#sigler drug cards

[siglerprescriptiondrugcards]

Venlafaxine Hydrochloride

Brand Name: Effexor, Effexor XR

Generic Available

Common Dosage Forms:

Tablets: 25 mg, 37.5 mg, 75 mg, 100 mg

Capsules, extended release: 37.5 mg, 75 mg, 150 mg

Tablets, extended release: 37.5 mg, 75 mg, 150 mg, 225 mg

FDA Indications/Dosages:

For the treatment of depression: Start with 75 mg/day administered in a single dose (XR) or 2-3 divided doses (tablets), taken with food. The dose may be increase to 150 mg/day. If needed, the dose should be further increased to 225 mg/day. When increasing the dose, increments of 75 mg/day should be made at intervals of no less than 4 days. Certain patients, including more severely depressed patients, may respond more to higher doses, up to a maximum of 375 mg/day.

For the treatment of generalized anxiety disorder (XR): Start with 37.5 mg/day. Maintenance dosage range is 75-225 mg/day.

For the treatment of social anxiety disorder (XR): Start with 75 mg/day. Maintenance dosage range is 75-225 mg/day.

Dosage during hepatic impairment: Reduce the total daily dose by 50% in patient with moderate hepatic impairment.

Dosage during renal impairment: Reduce the total daily dose by 25% in patients with mild to moderate renal impairment.

Switching patients to or from a monoamine oxidase inhibitor (MAOI): At least 14 days should elapse between discontinuation of an MAOI and initiation of therapy. In addition, at least 7 days should be allowed after stopping therapy before starting an MAOI.

Monitor: BP, IOP, Na

Pharmacology/Pharmacokinetics: The mechanism of action of venlafaxine is believed to be associated with its potentiation of neurotransmitter activity in the CNS. Studies have shown that venlafaxine and its active metabolite are potent inhibitors of neuronal serotonin and norepinephrine reuptake. They are also weak inhibitors of dopamine reuptake. Venlafaxine is well absorbed (~92%) and extensively metabolized in the liver. Approximately 87% of venlafaxine dose is recovered in the urine within 48 hours as either unchanged venlafaxine (5%), unconjugated O-desmethylvenlafaxine (ODV), conjugated ODV (26%), or other minor inactive metabolites (27%). Renal elimination of venlafaxine and its metabolites is the primary route of elimination.

Drug Interactions: Venlafaxine in combination with MAO inhibitors has resulted in serious, sometimes fatal, reactions. The use of other CNS active drugs, including antihistamines, should be approached with caution. Coadministration with aspirin or an NSAID may increase the risk of upper GI bleeding.

Contraindications/Precautions: It is recommended that venlafaxine not be used in combination with an MAOI, or with 14 days of discontinuing treatment with an MAOI. At least 1 week should be allowed after stopping venlafaxine before starting a MAOI. ANTIDEPRESSANTS INCREASE SUICIDAL THOUGHTS AND ACTIONS IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS. Use with caution in patients with pre-existing hypertension. For patients who experience a sustained increase in blood pressure while receiving venlafaxine, either a dose reduction or discontinuation should be considered. As with all antidepressants, caution should be used in patients with a history of mania. Venlafaxine should be used cautiously in patients with a history of seizures. In patients with renal impairment or cirrhosis of the liver, the clearances of venlafaxine and its active metabolite were decreased, thus prolonging the elimination half-lives of these substances. In patients who have received extended release forms for 6 weeks or more should have their dose tapered over at least a week period if therapy is discontinued.

Adverse Effects: The most common adverse effects include nausea, dry mouth, anorexia, constipation, drowsiness, insomnia, dizziness, nervousness, abnormal ejaculation, sweating, impotence, decreased libido, and yawning.

Patient Consultation:

Avoid alcohol while taking this medication.

Patients should be advised to inform their physician if they are taking, or plan to take, any prescription or over-the-counter drugs, since there is a potential for interactions.

Store in a cool, dry place away from sunlight and children.

Contact a physician if the above side effects are severe or persistent.

Swallow capsules while; do not crush, chew, dissolve, or divide.

Do not stop therapy before consulting with a physician.

Pay close attention to any changes, especially sudden changes, in mood behavior, thoughts, or feelings. Antidepressants may increase suicidal thoughts or actions.

Continued therapy of up to 2 weeks may be needed to show noticeable improvement.

[tabloidtoc]

Life & Style, February 25

Cover: George Clooney tells Amal that it’s over

Page 2: Photo Flash -- Cardi B in Bazaar 

Page 4: Contents

Page 6: Top 10 Winter White Looks -- Laura Harrier, Cara Santana, Natalie Portman, Regina King, Amy Adams 

Page 7: Gemma Chan, Kate Beckinsale, Saoirse Ronan, Danai Gurira, Nicole Kidman 

Page 8: Twinning -- Judith Light vs. Ashlee Simpson 

Page 12: Sex, drugs and trust issues -- inside Justin Bieber and Hailey Baldwin’s troubled marraige 

Page 13: Teresa Giudice and Lisa Rinna and Sarah Jessica Parker battle to be godmother to Andy Cohen’s newborn son, Throwback -- Wilmer Valderrama, Biggest Spenders of the Week -- Jennifer Garner, Kylie Jenner, Chris Pratt, Hailey Baldwin, Emily Ratajkowski 

Page 14: NeNe Leakes at war with Lisa Vanderpump, Priyanka Chopra’s nonstop partying, Whose Sports Car Is It? Jamie Foxx, Justin Bieber, Caitlyn Jenner, Kim Kardashian, Tyga, Drake 

Page 16: Kristin Cavallari is reality TV’s queen of mean 

Page 17: The Bachelor’s Demi Burnett not looking for love but wants to be on Bachelor in Paradise, Lea Michele’s laid-back bachelorette party in Hawaii included Emma Roberts and Jamie-Lynn Sigler and JoAnna Garcia Swisher, VIP Style -- Cardi B watched Travis Scott on stage, The Black Eyed Peas, Christina Applegate, Dwayne Wade and Gabrielle Union, Michelle Williams, Eva Longoria, Elizabeth Chambers, Aly Raisman 

Page 18: The Week in Photos -- The Lego Movie 2: The Second Part premiere with Elizabeth Banks, Tiffany Haddish, Chris Pratt, Alison Brie and Will Arnett 

Page 19: Miley Cyrus, Kate Middleton with a dog 

Page 20: Pink and her husband Carey Hart and kids with her when she gets a star on the Hollywood Walk of Fame, Alex Rodriguez, Andy Cohen 

Page 22: Gigi Hadid, Ashton Kutcher and son Dimitri, Busy Philipps 

Page 24: Ellie Kemper, Patrick Schwarzenegger, Brie Larson and Tracee Ellis Ross 

Page 26: Kiss Cam -- Kendall Jenner and niece Stormi, Glenn Close and dog Sir Pippin on Beanfield, Bryce Dallas Howard as Harvard’s Hasty Pudding Woman of the Year 

Page 28: Stars Behaving Badly -- Spencer Pratt and Keith Lemon, Khloe Kardashian, Celine Dion and Pepe Munoz 

Page 29: Bill Murray and Nick Offerman and David Ross 

Page 30: Say What?! Michelle Williams on social media, Zoe Kravitz on Reese Witherspoon, Christina Aguilera on Pink, Victoria Beckham on the Spice Girls, Rebel Wilson on dating books 

