Know the name.
Understand the medicine.

Names and formulations

• Zestril: oral tablet

Formulation distinction: Dose selection depends on indication, blood pressure, kidney function, volume status, and interacting therapy.

Major safety and monitoring

• Boxed warning: discontinue as soon as pregnancy is detected because renin-angiotensin system drugs can injure or kill the fetus.
• Monitor blood pressure, serum creatinine/eGFR, and potassium; watch for hypotension, kidney injury, and hyperkalemia.
• Angioedema can occur at any time and requires urgent evaluation, especially with tongue, lip, face, or airway swelling.

Counseling

• Avoid potassium supplements or potassium-containing salt substitutes unless the care team approves them.
• Report pregnancy promptly and seek emergency care for swelling involving the face, mouth, tongue, or throat.

Names and formulations

• Norvasc: oral tablet

Formulation distinction: Long half-life supports once-daily dosing. Peripheral edema is dose related; new or worsening swelling still deserves clinical assessment rather than self-diagnosis.

Major safety and monitoring

• Monitor blood pressure, dizziness, and peripheral edema.
• Symptomatic hypotension is possible, particularly with severe aortic stenosis.
• Angina or myocardial infarction can worsen after initiation or dose escalation in severe obstructive coronary disease.

Counseling

• Take consistently once daily, with or without food.
• Report troublesome ankle swelling, marked dizziness, or worsening chest pain.

Names and formulations

• Lipitor: oral tablet

Formulation distinction: Can be taken once daily at any time, with or without food; treatment intensity depends on dose and clinical goal.

Major safety and monitoring

• Assess for unexplained muscle pain, tenderness, or weakness; severe myopathy and rhabdomyolysis are uncommon but serious.
• Check liver enzymes before initiation and later when clinically indicated; stop for serious hepatic injury.
• Monitor a lipid panel and adherence to evaluate response.

Counseling

• Report severe or persistent muscle symptoms, especially with fever, malaise, or dark urine.
• Most pregnant patients should discontinue therapy after discussing the pregnancy with the prescriber; breastfeeding is not recommended during treatment.

Names and formulations

• Toprol-XL: extended-release; distinct from metoprolol tartrate immediate-release

Formulation distinction: Succinate ER and tartrate IR differ in release pattern, usual dosing frequency, and labeled uses; verify the salt and dosage form during transitions.

Major safety and monitoring

• Monitor heart rate, blood pressure, dizziness, and signs of worsening heart failure during titration.
• Abrupt withdrawal can worsen angina and precipitate myocardial infarction.
• May mask some warning signs of hypoglycemia and can contribute to bronchospasm in susceptible patients.

Counseling

• Do not stop suddenly without prescriber guidance.
• Extended-release tablets may be divided if scored, but should not be crushed or chewed.

Names and formulations

• Lasix: oral tablet

Formulation distinction: Dose timing and frequency depend on the indication and response; verify the prescribed oral strength and schedule.

Major safety and monitoring

• Boxed warning: excessive amounts can cause profound diuresis with water and electrolyte depletion.
• Monitor weight, blood pressure, volume status, kidney function, potassium, sodium, magnesium, and symptoms of dehydration.
• Rapid injection, high doses, severe kidney impairment, or other ototoxic drugs increase ototoxicity risk.

Counseling

• Unless otherwise directed, take earlier in the day to reduce nighttime urination and rise slowly if dizzy.
• Follow the care team's plan for daily weights and report rapid weight change, faintness, severe weakness, or reduced urine output.

Names and formulations

• Eliquis: oral tablet; indication-specific dosing

Formulation distinction: Dose and duration vary by indication; atrial-fibrillation dose reduction uses specific age, weight, and serum-creatinine criteria.

Major safety and monitoring

• Boxed warnings address thrombotic risk after premature discontinuation and spinal/epidural hematoma with neuraxial procedures.
• Monitor for bleeding, hemoglobin/hematocrit changes, and clinically relevant kidney and liver function; routine INR monitoring is not used to titrate apixaban.
• Contraindicated with active pathological bleeding.

Counseling

• Take exactly as prescribed and do not stop without a plan from the prescriber.
• Tell clinicians and dentists before procedures and report unusual bleeding, black stools, or blood in urine.

Names and formulations

• Jantoven: oral tablet

Formulation distinction: Tablet strengths are color coded, but strength should always be verified from the label; dosing is individualized to INR and clinical context.

Major safety and monitoring

• Boxed warning: can cause major or fatal bleeding; regular INR monitoring is required.
• Monitor for bleeding, interacting drugs, illness, alcohol changes, and major dietary changes; rare serious harms include skin necrosis and calciphylaxis.
• Generally contraindicated in pregnancy, with a narrow exception framework for selected patients with mechanical valves.

Counseling

• Keep vitamin K intake reasonably consistent rather than eliminating vitamin K-containing foods.
• Check before starting or stopping prescriptions, over-the-counter medicines, herbals, or supplements.

Names and formulations

• Plavix: oral tablet

Formulation distinction: A loading dose is used for selected acute coronary syndrome scenarios; maintenance dosing and aspirin co-therapy depend on indication.

Major safety and monitoring

• Boxed warning: patients with two CYP2C19 loss-of-function alleles have reduced activation and antiplatelet effect.
• Monitor for bleeding; premature discontinuation can increase cardiovascular risk.
• Rare thrombotic thrombocytopenic purpura requires urgent evaluation.

Counseling

• Do not stop before a prescriber-directed plan, especially after coronary stent placement.
• Report unusual bleeding and tell clinicians or dentists before procedures.

Names and formulations

• Xarelto: oral tablet; oral suspension has separate instructions

Formulation distinction: Adult 15- and 20-mg tablets require food; atrial-fibrillation doses are taken with the evening meal. Dosing and missed-dose rules depend on indication.

Major safety and monitoring

• Boxed warnings: thrombosis after premature discontinuation and spinal/epidural hematoma.
• Monitor bleeding and kidney/liver function; routine INR-guided titration is inappropriate.
• Contraindicated with active pathological bleeding; renal and hepatic restrictions vary by indication.

Counseling

• Do not stop without a prescriber-directed plan.
• Report significant bleeding and notify procedural clinicians.

Names and formulations

• Pradaxa: oral capsule; oral pellets are a distinct formulation

Formulation distinction: Swallow capsules whole; opening, crushing, or chewing increases exposure. Capsules and pellets are not interchangeable milligram for milligram.

Major safety and monitoring

• Boxed warnings: thrombosis after premature discontinuation and spinal/epidural hematoma.
• Monitor bleeding and kidney function; INR is not used for routine dose titration.
• Contraindicated with mechanical prosthetic heart valves or active pathological bleeding.

Counseling

• Keep capsules in original moisture-protective packaging, not pill organizers.
• Do not stop without guidance; report significant bleeding.

Names and formulations

• Brilinta: oral tablet

Formulation distinction: Twice-daily maintenance strength and duration depend on indication and time since the event. Aspirin maintenance is generally 75–100 mg/day when used together.

Major safety and monitoring

• Boxed warning: potentially fatal bleeding; do not initiate for urgent coronary bypass surgery.
• Contraindicated with active pathological bleeding or prior intracranial hemorrhage.
• Dyspnea and bradyarrhythmias can occur; assess new symptoms rather than assuming a benign drug effect.

Counseling

• Do not stop or change aspirin use without a treatment plan.
• Report unusual bleeding or unexpected shortness of breath.

Names and formulations

• Lovenox: Selected single-dose prefilled syringes; doses and concentrations differ across presentations and indications.

Formulation distinction: For the full prescribed prefilled-syringe dose, retain the air bubble. Inject subcutaneously into a held abdominal skin fold; do not give intramuscularly.

Major safety and monitoring

• Check renal function, CBC/platelets, and bleeding; severe renal impairment requires indication-specific dose reduction.
• Contraindicated with active major bleeding or immune-mediated HIT within 100 days or circulating antibodies.
• Neuraxial procedures can cause spinal/epidural hematoma; coordinate anticoagulant timing with the procedural team. PT/aPTT do not reliably measure enoxaparin effect.

Counseling

• Rotate abdominal sites, keep at least 2 inches from the navel, and do not rub afterward.
• Report unusual bleeding or new leg weakness/numbness after a spinal procedure; use a sharps container.

Names and formulations

• Heparin Sodium Injection (Hospira): Selected therapeutic/prophylactic injection vials and cartridges; not catheter-lock flush products.

Formulation distinction: Verify units, concentration, indication, and route. Therapeutic injection must not be substituted for a catheter-lock flush.

Major safety and monitoring

• Monitor bleeding, platelets, hematocrit, and coagulation testing for full-dose therapy; dose according to the prescribed protocol.
• A history of HIT/HITT is a contraindication; suspected HIT requires immediate treatment review, including heparin sources.
• Check potassium before treatment in at-risk patients and periodically when treatment exceeds 5 days or earlier when indicated; benzyl alcohol poses particular toxicity risks in infants.

Counseling

• Report bleeding, new thrombosis symptoms, or unusual bruising promptly.
• Tell the care team about OTC pain relievers and all other antithrombotic medicines.

Names and formulations

• Effient: Selected oral 5-mg and 10-mg tablets.

Formulation distinction: Label regimen: 60-mg loading dose, then 10 mg daily; consider 5 mg daily below 60 kg. Do not break tablets.

Major safety and monitoring

• Contraindicated with prior TIA/stroke or active pathological bleeding.
• Generally avoid at age 75 or older except selected high-risk patients; assess bleeding risk carefully.
• When possible, stop at least 7 days before surgery under the prescribing team’s plan; premature discontinuation after PCI risks thrombosis.

Counseling

• Report bleeding or neurologic symptoms promptly; do not stop on your own.
• Keep tablets in the original tightly closed container with its desiccant.

Names and formulations

• Ventolin HFA: metered-dose inhaler; priming and cleaning are device specific

Formulation distinction: Ventolin HFA priming, cleaning, dose-counter use, and inhalation technique are device specific; teach the actual inhaler dispensed.

Major safety and monitoring

• Increasing need or reduced response can signal deteriorating asthma and requires prompt reassessment.
• Monitor symptom relief, use frequency, tremor, heart rate, and potassium when high systemic exposure is plausible.
• Paradoxical bronchospasm can occur and may be life threatening.

Counseling

• Demonstrate inhaler technique, priming, cleaning, and dose-counter interpretation for the dispensed device.
• Seek care if the usual dose stops working or is needed more often than prescribed.

Names and formulations

• Breyna: budesonide/formoterol metered-dose inhaler with product-specific instructions

Formulation distinction: Strength, number of inhalations, and indication differ; follow the prescribed Breyna maintenance regimen and do not infer an acute-relief plan from this label.

Major safety and monitoring

• Rinse the mouth after maintenance doses to reduce oropharyngeal candidiasis risk.
• Monitor symptom control, rescue use, inhaler technique, paradoxical bronchospasm, and systemic corticosteroid effects when exposure is high or prolonged.
• LABA use without an inhaled corticosteroid increases asthma-related serious-event risk; this combination contains both components.

Counseling

• Use on schedule and keep the prescribed rescue plan available for sudden symptoms.
• Prime, clean, and track remaining actuations according to the exact inhaler supplied.

Names and formulations

• Spiriva HandiHaler: inhalation capsule for COPD; capsule is inhaled through the device, not swallowed
• Spiriva Respimat: inhalation spray for COPD and maintenance asthma in patients 6 years and older

Formulation distinction: HandiHaler and Respimat are different devices with different labeled strengths and indications; HandiHaler capsules must never be swallowed.

Major safety and monitoring

• Not a rescue medicine for acute bronchospasm.
• Monitor for paradoxical bronchospasm and anticholinergic effects, including urinary retention and worsening narrow-angle glaucoma.
• Use cautiously in severe kidney impairment because exposure and anticholinergic effects may increase.

Counseling

• Teach the exact device and confirm inhalation technique; do not place HandiHaler capsules in the mouth.
• Seek urgent care for eye pain with visual halos or inability to urinate.

Names and formulations

• Xopenex HFA: Selected levalbuterol tartrate metered-dose inhalation aerosol; nebulizer solutions have separate directions and are outside this card.

Formulation distinction: Each mouthpiece actuation supplies 45 mcg of levalbuterol free base, as levalbuterol tartrate. Shake before use. Prime with four sprays away from the face before first use or after more than three days without use.

Major safety and monitoring

• Paradoxical bronchospasm may be life threatening; stop the medicine and obtain prompt medical care if breathing worsens immediately after a dose.
• Increasing use or reduced relief requires immediate medical assessment. This bronchodilator does not replace an indicated anti-inflammatory asthma treatment.
• Monitor for palpitations, tremor and clinically significant cardiovascular effects. Hypokalemia can occur, particularly with interacting medicines or excessive exposure.
• Contraindicated with a history of hypersensitivity to levalbuterol, racemic albuterol or another product component.

Counseling

• Wash the plastic actuator with warm water and let it air-dry thoroughly at least weekly; follow the exact device instructions.
• Do not increase the dose or frequency yourself. Discard the inhaler when its dose indicator reaches zero.

Names and formulations

• Atrovent HFA: Selected ipratropium bromide inhalation aerosol; nebulized and intranasal products are outside this card.

Formulation distinction: Each mouthpiece actuation supplies 17 mcg of ipratropium bromide monohydrate. This solution aerosol does not require shaking. Prime with two sprays away from the face before first use or after more than three days without use.

Major safety and monitoring

• Avoid spraying into the eyes: increased eye pressure can precipitate or worsen narrow-angle glaucoma. Eye pain, red eyes, blurred vision or halos require immediate medical advice.
• Urinary retention can occur; use cautiously with prostatic hyperplasia or bladder-neck obstruction.
• Paradoxical bronchospasm and serious hypersensitivity reactions can occur; stop treatment and obtain prompt medical care for such reactions.
• Contraindicated with hypersensitivity to ipratropium, other product components, atropine or its derivatives. Pediatric safety and effectiveness have not been established.

Counseling

• Use the COPD maintenance regimen as prescribed; keep the separate acute-symptom plan provided by the treating clinician.
• Wash the mouthpiece at least weekly as directed and let it dry completely. Discard the inhaler when its dose indicator reads zero.

Names and formulations

• Combivent Respimat: Selected metered inhalation spray; nebulizer combinations and the older CFC aerosol have separate instructions and are outside this card.

Formulation distinction: One Respimat actuation supplies 20 mcg ipratropium bromide monohydrate and 100 mcg albuterol (as sulfate). The labeled schedule is one inhalation four times daily, with no more than six inhalations in 24 hours. These directions do not apply to nebulized combinations.

