking

• unusually weak or tired

• worsening of mood, thoughts or actions of suicide or dying

• yellowing of the eyes or skin

• diarrhea

• dizzy, drowsy

• headache

• loss of appetite

Warnings and Precautions:

Nervous System Effects

Pending revision, the material in this section should be considered in light of more recently available information in the MEDWATCH notification at the beginning of this monograph. Possible adverse neuropsychiatric effects are classified into 3 categories: somnolence and fatigue; coordination difficulties; behavioral changes.

Somnolence, asthenia, and coordination difficulties occur most frequently within first 4 weeks of treatment. Psychotic manifestations and hallucinations reported rarely. Possible behavioral symptoms (e.g., agitation, hostility, anxiety, apathy, emotional liability, depersonalization, depression, aggression, anger, irritability).

Discontinuance of Levetiracetam

Abrupt withdrawal may result in increased seizure frequency or status epileptics. (See Partial Seizures under Dosage and Administration.)

General Precautions

Hematologic Effects: Minor decreases in total mean erythrocyte count, mean hemoglobin, and mean hematocrit possible.

Possible leukopenia, neutropenia, pancytopenia with myelosuppression in some cases, and thrombocytopenia.

Hepatic Effects: No meaningful changes in liver function test results in controlled studies.

Possible Prescribing and Dispensing Errors

Ensure accuracy of prescription; similarity in spelling of Keppra® (levetiracetam) and Kaletra® (fixed combination of lopinavir and ritonavir, both antiretroviral agents) may result in errors.

Specific Populations

Pregnancy: Category C.

Keppra® Pregnancy Registry at 888-537-7734 or North American Antiepileptic

Lactation: Distributed into milk. Discontinue nursing or the drug because of potential risk in nursing infant.

Pediatric Use: Safety and efficacy not established in children ................
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