Page 32: Julia Roberts sweet surprise for husband Danny Moder -- an Alaskan getaway for his 50th birthday 

Page 33: 47-year-old Denise Richards and new husband Aaron Phypers are talking about having a baby, Ricki Lake’s risky romance with One Golden Thread founder Jeff Scult, Romance Report Card -- Jason Aldean, Leonardo DiCaprio, Kit Harington 

Page 34: Kim Kardashian tells Kanye West to stop spending money, Chanel Iman and Sterling Shepard are discussing another baby, Alexis Bellino dating a married man 

Page 35: Ariana Grande couldn’t care less that former fiance Pete Davidson is hooking up with Kate Beckinsale, Can You Believe They Dated? Ryan Reynolds and Kristen Johnston in 1999 

Page 36: Cover Story -- mismatched George and Amal Clooney seem headed for a devastating split 

Page 40: Kate Middleton and Meghan Markle battle over the royal supernanny 

Page 42: Why Miranda Lambert has been laying low in recent months 

Page 44: Jennifer Lawrence engaged 

Page 46: Stars who were teachers -- Hugh Jackman, Jon Hamm -- Ellie Kemper was his student 

Page 47: Sheryl Crow, Sylvester Stallone, Sting 

Page 48: Who Lives Here? Bruce Willis 

Page 50: Entertainment 

Page 51: Star Review -- Jane Krakowski, As Seen On-Screen -- the silver pendant Adrienne Bankert wore on GMA is Peggy Li’s Mother of Pearl and Agate Drop Necklace 

Page 52: Style -- Puffy Sleeves -- Nina Dobrev, Dua Lipa

Page 53: Victoria Justice, Alison Brie 

Page 54: Emily Blunt’s stylish start to the new year 

Page 56: Beauty -- Switching Up Your Hair -- Chrissy Teigen, Amanda Seyfried 

Page 57: Lucy Boynton, Priyanka Chopra 

Page 58: Style Crush -- Hilary Duff 

Page 60: How She Got That Body -- Chanel Iman 

Page 62: The Fabulous Life of Priyanka Chopra 

Page 64: Diva or Down-to-Earth? Rachel Bilson, Gal Gadot, Nicky Hilton 

Page 66: Social Stars Posts of the Week -- Liv Tyler, Jaimie Alexander, Jason Biggs, Kaley Cuoco 

Page 67: Julia Louis-Dreyfus and Kristofer Hivju, Danica Patrick and Aaron Rodgers, Margot Robbie, Hilaria Baldwin and 3 crying kids 

Page 68: Horoscope -- Pisces Rihanna, They’re Not Together But They Should Be -- Sagittarius Rita Ora and Pisces Trevor Noah 

Page 70: Made Ya Look -- Taboo and apl.de.ap of The Black Eyed Peas 

Page 72: What I’m Into -- Ellie Kemper 

[siglerprescriptiondrugcards]

Omeprazole

Brand Name: Prilosec

Generic Available

Common Dosage Forms:

Capsules, sustained release*: 10 mg, 20 mg, 40 mg

*Also available in a 20 mg nonprescription formulation

FDA Indications/Dosages:

Short-term treatment of active duodenal ulcer: 20 mg daily for 4-8 weeks.

Short-term treatment of erosive esophagitis or poorly responsive gastroesophageal reflux disease: 20 mg daily for 4-8 weeks.

Pathological hypersecretory conditions including Zollinger-Ellison syndrome, multiple endocrine adenomas, and systemic mastocytosis: Initial dose is 60 mg once a day. Doses up to 120 mg given three times a day have been administered. Some patients have been treated continuously for more than 5 years.

Maintenance therapy of healing erosive esophagitis: 20 mg given once daily.

To maintain the healing of erosive esophagitis and gastric ulcers: 20 mg given once daily.

For the treatment of GERD or other acid-related disorders in pediatric patients over the age of 2 years: For patients <20 kg give 10 mg daily. For patients >20kg give 20 mg daily.

As an adjunct in the treatment of H. pylori infection:

Dual Therapy: Omeprazole 40 mg once daily with clarithromycin 500 mg given 3 times a day for 14 days. If an ulcer was present at initiation of treatment, follow with omeprazole 20 mg once a day for 14 days.

Triple Therapy: Omeprazole 20 mg with clarithromycin 500 mg plus amoxicillin 1000 mg given twice daily for 10 days. If an ulcer was present at initiation of therapy, follow with omeprazole 20 mg once a day for 18 days.

Monitor: BMD, Mg

Pharmacology/Pharmacokinetics: Omeprazole is a proton-pump inhibitor (PPI) that suppresses the H+/K+ ATPase enzyme system at the secretory surface of the gastric parietal cell. The enzyme system is involved in the movement and production of gastric acid. Omeprazole is acid-labile and is formulated as enteric-coated granules. Onset after oral administration occurs within 1 hour and reached a maximum at 2 hours. The binding to the (H+/K+)-ATPase results in antisecretory activity that lasts for more than 72 hours.

Drug Interactions: Increases plasma levels of diazepam, phenytoin, and warfarin by inhibiting oxidative metabolism. May also interact with other drugs metabolized via the cytochrome P450 system (cyclosporine, disulfiram, benzodiazepine). Since the pharmacological effect of omeprazole increases gastric pH, absorption of drugs in which bioavailability is determined by gastric pH may be changed. This would include ketoconazole, digoxin, cyanocobalamin, ampicillin esters, and iron salts. Antacids may be used concomitantly. Voriconazole may increase plasma levels. Omeprazole inhibits the metabolism of cilostazol. Omeprazole prevents the conversion of clopidogrel to its active metabolite.

Contraindications/Precautions: Animal studies have shown a dose-related increased risk for gastric carcinoid tumors with long-term use. The levels of drug needed to produce tumors far exceeded the normal daily dose (up to 352 times the human dose). Pregnancy Category C.

Adverse Effects: Side effects are rare but may include back pain, cough, constipation, rash, and dizziness.

Patient Consultation:

Take 30 minutes prior to eating.

Antacids may be taken at the same time.

Store in a cool, dry place away from sunlight and children.

If a dose is missed, take it as soon as possible. If it is closer to the time of your next dose than the dose you missed, skip the missed dose and return to your dosing schedule. Do not double doses.

Contact a physician if the above side effects are severe or persistent.

For patients who have difficulty swallowing capsules, the contents of a capsule can be added to one tablespoon of applesauce, swallowed immediately and followed by a glass of cool water. The contents of the capsule should not be crushed or chewed.

[siglerprescriptiondrugcards]

Methylphenidate Hydrochloride

This medication is a Schedule II drug.

Brand Names: Ritalin, Methylin, Metadate, Concerta, Quillichew, Quillivant XR

Generic Available

Common Dosage Forms:

Tablets (Ritalin, Methylin): 5 mg, 10 mg, 20 mg

Tablets, sustained-release (Ritalin SR, Methylin ER, Metadate ER): 10 mg, 20 mg

Capsules, controlled-release (Ritalin LA, Metadate CD): 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg

Tablets, extended-release (Concerta): 18 mg, 27 mg, 36 mg, 54 mg

Tablets, chewable (Methylin): 2.5 mg, 5 mg, 10 mg

Solution (Methylin): 5 mg/5 mL, 10 mg/5 mL

Tablets, extended-release (Quillichew): 20 mg, 30 mg, 40 mg

Suspension, extended-release (Quillivant XR): 25 mg/5 mL after reconstitution

*Not all extended-release forms are AB-rated substitutions.

