Naplex 4

Olanzapine and fluoxetine

Olanzapine

Ziprasidone

Isocarboxazid - non selective MAO inhibitor

Tranylcypromine - non-selective MAO inhibitor

Phenylzine - non selective MAO inhibitor

Lithium

Divalproex

Valproic acid capsules and solution

IV valproic acid

Valproic Acid delayed release capsules

Azathioprine

• Carbidopa/levodopa
• Carbidopa inhibits dopa decarboxylase preventing peripheral metabolism of levo
• 70 to 100 mg of carb required to be effective and decrease nausea
• Nausea, dizziness, orthostasis, dyskinesias, dark urine, unusual sexual urges, used mostly in older adults
• Iron and protein-rich foods can decrease absorption

• Entacapone
• COMT Inhibitor 
• Inhibits COMT to prevent peripheral conversion of levodopa, only use with levodopa

Levo/carbi/entacapone

• Pramipexol - DA agonist
• Start 0.125 mg TID, titrate weekly to 0.5 to 1.5 mg TID
• Drowsiness, nausea, dizziness, orthostasis, hallucinations, dyskinesias, decrease dose if CrCl less than 60

• Ropinorole - DA agonist
• 0.25 mg TID, titrate weekly to 1 to 4 mg TID

• Rotigotine - patch formulation
• DA agonist
• 1 mg / 24 hours
• Remove prior to MRI

• Apomorphine
• DA agonist injection for advanced disease: a "rescue" movement agent for OFF periods
• CI with 5HT-receptor antagonists (like zofran)
• Severe N/V, hypotension (use trimethobenzamide for nausea at least 3 days prior to initial dose)

• Trimethobenzamide
• For use with apomorphine - start 3 days before and continued for at least first 3 monhts of therapy

• Amantadine
• Dopamine reuptake inhibitor - used in mild disease or for dyskinesias in advanced disease
• 100 mg BID to TID
• Decrease dose in renal impairment
• Nausea, dizzy, lightheaded

• Selegiline - selective MAO-B inhibitor
• Only has benefit when used WITH levo
• Ensam is a selegiline transdermal patch which is the only formulation used for depression
• 5 to 10 mg daily

Selegiline transdermal patch for depression

• Selegiline ODT formulation for PD
• 1.25 to 5 mg daily

• Rasagiline
• MAO-B inhibitor
• Rasagiline can used as initial monotherapy or adjunctive with levo
• 0.5 to 1 mg daily in am, can be activating
• When used as monotherapy, can cause HA, joint pain, and indigestion.
• More risk than selegiline for drug and food interactions.
• Drug interactions: meperidine, tramadol, methodone, propoxyphene, dextromethorphan, st jon's wort, mirtazapine, cyclobenzaprine

• Benztropine
• Centrally acting anticholinergic
• 0.5 to 2 mg TID
• Used for tremor - avoid in elderly

• Trihexphenidyl
• Centrally acting anticholinergic
• 1 to 2 mg TID

Peripheral and central anticholinergics, antihistamines, antiemetics, antipsychotics, barbiturates, benzos, skeltal muscle relaxants

phenothiazines, FGAs, SGAs, Reglan, cholinesterase inhibitors used for dementia

• Donepezil
• Acetylcholinesterease inhibitor
• Available ODT
• 5 to 10 mg QHS, new formula is 23 mg daily but this provides little benefit
• GI side effects, given QHS to help with nausea,

• Rivastigmine
• Available as a patch
• Acetylcholinesterase inhibitor
• 1.5 to 6 mg BID
• 4.6 and 9.5 mg / 24 hour patch
• With food

• Galantamine
• Acetylcholinesterase inhibitor
• 4 to 12 mg BID
• ER: start at 8 mg daily, then increase to 16 to 24 mg daily

• Tacrine
• Acetylcholinesterase inhibitor
• Hepatotoxicity - do not give with hx of tacrine induced jaundice or bilirubin
• 10 to 20 mg bid

• Memantine
• Blocks NMDA which inhibits glutamate from binding to NMDA receptors, decreases abnormal activation
• 5 to 10 mg BID or 28 mg daily if XR (start at 7 and titrate weekly)
• GI, HA
• Rare: flu like sx, arthralgia, UTI, urinary retention, small risk of seizures