Major safety and monitoring

• Paradoxical bronchospasm can be life threatening; discontinue and obtain immediate medical care if breathing worsens after a dose.
• Avoid spraying into the eyes. Eye pain, blurred vision or halos with red eyes may indicate increased eye pressure and require immediate medical assessment.
• Use cautiously with prostatic hyperplasia or bladder-neck obstruction because ipratropium can cause urinary retention.
• Albuterol can cause clinically significant cardiovascular effects and hypokalemia. Reduced relief or increased need warrants immediate medical assessment.

Counseling

• For first use, insert the cartridge and prime toward the ground until a mist is visible, then repeat three more times. Demonstrate the exact Respimat instructions.
• Do not add extra ipratropium or albuterol or increase the prescribed frequency on your own; ask the clinician to review all inhalers for overlapping ingredients.

Names and formulations

• Fluticasone Propionate HFA (Prasco): Selected authorized-generic metered-dose aerosol. Nasal sprays, dry-powder inhalers and combination products are outside this card.

Formulation distinction: The HFA aerosol delivers 44, 110 or 220 mcg from the mouthpiece per actuation. First-use priming requires four sprays away from the face, shaking for five seconds before each. After more than seven days without use or if dropped, re-prime with one spray after shaking for five seconds.

Major safety and monitoring

• Watch for oral thrush and voice changes; assess inhaler technique and mouth rinsing.
• Monitor growth in children and systemic corticosteroid effects, including adrenal suppression. Review bone and eye risks during longer-term treatment.
• Worsening wheeze immediately after a dose can be paradoxical bronchospasm: stop this inhaler and obtain immediate treatment and medical assessment.
• Contraindicated with ingredient hypersensitivity and as primary treatment of severe acute asthma requiring intensive measures.

Counseling

• Shake for five seconds before each treatment spray; coordinate actuation with a slow, deep inhalation. Follow the exact device instructions.
• Rinse the mouth and spit after use. Take the prescribed regular doses; full benefit may take one to two weeks or longer. Do not increase doses or stop treatment without clinician guidance.

Names and formulations

• Pulmicort Flexhaler: Selected 90/180-mcg dry-powder device. Nebulized budesonide and budesonide/formoterol combinations have separate instructions.

Formulation distinction: Flexhaler is a 90- or 180-mcg dry-powder inhaler. Prime the new device before first use, then load each prescribed dose as instructed. Inhale deeply and forcefully; a dose may not be tasted or felt.

Major safety and monitoring

• Severe milk-protein allergy is a contraindication: the lactose excipient contains trace milk proteins. Ingredient hypersensitivity is also a contraindication.
• Monitor oral thrush, pediatric growth, systemic corticosteroid effects, and bone or eye risks during prolonged use.
• Immediate worsening wheeze after inhalation may be paradoxical bronchospasm; stop the product and obtain immediate treatment and medical assessment.
• It must not be used as the primary treatment of severe acute asthma requiring intensive measures.

Counseling

• Do not repeat an inhalation solely because no powder was tasted or felt. Breathe out away from the mouthpiece.
• Rinse the mouth and spit after each dose. Keep the device dry; wipe the outside of the mouthpiece weekly with a dry tissue, without water or other liquids.

Names and formulations

• QVAR RediHaler: Selected Teva breath-actuated metered-dose aerosol, 40 or 80 mcg per breath actuation. Original press-and-breathe QVAR, nasal products and other devices are outside this card.

Formulation distinction: QVAR RediHaler is a breath-actuated aerosol with 40- and 80-mcg strengths. It has no push button, requires no priming or shaking, and must not be used with a spacer or holding chamber. Close the white cap to prepare each inhalation, then open it and inhale deeply through the upright device.

Major safety and monitoring

• Watch for oral thrush and assess mouth-rinsing and inhaler technique.
• Monitor pediatric growth and systemic corticosteroid effects, including adrenal suppression; review bone and eye risks during longer-term treatment.
• Immediate worsening wheeze after a dose may be paradoxical bronchospasm: treat immediately with a short-acting inhaled bronchodilator, discontinue this inhaler and obtain medical assessment.
• Contraindicated as primary treatment of status asthmaticus or other acute asthma episodes requiring intensive measures, and with ingredient hypersensitivity.

Counseling

• Breathe out away from the inhaler. Keep it upright, form a seal around the mouthpiece, inhale deeply to release the medicine, hold the breath for 5 to 10 seconds, then close the cap.
• Rinse the mouth with water without swallowing after the prescribed inhalations. Keep the device dry; wipe the mouthpiece weekly with a clean, dry cloth or tissue and never wash it in water.

Names and formulations

• Alvesco: Selected Covis 80- or 160-mcg metered-dose oral inhalation aerosol. Intranasal ciclesonide and other formulations are outside this card.

Formulation distinction: Alvesco is a conventional press-and-breathe metered-dose aerosol delivering 80 or 160 mcg per actuation. Prime with three sprays before first use and after more than 10 consecutive days without use. It does not need shaking.

Major safety and monitoring

• Watch for oral thrush and assess mouth-rinsing and inhaler technique.
• Monitor pediatric growth and systemic corticosteroid effects, including adrenal suppression; review bone and eye risks during longer-term treatment.
• Immediate worsening wheeze after a dose may be paradoxical bronchospasm: treat immediately with a fast-acting inhaled bronchodilator, discontinue this inhaler and obtain medical assessment.
• Contraindicated as primary treatment of status asthmaticus or other acute asthma episodes requiring intensive measures, and with ingredient hypersensitivity.

Counseling

• Breathe out fully, then inhale deeply and slowly while pressing the dose-indicator button fully. Hold the breath for about 10 seconds or as long as comfortable.
• Rinse the mouth with water and spit after each dose. Keep the device dry; clean the mouthpiece inside and out weekly with a clean, dry tissue and never place it in water.

Names and formulations

• Asmanex Twisthaler: Selected Organon cap-activated dry-powder inhaler, labeled 110 or 220 mcg. Asmanex HFA aerosol, nasal and topical mometasone, and combination products are outside this card.

Formulation distinction: The 110- and 220-mcg strengths describe measured mometasone doses; they deliver 100 and 200 mcg, respectively, from the mouthpiece under in-vitro testing. Mouthpiece delivery is not a guarantee of lung deposition, which depends on patient factors such as inspiratory flow. The powder contains lactose with trace milk proteins.

Major safety and monitoring

• Contraindicated with known milk-protein or other ingredient hypersensitivity, and as primary treatment of status asthmaticus or acute asthma episodes requiring intensive measures.
• Assess oral thrush, mouth-rinsing and inhaler technique; monitor pediatric growth and review bone and eye risks during longer-term use.
• Systemic corticosteroid effects, including adrenal suppression, can occur. A switch from chronic oral corticosteroids requires supervised tapering and monitoring, not abrupt withdrawal.
• Immediate worsening wheeze after inhalation may be paradoxical bronchospasm: treat immediately with a fast-acting inhaled bronchodilator, discontinue Twisthaler and obtain medical assessment.

Counseling

• Use regularly as prescribed. Hold upright when removing the cap, inhale rapidly and deeply, and do not breathe out through the device. Wipe the mouthpiece dry and replace the cap immediately, turning until it clicks. Rinse the mouth with water and spit after use.
• Write the pouch-opening date on the cap label. Discard 45 days after opening the foil pouch or when the counter reads 00 and the final dose has been inhaled, whichever comes first. Do not use a device whose dose counter is not working correctly.

Names and formulations

• Advair Diskus: Selected GSK Diskus dry-powder device: 100/50, 250/50 or 500/50 mcg per blister. Advair HFA, Wixela Inhub, other devices and fluticasone furoate combinations are outside this card.

Formulation distinction: Strengths list fluticasone propionate first and salmeterol second. For COPD, the labeled dosage is one inhalation of 250/50 twice daily, about 12 hours apart; an efficacy advantage of 500/50 over 250/50 has not been demonstrated. Asthma strength selection is age- and patient-specific: the labeled regimen for ages 4–11 is 100/50 twice daily, while ages 12 and older may use 100/50, 250/50 or 500/50 twice daily as prescribed.

Major safety and monitoring

• Contraindicated with severe milk-protein hypersensitivity or hypersensitivity to either active ingredient or an excipient; the powder contains lactose with milk proteins. Also contraindicated as primary treatment of acute asthma/COPD episodes requiring intensive measures.
• Monitor for oral thrush and for pneumonia signs in patients with COPD. Review systemic corticosteroid risks, including adrenal suppression, bone effects and eye effects; monitor pediatric growth.
• Do not combine with another LABA-containing medicine. Review palpitations, tremor and cardiovascular risk; beta-agonist effects can include hypokalemia and hyperglycemia.
• Immediate increased wheezing after a dose may be paradoxical bronchospasm: treat immediately with an inhaled short-acting bronchodilator, discontinue Advair Diskus and obtain medical assessment.

Counseling

• Hold the Diskus level and flat, open it and slide the lever until it clicks to prepare one dose. Breathe out away from the mouthpiece, then inhale quickly and deeply through the mouth. Hold the breath about 10 seconds or as long as comfortable; close the device after use.
• Rinse the mouth and spit after each dose. Do not take an extra dose merely because you cannot taste or feel the powder. Do not wash the device or use it with a spacer; keep it dry.
• Mark the pouch-opening date and discard one month after opening the foil pouch or when the counter reads 0, whichever comes first. Do not use extra doses for sudden symptoms; follow the prescribed rescue plan and seek care for worsening breathing.

Names and formulations

• Breo Ellipta: Selected GSK Ellipta dry-powder combination, 50/25, 100/25 or 200/25 mcg per actuation. Other Ellipta products, fluticasone propionate combinations and other devices are outside this card.

Formulation distinction: All labeled regimens use one inhalation once daily. COPD uses 100/25. For asthma, ages 5–11 use 50/25, ages 12–17 use 100/25, and adults aged 18 and older use 100/25 or 200/25 as prescribed. Strength numbers refer to fluticasone furoate/vilanterol in mcg; they are not interchangeable with other products' strengths.

Major safety and monitoring

• Contraindicated with severe milk-protein hypersensitivity or hypersensitivity to an ingredient; the powder contains lactose with milk proteins. Also contraindicated as primary treatment of acute asthma/COPD episodes requiring intensive measures.
• Monitor for oral thrush and pneumonia signs in COPD. Review systemic corticosteroid effects, adrenal suppression, bone and eye risks; monitor pediatric growth.
• Do not use another LABA-containing therapy at the same time. Review cardiovascular effects, including rapid heartbeat, and be alert to hypokalemia and increased blood glucose.
• If immediate increased wheezing occurs after dosing, treat possible paradoxical bronchospasm immediately with an inhaled short-acting bronchodilator, discontinue Breo Ellipta and obtain medical assessment.

Counseling

• Open the cover only when ready to inhale; slide it down until it clicks. Breathe out away from the inhaler, then take one long, steady, deep breath through the mouth without blocking the air vent. Hold the breath about 3–4 seconds or as long as comfortable.
• Close the cover after inhalation and rinse the mouth, spitting out the water. Opening and closing without inhaling wastes the prepared dose. Do not take another dose merely because you did not taste or feel it. Routine cleaning is unnecessary; the mouthpiece may be wiped with a dry tissue if needed.
• Use at the same time each day, no more than once every 24 hours. Record the tray-opening date and discard six weeks after opening the foil tray or when the counter reads 0, whichever comes first. Extra inhalations are not rescue doses.

Names and formulations

• Anoro Ellipta: Selected GSK Ellipta dry-powder inhaler, 62.5/25 mcg per actuation. Umeclidinium-only products, ICS-containing combinations, other Ellipta combinations and other devices are outside this card.

Formulation distinction: The product is labeled as 62.5 mcg umeclidinium and 25 mcg vilanterol per actuation as a dry powder for oral inhalation. The XML also records standardized in-vitro delivered amounts of 55 mcg umeclidinium and 22 mcg vilanterol; these measurement contexts should not be conflated. The labeled dosage is one actuation once daily at the same time each day, never more than once in 24 hours.

Major safety and monitoring

• Contraindicated with severe milk-protein hypersensitivity or hypersensitivity to an ingredient; the lactose-containing powder contains milk proteins. LABA use without an inhaled corticosteroid is also contraindicated in asthma, and Anoro Ellipta is not indicated for asthma.
• Do not use for acute symptoms or with another LABA-containing therapy. Increasing need for a short-acting bronchodilator can signal worsening COPD and requires prompt reassessment rather than extra Anoro doses.
• Monitor for paradoxical bronchospasm and beta-agonist cardiovascular effects. Use caution with cardiovascular disease, narrow-angle glaucoma, urinary retention, convulsive disorders or thyrotoxicosis. The label separately notes that related beta2-agonist doses have aggravated preexisting diabetes mellitus and ketoacidosis; be alert to hypokalemia and hyperglycemia.
• Avoid another anticholinergic-containing drug because additive anticholinergic effects may increase. Reconcile medicines for duplicate LAMA/LABA therapy.

Counseling

• Open the cover only when ready to inhale; sliding it down until it clicks prepares one dose and moves the counter. Opening and closing without inhaling wastes that dose. Do not shake the inhaler.
• Breathe out fully away from the mouthpiece. Seal the lips around the mouthpiece without blocking the air vent, then take one long, steady, deep breath through the mouth. Hold the breath about 3 to 4 seconds, or as long as comfortable, then breathe out slowly.
• Do not take another dose merely because the powder was not tasted or felt. Routine cleaning is unnecessary; if needed, wipe the mouthpiece with a dry tissue. Discard six weeks after opening the foil tray or when the counter reads 0, whichever comes first.

Names and formulations

• Stiolto Respimat: Selected Boehringer Ingelheim metered inhalation spray, 2.5/2.5 mcg per actuation. Tiotropium-only, olodaterol-only, other combination products and other inhaler devices are outside this card.

Formulation distinction: Each actuation from the mouthpiece delivers 2.5 mcg tiotropium and 2.5 mcg olodaterol. Two actuations equal one dose and deliver 5 mcg of each active moiety. The labeled regimen is two inhalations once daily at the same time, never more than two inhalations in 24 hours.