FDA Indications/Dosages:

For the treatment of attention-deficit disorders in children (>6 years): Initially 5 mg twice a day before breakfast and lunch with gradual increases in increments of 5-10 mg weekly.

For the treatment of narcolepsy in adults: 10-60 mg daily in 2-3 divided doses.

SR tablets can be given in two divided doses.

CD/LA/ER forms can be given once daily in the morning.

Pharmacology/Pharmacokinetics: Methylphenidate presumably activates the brain stem arousal system and cortex to produce its stimulant effect. Peak plasma levels are reached in 2 hours with the tablets and in 5 hours with the SR tablets. Half-life of immediate-release tablets range from 1-3 hours with effects lasting for 4-6 hours. Each bead-filled capsule of the LA formulation provides an immediate release of methylphenidate for rapid onset of action, and a second release of medication approximately 4 hours after administration. The bimodal release formulation of LA capsules provides two peak concentrations of medications.

Drug Interactions: May produce hypertensive crises when used with MONOAMINE OXIDASE INHIBITORS. May increase serum levels of phenytoin, phenobarbital, warfarin, and serotonin-reuptake inhibitors. Serious adverse effects have occurred when used with clonidine.

Contraindications/Precautions: Use is contraindicated in patients with anxiety, tension, agitations, in patients with glaucoma or motor tics, and in patients with a gamily history or diagnosis of Tourette’s syndrome. CNS STIMULANTS HAVE A HIGH POTENTIAL FOR ABUSE. Use is contraindicated in patients currently taking or within 14 days of taking a monoamine oxidase inhibitor. Use with caution in patients with seizures. Stimulants may increase blood pressure and heart rate and caution should be used in patients with hypertension or any other cardiac abnormality. Use with caution in emotionally unstable patients, such as those with a history of drug dependance or alcoholism, and in patients with bipolar disorder. Methylphenidate should not be used in patients under six years of age. Pregnancy Category C.

Adverse Effects: Nervousness, insomnia, anorexia, nausea, dizziness, palpitations, headache, angina, and drowsiness.

Patient Consultation:

Take last dose early in the evening to avoid insomnia.

WARNING: This medication may be habit-forming.

This prescription cannot be refilled.

Store in a cool, dry place away from sunlight and children.

Contact a physician if the above side effects are severe or persistent.

If a dose is missed, skip it and return to normal dosing schedule.

LA capsules may be swallowed whole, or the contents sprinkled over soft food and ingested without chewing.

Swallow extended-release tablets whole, do not break, chew, or crush.

[siglerprescriptiondrugcards]

Testosterone Gel (Topical)

This medication is a Schedule III drug.

Brand Name: Androgel, Fortesta, Testim

Generic Available

Common Dosage Forms*:

Topical 1% Gel Pump (Androgel): Each pump contains 75 g or 60 metered 1.25 g doses containing 12.5 mg testosterone

Topical 1% Gel Foil Packets (Androgel): 2.5 g/packet (25 mg testosterone) or 5 g/packet (50 mg testosterone)

Topical 1.62% Gel (Androgel): Each pump contains 75 g or 60 metered 1.25 g doses containing 20.25 mg testosterone

Topical 2% Gel (Fortesta): Each pump actuation contains 10 mg testosterone

*Testosterone is also available in topical patches, injection, and oral formulations

FDA Indications/Dosages:

For replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone including primary hypogonadism and hypogonadotropic hypogonadism: The recommended starting dose is 50 mg applied once daily (5 g of the 1% gel [4 actuations] or 2.5 g of the 1.62% gel [actuations]). Doses should be applied to the upper arms and shoulders. Maximum recommended dose is 81 mg/day.

Monitor: Hematocrit, Hemoglobin, Serum testosterone, PSA, Lipid panel, LFT

Pharmacology/Pharmacokinetics: Endogenous androgens, including testosterone and dihydrotestosterone (DHT) are the major sex hormones in males and are involved in development of the male sex organs and secondary sex characteristics. Testosterone and DHT binds to certain receptor proteins found in the cytoplasm of sensitive hormone-receptor complex. This hormone-receptor complex enters the nucleus of the cell where it reacts with chromatin, or DNA. The hormone, or possibly the receptor, then uses stored information to stimulate, or in some cases inhibit, the transcription of mRNA. The stimulation of mRNA results in the synthesis of specific enzymes that carry out its actions. Topically applied testosterone gel provides continuous absorption of testosterone for 24 hours.

Drug Interactions: May decrease insulin requirements by decreasing blood glucose, may change anticoagulant activity, may increase fluid retention when used with corticosteroids.

Contraindications/Precautions: Contraindicated in males with carcinoma of the breast or prostate and in women. May increase symptoms of BPH and the risk of prostate cancer. May cause polycythemia; check baseline hematocrit and recheck 3-6 months after starting treatment. Use with caution in patients with congestive heart failure due to increased risk for edema. Use with caution in patients with hyperlipidemia. SECONDARY EXPOSURE TO TESTOSTERONE HAS CAUSED VIRILIZATION IN CHILDREN. Pregnancy Category X.

Adverse Effects: The most common adverse reactions include increased PSA, emotional lability (anger, mood swings, aggression), hypertension, increased hematocrit or hemoglobin, contact dermatitis.

Patient Consultation:

Apply to clean, dry skin once daily.

Decrease the risk of transferring the gel to others by applying to areas of the upper body (upper arms and shoulders) which are covered by a short-sleeve shirt. Do not apply to genital areas.

Wash hands after application.

Allow area to dry before covering with clothes.

Women and children should avoid contact with unwashed or unclothed areas of applications.

Avoid showering or swimming for 2 hours after application.

If a dose is missed, skip it and continue with regular dosing schedule. Do not double doses.

Notify your physician if you trouble starting to urinate or if you experience increased urination at night.

Report to your physician any unusual swelling or pain in the legs, ankles, or feet.

[siglerprescriptiondrugcards]

Duloxetine Hydrochloride

Brand Name: Cymbalta

Generic Available

Dosage Forms:

Capsules: 20 mg, 30 mg, 60 mg

FDA Indications/Dosages:

For the treatment of major depressive disorder (MDD): The normal total daily dose is 40-60 mg. A 40 mg daily dose should be given as 20 mg twice a day. A 60 mg daily dose may be given as 30 mg twice a day or 60 mg once a day.

For the management of neuropathic pain associated with diabetic peripheral neuropathy: 60 mg per day.

For the treatment of generalized anxiety disorder (GAD): Start with 30 mg daily for 1 week and then increase to 60 mg daily. Maximum daily dose is 120 mg.

For the management of chronic musculoskeletal pain: Start with 30 mg daily for 1 week then increase to 60 mg daily.

If the choice to discontinue duloxetine is made, a gradual reduction of dose rather than abrupt cessation is recommended. At least 14 days should elapse between discontinuation of a monoamine oxidase inhibitor and initiation of duloxetine. At least 5 days should elapse before starting an MOAI after discontinuing duloxetine.

