High Risk Medication Alternative Table - SCAN Health Plan
High Risk Medication Alternative Table
Description Anticholinergics
Antithrombotics Anti-infective Cardiovascular
High Risk Medication
Rationale for risk*
brompheniramine2, carbinoxamine2, Highly anticholinergic, clearance reduced with
chlorpheniramine2, clemastine2, advanced age, and tolerance develops when
cyproheptadine,
used as hypnotic; greater risk of confusion, dry
dexbrompheniramine2,
mouth, constipation, and other anticholinergic
dexchlorpheniramine2,
effects and toxicity.
diphenhydramine (oral)2,
dimenhydrinate2, doxylamine2,
hydroxyzine,
meclizine, promethazine,
triprolidine2
Alternatives
Allergy: levocetirizine, desloratadine, montelukast, azelastine, intranasal steroid (e.g., fluticasone), OTCs such as cetirizine, loratadine, fexofenadine, or intranasal normal saline (member to pay out of pocket) Cough: OTCs such as guaifenesin, dextromethorphan (member to pay out of pocket) Anti-emetic: ondansetron-oral1, granisetron-oral1, aprepitantoral1
benztropine (oral), trihexyphenidyl Not recommended for prevention of
carbidopa & levodopa, carbidopa & levodopa & entacapone,
extrapyramidal symptoms with antipsychotics; ropinirole, pramipexole, amantadine
more-effective agents available for treatment of
Parkinson's disease.
dipyridamole - oral short acting (does not apply to ER combination with aspirin)
May cause orthostatic hypotension; more effective alternatives available; intravenous form acceptable for use in cardiac stress testing.
dipyridamole & aspirin, clopidogrel
nitrofurantoin
Potential for pulmonary toxicity; safer
For UTI Treatment, use sulfamethoxazole/trimethoprim,
alternatives available; lack of efficacy in patients fluoroquinolone (i.e., ciprofloxacin), cephalosporins (i.e.,
with CrCl < 30 mL/min due to inadequate drug cephalexin), amoxicillin-clavulanate
concentration in the urine.
Note: Dosage reduction required for ciprofloxacin and
sulfamethoxazole/trimethoprim if CrCl 6mg/day) , imipramine, nortriptyline, paroxetine
Highly anticholinergic, sedating, and causes orthostatic hypotension; safety profile of lowdose doxepin (6 mg/day) is comparable with that of placebo.
Neuropathic pain: gabapentin, duloxetine, pregabalin, lidocaine patch1, lidocaine topical/ointment3, capsaicin topical (OTC ? member to pay out of pocket) Note: Dosage reduction required for gabapentin and pregabalin if CrCl ................
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