Major safety and monitoring

• Contraindicated with hypersensitivity to tiotropium, ipratropium, olodaterol or a product component. LABA use without an inhaled corticosteroid is contraindicated in asthma; Stiolto Respimat is not indicated for asthma.
• Do not use for acute symptoms, exceed the daily dose or combine with another LABA-containing medicine. Increasing rescue-inhaler use can signal worsening COPD and requires prompt reassessment rather than extra Stiolto doses.
• Monitor for immediate hypersensitivity, paradoxical bronchospasm and beta-agonist cardiovascular effects. Use caution with cardiovascular or convulsive disorders, thyrotoxicosis, narrow-angle glaucoma and urinary retention; be alert to hypokalemia and hyperglycemia.
• No renal dose adjustment is specified, but closely monitor patients with moderate-to-severe renal impairment, defined in this label as creatinine clearance below 60 mL/min, for anticholinergic adverse effects.

Counseling

• Use the Stiolto cartridge only with its Stiolto Respimat inhaler. Before first use, insert the cartridge and prime toward the ground until an aerosol cloud appears, then repeat the Turn-Open-Press sequence three more times.
• For each daily puff, keep the cap closed and turn the clear base a half turn until it clicks, open the cap fully, breathe out, then press while taking a slow deep breath without blocking the air vents. Hold the breath for 10 seconds or as long as comfortable. Repeat the sequence for two total puffs.
• If unused for more than 3 days, release one puff toward the ground before use. If unused for more than 21 days, actuate until a mist is visible and repeat three more times. Discard three months after cartridge insertion, when the inhaler locks or at expiration, whichever comes first.

Names and formulations

• Trelegy Ellipta: Selected GSK dry-powder oral inhaler, 100/62.5/25 or 200/62.5/25 mcg per actuation. Single ingredients, dual combinations and other triple inhalers are outside this card.

Formulation distinction: Use one inhalation once daily at the same time each day, never more than once in 24 hours. The strengths differ in fluticasone furoate content; umeclidinium and vilanterol remain 62.5 and 25 mcg. The higher strength is not the labeled COPD dose.

Major safety and monitoring

• Contraindicated with severe milk-protein allergy or hypersensitivity to a component, and as primary treatment of status asthmaticus or acute COPD/asthma episodes requiring intensive measures.
• Monitor for oral thrush, pneumonia in patients with COPD, systemic corticosteroid effects, and bone or eye effects with longer-term use.
• Use caution with cardiovascular disorders, narrow-angle glaucoma and urinary retention; be alert to hypokalemia and hyperglycemia. New eye pain or difficulty passing urine requires prompt medical assessment.
• Do not combine with another LABA; avoid other anticholinergic-containing drugs because of additive effects. Sudden worsening wheeze after a dose may be paradoxical bronchospasm: use a short-acting inhaled bronchodilator, stop Trelegy and seek medical assessment.

Counseling

• Open the cover only when ready to inhale. Opening and closing it without inhaling wastes that dose; the lost dose cannot be inhaled later, and reopening cannot deliver two doses in one inhalation.
• Breathe out away from the mouthpiece, then take one long, steady, deep breath through the mouth without blocking the air vent. Hold the breath about 3 to 4 seconds or as long as comfortable. Do not repeat the dose just because it was not tasted or felt.
• Rinse the mouth with water and spit after use. Keep the inhaler dry; use a dry tissue for the mouthpiece if needed. Discard six weeks after opening the foil tray or when the counter reaches zero, whichever comes first.

Names and formulations

• Theo-24: Selected Endo USA oral capsules: 100, 200, 300 and 400 mg. Directions for other extended-release tablets, liquids or intravenous aminophylline are outside this card.

Formulation distinction: The extended-release capsule permits once-daily dosing in appropriate patients; some rapid metabolizers need a different prescribed schedule. Individualize the dose using serum concentrations. The label advises morning administration for once-daily use, not bedtime dosing.

Major safety and monitoring

• Contraindicated with hypersensitivity to theophylline or a product component. Use extreme caution with seizure disorders, active peptic ulcer disease or cardiac arrhythmias other than bradyarrhythmias.
• Reduced clearance can cause severe toxicity, including seizures and dangerous arrhythmias. Review age, liver disease, heart failure, sustained fever, smoking changes and interacting medicines when planning serum-level monitoring.
• New nausea or vomiting, especially repeated vomiting, or other toxicity symptoms require withholding further doses and immediate medical assessment with a serum theophylline level. Do not wait for a scheduled monitoring visit.

Counseling

• Tell the care team before starting or stopping smoking. Stopping tobacco smoking can reduce clearance and raise theophylline concentrations; nicotine gum does not preserve smoking-related clearance. Monitoring and prescriber-directed dose reassessment are needed.
• Do not change the dose or timing yourself. If a dose is missed, take the next dose at the scheduled time without making up the missed dose.
• A high-fat meal can increase Theo-24 absorption and peak concentrations. For prescribed doses at or above 900 mg or 13 mg/kg, whichever is less, the label says not to take Theo-24 less than 1 hour before a high-fat meal; confirm the prescribed meal schedule with the care team.

Names and formulations

• Prilosec: prescription delayed-release products
• Prilosec OTC: 20-mg delayed-release course for frequent heartburn; not immediate relief

Formulation distinction: Delayed-release forms should not be crushed or chewed; prescription and OTC products differ in indications, directions, and duration.

Major safety and monitoring

• Use the lowest effective duration consistent with the indication and reassess persistent symptoms or alarm features.
• Longer exposure can be associated with hypomagnesemia, vitamin B12 deficiency, fractures, and Clostridioides difficile-associated diarrhea in susceptible patients.
• Monitor magnesium or other parameters when prolonged therapy and patient-specific risk justify it.

Counseling

• Take before eating as directed and swallow delayed-release dosage forms according to product instructions.
• OTC therapy is not immediate relief and should not be extended or repeatedly restarted outside label directions without evaluation.

Names and formulations

• Ondansetron hydrochloride: film-coated oral tablet

Formulation distinction: The bound label covers film-coated oral tablets. Other oral dosage forms and injections have separate handling and administration instructions.

Major safety and monitoring

• Can prolong QT and has been associated with torsades de pointes; correct electrolyte abnormalities and use ECG monitoring in higher-risk patients.
• Serotonin syndrome has been reported, especially with other serotonergic medicines.
• May mask progressive ileus or gastric distention after abdominal surgery or chemotherapy.

Counseling

• Take the film-coated tablet exactly as prescribed; do not substitute another dosage form without checking its instructions.
• Report fainting, palpitations, severe agitation, muscle rigidity, or persistent abdominal distention.

Names and formulations

• Reglan: oral tablet

Formulation distinction: Kidney function and CYP2D6 status or inhibitors can affect exposure; dose reduction may be required.

Major safety and monitoring

• Boxed warning: can cause tardive dyskinesia; avoid treatment longer than 12 weeks except rare situations where benefit outweighs risk.
• Monitor for involuntary movements, acute dystonia, akathisia, parkinsonism, neuroleptic malignant syndrome, depression, and sedation.
• Stop and evaluate if tardive dyskinesia symptoms develop.

Counseling

• Report lip smacking, tongue movements, facial grimacing, tremor, rigidity, or other uncontrolled movements promptly.
• Avoid alcohol and use caution driving until the sedating effects are known.

Names and formulations

• Protonix: Oral delayed-release tablets and granules for oral suspension; intravenous Protonix has a separate label.

Formulation distinction: Tablets are swallowed whole with or without food. Granules use applesauce or apple juice about 30 minutes before a meal; do not crush or chew either form, and do not divide a granule packet to make a smaller dose.

Major safety and monitoring

• Symptom relief does not exclude gastric malignancy; evaluate inadequate response or early relapse.
• Stop and evaluate suspected acute tubulointerstitial nephritis or severe cutaneous reactions.
• Persistent diarrhea may signal C. difficile infection. Use the lowest effective dose and duration appropriate for the indication.
• Long-term use can involve fractures, vitamin B12 deficiency, low magnesium and fundic gland polyps; consider mineral monitoring in susceptible patients.

Counseling

• Check which formulation you have because meal timing differs.
• For oral granules, use only the specified apple vehicles and swallow promptly without chewing.
• Report persistent diarrhea, rash, reduced kidney function symptoms, or signs of low magnesium such as cramps or palpitations.

Names and formulations

• Pepcid: Selected prescription 20- and 40-mg tablets; OTC Pepcid AC and combination Pepcid Complete follow separate labels.

Formulation distinction: For nonerosive GERD with normal renal function, the labeled regimen is 20 mg twice daily for up to 6 weeks. Adjust by indication when creatinine clearance is below 60 mL/min; tablet doses are intended for patients weighing at least 40 kg.

Major safety and monitoring

• Renal impairment increases exposure; use the lowest effective adjusted dose.
• Confusion, delirium and other CNS reactions occur particularly in older adults or renal impairment; prolonged QT intervals are also reported with moderate/severe renal impairment.
• Contraindicated after serious hypersensitivity to famotidine or another H2 antagonist.
• Evaluate suboptimal response or early relapse because symptom improvement does not exclude gastric malignancy.

Counseling

• May take with or without food. For once-daily use take before bedtime; twice-daily use is morning and bedtime.
• Report confusion, severe drowsiness or palpitations and tell clinicians about kidney disease.
• Check with the pharmacist before adding other acid reducers or medicines needing stomach acid for absorption.

Names and formulations

• Carafate: Selected 1-g oral tablets; oral suspension has a separate label. Never administer intravenously.

Formulation distinction: The adult active-ulcer tablet regimen is 1 g four times daily on an empty stomach; maintenance is 1 g twice daily. Continue active-ulcer treatment for 4–8 weeks unless healing is demonstrated sooner.

Major safety and monitoring

• Use caution in chronic renal failure or dialysis because absorbed aluminum can accumulate and cause toxicity; other aluminum products increase the burden.
• Constipation is the most frequent adverse effect. Bezoars have occurred, often with delayed gastric emptying or enteral feeding.
• Assess swallowing difficulty because tablet aspiration and respiratory complications have been reported.
• Serious hypersensitivity reactions can occur; known product hypersensitivity is a contraindication.

Counseling

• Take on an empty stomach; keep antacids at least 30 minutes before or after sucralfate.
• Review the whole medication schedule because binding can reduce absorption of other medicines.
• Report swallowing trouble or persistent constipation; do not stop the healing course solely because pain improves.

Names and formulations

• MiraLAX: Unflavored PEG 3350 powder, 17 g per cap-marked dose or packet; not an electrolyte bowel-preparation solution.

Formulation distinction: For ages 17 and older, dissolve 17 g fully in 4–8 ounces of beverage once daily. Do not drink if clumps remain. OTC directions limit use to seven days; age 16 or younger requires a clinician.

Major safety and monitoring

• Do not use with kidney disease except under clinician advice and supervision.
• Seek advice before use with nausea, vomiting, abdominal pain, IBS or a bowel-habit change lasting more than two weeks.
• Stop and seek advice for rectal bleeding, worsening abdominal symptoms, diarrhea or need for use longer than one week.

Counseling

• Do not take more than directed or expect immediate evacuation.
• Do not mix with starch-based thickeners used for swallowing difficulty.
• Check with a clinician or pharmacist if taking a prescription medicine.

Names and formulations

• Linzess: 72-, 145- and 290-mcg oral capsules; pediatric age eligibility and dose depend on the indication.

Formulation distinction: Adults: IBS-C 290 mcg daily; CIC 145 mcg daily or 72 mcg for presentation/tolerability. Pediatric: IBS-C age seven or older, 145 mcg daily; FC age two or older, 72 mcg daily. Take at least 30 minutes before a meal on an empty stomach.

Major safety and monitoring

• Boxed warning and contraindication below age two because of serious dehydration risk.
• Contraindicated with known or suspected mechanical GI obstruction.
• Severe diarrhea requires suspending treatment and rehydration; assess dizziness, syncope and dehydration.

Counseling

• Do not crush or chew capsules or contents. If unable to swallow, use the labeled applesauce or water preparation instructions.
• Skip a missed dose and take the next at its regular time; do not double.
• Keep in the original container, protect from moisture and keep out of children’s reach.

Names and formulations

• Lialda: 1.2-g delayed-release tablets; oral and rectal mesalamine formulations have distinct release and dosing instructions.

Formulation distinction: Adults: induction 2.4–4.8 g once daily; maintenance 2.4 g daily. Take with food and swallow whole, without splitting or crushing. Pediatric dosing is weight- and treatment-phase-based.

Major safety and monitoring

• Check renal function before treatment and periodically; discontinue if renal function deteriorates.
• Acute intolerance can resemble a UC flare with cramping, abdominal pain and bloody diarrhea, sometimes fever, headache or rash; stop and promptly evaluate if suspected.
• Contraindicated with salicylate/aminosalicylate hypersensitivity. Severe skin reactions or systemic hypersensitivity require immediate assessment and discontinuation.
• Maintain hydration to reduce kidney-stone risk; assess risk with renal or hepatic impairment.

Counseling

• Take with food and adequate fluids; keep tablets intact.
• Report new or worsening bloody diarrhea, fever, rash or significant pain promptly.
• Do not substitute instructions from a different mesalamine release formulation.

Names and formulations

• Zoloft: tablet and oral concentrate; concentrate requires dilution

Formulation distinction: The oral concentrate must be diluted only with a permitted beverage immediately before use; tablet and concentrate dosing are not prepared the same way.

Major safety and monitoring

• Boxed warning: monitor children, adolescents, and young adults for suicidal thoughts or behavior, especially early in treatment and after dose changes.
• Monitor for serotonin syndrome, hyponatremia, abnormal bleeding, activation of mania/hypomania, and discontinuation symptoms.
• Clinical benefit may take time; reassess adherence, response, and tolerability rather than escalating prematurely.

Counseling

• Take consistently and do not stop abruptly without a tapering plan.
• Seek help promptly for worsening mood, suicidal thoughts, severe agitation, fever with rigidity, or confusion.

Names and formulations

• Wellbutrin XL: once-daily ER product for depression/SAD
• Zyban: recognizable sustained-release smoking-cessation brand; separate indication and directions

Formulation distinction: Immediate-release, sustained-release, and extended-release products differ in frequency and maximum single-dose rules; verify the formulation and total daily bupropion from all products.

Major safety and monitoring

• Boxed warning: monitor for suicidal thoughts and behavior in children, adolescents, and young adults.
• Seizure risk is dose related; contraindicated with seizure disorders, current or prior bulimia/anorexia nervosa, and abrupt withdrawal from alcohol, benzodiazepines, barbiturates, or antiepileptic drugs.
• Monitor blood pressure, mood activation, agitation, and neuropsychiatric symptoms.

Counseling

• Swallow XL tablets whole; do not crush, divide, or chew.
• Take in the morning when prescribed once daily and avoid doubling after a missed dose.