Pharmacology/Pharmacokinetics: Duloxetine is a potent inhibitor of neuronal serotonin and norepinephrine reuptake and a slight inhibitor of dopamine reuptake. Its mechanism of action is thought to be due to a potentiation of serotonergic and noradrenergic activity in the CNS. Duloxetine is well absorbed orally with peak plasma concentrations reached in 6 hours. Food slightly delays the time to peak plasma levels and decreases amount absorbed by 10%. Evening doses delay absorption by 3 hours and increase apparent clearance of duloxetine by 30%. Metabolism occurs via many pathways, including hepatic isoenzymes CYP2D6 and CYP1A2. Elimination half-life is approximately 12 hours and steady-state levels are reached in 3 days.

Drug Interactions: Serious and sometimes fatal reactions have occurred in patients taking a serotonin reuptake inhibitor with MONOAMINE OXIDASE INHIBITORS. Potents inhibitors of CYP1A2 (fluvoxamine, quinolones) and CYP2D6 (paroxetine, fluoxetine, quinidine) will increase plasma levels of duloxetine. Plasma levels of drugs metabolized by CYP2D6 (tricyclic antidepressants, phenothiazines, propafenone, and flecainide) may be increased when used with duloxetine.

Contraindications/Precautions: ANTIDEPRESSANTS INCREASE SUICIDAL THOUGHTS AND ACTIONS IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS. Use is contraindicated in patients taking monoamine oxidase inhibitors and in patients with uncontrolled narrow-angle glaucoma. Patients being treated with antidepressants should be observed closely for clinically worsening and suicidality, especially at the beginning of therapy, or at the time of dose changes. Use with caution in patients with impaired hepatic function and in patients with heavy alcohol use. Duloxetine may increase blood pressure and active mania/hypomania in some individuals; use appropriate precautions. Use with caution in patients with a history of seizures or controlled narrow-angle glaucoma. Do not use late into the third trimester. Nursing is not recommended while on duloxetine. Pregnancy Category C.

Adverse Effects: Adverse effects occurring in more than 2% of the population include nausea (20%), dry mouth (15%), constipation (11%), insomnia (11%), dizziness (9%), diarrhea (8%), decreased appetite (8%), fatigue (8%), drowsiness (7%), sweating (6%), vomiting (5%), blurred vision (4%), and erectile dysfunction (4%).

Patient Consultation:

Therapeutic effects may take as long as 4 weeks to appear.

May cause drowsiness. Use caution while operating machinery or when mental alertness is required.

Avoid alcohol while taking this medication.

Consult your physician or pharmacist before taking nonprescription medications.

Do not abruptly discontinue medication.

Store in a cool, dry place away from sunlight and children.

Contact a physician if the above side effects are severe or persistent.

If a dose is missed, skip it and return to normal dosing schedule.

Pay close attention to any changes, especially sudden changes, in mood behaviors, thoughts, or feelings. Antidepressants may increase suicidal thoughts or feelings.

Continued therapy of up to 2 weeks may be needed to show noticeable improvement.

[siglerprescriptiondrugcards]

Desvenlafaxine

Brand Name: Pristiq

Generic Available

Common Dosage Forms:

Tablets, extended-release: 25 mg (38 mg desvenlafaxine succinate), 50 mg (76 mg desvenlafaxine succinate), 100 mg (152 mg desvenlafaxine succinate).

FDA Indications/Dosages:

For the treatment of major depressive disorder (MDD): The recommended dose is 50 mg once daily, with or without food. Doses of up to 400 mg per day can be effective although with higher incidences of adverse effects and no more effectiveness than 50 mg.

Dosing in patients with severe renal impairment (24-hr CrCL <30 mL/min): Give 50 mg every other day.

A gradual reduction of dose rather than abrupt cessation is recommended when discontinuing desvenlafaxine.

Monitor: BP, IOP, Na.

Pharmacology/Pharmacokinetics: Non-clinical studies have shown that desvenlafaxine is a potent inhibitor of neuronal serotonin and norepinephrine reuptake. Desvenlafaxine is well absorbed (~80%) with about 45% excreted in the urine as unchanged drug 72 hours after an oral dose. The remaining drug is metabolized primarily by conjugation and to a minor extent, through oxidative metabolism (CYP3A4). Peak plasma levels are reached in about 7.5 hours. Mean terminal half-life is approximately 11 hours. Once-daily dosing produces steady-state levels after 4 or 5 days of therapy.

Drug Interactions: Combination with MAO inhibitors may produce serious and fatal reactions. Allow 14 days to pass between the use of a MAO inhibitor and desvenlafaxine. The use of other CNS active drugs, including antihistamines, should be approached with caution. Coadministration with aspirin or an NSAID may increase the risk of upper GI bleeding. Use with caution in combination with other serotonergic drugs due to the possibility of serotonin syndrome.

Contraindications/Precautions: ANTIDEPRESSANTS INCREASE SUICIDAL THOUGHTS AND ACTIONS IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS. It is recommended that desvenlafaxine not be used in combination with an MAOI, or within 14 days of discontinuing treatment with an MAOI. At least 1 week should be allowed after stopping desvenlafaxine before starting an MAOI. Use with caution in patients with preexisting hypertension. For patients who experience a sustained increase in blood pressure while receiving desvenlafaxine, either dose reduction or discontinuation should be considered. As with all antidepressants, caution should be used in patients with a history of mania. Use cautiously in patients with a history of seizures. Not indicated for use in pediatric patients. Pregnancy Category C.

Adverse Effects: The most common adverse effects include nausea, dry mouth, anorexia, constipation, drowsiness, insomnia, dizziness, sweating, erectile disfunction, and decreased libido.

Patient Consultation:

Pay close attention to any changes, especially sudden changes, in mood behaviors, thoughts, or feelings. Antidepressants may increase suicidal thoughts or actions.

Continued therapy of up to 2 weeks may be needed to show noticeable improvement.

Avoid alcohol while taking this medication.

Swallow tablets whole; do not crush, chew, dissolve, or divide.

Patients should be advised to inform their physician or pharmacist if they are taking, or plan to take, any prescription or over-the-counter drugs, since there is a potential for interactions.

Do not abruptly stop therapy before consulting with a physician.

Contact a physician if the above side effects are severe or persistent.

If a dose is missed, take it as soon as you remember. If it is close to the time of your next dose, skip the missed dose and return to your normal dosing schedule. Do not double doses.

The matrix tablet shell may be found intact in the stool.

[siglerprescriptiondrugcards]

Sertraline Hydrochloride

Brand Name: Zoloft

Generic Available

Common Dosage Forms:

Tablets: 25 mg, 50 mg, 100 mg

Oral Concentrate: 20 mg/mL (12% alcohol)

FDA Indications/Dosages:

Treatment of depression* and obsessive-compulsive disorder (OCD): Start with 50 mg once daily. Increase dosage as needed no sooner than weekly up to a maximum of 200 mg/day. Treatment for up to 16 weeks has shown as improvement in depressive states. Success in treatment for periods longer than 16 weeks is unknown.