• Methylphenidate IR
• 2.5 to 20 mg tabs

• Methylphenidate IR
• 2.5 mg to 20 mg tabs

• Methylphenidate long acting
• 1/2 IR and 1/2 SR
• 10 to 40 mg tabs

• Methylphenidate sustained release
• 20 mg SR tabs

• Methylphenidate EXt Release
• 10 to 20 mg ER tabs

Methylphenidate XR oral suspension

Methylphenidate IR with OROS system

Methylphenidate IR with beads that dissolve at different rates

Methylphenidate transdermal patch

• Dexmethylphenidate
• 2.5 to 10 mg tabs for IR
• 5 to 20 mg caps for ER

Dextroamphetamine and amphetamine mixed salts

• dextroamphetamine IR
• Available as dexedrine spansules

Lisdexamfetamine

Focalin XF, Ritalin LA, Metadate CD, Adderall XR

• Atomoxetine
• 40 to 80 mg capsules, occassionally up to 100 mg
• Black Box, suicide, liver injury, CV problems, glaucoma
• GI fatigue

• Guanfacine XR
• Daily start at 1mg, go up to 4

• Clondine XR
• Start at 0.1 mg QHS, titrate weekly
• Rebound HTN is stopped abruptly, extended Release formula is supposed to have fewer SE

• Modafinil
• 200 mg daily
• HA, dizzy, anxiety, agitation, rash

• Armodafanil
• 150 to 250 mg daily

• Beta blockers, especially propranolol
• Clonidine
• Steroids
• Cyclosporine
• Ethanol
• Isotretinoin
• Indomethacin
• Interferons
• Methadone
• Methyldopa
• Oral contraceptives
• Stimulants
• Procainamide
• Reserpine
• Statins
• Varenicline

• Albuterol if swallowed
• Abilify
• Caffeine
• Stimulants
• Decongestants
• Bupropion
• Fluoxetine
• Illicit drugs

• Propranolol for stage fright
• 10 to 40 mg 1 hour prior to event
• Non selective beta blocker so avoid with asthma and COPD

• Lorazepam
• 0.5 to 2 mg prn

• Alprazolam
• 0.25 o 2 mg prn

Chlordiazepoxide

• Clonazepam
• 0.125 to 2 mg prn

Clorazepate

• Diazepam
• 3.75 to 15 mg prn

Oxazepam

• Temazepam
• 7.5 to 30 QHS

• Buspirone
• 5HT1 Partial Agonist
• Start 7.5 mg BID can increase by 5 mg / day every 2 to 3 days until 30 mg / day
• Decrease dose with dilt, verap, erythro

• Zolpidem
• 5 to 10 mg QHS
• Do not take with fatty foods, a heavy meal
• May cause parasomnias

• Zaleplon
• 5 to 10 mg QHS

• Eszopiclone
• 1 to 3 mg QHS

• Ramelteon
• Melatonin Receptor Agonist
• Do not take with fatty food
• 8 mg QHS

• Doxepin ER
• 6 mg QHS or 3 mg if greater than 65 years
• Used for difficulty staying asleep

• Zolpidem SL
• Intermezzo SL for night time awakening

• Aluminum causes constipation
• Magnesium causes diarrhea - think magnesium citrate
• Al and Mg can accumulate with CrCl less than 30

Famotidine and Ibuprofen

• Famotidine
• 10 and 20 OTC strength 20 and 40 RX strength

• Ranitidine
• OTC 75 and 150
• RX 300

• Nizatadine
• OTC 75
• RX 150 and 300

• Cimetidine
• OTC 200
• RX 300 400 and 800

• Prilosec
• Zegerid
• Protonix
• Prevacid
• Dexilant
• Nexium
• Vimovo
• Aciphex
• Do not crush or chew pantoprazole or rabeprazole tablets or capsules
• Esomeprazole and Pantoprazole available as injection

• Misoprostol
• 100 mcg after dinner, then 100 mcg or 200 mcg QID
• Preg cat X
• Diarrhea, ab pain

• Sucralafate
• 1 g tab QID before meals and at bedtime
• Avoid in severe renal disease
• May cause constipation

• Metoclopramide
• 10 mg QID before meals and at bedtime
• Decrease dose when CrCl less than 40

• Methylcellulose
• Bulk laxative

• Calcium Polycarbophil
• Bulk laxative

• Psyllium
• Bulk laxative

Docusate

Bisacodyl

Senna

• Methylnaltrexone
• Blocks opioid receptors in the gut to relieve constipation - only for use with opioids after failure with colace and stimulant

• Magnesium salts
• Salts retain fluid in the bowel lumen with net increase of fluid secretions in the small intesting

• Polyethylene glycol
• Hyperosmotic

• Lubiprostone
• Activates chloride channels in the gut leading to increased fluid in gut and movement
• 24 mcg capsule BID with food

• Bismuth subsalicylate
• DOn't give to children
• SE include black tongiue, rarely tinnitus

• Loperamide
• DNE 16 mg / d

• Diphenoxylate 2.5 mg withatropine 0.025 mg
• mac 20 mg / day