Names and formulations

• Seroquel: immediate-release tablet
• Seroquel XR: extended-release tablet with distinct administration and indication details

Formulation distinction: IR and XR products are not administered identically; XR tablets must be swallowed whole and are generally taken without food or with a light meal per label.

Major safety and monitoring

• Boxed warning: increased mortality in older adults with dementia-related psychosis; quetiapine is not approved for dementia-related psychosis.
• Boxed warning: antidepressants increased suicidal thoughts and behaviors in pediatric and young-adult patients in short-term studies; monitor for clinical worsening and emergent suicidality.
• Monitor weight, glucose, lipids, blood pressure, orthostasis, sedation, extrapyramidal symptoms, and tardive dyskinesia.
• Evaluate fever, rigidity, altered mental status, or autonomic instability urgently for neuroleptic malignant syndrome.

Counseling

• Rise slowly and avoid driving or hazardous tasks until sedation and orthostasis are understood.
• Report new or worsening depression, suicidal thoughts, unusual behavior changes, abnormal movements, severe restlessness, or marked metabolic changes promptly.

Names and formulations

• Lexapro: Selected oral tablet label; its 1-mg/mL branded oral solution is listed as not currently marketed. Generic product labeling can differ.

Formulation distinction: Take tablets once daily, morning or evening, with or without food. The recommended dose is 10 mg daily for most elderly patients and patients with hepatic impairment.

Major safety and monitoring

• Monitor for worsening mood and suicidal thoughts, particularly early in treatment or after dose changes; antidepressants carry a boxed warning for increased risk in pediatric and young adult patients.
• Screen for bipolar disorder before treatment; activation of mania or hypomania can occur.
• Serotonin syndrome can occur, especially with other serotonergic drugs; MAOIs are contraindicated.
• Hyponatremia/SIADH can cause confusion, weakness or unsteadiness; older adults and patients taking diuretics are at greater risk.
• Bleeding risk increases with NSAIDs, antiplatelets and anticoagulants. Assess sexual adverse effects and discontinuation symptoms.

Counseling

• Take consistently; discuss a gradual taper with the prescriber rather than stopping abruptly.
• Seek urgent help for new severe agitation with fever, sweating, tremor or muscle rigidity. Report new confusion, falls, unusual bleeding or suicidal thoughts promptly.
• Discuss sexual adverse effects rather than silently stopping treatment.

Names and formulations

• Prozac: Selected daily oral capsule label; do not apply its instructions automatically to delayed-release weekly products or an olanzapine/fluoxetine combination.

Formulation distinction: Daily capsules may be taken with or without food. Dose and schedule depend on indication. Fluoxetine and its active metabolite persist for weeks, so dose changes and interacting-drug switches need time.

Major safety and monitoring

• Monitor for worsening mood and suicidal thoughts, particularly early in treatment or after dose changes; antidepressants carry a boxed warning for increased risk in pediatric and young adult patients.
• Screen for bipolar disorder; monitor for mania, anxiety, insomnia and appetite or weight changes.
• Serotonin syndrome and QT prolongation are important risks; pimozide and thioridazine are contraindicated.
• Assess hyponatremia and bleeding risk, especially with diuretics, NSAIDs, antiplatelets or anticoagulants.
• Use a lower or less frequent dose with hepatic impairment; its long half-life prolongs interactions after discontinuation.

Counseling

• Benefit may take several weeks. Do not change the dose or stop treatment without a plan.
• Tell every prescriber about recent fluoxetine use even after it has been stopped.
• Report suicidal thoughts, marked agitation, palpitations, fainting or unusual bleeding promptly.

Names and formulations

• Celexa: Selected immediate-release oral tablets. Citalopram and escitalopram are distinct drugs and are not substituted at equal doses.

Formulation distinction: Take once daily with or without food. Usual adult initiation is 20 mg daily; doses above 40 mg daily are not recommended. The maximum is 20 mg daily for patients older than 60 years, hepatic impairment, CYP2C19 poor metabolizers, or concomitant CYP2C19 inhibitors.

Major safety and monitoring

• Monitor for worsening mood and suicidal thoughts, particularly early in treatment or after dose changes; antidepressants carry a boxed warning for increased risk in pediatric and young adult patients.
• Dose-dependent QT prolongation can cause torsades de pointes. Assess QT risk, interacting drugs, and potassium/magnesium; ECG and electrolyte monitoring are indicated in selected risk settings.
• Avoid use in congenital long-QT syndrome, bradycardia, hypokalemia/hypomagnesemia, recent acute myocardial infarction, uncompensated heart failure or other QT-prolonging drugs unless benefit outweighs risk. Discontinue for persistent QTc above 500 ms.
• Screen for bipolar disorder; monitor serotonin syndrome and hyponatremia. MAOIs and pimozide are contraindicated.
• Review bleeding risk, sexual dysfunction and symptoms during discontinuation.

Counseling

• Report palpitations, dizziness or fainting promptly.
• Do not increase the dose on your own; age and interacting medicines can lower the maximum permitted dose.
• Taper with the prescriber rather than stopping abruptly.

Names and formulations

• Paxil: Selected immediate-release tablets. Paxil CR has a separate release formulation and label. The selected label lists the branded suspension as not currently marketed.

Formulation distinction: Take once daily in the morning with or without food. Starting doses differ by indication; elderly patients and those with severe renal or hepatic impairment start at 10 mg daily, with a maximum of 40 mg daily.

Major safety and monitoring

• Monitor for worsening mood and suicidal thoughts, particularly early in treatment or after dose changes; antidepressants carry a boxed warning for increased risk in pediatric and young adult patients.
• Screen for bipolar disorder and monitor for serotonin syndrome, mania and discontinuation symptoms; avoid abrupt withdrawal.
• First-trimester exposure is associated with increased cardiovascular-malformation risk; discuss pregnancy plans and treatment options with the prescriber.
• Assess hyponatremia, bleeding risk and sexual dysfunction.
• MAOIs, thioridazine and pimozide are contraindicated; CYP2D6 inhibition creates important interactions.

Counseling

• Report new suicidal thoughts or significant mood changes promptly.
• Discuss pregnancy or pregnancy plans before starting or changing treatment; do not stop abruptly on your own.
• If doses are missed or treatment is ending, contact the prescriber about a gradual taper.

Names and formulations

• Effexor XR: Selected extended-release capsules; immediate-release venlafaxine tablets and other extended-release products require their own instructions.

Formulation distinction: Take once daily with food at the same time each day. Swallow the capsule whole, or sprinkle its entire contents on a spoonful of applesauce, swallow immediately without chewing, then drink water. Do not crush or dissolve the pellets.

Major safety and monitoring

• Monitor for worsening mood and suicidal thoughts, particularly early in treatment or after dose changes; antidepressants carry a boxed warning for increased risk in pediatric and young adult patients.
• Control hypertension before starting; monitor blood pressure before treatment and regularly during therapy. Sustained increases may require dose reduction or discontinuation.
• Reduce total daily dose in renal or hepatic impairment; the reduction depends on severity and dialysis status.
• Screen for bipolar disorder; monitor serotonin syndrome, hyponatremia and bleeding risk.
• Withdrawal can be substantial; individualize a gradual taper, which may take months in some patients.

Counseling

• Do not chew sprinkled pellets or divide capsule contents to estimate a dose.
• Keep blood-pressure follow-up appointments and report significant mood changes.
• Arrange refills and discuss tapering before stopping; abrupt cessation can cause dizziness and electric-shock-like sensations.

Names and formulations

• Cymbalta: Selected delayed-release capsules; swallowing instructions should not be transferred from separately labeled sprinkle products.

Formulation distinction: Swallow Cymbalta capsules whole with or without food. Do not open, crush or chew them or sprinkle contents on food. Dosing depends on indication.

Major safety and monitoring

• Monitor for worsening mood and suicidal thoughts, particularly early in treatment or after dose changes; antidepressants carry a boxed warning for increased risk in pediatric and young adult patients.
• Avoid use with substantial alcohol intake or chronic liver disease/cirrhosis. Discontinue for jaundice or clinically significant liver dysfunction; do not resume unless another cause is established.
• Avoid use with severe renal impairment (GFR below 30 mL/min).
• Monitor blood pressure; orthostatic hypotension, syncope and falls can occur, especially with dose increases.
• Screen for bipolar disorder; assess serotonin syndrome, bleeding risk, hyponatremia and discontinuation symptoms.

Counseling

• Report dark urine, jaundice or right-upper abdominal pain promptly.
• Discuss alcohol intake and kidney or liver disease before treatment.
• Swallow whole and taper with the prescriber; do not abruptly stop treatment.

Names and formulations

• Remeron / RemeronSolTab: Remeron is a conventional tablet; RemeronSolTab is an orally disintegrating tablet with specific blister and handling instructions.

Formulation distinction: Start at 15 mg once daily, preferably in the evening before sleep; adjust no more often than every 1–2 weeks. For SolTab, use dry hands, remove only when ready, place on the tongue immediately and allow to disintegrate; do not split, crush or chew.

Major safety and monitoring

• Monitor for worsening mood and suicidal thoughts, particularly early in treatment or after dose changes; antidepressants carry a boxed warning for increased risk in pediatric and young adult patients.
• Somnolence, increased appetite and weight gain are common; monitor weight and functional impairment. Cholesterol and triglyceride elevations may occur.
• Rare severe neutropenia/agranulocytosis: sore throat, fever or other infection signs with a low WBC count require discontinuation and close monitoring.
• Screen for bipolar disorder; watch for serotonin syndrome, QT risk, hyponatremia and severe hypersensitivity/DRESS.
• Dose reduction may be needed in moderate-to-severe renal or hepatic impairment; avoid abrupt discontinuation.

Counseling

• Avoid driving until you know its effects; avoid alcohol and benzodiazepines because impairment can increase.
• Report fever, sore throat, mouth sores or rash promptly.
• Take SolTab immediately after opening its blister; it can dissolve without water.

Names and formulations

• Generic trazodone hydrochloride tablets: Selected Apotex immediate-release tablets; this card does not describe oral solution or other release formulations.

Formulation distinction: Take shortly after a meal or light snack. Selected tablets may be swallowed whole or broken in half along the score; do not chew or crush. Antidepressant dosing is individualized and commonly divided.

Major safety and monitoring

• Monitor for worsening mood and suicidal thoughts, particularly early in treatment or after dose changes; antidepressants carry a boxed warning for increased risk in pediatric and young adult patients.
• QT prolongation and torsades can occur even at low immediate-release doses; avoid known QT prolongation, interacting QT-prolonging drugs and relevant arrhythmia risk factors.
• Orthostatic hypotension, syncope and sedation can impair driving and increase fall risk.
• An erection lasting longer than 4 hours, painful or not, requires immediate discontinuation and emergency medical attention.
• Screen for bipolar disorder; assess serotonin syndrome, bleeding, hyponatremia and discontinuation symptoms.

Counseling

• Take after food and rise slowly from sitting or lying down.
• Avoid alcohol and driving until its effects are known.
• Seek emergency help for an erection lasting more than 4 hours; do not wait for pain. Taper with the prescriber when ending therapy.

Names and formulations

• Generic buspirone hydrochloride tablets: Selected Strides oral tablets; follow the dispensed strength’s scoring instructions.

Formulation distinction: The labeled starting total is 15 mg/day, generally 7.5 mg twice daily, with individualized titration. Take consistently either always with food or always without food because food increases bioavailability.

Major safety and monitoring

• MAOI antidepressants are contraindicated with buspirone and within 14 days in either switching direction; linezolid and intravenous methylene blue require specific management.
• Monitor serotonin syndrome, particularly when combining serotonergic medicines.
• Dizziness, nausea, headache and restlessness can occur; avoid driving until individual effects are known.
• Use in severe hepatic or renal impairment cannot be recommended in the selected label.
• Buspirone does not prevent benzodiazepine withdrawal; replacing chronic benzodiazepine therapy requires a separate gradual-withdrawal plan.

Counseling

• Take the prescribed scheduled doses consistently in relation to food; do not change the dose on your own.
• Avoid large amounts of grapefruit juice and discuss all interacting medicines.
• Do not abruptly stop a benzodiazepine merely because buspirone has been prescribed.

Names and formulations

• Abilify: Selected oral tablet label. Long-acting injections have separate indications, initiation and missed-dose instructions.

Formulation distinction: Take oral tablets with or without food. Doses differ substantially between adjunctive MDD and schizophrenia; do not transfer oral doses directly to a long-acting injection.

Major safety and monitoring

• Boxed warnings address increased mortality in elderly patients with dementia-related psychosis and suicidality with antidepressant use in younger patients; Abilify is not approved for dementia-related psychosis.
• Monitor weight, glucose and lipids; metabolic adverse effects remain possible.
• Assess akathisia, other movement symptoms and tardive dyskinesia; fever, rigidity and altered mental status can indicate neuroleptic malignant syndrome.
• Ask about new gambling, shopping, eating or sexual urges; pathological gambling and other compulsive behaviors may require dose reduction or stopping.
• Monitor orthostatic symptoms, falls and sedation; monitor CBC in patients with relevant low-WBC history.

Counseling

• Report uncontrollable urges even if they seem unrelated to medication.
• Report severe restlessness or abnormal movements; seek urgent care for fever with rigidity or confusion.
• Rise slowly and avoid driving until you know the effects.

Names and formulations

• Risperdal / Risperdal M-TAB: Selected oral tablets, 1-mg/mL solution and orally disintegrating tablets. Long-acting injections use separate regimens.

Formulation distinction: The solution can be taken directly or mixed with water, coffee, orange juice or low-fat milk; do not mix with cola or tea. Start at 0.5 mg twice daily in adults with severe renal or hepatic impairment and titrate cautiously.

Major safety and monitoring

• Boxed warning: increased mortality in elderly patients with dementia-related psychosis; not approved for that use. Cerebrovascular events are also a concern in that population.
• Monitor weight, glucose and lipids for metabolic changes.
• Persistent prolactin elevation may cause galactorrhea, amenorrhea, sexual dysfunction and, with prolonged hypogonadism, decreased bone density.
• Monitor extrapyramidal symptoms and tardive dyskinesia; fever, rigidity and mental-status change require urgent assessment for neuroleptic malignant syndrome.
• Assess orthostatic hypotension, falls and sedation. Check CBC frequently when there is a relevant low-WBC history.

Counseling

• Measure solution with the supplied calibrated oral syringe. Check beverage compatibility before mixing.
• Remove M-TAB only when ready and place immediately on the tongue; do not push it through the foil.
• Report abnormal movements, breast discharge, menstrual changes or sexual dysfunction.