Treatment of panic disorder, with or without agoraphobia and post-traumatic stress disorder (PTSD): Start with 25 mg once daily. Increase dosage as needed no sooner than weekly up to a maximum of 200 mg/day.

Treatment of premenstrual dysphoric disorder: Start with 50 mg/day, either daily throughout the menstrual cycle or limited to the luteal phase of the menstrual cycle. Changes in dose should be made at the start of the menstrual cycle up to a maximum of 150 mg/day.

Treatment of social anxiety disorder: Start with 25 mg once daily. After one week, the dose should be increase to 50 mg once daily.

*Depression is characterized by a depressed or dysphoric mood that lasts almost daily for an extended time (>2 weeks). 4 out of 8 of the following symptoms should be present to accurately diagnose the episode as depression: change in appetite, change in sleep patterns, psychomotor agitation, loss of interest in usual activities, increased fatigue, feelings of guilt or worthlessness, impaired concentration, and a suicide attempt or suicidal ideation.

Pharmacology/Pharmacokinetics: Sertraline is chemically unrelated to tricyclic or tetracyclic antidepressants. Its mechanism of action is thought to be due to its inhibition of CNS neuronal uptake of serotonin (5HT). It has very week actions on norepinephrine and dopamine neuronal reuptake. It has no significant affinity for adrenergic, cholinergic, GABA, dopaminergic, histaminergic, benzodiazepine, or serotonergic receptors. Terminal elimination half-life is 26 hours. Sertraline undergoes extensive first-pass metabolism (N-demethylation) to form a less active metabolite. Excretion occurs both through the urine and through feces. Sertraline is highly bound to plasma proteins (98%) and is a substrate for P450 hepatic isoenzyme CYP3A3/4.

Drug Interactions: Use in combination (within 14 days) with MONOAMINE OXIDASE INHIBITORS (MAOI) may cause serious or even fatal reactions. May increase PIMOZIDE levels. May be displaced by or displace other highly protein-bound drugs (warfarin, digitoxin). May decrease clearance of diazepam and tolbutamide. Variable effects may occur when used with other CYP3A3/4 substrates. Coadministration with aspirin or an NSAID may increase the risk of upper GI bleeding.

Contraindications/Precautions: Do not use pimozide or within 14 days of therapy with an MAOI. ANTIDEPRESSANTS INCREASE SUICIDAL THOUGHTS AND ACTIONS IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS. Suicide attempts are possible in depression and may continue until significant remission occurs. Only the smallest quantity possible should be dispensed. Use with caution in patients with renal or hepatic dysfunction. Although drowsiness is not a major adverse effect, patients should be careful when performing tasks which require alertness. Abrupt discontinuation of therapy may cause adverse effects including dysphoric mood, irritability, agitation, dizziness, anxiety, confusion, insomnia, and headache. Pregnancy Category B.

Adverse Effects: Nausea, diarrhea, dyspepsia, tremor, dizziness, insomnia, sweating, dry mouth, or male sexual dysfunction (ejaculatory delay).

Patient Consultation:

Continued therapy may be needed to show noticeable improvement. Do not stop therapy before consulting with a physician.

Sertraline oral concentrate must be diluted prior to use. Place the proper dose in 4 oz. of water, ginger ale, lemon/lime soda, lemonade, or orange juice ONLY. Do not mix in any other beverage. Take immediately after mixing. Do not premix doses.

Avoid alcohol while taking this medication.

Use caution when performing tasks that require mental alertness.

Consult with your physician or pharmacist before taking nonprescription medications.

Do not abruptly discontinue medication.

Store in a cool, dry place away from sunlight and children.

Contact a physician if the above side effects are severe or persistent.

If a dose is missed, skip it and return to normal dosing schedule.

Pay close attention to any changes, especially sudden changes, in mood behaviors, thoughts, or feelings. Antidepressants may increase suicidal thoughts and actions.

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Quetiapine Fumarate

Brand Name: Seroquel

Generic Available

Common Dosage Forms:

Tablets: 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, 400 mg

Tablets, extended release (XR): 50 mg, 150 mg, 200 mg, 300 mg, 400 mg

FDA Indications/Dosages:

For the treatment of schizophrenia: Initial dose should be started at 25 mg twice a day, with increases in increments of 25-50 mg two to three times a day on the second and third day. Maintenance dose should be between 300-400 mg daily, given in 2-3 divided doses or one extended-release tablet. Further dosage adjustments should not be made in less than every 2 days. Maximum daily dose is 800 mg/day. Indications for a slower dosage titration include the elderly, hepatic dysfunction, and hypotensive patients.

For the treatment of depressive episodes associated with bipolar disorder: Taper up to 300 mg at bedtime by starting with 50 mg and increasing to 100 mg the second day and 200 mg the third day.

For the treatment of acute manic episodes associated with bipolar 1 disorder, as monotherapy or adjunct therapy to lithium or divalproex: Initial dose should be started at 50 mg twice a day. Increase dose by 100 mg/day until a total daily dose of 400 mg is reached. Further dosage adjustments up to 800 mg/day may be made.

For the treatment of major depressive disorder (XR tablets only): Start with 50 mg on days 1 and 2 then increase to 150 mg on days 3 and 4. Maintenance dose is 150-300 mg once daily.

Hepatic function impairment dosing: Start patients on 25 mg/day and increase by 25 mg/day, depending on the clinical response and tolerability of the patient.

Monitor: FBG, Lipid panel, Weight, BP, CBC, Eye (q6 months)

Pharmacology/Pharmacokinetics: Quetiapine fumarate is a multiple neurotransmitter antagonist with activity at serotonin 5HT1A and 5HT2, dopamine D1 and D2, histamine H1, and adrenergic alpha-1 and alpha-2 receptors. The mechanism of action of quetiapine is thought to be due to its action at the dopamine D2 and serotonin 5HT2 receptors. Peak plasma levels are reached in 1.5 hours after an oral dose. Elimination occurs via hepatic metabolism with a terminal half-life of about 6 hours.

Drug Interactions: May have additive sedative effects with other CNS depressants. Oral clearance is increased by phenytoin and thioridazine.

Contraindications/Precautions: CONTRAINDICATED IN PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS. MAY INCREASE SUICIDAL THOUGHTS IN CHILDREN AND YOUNG ADULTS. Rare cases of neuroleptic malignant syndrome have been reported during clinical trials. Be observant for signs such as hyperpyrexia, muscle rigidity, altered mental state, and autonomic instability. Tardive dyskinesia (TD) has been reported in patients taking antipsychotic medications. If signs and symptoms of TD appear during therapy, discontinuation of medication may be warranted. Orthostatic hypotension may occur during treatment, especially during the initial dose-titration period. Use caution in patients predisposed to hypotension. Cataracts may develop during treatment. Lens examination should occur initially and at six-month intervals. Use with caution in patients predisposed to seizures, dysphagia, hypothyroidism, or with a history of breast cancer. Atypical antipsychotics have been associated with severe hyperglycemic reactions. These reactions have included ketoacidosis, coma, and death. Patients with established diagnosis of diabetes mellitus who are started on quetiapine should be monitored regularly for worsening of glucose control. Avoid breast feeding during therapy. Pregnancy Category C.