Names and formulations

• Zyprexa / Zyprexa Zydis: This card focuses on oral tablets and orally disintegrating tablets; short-acting IM and long-acting injectable olanzapine require separate administration and monitoring.

Formulation distinction: Oral tablets are taken once daily with or without food. For Zydis, peel back foil with dry hands and place the tablet immediately on the tongue; it disintegrates with or without liquid.

Major safety and monitoring

• Boxed warning: increased mortality in elderly patients with dementia-related psychosis; not approved for that use.
• Obtain fasting glucose and fasting lipids at baseline and periodically; monitor weight regularly. Severe hyperglycemia, dyslipidemia and weight gain can occur.
• Monitor sedation, orthostatic hypotension, falls and anticholinergic effects such as constipation; use caution with urinary retention or ileus risk.
• Assess movement symptoms and tardive dyskinesia. Fever, rigidity and altered mental status require urgent evaluation for neuroleptic malignant syndrome.
• Rash with fever or systemic symptoms can represent DRESS; discontinue if DRESS is suspected.

Counseling

• Keep weight and laboratory follow-up appointments. Report excessive thirst, frequent urination or weakness.
• Avoid alcohol; rise slowly and use caution driving until effects are known.
• Report severe constipation, abnormal movements or rash with fever promptly.

Names and formulations

• Lithobid: Selected 300-mg lithium carbonate extended-release tablets. Other salts and immediate-release formulations require their own conversion and dosing instructions.

Formulation distinction: Swallow extended-release tablets whole; never crush or chew. Individualize dose to clinical response and serum levels. Draw levels just before the next dose, about 8–12 hours after the preceding dose under this label, and record collection timing.

Major safety and monitoring

• Boxed warning: toxicity can occur near therapeutic concentrations; reliable serum-level measurement must be available. Assess clinical symptoms as well as the number.
• Monitor lithium concentration, renal function and thyroid function. Renal concentrating defects may cause polyuria, thirst and dehydration.
• Dehydration, sodium loss, renal dysfunction and interacting medicines increase toxicity risk.
• New diarrhea, vomiting, ataxia, slurred speech or confusion require withholding lithium and urgent medical assessment.
• Review pregnancy plans and cardiac history, including Brugada syndrome; risks and monitoring require individual assessment.

Counseling

• Maintain a consistent normal salt intake and adequate fluid intake as advised; report prolonged sweating, vomiting, diarrhea or fever.
• Check with a pharmacist before NSAIDs or new blood-pressure medicines.
• Attend timed blood tests and tell the clinician when the last dose was taken.

Names and formulations

• Lamictal / Lamictal ODT: Selected immediate-release tablets, tablets for suspension and ODT; Lamictal XR has separate instructions and indications.

Formulation distinction: Titration depends on age, indication and interacting medicines. For an adult with bipolar I taking valproate, initial dosing is 25 mg every other day for weeks 1–2. Tablets for suspension may be chewed, swallowed or dispersed as directed; do not apply XR instructions to these forms.

Major safety and monitoring

• Boxed warning: serious rashes including Stevens-Johnson syndrome and toxic epidermal necrolysis. Valproate, excessive starting dose, rapid escalation and HLA-B*1502 increase risk; stop at first rash unless clearly unrelated.
• DRESS, hemophagocytic lymphohistiocytosis and blood dyscrasias may present with fever or systemic illness; assess promptly.
• Weigh arrhythmia risk carefully in clinically important structural or functional heart disease; other sodium-channel blockers may increase that risk.
• Monitor suicidal thoughts and mood changes. Gradual discontinuation is generally needed unless safety requires faster withdrawal.
• After an interruption longer than 5 half-lives, follow initial titration recommendations; half-life varies with interacting drugs. Do not independently restart the old dose.

Counseling

• Report any rash promptly, particularly with fever, mouth sores or facial swelling.
• Do not accelerate the titration or resume an old maintenance dose after a prolonged gap without contacting the prescriber.
• Tell the team before starting or stopping estrogen-containing contraception because maintenance dosing may need adjustment.

Names and formulations

• Strattera: Selected oral capsules under the June 2026 US label. Atomoxetine is a nonstimulant ADHD treatment and is not a controlled substance.

Formulation distinction: Swallow capsules whole; do not open because contents irritate the eyes. Give once each morning or evenly divided morning and late afternoon/early evening. Moderate/severe hepatic impairment lowers initial and target doses; strong CYP2D6 inhibition requires a longer titration interval.

Major safety and monitoring

• Boxed warning: closely monitor pediatric patients for suicidal thoughts/behavior, worsening symptoms, or unusual behavior, particularly early or during dose changes.
• Screen for bipolar disorder and assess cardiovascular history. Measure BP/pulse at baseline, after dose increases, and periodically; monitor pediatric height/weight.
• Stop and do not restart with jaundice or laboratory evidence of liver injury. Ask about urinary retention and emergent manic/psychotic symptoms.
• MAOIs within 14 days, narrow-angle glaucoma, pheochromocytoma, and severe cardiovascular disorders vulnerable to BP/HR increases are contraindications.

Counseling

• Report jaundice, dark urine, new suicidal thoughts, fainting, or an abnormally persistent erection promptly.
• If capsule contents contact the eyes, rinse immediately with water and obtain medical advice.

Names and formulations

• Concerta: This card is specific to the osmotic extended-release tablet. Other methylphenidate products have different delivery systems and administration instructions.

Formulation distinction: Take once each morning, with or without food. Swallow whole with liquid; never chew, divide, or crush. The nonabsorbable shell may appear in stool after drug delivery. Use another formulation if the tablet cannot be swallowed whole.

Major safety and monitoring

• Boxed warning: assess and monitor abuse, misuse, and addiction risk; misuse can cause overdose or death.
• Assess cardiac history, BP/pulse, manic/psychotic symptoms, tics/Tourette history, pediatric growth, and appetite.
• Avoid serious cardiac disease; do not ordinarily use with severe pre-existing GI narrowing because the tablet does not deform.
• Monitor digital circulation/Raynaud symptoms; urgent assessment is needed for priapism or acute glaucoma symptoms.

Counseling

• Store securely, never share, and use approved disposal methods for unused doses.
• A shell in stool alone does not mean the medicine failed. Report chest pain, fainting, painful persistent erection, or new finger/toe color changes.

Names and formulations

• Adderall XR: Selected extended-release capsule; immediate-release amphetamine tablets and other long-acting products have different regimens.

Formulation distinction: Take once in the morning. Swallow the capsule whole, or sprinkle the entire contents on applesauce and swallow immediately without chewing. Do not divide a capsule dose or store the mixture. Severe renal impairment requires lower dosing; ESRD use is not recommended.

Major safety and monitoring

• Boxed warning: assess and monitor abuse, misuse, and addiction; overdose and death can occur with misuse.
• Avoid serious cardiac disease; monitor BP/pulse, appetite, pediatric growth, sleep, mania/psychosis, and tics.
• Assess Raynaud symptoms, seizures, and serotonin syndrome, especially with serotonergic drugs.
• Pregnancy may involve fetal risk; the label does not recommend breastfeeding during treatment.

Counseling

• Avoid afternoon doses that worsen insomnia; store securely and never share.
• Report chest pain, fainting, new psychotic symptoms, or cold/painful/discolored fingers and toes.

Names and formulations

• Ativan: Selected immediate-release oral tablets; injection and extended-release lorazepam capsules are separate products with different instructions.

Formulation distinction: Individualize the divided oral regimen. Elderly or debilitated patients generally start at 1–2 mg/day in divided doses. Use a gradual, patient-specific taper after ongoing use; do not copy a fixed rapid stopping schedule.

Major safety and monitoring

• Boxed warnings cover opioid-related respiratory depression/death, abuse/misuse/addiction, and physical dependence with potentially life-threatening withdrawal.
• Assess sedation, cognition, falls, breathing risk, depression, and substance-use risk. Use caution with COPD or sleep apnea.
• Acute narrow-angle glaucoma is contraindicated. Late-pregnancy exposure can cause neonatal sedation or withdrawal.
• Safety/effectiveness below age 12 are not established under this tablet label.

Counseling

• Avoid alcohol and unsupervised sedative combinations; do not drive until effects are known.
• Do not stop abruptly. Store securely, never share, and seek urgent help for slowed breathing or extreme sedation.

Names and formulations

• Ambien: Selected immediate-release bedtime tablets, not Ambien CR or middle-of-the-night sublingual products.

Formulation distinction: Initial dose: women 5 mg; men 5 or 10 mg once immediately before bed with 7–8 hours available for sleep. Elderly patients and mild/moderate hepatic impairment: 5 mg. Maximum 10 mg/night; no same-night redosing. Food can delay onset.

Major safety and monitoring

• Boxed warning: complex sleep behaviors can cause serious injury or death. Stop immediately after such an event; subsequent zolpidem use is contraindicated.
• Assess next-day impairment, falls, depression/suicidal thinking, respiratory compromise, misuse, dependence, and withdrawal.
• Avoid severe hepatic impairment. Reevaluate persistent insomnia after 7–10 days. Pediatric safety/effectiveness are not established.
• Late-pregnancy exposure may cause neonatal sedation and respiratory depression.

Counseling

• Take only when ready for bed and able to remain in bed a full night. Do not combine with alcohol.
• Report sleep-driving, sleep-eating, or other activities without full awareness immediately, even if the dose was low.

Names and formulations

• Amoxicillin and clavulanate potassium: immediate-release tablets, chewable tablets, and oral suspensions in the bound label

Formulation distinction: Products with the same amoxicillin amount can contain different clavulanate amounts; the immediate-release tablets, chewables, and suspensions in this label are not substituted by amoxicillin milligrams alone.

Major safety and monitoring

• Avoid in patients with serious beta-lactam hypersensitivity; stop and treat promptly if anaphylaxis occurs.
• Contraindicated with a previous history of amoxicillin/clavulanate-associated cholestatic jaundice or hepatic dysfunction.
• Monitor diarrhea and hepatic symptoms; Clostridioides difficile-associated diarrhea and hepatic injury can occur.

Counseling

• Take at the start of a meal to improve tolerance and clavulanate absorption.
• Shake suspension well, refrigerate when the dispensed label directs, measure accurately, and discard on schedule.

Names and formulations

• Doxycycline hyclate: generic oral tablet in the bound label

Formulation distinction: Verify the salt, strength, and dosage form. Administration instructions can differ among doxycycline products.

Major safety and monitoring

• Can cause photosensitivity, esophageal irritation/ulceration, intracranial hypertension, and severe skin reactions.
• Tooth discoloration and effects on bone growth are class concerns during tooth development; specific severe infections may justify use despite age or pregnancy concerns.
• Monitor clinical response and adverse effects; avoid unnecessary use to reduce resistance.

Counseling

• Take with a full glass of water and remain upright; do not take immediately before bed.
• Use sun protection and separate from aluminum, calcium, magnesium, iron, or bismuth products according to product instructions.

Names and formulations

• Bactrim / Bactrim DS: single-strength and double-strength tablets contain different amounts of both components

Formulation distinction: Dose is often expressed by the trimethoprim component; one DS tablet contains twice the active ingredients of one single-strength tablet.

Major safety and monitoring

• Can cause severe cutaneous reactions, blood dyscrasias, hyperkalemia, kidney injury, and hypersensitivity; stop and evaluate promptly for rash or systemic toxicity.
• Monitor kidney function, potassium, and CBC when patient factors, dose, or duration increase risk.
• Contraindications and pregnancy/newborn restrictions are specific; verify the current label before use.

Counseling

• Maintain adequate fluid intake unless fluid restriction has been prescribed.
• Report rash, mouth sores, fever, unusual bruising, severe weakness, or reduced urine output promptly.

Names and formulations

• Diflucan: tablet and oral suspension

Formulation distinction: Most multidose regimens require kidney-function assessment; vaginal candidiasis single-dose therapy should not be generalized to invasive or deep-site disease.

Major safety and monitoring

• Can cause serious hepatotoxicity, severe skin reactions, QT prolongation, and torsades de pointes.
• Monitor liver tests, kidney function, electrolytes, and ECG risk when patient factors or interacting drugs warrant.
• Pregnancy risk depends on dose, duration, and indication; confirm current recommendations rather than extrapolating from a single-dose regimen.

Counseling

• Complete the prescribed regimen and report jaundice, dark urine, severe rash, fainting, or palpitations.
• Shake suspension well and use an accurate measuring device.

Names and formulations

• Amoxil: Brand-name association; this card follows the selected Chartwell generic oral products. Amoxicillin alone is different from amoxicillin/clavulanate.

Formulation distinction: The selected label covers capsules, tablets, chewable tablets, and several suspension concentrations. Dose and frequency depend on infection, age, weight, and kidney function; never transfer the same mL dose between different liquid strengths.

Major safety and monitoring

• Avoid in patients with a prior serious reaction to amoxicillin or another beta-lactam; anaphylaxis and severe skin reactions require discontinuation and urgent care.
• Assess kidney function. Patients with GFR below 30 mL/min must not receive the 875-mg dose; use the label’s lower-dose renal regimens.
• Protracted vomiting 1–4 hours after a dose, sometimes without rash or breathing symptoms, can indicate drug-induced enterocolitis syndrome; discontinue and evaluate.
• Evaluate severe, persistent, watery or bloody diarrhea for C. difficile, including after therapy. Avoid amoxicillin in mononucleosis because rash is common.

Counseling

• Take at the start of a meal to reduce stomach intolerance, following this selected label. Take the prescribed course unless a clinician directs a change or a serious reaction requires stopping.
• Shake suspension before measuring. Refrigeration is preferred but not required; discard the reconstituted product after 14 days.
• Report hives, breathing difficulty, a progressive rash, severe vomiting, or significant diarrhea promptly; breathing difficulty needs emergency care.

Names and formulations

• Keflex: Historical brand name; FDA lists Keflex products as discontinued. This card uses current Lupin generic capsule labeling.

Formulation distinction: This card addresses oral capsules. Doses are divided through the day according to the prescription; the selected label allows administration with or without food. Kidney impairment can change the total daily dose or interval.

Major safety and monitoring

• Assess beta-lactam allergy history; stop and seek care for anaphylaxis or serious rash. Cephalexin is contraindicated in known cephalosporin hypersensitivity.
• Review renal function: for patients at least 15 years old with CrCl 30–59 mL/min, the selected label limits the total daily dose to 1 g; lower function needs additional adjustment. Accumulation increases seizure risk.
• Significant diarrhea during or after therapy needs assessment for C. difficile.
• Investigate new anemia for possible immune hemolysis. Monitor prothrombin time in patients at risk, including those with poor nutrition, kidney/liver impairment, prolonged therapy, or anticoagulants.

Counseling

• Take doses at the prescribed intervals and complete the directed course unless your clinician changes it.
• Report new severe diarrhea, unusual bruising, or symptoms of anemia such as marked fatigue.

Names and formulations

• Omnicef: Historical brand name; FDA lists Omnicef products as discontinued. This card uses current Lupin 300-mg generic capsule labeling.

Formulation distinction: Capsules may be taken with or without food. Once-daily dosing is not the labeled approach for pneumonia or skin infections: those capsule regimens use twice-daily dosing when renal function permits.

Major safety and monitoring

• Review cephalosporin and other beta-lactam allergies before treatment; discontinue for an allergic reaction.
• For adults with CrCl below 30 mL/min, the selected label reduces cefdinir to 300 mg once daily; hemodialysis has separate instructions.
• Evaluate watery or bloody diarrhea during treatment or even weeks after completion for C. difficile.
• Iron-containing products can produce reddish stool through a nonabsorbed cefdinir–iron complex; do not automatically dismiss pain, fever, or suspected bleeding as harmless discoloration.

Counseling

• Separate cefdinir from iron supplements and aluminum/magnesium antacids by at least 2 hours in either direction.
• Follow the prescribed schedule for the specific infection and do not change twice-daily treatment to once daily on your own.

Names and formulations

• Ceftin: Historical oral brand name; FDA lists Ceftin products as discontinued. This card uses current Ascend generic tablet labeling and its tablet/suspension distinction.

Formulation distinction: Tablets and oral suspension are not bioequivalent and must not be substituted milligram for milligram. The selected tablets may be taken with or without food; swallow whole because crushing produces a strong, persistent bitter taste.

Major safety and monitoring

• Contraindicated with known hypersensitivity to cefuroxime axetil or another beta-lactam; serious allergic reactions require discontinuation and treatment.
• Extend the dosage interval when CrCl is below 30 mL/min; consult the regimen for the patient’s renal function and dialysis status.
• Assess significant diarrhea for C. difficile during or after treatment.
• Monitor for superinfection with nonsusceptible bacteria or fungi if symptoms persist or new symptoms develop.

Counseling

• If unable to swallow the tablet, ask for an appropriate liquid regimen; a direct same-milligram switch is not valid.
• Give cefuroxime axetil at least 1 hour before or 2 hours after a short-acting antacid; discuss acid suppressants before use.

Names and formulations

• Zithromax: Selected immediate-release tablets and oral suspension. Instructions do not apply automatically to an extended-release suspension or IV product.

Formulation distinction: Oral regimens vary by indication; a five-day Z-Pak is not the regimen for every infection. Tablets and the selected suspension may be taken with or without food. Reconstituted suspension is used within 10 days.

Major safety and monitoring

• Review QT-prolonging drugs, bradycardia, low potassium/magnesium, and prior QT prolongation or torsades before dispensing.
• Do not use with prior azithromycin-associated cholestatic jaundice/hepatic dysfunction; discontinue for hepatitis symptoms.
• Anaphylaxis and severe skin reactions require discontinuation and urgent treatment. Significant diarrhea warrants assessment for C. difficile.
• Myasthenia gravis can worsen. In neonates, vomiting or feeding irritability requires assessment for pyloric stenosis.
• The label describes a potential short-term cardiovascular mortality signal from observational studies; balance risk and benefit, especially when cardiac risk factors are present.

Counseling

• Follow the exact day-by-day directions. Shake oral suspension and measure the prescribed volume; do not reuse leftover antibiotic.
• Report fainting, palpitations, jaundice, severe rash, or severe diarrhea promptly.

Names and formulations

• Biaxin: Historical brand name; FDA lists Biaxin immediate-release products as discontinued. This card uses Aurobindo generic immediate-release tablets, not extended-release tablets.

Formulation distinction: The selected immediate-release tablets can be taken with or without food. Dose, duration, and companion drugs depend on the infection; immediate-release instructions are not interchangeable with extended-release instructions.

Major safety and monitoring

• Avoid with known QT prolongation, QT-prolonging drugs, uncorrected low potassium/magnesium, or significant bradycardia.
• Medication reconciliation is essential: contraindicated pairs include simvastatin/lovastatin and certain other CYP3A substrates; colchicine is contraindicated with clarithromycin in renal or hepatic impairment.
• Reduce the dose for severe renal impairment. Prior clarithromycin-associated cholestatic jaundice/hepatic dysfunction is a contraindication; stop for hepatitis symptoms.
• Severe hypersensitivity, C. difficile diarrhea, or worsening myasthenia symptoms require assessment. Use in pregnancy only when no appropriate alternative exists, as specified by the label.
• Balance benefits against the label’s possible long-term mortality risk in patients with coronary artery disease.

Counseling

• Provide the pharmacist a complete medication list, including colchicine, cholesterol drugs, anticoagulants, and supplements.
• Report jaundice, marked muscle pain or weakness, palpitations, severe rash, or significant diarrhea promptly.

Names and formulations

• Cleocin HCl: Selected oral clindamycin hydrochloride capsules. Oral palmitate liquid, injectable phosphate, topical acne products, and vaginal products have different instructions.

Formulation distinction: Take capsules with a full glass of water (6–8 oz) and at least 30 minutes before lying down. The capsules are unsuitable for someone unable to swallow them whole; the oral solution uses a different salt/formulation.

Major safety and monitoring

• Boxed warning: C. difficile infection can cause severe or fatal colitis and can appear more than two months after antibiotics. Significant diarrhea requires stopping the drug and clinical assessment.
• Avoid with prior clindamycin or lincomycin hypersensitivity; severe allergic or skin reactions require permanent discontinuation and treatment.
• Acute kidney injury has been reported; consider renal monitoring with pre-existing kidney impairment or concurrent nephrotoxic drugs.
• During prolonged therapy, periodically check liver function, kidney function, and blood counts; use caution with previous colitis.

Counseling

• Use a full glass of water and stay upright for at least 30 minutes after swallowing a capsule.
• Report significant diarrhea promptly, including after the course ends; do not simply suppress it without evaluation.
• Take each dose as directed; report painful swallowing or severe chest discomfort after a capsule.

Names and formulations

• Flagyl 375: Selected 375-mg oral capsule label. Other oral strengths, extended-release tablets, topical/vaginal formulations, and IV products require their own directions.

Formulation distinction: The selected capsule contains 375 mg. Dose and course vary by indication and liver function; do not use vaginal or topical directions for systemic oral treatment.

Major safety and monitoring

• Stop and promptly report numbness, tingling, ataxia, seizures, or other new neurologic symptoms; neuropathy and encephalopathy can occur.
• Contraindicated in Cockayne syndrome because severe, sometimes fatal liver failure can occur. Severe hepatic impairment requires indication-specific dose or interval adjustment.
• Avoid with disulfiram used within the last 2 weeks. Pregnancy requires indication-specific review: the capsule label’s first-trimester trichomoniasis restriction differs from CDC guidance to test and treat symptomatic pregnant patients at any stage. Resolve the regimen with the prescriber.
• Severe skin/hypersensitivity reactions require prompt assessment. Use caution with blood dyscrasias and follow the label’s leukocyte-count monitoring.
• The boxed warning describes carcinogenicity in rodents; avoid unnecessary use and reserve for appropriate indications.

Counseling

• The product label advises avoiding alcohol and propylene glycol during therapy and for at least 3 days afterward. CDC’s BV guidance finds no convincing evidence of a disulfiram-like alcohol interaction. Discuss the differing guidance and product-specific instructions with the treating team.
• A metallic taste and nausea may occur; report persistent neurologic symptoms or a severe rash promptly.
• For trichomoniasis, discuss sexual-partner treatment and reinfection prevention with the treating team.

Names and formulations

• Macrobid: Selected 100-mg oral combination capsule: 75 mg monohydrate plus 25 mg macrocrystals. This is not the same formulation or schedule as macrocrystals-only Macrodantin.

Formulation distinction: Macrobid is taken with food, commonly at breakfast and dinner on its prescribed every-12-hour schedule. The food effect improves absorption and tolerance; confirm the formulation before translating a nitrofurantoin prescription.

Major safety and monitoring

• Review kidney function against both product labeling and current guidance. The Macrobid label contraindicates use at CrCl below 60 mL/min; EAU guidance uses eGFR below 30 mL/min/1.73 m². These are different measures; reconcile the applicable criterion before dispensing.
• Stop and evaluate cough, dyspnea, fever, or chest symptoms for pulmonary reactions. Long-term exposure particularly raises concern for chronic lung injury.
• Rare serious liver injury and potentially irreversible neuropathy can occur; monitor appropriate liver, renal, and pulmonary parameters during longer treatment.
• Hemolysis can occur with G6PD deficiency. Contraindicated at term (38–42 weeks), during labor or when labor is imminent, and in infants younger than one month.
• Prior nitrofurantoin-associated cholestatic jaundice/hepatic dysfunction is a contraindication; significant diarrhea also requires assessment.

Counseling

• Take each capsule with food and follow the prescribed course. Brown urine can occur.
• Promptly seek reassessment for fever, flank pain, worsening symptoms, breathing difficulty, jaundice, or new numbness.

Names and formulations

• Cipro: Selected immediate-release tablets and oral suspension. Extended-release, ophthalmic, otic, and IV products are outside this card.

Formulation distinction: Take at least 2 hours before or 6 hours after multivalent-cation products such as aluminum/magnesium antacids, sucralfate, iron, or zinc. Do not take with dairy or calcium-fortified juice alone; a meal containing them is acceptable.

Major safety and monitoring

• Boxed warnings include disabling tendon, peripheral nerve, and CNS reactions. Stop promptly for these symptoms and avoid in patients with prior serious fluoroquinolone reactions.
• Avoid with myasthenia gravis. Tendon risk is increased by older age, corticosteroids, and transplantation.
• Review kidney function for dose adjustment and assess QT risk, blood-glucose disturbances, and C. difficile diarrhea.
• Use only when alternatives are unavailable in patients with a known aortic aneurysm or elevated aneurysm risk. Sudden severe chest, back, or abdominal pain needs emergency evaluation.
• Tizanidine is contraindicated; serious drug interactions also occur with theophylline and other CYP1A2 substrates.

Counseling

• Maintain hydration and follow the cation-separation instructions; do not assume all fluoroquinolones use the same interval.
• Stop, rest the affected area, and promptly contact the clinician for tendon pain; report new burning/numbness or marked mental-status changes.
• For Cipro suspension, shake for about 15 seconds and swallow the microcapsules without chewing; this product must not be given through a feeding/NG tube.

Names and formulations

• Levaquin: Historical US brand name; FDA lists Levaquin products as discontinued. This card uses current Chartwell generic oral tablet labeling.

Formulation distinction: Selected tablets may be taken with or without food. Many adult regimens are once daily, but renal impairment can change dose or interval. Tablet instructions do not automatically apply to an oral solution.

Major safety and monitoring

• Boxed warnings include disabling tendon, nerve, and CNS reactions. Stop promptly if they occur; avoid after a previous serious fluoroquinolone reaction.
• Avoid with myasthenia gravis. Tendon rupture risk increases with corticosteroids, age over 60, and organ transplantation.
• Adjust regimens for CrCl below 50 mL/min. Maintain hydration and monitor renal function as appropriate.
• Assess QT-prolongation risk and glucose disturbances, especially with diabetes treatment; watch for C. difficile diarrhea.
• For known aortic aneurysm or elevated risk, reserve use for situations without an alternative; sudden severe chest, back, or abdominal pain requires emergency care.

Counseling

• Take levofloxacin at least 2 hours before or after iron, zinc-containing multivitamins, sucralfate, or magnesium/aluminum antacids.
• Stop the drug, rest the affected tendon, and contact the clinician promptly for tendon pain or swelling; report new neuropathy or CNS symptoms.
• Maintain hydration and avoid excessive sun/UV exposure.

Names and formulations

• Valtrex: Selected oral tablets; the label also describes pharmacist-prepared pediatric suspensions from 500-mg tablets. Valacyclovir and acyclovir are different drugs and are not exchanged milligram for milligram.

Formulation distinction: Regimens vary greatly: with normal renal function, a cold-sore course is two 2-g doses 12 hours apart for one day, while shingles uses a different multi-day regimen. Kidney impairment requires indication-specific adjustment.

Major safety and monitoring

• Review renal function, age, hydration, and nephrotoxic drugs; excess exposure or dehydration can cause acute kidney injury.
• Agitation, hallucinations, confusion, or seizures can occur, especially in older adults or with excessive renal dosing; discontinue and assess CNS reactions.
• Avoid with significant hypersensitivity to valacyclovir or acyclovir; stop for a painful mucosal or progressive severe rash.
• TTP/HUS occurred at 8-g/day trial doses in advanced HIV and transplant populations; stop and evaluate compatible clinical/laboratory findings.

Counseling

• Start episodic therapy at the earliest specified symptom and follow the regimen for that indication. Maintain adequate hydration.
• Suppressive treatment reduces but does not eliminate genital-herpes transmission. Continue safer-sex precautions and avoid sexual contact when lesions or symptoms are present.
• Take tablets with or without food. Label-prepared suspension requires refrigeration, shaking, and disposal after 28 days.

Names and formulations

• Zovirax: Historical oral brand name; FDA lists oral Zovirax products as discontinued. This card uses Avet generic oral tablets and excludes topical and injectable dosing.

Formulation distinction: Oral regimens differ by indication: the selected label’s usual shingles regimen is 800 mg every 4 hours, five times daily, for 7–10 days before renal adjustment. Do not use an IV or topical regimen for oral tablets.

Major safety and monitoring

• Assess renal function and adjust the regimen; renal failure and crystalluria can occur, particularly with dehydration or excessive exposure.
• Confusion, hallucinations, tremor, or seizures require assessment; CNS reactions can be more pronounced in older patients and renal impairment.
• Avoid with significant acyclovir/valacyclovir hypersensitivity; stop immediately for a painful rash with mucosal involvement or a progressive severe rash.
• TTP/HUS has been reported in immunocompromised patients. Watch for otherwise unexplained hematologic and renal abnormalities.

Counseling

• Maintain adequate hydration and start episodic therapy promptly as directed. Tablets may be taken with or without food.
• Acyclovir does not cure genital herpes. Avoid sexual contact during lesions or symptoms; transmission can also occur without visible lesions.
• Use the exact prescribed frequency, including any renal adjustment; do not combine multiple scheduled doses into one.