Adverse Effects: Somnolence (18%), dizziness (10%), constipation (9%), postural hypotension (7%), dry mouth (7%), and dyspepsia (6%). Adverse effects occurring in approximately 1% of patients include: hypertonia, flu syndrome, anorexia, palpitations, pharyngitis, rhinitis, cough, dyspnea, peripheral edema, sweating, and leukopenia.

Patient Consultation:

Use caution when rising from a prone position, especially during initial dose-titration period.

May cause drowsiness-use caution when performing activities that require alertness.

May be taken without regard to meals.

Seroquel XR should be swallowed whole and not crushed, divided, or chewed.

Do not change dosage except on the orders of your physician.

Store in a cool, dry place away from sunlight and children.

Contact a physician if the above side effects are severe or persistent.

If a dose is missed, skip it and return to normal dosing schedule.

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Oxcarbazepine

Brand Names: Trileptal, Oxtellar XR

Generic Available

Common Dosage Forms:

Tablets: 150 mg, 300 mg, 600 mg

Tablets, extended release (Oxtellar XR): 150 mg, 300 mg, 600 mg

Oral Suspension: 300 mg/5 mL (60 mg/mL)

FDA Indications/Dosages:

For use as monotherapy or adjunctive therapy in the treatment of partial seizures in adults and children ages 4-16 years with epilepsy:

Adults: Start with 300 mg given twice a day. If used as adjunctive therapy, increase the daily dose to 1200 mg after one week. If converting to monotherapy, increase by 600 mg on a weekly basis until 2400 mg/day is reached. Decrease the concomitant antiepileptic drug (AED) over a 3–6-week period. If initiating as monotherapy, increase the daily dose 300 mg every third day until a maximum of 2400 mg/day is reached. Extended-release tablets may be given once daily at bedtime.

Children: Start with 8-10 mg/kg/day, not to exceed 600 mg/day, given in a BID regimen. If used as an adjunctive therapy, increase the daily dose to 20 mg/kg/day after one week and to 30 mg/kg/day after two weeks. If converting to monotherapy, increase by 10 mg/kg/day on a weekly basis until 30 mg/kg/day is reached. Decrease the concomitant AED over a 3–6-week period. If initiating as monotherapy, increase the daily dose 5 mg/kg/day every third day until a maximum of 2100 mg/day is reached.

Monitor: Na

Pharmacology/Pharmacokinetics: Oxcarbazepine may produce its anti-seizure activity by blockade of voltage-sensitive sodium channels, resulting in stabilization of hyperexcited neural membranes, inhibition of repetitive neuronal firing, and diminution of propagation of synaptic impulses. Oxcarbazepine also increases potassium conductance and modulation of high voltage activated calcium channels. After oral administration, oxcarbazepine is extensively metabolized to its pharmacologically active 10-monohydroxy metabolite (MHD). The half-life of oxcarbazepine is 2 hours while half-life of MHD is 9 hours. Peak plasma levels are reached in 6 hours and at steady state the pharmacokinetics are linear over the dose range of 300-2400 mg/day.

Drug Interactions: Carbamazepine, phenobarbital, phenytoin, valproic acid, and verapamil all decrease the plasma concentration of MHD. Oxcarbazepine and MHD likewise increase the plasma concentrations of phenobarbital and phenytoin. Oxcarbazepine and MHD induce CYP3A4/5 resulting in decreased levels of felodipine as well as both the estrogens and progestins found in oral contraceptives.

Contraindications/Precautions: Contraindicated in patients hypersensitive to oxcarbazepine. Approximately 25-30% of patients who have hypersensitive reactions to carbamazepine will have similar reactions to oxcarbazepine. Stevens-Johnson syndrome and toxic epidermal necrolysis have occurred in patients taking oxcarbazepine. Clinically significant hyponatremia can occur during treatment with oxcarbazepine. Periodically measure sodium levels and watch for hyponatremia (e.g., nausea, malaise, headache, lethargy, or confusion). Do not abruptly discontinue therapy. Antiepileptic drugs increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indications. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior. Oxcarbazepine is excreted in breast milk, therefore, do not use in nursing mothers. Pregnancy Category C.

Adverse Effects: The most common adverse effects observed are dizziness, somnolence, diplopia, fatigue, nausea, vomiting, ataxia, abnormal vision, abdominal pain, tremor, dyspepsia, and abnormal gait. Less frequent but potentially severe adverse effects include hyponatremia and skin reactions (see above).

Patient Consultation:

May be taken without regard to meals.

May cause drowsiness. Use caution while operating machinery or when alertness is required.

Avoid alcohol while taking this medication.

Shake suspension well before each use.

Store in a cool, dry place, away from sunlight and children.

If a dose is missed, take it as soon as possible. If it is closer to the time of your next dose than the dose you missed, skip the missed dose and return to your dosing schedule. Do not double doses.

Contact a physician if the above side effects are severe or persistent.

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Lamotrigine

Brand Name: Lamictal (XR, ODT, CD):

Generic Available

Common Dosage Forms:

Tablets, chewable: 2 mg, 5 mg, 25 mg

Tablets, oral: 25 mg, 100 mg, 150 mg, 200 mg

Tablets, orally-disintegrating: 25 mg, 100 mg, 150 mg, 200 mg

Tablets, extended release: 25 mg, 100 mg, 150 mg, 200 mg, 300 mg

FDA Indications/Dosages:

As adjunctive therapy in pediatric and adult patients with partial seizures or generalized seizures of Lennox-Gastaut syndrome and in primary generalized tonic-clonic seizures: Normal dose range is from 25-200 mg once daily. Daily doses over 200 mg should be given in two divided doses.

>In children aged 2-12 years taking valproic acid, start with 0.15 mg/kg/day for 2 weeks, increase to 0.3 mg/kg/day for 2 weeks, to a maintenance dose of 1-5 mg/kg/day.

>In children aged 2-12 years taking an EIAED*, start with 0.6 mg/kg/day for 2 weeks, increase to 1.2 mg/kg/day for 2 weeks, to a maintenance dose of 5-15 mg/kg/day.

>In adults taking valproic acid, start with 25 mg every other day for 2 weeks, increase to 25 mg every day for 2 weeks, to a maintenance dose of 100-400 mg/day.

>In adults taking an EIAED*, start with 50 mg/day for 2 weeks, increase to 100 mg/day for 2 weeks, to a maintenance dose of 300-500 mg/day.

For the conversion to monotherapy in adults with partial seizures who are receiving treatment with a single EIAED* or valproic: Start with 50 mg/day for 2 weeks, increase to 100 mg/day for 2 weeks, to a maintenance dose of 300-500 mg/day, and then gradually withdraw the EIAED over a period of 4 weeks.

*EIAED (enzyme-inducing antiepileptic drugs) include phenytoin, carbamazepine, and phenobarbital.

For the maintenance treatment of bipolar I disorder to delay the time of occurrence of mood episodes: titrate upwards beginning with 25 mg daily in patients not taking carbamazepine (or other enzyme-inducing agents) or valproic acid. Double the dose every other week to a target dose of 200 mg daily. In patients on valproic acid, divide the dose in half. In patients taking carbamazepine, double the dose.