Names and formulations

• Tamiflu: Selected oral capsules and commercial powder for 6-mg/mL suspension. Emergency suspension prepared from capsules has separate preparation/storage instructions.

Formulation distinction: For adults/adolescents with normal renal function, labeled treatment is 75 mg twice daily for 5 days; prophylaxis uses a different schedule. The commercial suspension is 6 mg/mL; adjust adult dosing when CrCl is 60 mL/min or less.

Major safety and monitoring

• Stop for serious allergy or a severe skin reaction; prior serious hypersensitivity is a contraindication.
• Monitor for confusion or abnormal behavior, especially in children. Influenza itself can cause these events, and the drug’s causal contribution is not established.
• Check renal function and dialysis status; the label does not recommend use in end-stage renal disease without dialysis.
• The suspension contains sorbitol and can cause problems in hereditary fructose intolerance. Assess worsening illness for bacterial complications.

Counseling

• Start promptly as prescribed; take with food if needed to improve nausea or vomiting. Treatment and prevention doses are different.
• Shake commercial suspension and measure in mL. After mixing, use within 17 days refrigerated or 10 days at controlled room temperature.
• Continue annual influenza vaccination; this medication does not supply lasting immunity.

Names and formulations

• Lamisil: Historical oral-tablet brand; FDA lists Lamisil tablets as discontinued. This card uses Cipla generic 250-mg oral tablets, not OTC topical Lamisil products.

Formulation distinction: The labeled adult regimen is 250 mg once daily for 6 weeks for fingernails or 12 weeks for toenails. Visible improvement may lag for months while healthy nail grows out; tablets may be taken with or without food.

Major safety and monitoring

• Contraindicated with chronic or active liver disease. Obtain baseline liver tests and monitor periodically; stop for biochemical or clinical liver injury.
• Stop for taste or smell disturbance; these may be prolonged and can impair intake. Report depressive symptoms.
• Severe skin reactions require discontinuation. New fever or infection symptoms warrant assessment for neutropenia; consider CBC monitoring during prolonged treatment in immunodeficiency.
• Unexplained anemia/thrombocytopenia can suggest thrombotic microangiopathy and needs prompt assessment.

Counseling

• Stop and promptly report jaundice, dark urine, pale stool, persistent nausea, poor appetite, or right upper abdominal pain.
• Do not extend treatment simply because the nail still looks abnormal immediately after the course; healthy nail takes time to grow.
• Report taste/smell changes, mood symptoms, or progressive rash.

Names and formulations

• Mycostatin: Historical oral-suspension brand; FDA lists that Mycostatin product as discontinued. This card uses PAI Pharma generic 100,000-units/mL oral suspension, not skin powder, cream, or vaginal products.

Formulation distinction: The selected adult/child dose is 4–6 mL four times daily, with half on each side of the mouth; retain as long as possible before swallowing. Infant dosing is different. Measure units and mL correctly.

Major safety and monitoring

• Avoid with hypersensitivity to any component; discontinue for sensitization or oral irritation.
• Rare severe skin or allergic reactions can occur; facial swelling or breathing difficulty needs urgent care.
• Nausea, vomiting, diarrhea, and stomach upset can occur; assess persistent or severe symptoms.
• Persistent symptoms or concern for systemic infection need reassessment; poor systemic absorption is an important limitation.

Counseling

• Shake well. Distribute the measured dose around the mouth and retain it before swallowing; do not immediately gulp it down.
• Continue the prescribed course; the label specifies at least 48 hours after symptoms disappear and cultures demonstrate Candida eradication.
• Store at 20–25°C and avoid freezing. In infants and young children, place half the dose on each side and avoid feeding for 5–10 minutes.

Names and formulations

• Metformin hydrochloride: immediate-release oral tablet
• Glumetza: extended-release oral tablet

Formulation distinction: Immediate-release and extended-release tablets differ in dosing and administration; ER tablets should be swallowed whole and may leave a soft shell in stool.

Major safety and monitoring

• Boxed warning: metformin-associated lactic acidosis is rare but serious; risk rises with severe kidney impairment, hypoxic states, liver impairment, and excessive alcohol use.
• Assess eGFR before initiation and periodically; initiation is not recommended at eGFR 30–45 mL/min/1.73 m² and use is contraindicated below 30.
• Monitor vitamin B12 periodically, especially with anemia, neuropathy, or long-term therapy.

Counseling

• Take with meals to reduce gastrointestinal effects; swallow ER tablets whole.
• Avoid excessive alcohol and tell the radiology team about metformin before iodinated-contrast procedures.

Names and formulations

• Lantus: U-100 insulin glargine vial and SoloStar pen
• Toujeo: U-300 insulin glargine SoloStar and Max SoloStar pens

Formulation distinction: Lantus U-100 and Toujeo U-300 concentrations, devices, and product names must be verified every time; conversion may require dose adjustment and closer glucose monitoring.

Major safety and monitoring

• Hypoglycemia is the most common serious risk; monitor glucose and individualize targets and dose changes.
• Insulin can cause hypokalemia; monitor potassium in patients at risk.
• Prevent medication errors by checking label, concentration, device, and dose before every injection.

Counseling

• Never share a pen, even if the needle is changed; use a new needle and rotate injection sites.
• Do not dilute or mix insulin glargine with another insulin and follow the product-specific storage and missed-dose plan.

Names and formulations

• Synthroid: oral tablet

Formulation distinction: Levothyroxine has a narrow dosing margin; keep the product, timing, and administration consistent and recheck TSH after clinically meaningful dose or product changes.

Major safety and monitoring

• Boxed warning: thyroid hormones are not for obesity treatment or weight loss; high doses can cause serious or life-threatening toxicity.
• Monitor TSH and, when indicated, free T4; over-replacement can cause atrial fibrillation, angina, and bone loss.
• Dose needs change with age, pregnancy, absorption, interacting drugs, and clinical status.

Counseling

• Take on an empty stomach 30–60 minutes before breakfast with water, consistently each day.
• Separate calcium or iron supplements by at least 4 hours and tell the prescriber before switching products.

Names and formulations

• Ozempic: once-weekly injection for labeled type 2 diabetes and risk-reduction indications
• Rybelsus: oral semaglutide with product-specific fasting administration
• Wegovy: weight-management and cardiovascular-risk indications; presentation-specific directions

Formulation distinction: Ozempic, Rybelsus, and Wegovy are not interchangeable dosage forms; strength, titration, missed-dose instructions, and indications differ, and semaglutide products should not be combined.

Major safety and monitoring

• Boxed warning: thyroid C-cell tumors occurred in rodents; contraindicated with a personal or family history of medullary thyroid carcinoma or MEN2.
• Monitor for pancreatitis, gallbladder disease, severe GI reactions, dehydration-related kidney injury, and diabetic retinopathy complications in at-risk patients.
• Hypoglycemia risk rises when combined with insulin or an insulin secretagogue.

Counseling

• Follow the exact titration and missed-dose directions for the dispensed product; never improvise a conversion between oral and injectable products.
• Tell the procedural or anesthesia team because delayed gastric emptying may affect aspiration-risk planning.

Names and formulations

• Glucotrol XL: Extended-release glipizide; immediate-release tablets have different meal instructions.

Formulation distinction: Immediate-release tablets are generally taken about 30 minutes before a meal; Glucotrol XL is taken with breakfast or the first main meal. Do not crush, split or chew XL tablets.

Major safety and monitoring

• Severe hypoglycemia can occur, especially with reduced food intake, kidney or liver impairment, or other glucose-lowering drugs.
• Glucotrol XL should be avoided in glucose-6-phosphate dehydrogenase (G6PD) deficiency because of hemolysis risk.
• Avoid Glucotrol XL with preexisting severe gastrointestinal narrowing.

Counseling

• Know how to recognize and treat low glucose; follow the prescribed monitoring and meal plan.
• An empty XL tablet shell may appear in stool.

Names and formulations

• Amaryl: Brand-name association; this card uses the cited generic glimepiride tablet labeling.

Formulation distinction: Taken once daily with breakfast or the first main meal. The labeled starting dose for patients with renal impairment is 1 mg daily, with cautious titration.

Major safety and monitoring

• Severe hypoglycemia can occur; older adults and patients with kidney or liver impairment need particular caution.
• Reduced food intake, alcohol or other glucose-lowering drugs can increase hypoglycemia risk.
• G6PD deficiency increases hemolysis risk; consider a non-sulfonylurea alternative.

Counseling

• Take with the planned meal and follow glucose-monitoring instructions.
• Learn the symptoms and treatment of low glucose; beta blockers can make warning symptoms less apparent.

Names and formulations

• Glynase: Brand name for glyburide; verify the exact dispensed formulation.

Formulation distinction: The cited Teva product is micronized glyburide, in 1.5-, 3- and 6-mg tablets. Micronized and nonmicronized products are not interchangeable by simply matching the milligram dose; switching requires retitration.

Major safety and monitoring

• Severe hypoglycemia can occur, with greater risk in older, malnourished or renally/hepatically impaired patients.
• Monitor glucose and longer-term glycemic control; reduced food intake or other glucose-lowering drugs can increase hypoglycemia risk.
• G6PD deficiency increases hemolysis risk; consider a non-sulfonylurea alternative.

Counseling

• The cited micronized product is taken with breakfast or the first main meal.
• Know how to recognize and manage low glucose; do not switch tablet formulations on your own.

Names and formulations

• Januvia: Single-ingredient sitagliptin tablets; combination products have additional ingredients and precautions.

Formulation distinction: Once-daily oral tablet, with or without food. Renal dosing uses estimated glomerular filtration rate (eGFR): 100 mg at ≥45, 50 mg at 30–<45, and 25 mg at <30 mL/min/1.73 m², including dialysis.

Major safety and monitoring

• Check kidney function before treatment and periodically; acute renal failure has been reported.
• Stop and evaluate if pancreatitis is suspected.
• Assess heart-failure risk and monitor symptoms; the label cites findings with two other DPP-4 inhibitors.
• Serious hypersensitivity, severe joint pain and bullous pemphigoid are reported risks.

Counseling

• Promptly report persistent severe abdominal pain, new blisters or severe joint pain.
• Report new shortness of breath, swelling or rapid weight gain.

Names and formulations

• Tradjenta: Single-ingredient linagliptin tablet; do not apply its renal instructions to combination products.

Formulation distinction: 5 mg orally once daily, with or without food. No dose adjustment is recommended for renal impairment.

Major safety and monitoring

• Pancreatitis, including fatal cases, has been reported; stop and evaluate if suspected.
• Insulin or sulfonylurea combinations can increase hypoglycemia risk.
• Serious hypersensitivity, severe joint pain and bullous pemphigoid are reported risks.
• Assess heart-failure risk and monitor symptoms; the label cites findings with two other DPP-4 inhibitors.

Counseling

• Promptly report persistent severe abdominal pain, new blisters or severe joint pain.
• Report new breathlessness, swelling or rapid weight gain.

Names and formulations

• Onglyza: Saxagliptin brand name; this card follows the cited Glenmark generic tablet labeling.

Formulation distinction: Once-daily oral tablet, with or without food; do not cut, crush or chew. At eGFR <45 mL/min/1.73 m², the labeled dose is 2.5 mg daily. Give after hemodialysis.

Major safety and monitoring

• Heart-failure hospitalization was increased in the SAVOR trial; assess risk and monitor symptoms.
• Assess renal function before treatment and as clinically indicated.
• Stop and evaluate if pancreatitis is suspected.
• Serious hypersensitivity, severe joint pain, bullous pemphigoid and hypoglycemia with insulin/sulfonylureas are reported risks.

Counseling

• Report breathlessness, swelling or rapid weight gain promptly.
• Report persistent severe abdominal pain; do not take an extra dose after a missed dose.

Names and formulations

• Nesina: Single-ingredient alogliptin tablets.

Formulation distinction: Once-daily tablet, with or without food; do not split. Dosing uses creatinine clearance (CrCl): 25 mg at ≥60, 12.5 mg at 30–<60, and 6.25 mg at <30 mL/min, including end-stage renal disease.

Major safety and monitoring

• Assess kidney function before treatment and periodically; reduced renal function requires dose adjustment.
• Assess heart-failure risk and monitor symptoms.
• Stop and evaluate if pancreatitis is suspected; hepatic failure has also been reported.
• Serious hypersensitivity, severe joint pain, bullous pemphigoid and hypoglycemia with insulin/sulfonylureas are reported risks.

Counseling

• Report persistent severe abdominal pain, jaundice or dark urine promptly.
• Report new breathlessness, swelling or rapid weight gain; do not double a missed dose.

Names and formulations

• Jardiance: Single-ingredient 10- and 25-mg oral tablets; combination products have separate labels.

Formulation distinction: Take 10 mg each morning with or without food. An increase to 25 mg is for additional glycemic control in patients tolerating 10 mg. Use for glycemic control is not recommended at eGFR below 30 mL/min/1.73 m².

Major safety and monitoring

• Assess kidney function and volume status before treatment; correct volume depletion and monitor patients at risk of hypotension, including loop-diuretic users.
• Ketoacidosis can occur with glucose below 250 mg/dL. Stop and urgently evaluate suggestive symptoms; it is not indicated for glycemic control in type 1 diabetes.
• Monitor urinary/genital infections and foot lesions. Perineal pain or swelling with fever needs immediate evaluation for Fournier gangrene.
• Insulin or sulfonylureas can increase hypoglycemia risk; assess whether their doses need reduction.

Counseling

• Withhold at least 3 days, if possible, before surgery or prolonged-fasting procedures; resume when clinically stable and eating again.
• Stop and seek immediate care for nausea, vomiting, abdominal pain or shortness of breath suggesting ketoacidosis, even if glucose is not very high.
• Report dizziness, urinary symptoms and new foot sores; do not double a missed dose.

Names and formulations

• Farxiga: Single-ingredient 5- and 10-mg oral tablets.

Formulation distinction: For glycemic control, start 5 mg once daily; may increase to 10 mg. For other labeled adult indications, use 10 mg daily. Glycemic use is not recommended below eGFR 45; initiation for other indications is not recommended below eGFR 25 mL/min/1.73 m².

Major safety and monitoring

• Assess renal function and volume status; correct depletion before starting and monitor hypotension risk.
• Ketoacidosis may present without marked hyperglycemia. Stop and promptly evaluate suggestive symptoms; not indicated for type 1 diabetes glycemic control.
• Monitor genitourinary infections; perineal swelling or pain with fever or malaise requires urgent assessment.
• Hypoglycemia risk rises with insulin or secretagogues; their dose may need reduction.