Monitor: CBC

Pharmacology/Pharmacokinetics: The exact mechanism of action of lamotrigine is unknown. It has weak (or zero) effects on serotonin, adrenergic, dopamine, histamine, opioid, muscarinic, GABA, or adenosine A1 or A2 receptors. Its mechanism of action may be due to an inhibition of voltage-sensitive sodium channels, resulting in a stabilization of neuronal membranes and modulation of presynaptic transmitter release of excitatory amino acids (e.g., glutamine and aspartate). After an oral dose, peak plasma levels are reached in 2-5 hours, depending on current AED therapy. Elimination half-life ranges from 12-14 hours in patients taking an EIAED to 70 hours in patients taking valproic acid. Approximately 55% is bound to serum proteins.

Drug Interactions: Enzyme-inducing antiepileptic drugs (such as phenytoin, carbamazepine, and phenobarbital) as well as rifampin increase the metabolism and decrease the plasma concentration of lamotrigine. Valproic acid increases plasma concentration while lamotrigine decreases the plasma concentration of valproic acid. Lamotrigine is a potent inhibitor of dihydrofolate reductase therefore use caution when using other drugs that inhibit folate metabolism. Use with ORAL CONTRACEPTIVES may decrease the serum concentrations of the progestin component while significantly decreasing the serum concentration of lamotrigine.

Contraindications/Precautions: SERIOUS LIFE-THREATENING RASHES HAVE BEEN REPORTED IN ASSOCIATION WITH THE USE OF LAMOTRIGINE. Rashes usually occur within the first two weeks of therapy and are more common in pediatric patients and in patients taking valproic acid. Serious hypersensitivity reactions have also occurred, and patients should promptly report and fever or lymphadenopathy to a physician. Lamotrigine is known to bind to melanin-containing tissues and may cause toxicity with long-term use therefore periodic ophthalmic tests should be performed. Do not use in nursing mothers. Pregnancy Category C.

Adverse Effects: Dizziness (38%), ataxia (22%), somnolence (14%), headache (29%), diplopia (28%), blurred vision (16%), nausea (19%), vomiting (9%), and rash (10%).

Patient Consultation:

Patients should promptly report any signs of hypersensitivity (fever, lymphadenopathy) or rash to a physician.

Do not increase or change dosage without specific instructions from a physician.

May cause drowsiness. Use caution while operating machinery or when mental alertness is required.

Patients should inform their physician if they become pregnant, intend to become pregnant, or intend to breast-feed an infant during therapy.

If a dose is missed, take it as soon as possible but do not double the next dose.

Contact a physician is the above side effects are severe or persistent.

Chewable tablets may be chewed or dispersed in a teaspoonful of water or diluted fruit juice.

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Brand Name: Atarax

Generic Available

Common Dosage Forms:

Tablets: 10 mg, 35 mg, 50 mg

Syrup: 10 mg/5 mL (0.5% alcohol)

Injections: 25 mg/mL, 50 mg/mL in ampules and multi-dose vials

FDA Indications/Dosages: For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested:

Adults: 50-100 mg four times a day. Children (over 6 years old): 50-100 mg daily in divided doses.

Children (under 6 years old): 50 mg daily in divided doses.

For the management of pruritus due to allergic conditions such as chronic urticaria, atopic dermatitis, and contact dermatoses and in histamine-mediated pruritus:

Adults: 25 mg three to four times a day.Children (over 6 years old): 50-100 mg daily in divided doses.

Children (under 6 years old): 50 mg daily in divided doses.

As a sedative when used as a premedication and following general anesthesia: 50-100 mg for adults and 0.6 mg/kg for children.

Pharmacology/Pharmacokinetics: Hydroxyzine antagonizes the H1 (histamine) receptors in peripheral tissues. It may also suppress histamine activity in the subcortical region of the CNS. Onset of action occurs within 15-30 minutes.

Drug Interactions: CNS depression may be increased when used with alcohol or other CNS depressants.

Contraindications/Precautions: Use is contraindicated in early pregnancy. Use with caution in nursing mothers and in patients taking central nervous system depressants. No Pregnancy Category Established.

Adverse Effects: Drowsiness and dry mouth.

Patient Consultation:

May cause drowsiness. Use caution while operating machinery or when mental alertness is required.

Avoid alcohol while taking this medication.

Store in a cool, dry place away from sunlight and children.

Contact a physician if the side effects are severe or persistent.

If a dose is missed, skip it and return to normal dosing schedule.

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Bupropion Hydrochloride

Brand Names: Wellbutrin, Forfivo XL, Zyban

Generic Available

Common Dosage Forms:

Tablets, immediate-release: 75 mg, 100 mg.

Tablets, sustained-release (SR): 100 mg, 150 mg, 200 mg.

Tablets, extended-release (XL): 150 mg, 300 mg, 450 mg.

Tablets, sustained-release (Zyban): 150 mg.

FDA Indications/Dosages:

Treatment of depression and for the prevention of seasonal major depressive episodes in patients with seasonal affective disorder: Immediate-release formulation: Start with 100 mg twice a day. Increase dose a maximum of 100 mg/day no sooner than every three days to achieve maximum benefit. Usual adult dose is 100 mg three times a day. Maximum daily dose is 450 mg/day. No single dose should exceed 150 mg. Use the lowest dose possible to achieve desired results. Sustained-release formulation: Give up to 400 mg/day in two divided doses. Target dose is 300 mg/day. Extended-release formulation: 150 to 300 mg given once per day.

As an aid to smoking cessation (Zyban): Start with 150 mg daily for 3 days then increase to 150 mg twice a day.

Pharmacology/Pharmacokinetics: Bupropion is unrelated to tricyclic or tetracyclic antidepressants. It is chemically related to phenylethylamines. Its actions seem to be produced by a dose-related CNS stimulant effect. It is a weak inhibitor of neuronal uptake of norepinephrine and dopamine, and does not inhibit monoamine oxidase. Its effects are thought to be mediated by noradrenergic and/or dopaminergic mechanisms. Peak steady-state plasma levels following BID dosing of sustained-release formulations are 15% lower and trough concentrations are 7% higher than those found after the immediately-release formulation is given TID. Plasma half-life is between 8 to 24 hours. Bupropion is metabolized to inactive and active metabolites by the CYP2B6 isoenzyme system and excreted in the urine and feces. Up to 80% is bound to plasma proteins.

Drug Interactions: Toxicity is increased by monoamine oxidase inhibitors and L-dopa. Alcohol may lower seizure threshold. Drugs which affect the CYP2B6 isoenzyme system (orphenadrine, thiotepa, cyclophosphamide, ticlopidine) may affect bupropion plasma levels. Ritonavir and lopinavir reduce the plasma levels of bupropion. Bupropion is an inhibitor of CYP2D6 therefore it may increase plasma levels of tricyclic antidepressants, paroxetine, fluoxetine, sertraline, haloperidol, risperidone, thioridazine, metoprolol, propafenone, or flecainide.

Contraindications/Precautions: Contraindicated in patients with a seizure disorder, history of bulimia or anorexia nervosa, or with 14 days of therapy with a monoamine oxidase inhibitor. ANTIDEPRESSANTS INCREASE SUICIDAL THOUGHTS AND ACTIONS IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS. Wellbutrin has been associated with precipitating dose-related seizures. Seizure incidence tenfold between daily doses of 450 mg and 600 mg. May cause various psychomotor disturbances such as mania, psychosis, and hallucinations. Use with caution in patients with impaired liver or kidney function. Pregnancy Category C.

Adverse Effects: Dizziness, constipation, weight loss, dry mouth, insomnia, sweating, agitation, and tremor.

Patient Consultation:

Take immediate-release tablets at regular intervals no sooner than three to four times a day.

Take extended-release tablets in the morning if possible to avoid insomnia.

Swallow SR and XL tablets whole-do not crush or chew.

If a dose is missed, wait until the next scheduled dose - DO NOT DOUBLE DOSES.

Do not take OTC medications without first consulting a physician or pharmacist.

Refrain from consuming alcohol.

Store in a cool, dry place away from sunlight.

Contact a physician if side effects become severe or bothersome or if a seizure occurs.

Weight gain or loss may be temporary-contact your physician if bothersome.

Pay close attention to any changes, especially sudden changes, in mood behaviors, thoughts, or feelings. Antidepressants may increase suicidal thoughts or actions.

Continued therapy of up to 2 weeks may be needed to show noticeable improvement.

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Citalopram Hydrobromide

Brand Name: Celexa

Generic Available

Common Dosage Forms:

Tablets: 10 mg, 20 mg, and 40 mg.

Solution: 10 mg/5 mL

FDA Indications/Dosages:

For the treatment of depression*: Begin with a dose of 20 mg given once a day and gradually increase to a dose of 40 mg once a day. The full antidepressant effect may not be seen until 4 weeks of treatment has passed. At least 14 days should elapse between the discontinuation of monoamine oxidase inhibitor and the start of citalopram.

*Depression is characterized by a depressed or dysphoric mood that lasts almost daily for an extended time (>2 weeks). 4 out of 8 of the following symptoms should be present to accurately diagnose the episode as depression: change in appetite, change in sleep patterns, psychomotor agitation, loss of interest in usual activities, increased fatigue, feelings of guilt or worthlessness, impaired concentration, and a suicide attempt or suicidal ideation.

Pharmacology/Pharmacokinetics: Citalopram blocks the neuronal uptake of serotonin, but not of norepinephrine or dopamine, into human platelets in the CNS. Citalopram binds much less potently than classical tricyclic antidepressants to muscarinic, histaminergic, and alpha-adrenergic receptors. Peak plasma levels are reached 4 hours after an oral dose with a mean terminal half-life of 35 hours. The primary isoenzymes involved in the metabolism of citalopram are CYP3A4 and CYP2C19.

Drug Interactions: Coadministration with MONOAMINE OXIDASE INHIBITORS may produce serious reactions resembling neuroleptic malignant syndrome. Potent inhibitors of CYP3A4 have been shown to have to effect on the plasma clearance of citalopram. Cimetidine may increase plasma levels. Coadministration with aspirin or an NSAID may increase the risk of upper GI bleeding.

Contraindications/Precautions: ANTIDEPRESSANTS INCREASE SUICIDAL THOUGHTS AND ACTIONS IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS. Contraindicated within 14 days of taking monoamine oxidase inhibitors. Several reversible cases of hyponatremia have occurred during treatment. Due to possibility of suicide attempts, caution should be taken in dispensing large quantities of this medication. Use with caution in patients with liver disease and during nursing. Abrupt discontinuation of therapy may cause adverse effects including dysphoric mood, irritability, agitation, dizziness, anxiety, confusion, insomnia, and headache. Pregnancy Category C.

Adverse Effects: Nausea (21%), dry mouth (20%), somnolence (18%), insomnia (15%), diarrhea (8%), ejaculation disorder (6%), and impotence (3%). Other adverse effects occurred at the same rate as placebo.

Patient Consultation:

May impair cognitive and motor performance. Use caution while operating machinery or when mental alertness is required. Up to 2 weeks may be needed before therapeutic effects are seen.

Do not abruptly discontinue medication.

Avoid alcohol while taking this medication.

Store in a cool, dry place away from sunlight and children.

If a dose is missed, skip it and return to normal dosing schedule.

Pay attention to any changes, especially sudden changes, in mood behaviors, thoughts, or feelings. Antidepressants may increase suicidal thoughts or actions.

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Hydroxyzine Pamoate

Brand Name: Vistaril

Generic Available

Common Dosage Forms:

Capsules: 25 mg, 50 mg, 100 mg

FDA Indications/Dosages:

For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested: The normal adult dosage is 50-100 mg up to 4 times a day. For children over 6 years of age, use 50-100 mg per day in divided doses. For children under 6 years of age, give 50 mg per day in divided doses.

As a sedative when used as a premedication and following general anesthesia: 50-100 mg for adults and 0.6 mg/kg for children.

Pharmacology/Pharmacokinetics: Hydroxyzine antagonizes the H1 (histamine) receptors in the subcortical region of the central nervous system. Primary skeletal muscle relaxation, bronchodilator activity, and antihistaminic and analgesic activity have been demonstrated. Onset of action occurs within 15-30 minutes.

Drug Interactions: May potentiate the effects of opioids and barbiturates, dosage adjustments may be necessary.

Contraindications/Precautions: Contraindicated in patients with a known hypersensitivity to hydroxyzine. Use with caution in patients taking other CNS depressants. Not indicated for use in nursing mothers. Sedating drugs may cause confusion and over-sedation in the elderly; elderly patients should be started on a lower dose. No Pregnancy Category Established.

Adverse Effects: The most common adverse effects are drowsiness and dry mouth. Drowsiness is usually transitory in nature and may disappear after a few days of treatment.

Patient Consultation:

May cause drowsiness. Use caution while operating machinery or when mental alertness is required.

Avoid alcohol while taking this medication.

Store in a cool, dry place away from sunlight and children.

Contact a physician if the side effects are severe or persistent.

If a dose is missed, skip it and return to normal dosing schedule.

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Alfalfa

Scientific Names: Medicago sativa Other Common Names: Purple medick, buffalo herb, lucerne, medicago Overall Safety: 😊

Therapeutic Efficacy and Considerations: Hyperlipoproteinemia: 😐 One very small study offers preliminary evidence for minimal beneficial effects on lowering cholesterol. Although more research is warranted, it cannot be recommended at this time. Dose: 40 g alfalfa seed three times a day (used in study, lower doses of 10 g three times a day are more traditional).

Chemistry/Pharmacology: Alfalfa components, such as saponins, inhibit cholesterol absorption while increasing excretion of bile acids. Animal studies have noted decreases in LDL, but no change in HDL levels. Other properties associated with alfalfa include increased estrogenic effects from isoflavonoids such as genistein, daidzein, and biochanin A, and stimulation of immune functions by L-canavanine. Alfalfa root has been noted to have some antifungal properties.

Drug Interactions: Generally, well tolerated. Anticoagulants, oral contraceptives and HRT, hypoglycemic drugs and insulin (all due to possible additive effects based on theory or mechanism). May increase effects of photosensitizing medications and antagonize effects of immunosuppressive agents.

Contraindications/Precautions: Contraindicated in patients with systemic lupus erythematosus, estrogen-sensitive cancers, diabetes, hormone-replacement therapy, pregnancy, and anticoagulant therapy.

Adverse Effects: Hypotension, hypoglycemia, photosensitivity, breast tenderness. Rare reports of pancytopenia and lupus-like reaction (associated with the use of seeds, not leaves and stems).