Counseling

• Withhold at least 3 days, if possible, before surgery or prolonged fasting; restart when stable and eating.
• Report vomiting, abdominal pain, shortness of breath, dehydration or infection symptoms promptly.
• Below eGFR 25, an adult already receiving 10 mg may continue for the labeled kidney/cardiovascular risk-reduction purpose; this is different from initiating therapy.

Names and formulations

• Invokana: Single-ingredient 100- and 300-mg oral tablets.

Formulation distinction: For glycemic control, start 100 mg before the first meal. Usual maximum is 100 mg daily at eGFR 30 to below 60; 300 mg may be used for additional glycemic control when renal function permits. UGT-inducer coadministration has separate dose instructions.

Major safety and monitoring

• Check renal function and volume status. Initiation below eGFR 30 is not recommended; selected adults already treated with albuminuria above 300 mg/day may continue 100 mg for renal/cardiovascular benefit.
• Ketoacidosis may occur with glucose below 250 mg/dL; stop and urgently evaluate suggestive symptoms.
• Lower-limb amputations increased in CANVAS studies. Assess foot risk and monitor new pain, ulcers or infection; consider fracture risk before starting.
• Monitor volume depletion, genital/urinary infection, and hypoglycemia when combined with insulin or secretagogues.

Counseling

• Take before the first meal; do not double a missed dose.
• Perform preventive foot care and promptly report sores, pain or infection.
• Withhold at least 3 days, if possible, before surgery or prolonged fasting; restart when stable and eating.

Names and formulations

• Actos: 15-, 30- and 45-mg oral tablets; excludes combination products.

Formulation distinction: Taken once daily without regard to meals. Usual starting dose is 15 or 30 mg; maximum 45 mg. For NYHA class I–II heart failure, the labeled starting dose is 15 mg.

Major safety and monitoring

• Boxed warning: fluid retention can cause or worsen heart failure. Initiation in NYHA class III–IV heart failure is contraindicated; not recommended in symptomatic heart failure.
• Obtain liver tests before treatment; promptly investigate jaundice, dark urine or other liver-injury symptoms.
• Do not use with active bladder cancer; weigh uncertain recurrence risk in a patient with prior bladder cancer.
• Consider fractures, especially in women, and promptly evaluate visual changes for macular edema. Hypoglycemia risk rises with insulin or secretagogues.

Counseling

• Report rapid weight gain, edema or breathlessness promptly, especially after a dose increase.
• Report blood in urine or new urinary symptoms and keep regular eye examinations.
• Insulin doses may need adjustment; do not change them without the treatment team.

Names and formulations

• Trulicity: Once-weekly single-dose subcutaneous pens; not an insulin product.

Formulation distinction: Adults start 0.75 mg weekly; after 4 weeks may increase to 1.5 mg, then in 1.5-mg increments after at least 4 weeks at each dose, up to 4.5 mg. Pediatric maximum is 1.5 mg weekly.

Major safety and monitoring

• Boxed warning for rodent thyroid C-cell tumors; human relevance is unknown. Contraindicated with personal/family medullary thyroid carcinoma or MEN2.
• Stop and evaluate suspected pancreatitis; evaluate suspected gallbladder disease.
• Severe gastrointestinal effects can cause dehydration and kidney injury; monitor renal function with volume-depleting symptoms. Not recommended with severe gastroparesis.
• Monitor existing diabetic retinopathy. Insulin or sulfonylureas increase hypoglycemia risk.

Counseling

• Inject weekly with or without food; rotate sites and never mix with insulin.
• Take a missed dose only if at least 72 hours remain until the next one; otherwise skip it.
• Tell procedural/anesthesia teams about use because delayed gastric emptying can increase aspiration concern.

Names and formulations

• Victoza: Daily subcutaneous pen for diabetes dosing (0.6, 1.2 or 1.8 mg); other liraglutide products have different indications and instructions.

Formulation distinction: Adults start 0.6 mg daily for 1 week, then 1.2 mg; may increase to 1.8 mg after at least another week. The adult 0.6-mg dose supports tolerability and is not effective for glycemic control. After more than 3 days without a dose, restart at 0.6 mg and retitrate with the prescriber.

Major safety and monitoring

• Boxed warning for rodent thyroid C-cell tumors; human relevance is unknown. Contraindicated with personal/family MTC or MEN2.
• Stop and evaluate suspected pancreatitis; evaluate suspected gallbladder disease.
• Monitor renal function with vomiting, diarrhea or dehydration; not recommended with severe gastroparesis.
• Insulin or secretagogues raise hypoglycemia risk. Never share pens, even with a new needle.

Counseling

• Inject once daily at any time, independently of meals; rotate injection sites.
• Do not make up a missed dose with extra medicine. Contact the prescriber for titration after a lapse longer than 3 days.
• Tell the anesthesia team before procedures because of aspiration reports; do not combine with another liraglutide product.

Names and formulations

• Humalog: Rapid-acting solution: U-100 and U-200. This card excludes premixed Humalog products.

Formulation distinction: Inject subcutaneously within 15 minutes before or immediately after a meal. U-200 is for subcutaneous pen use, not pumps or intravenous administration. Pen windows show actual units: no dose conversion.

Major safety and monitoring

• Hypoglycemia can be severe; monitor glucose and adjust individualized dosing for meals, activity, illness, or renal/hepatic changes.
• Never transfer U-200 from a pen into a syringe. Check the insulin name and concentration before every dose.
• Insulin can cause hypokalemia; monitor potassium in at-risk patients.
• Rotate sites and avoid lipodystrophy/amyloidosis. Regimen or site changes need closer glucose checks. Never share pens, needles or syringes.

Counseling

• Have a meal ready for a mealtime dose and learn recognition and treatment of hypoglycemia.
• Use only clear, colorless solution. Pump users need a backup injection plan for pump failure.
• Only U-100 may be mixed with NPH for subcutaneous injection: draw lispro first and inject immediately; do not mix in a pump.

Names and formulations

• NovoLog: U-100 rapid-acting solution; excludes premixed NovoLog and other aspart formulations with different timing instructions.

Formulation distinction: For subcutaneous injection, give within 5–10 minutes before a meal. May be mixed only with NPH for injection: withdraw NovoLog first and inject immediately. Never mix or dilute it in a pump.

Major safety and monitoring

• Hypoglycemia is the principal risk; individualize doses and monitor more closely with illness or renal/hepatic changes.
• Check the insulin label before every dose; never share pens, cartridges, needles or syringes.
• Monitor potassium in patients at risk for hypokalemia.
• Pump interruption can rapidly produce hyperglycemia and ketoacidosis; users need training and backup insulin.

Counseling

• Coordinate the injection with a meal and rotate sites, avoiding abnormal thickened or lumpy areas.
• Use clear, colorless solution. Regimen changes require close glucose checks.
• For pumps, replace reservoir insulin at least every 7 days or sooner if the pump instructions require; follow device instructions for infusion-set changes.

Names and formulations

• Tresiba: Long-acting basal insulin: U-100 vial/pen and U-200 pen. U-200 pen doses advance in 2-unit increments.

Formulation distinction: Adults inject once daily at any time; children use the same time daily. Allow 3–4 days between dose increases. Pen windows show actual units, so no concentration conversion is needed.

Major safety and monitoring

• Hypoglycemia can be prolonged; individualize dosing and monitor glucose, particularly after regimen changes.
• Use subcutaneously only: no intravenous use, pump use, mixing or dilution. Never withdraw insulin from a pen with a syringe.
• Monitor potassium in at-risk patients; renal/hepatic impairment may increase hypoglycemia risk.
• Never share pens, needles or syringes; rotate sites and avoid abnormal tissue.

Counseling

• An adult who misses a dose should take it during waking hours when remembered, ensuring at least 8 hours between injections.
• For a missed pediatric dose, contact the clinician and monitor glucose more frequently until the next dose.
• Check the insulin label and use only clear, colorless solution.

Names and formulations

• Baqsimi: 3-mg single-use intranasal device; no reconstitution or inhalation required.

Formulation distinction: Give one 3-mg actuation into one nostril, then call emergency assistance. If there is no response after 15 minutes, another 3-mg dose from a new device may be given while help is on the way.

Major safety and monitoring

• Contraindicated with pheochromocytoma, insulinoma, or prior hypersensitivity to glucagon/components.
• May not work when liver glycogen is depleted, as in starvation or adrenal insufficiency; emergency care remains necessary.
• Serious allergic reactions can occur. Common effects include nausea, vomiting and nasal/eye irritation.

Counseling

• Teach caregivers where it is stored and how to use it; the patient need not inhale or be awake.
• Do not test the device or remove its shrink wrap until needed; each device supplies one dose.
• Once the person responds and can safely swallow, give oral carbohydrate to help prevent recurrence.

Names and formulations

• Generic methimazole tablets: Selected Aiping 5- and 10-mg oral tablets; no claim about availability of a brand product.

Formulation distinction: An oral tablet with dose individualized to severity and thyroid tests. The selected label describes divided daily dosing; follow the prescribed regimen rather than changing frequency independently.

Major safety and monitoring

• Fever or sore throat can signal agranulocytosis: hold methimazole and obtain urgent clinical assessment and CBC with differential; resume only with clinician clearance.
• Monitor thyroid function, including TSH/free T4, to avoid hypothyroidism and guide adjustment.
• Evaluate liver-injury symptoms promptly. Stop for clinically significant liver abnormalities under clinical assessment.
• First-trimester use can cause fetal harm; pregnancy or pregnancy planning needs immediate treatment review. Vasculitis symptoms also require prompt evaluation.

Counseling

• With fever or severe sore throat, pause doses and seek urgent care instead of only treating the symptoms.
• Report jaundice, new rash, blood in urine, reduced urine, or coughing blood.
• Keep thyroid-test appointments and promptly discuss pregnancy; do not independently switch antithyroid drugs.

Names and formulations

• Generic prednisone tablets: Selected ANI immediate-release oral tablets; excludes delayed-release formulations.

Formulation distinction: Immediate-release tablets require individualized dosing. After prolonged therapy, use a clinician-directed gradual withdrawal rather than abruptly stopping.

Major safety and monitoring

• Can suppress adrenal function; stress, illness or surgery may require a clinician-directed corticosteroid adjustment even after withdrawal.
• Increases infection risk and can mask symptoms. Screen for hepatitis B before immunosuppressive, such as prolonged, treatment; systemic fungal infection is a contraindication.
• Monitor glucose, blood pressure and fluid status; longer exposure increases concerns about osteoporosis, cataracts and glaucoma.
• Insomnia, mood changes and severe psychiatric effects can occur; monitor children’s growth with prolonged therapy.

Counseling

• Do not abruptly stop prolonged therapy; follow the prescribed taper and tell clinicians about recent steroid use.
• Promptly report infection or exposure to chickenpox/measles; discuss vaccination plans with the care team.
• Report severe mood or visual changes and attend monitoring appointments during long-term treatment.

Names and formulations

• Cozaar: oral tablet

Formulation distinction: Tablets and a label-described compounded suspension require different preparation and storage instructions.

Major safety and monitoring

• Boxed warning: fetal toxicity; discontinue promptly when pregnancy is detected.
• Monitor potassium and kidney function; hyperkalemia and acute kidney injury can occur.
• Monitor blood pressure, particularly with volume depletion or concurrent diuretics.

Counseling

• Report pregnancy promptly.
• Check before using potassium supplements, potassium salt substitutes, or regular NSAIDs.

Names and formulations

• Diovan: oral tablet; label also describes a compounded suspension

Formulation distinction: Diovan tablets and the label-described suspension are not interchangeable milligram for milligram; suspension exposure is higher.

Major safety and monitoring

• Boxed warning: fetal toxicity; discontinue promptly when pregnancy is detected.
• Monitor potassium and kidney function; risk increases with kidney disease or interacting medicines.
• Volume depletion can increase symptomatic hypotension.

Counseling

• Report pregnancy or fainting promptly.
• Do not add potassium-containing salt substitutes without guidance.

Names and formulations

• Benicar: oral tablet

Formulation distinction: Once-daily tablets can be taken with or without food; pediatric suspension preparation follows the product label.

Major safety and monitoring

• Boxed warning: fetal toxicity; discontinue promptly when pregnancy is detected.
• Monitor potassium, kidney function, and blood pressure.
• Severe chronic diarrhea with substantial weight loss may indicate sprue-like enteropathy, sometimes after months or years.

Counseling

• Report persistent diarrhea, weight loss, or marked dizziness.
• Report pregnancy promptly and check before adding potassium products.

Names and formulations

• Ramipril: generic oral capsule; brand availability is not asserted

Formulation distinction: If needed, capsule contents may be mixed with the specific food or liquid and quantities described in the label; consume the entire mixture.

Major safety and monitoring

• Boxed warning: fetal toxicity.
• Angioedema may occur at any time; airway involvement is an emergency.
• Monitor blood pressure, potassium, and kidney function; persistent dry cough can occur.

Counseling

• Seek emergency help for tongue, throat, or facial swelling.
• Report pregnancy promptly; avoid unapproved potassium supplements.

Names and formulations

• Vasotec: oral tablet

Formulation distinction: Oral enalapril is a prodrug; verify the product and route rather than confusing it with injectable enalaprilat.

Major safety and monitoring

• Boxed warning: fetal toxicity.
• Angioedema can obstruct the airway; prior ACE-inhibitor angioedema is a contraindication.
• Monitor potassium, kidney function, and blood pressure; cough and hypotension can occur.

Counseling

• Report pregnancy promptly and seek emergency care for mouth or throat swelling.
• Check before starting potassium supplements or salt substitutes.

Names and formulations

• Coreg: immediate-release oral tablet

Formulation distinction: Coreg tablets are generally dosed twice daily; verify the formulation and prescribed schedule rather than switching release systems independently.

Major safety and monitoring

• Monitor pulse, blood pressure, weight, and worsening heart failure during titration.
• Do not stop abruptly; withdrawal can precipitate angina or myocardial infarction.
• Contraindicated with bronchial asthma or related bronchospastic conditions; may mask hypoglycemia warning signs.

Counseling

• Take tablets with food to slow absorption and reduce orthostatic symptoms.
• Report fainting, increasing breathlessness, or rapid weight gain.

Names and formulations

• Tenormin: oral tablet

Formulation distinction: Renal elimination makes kidney function important for dose selection, particularly in older adults.

Major safety and monitoring

• Abrupt withdrawal can exacerbate angina or precipitate myocardial infarction.
• Monitor pulse, blood pressure, conduction problems, and heart-failure symptoms.
• May mask hypoglycemia warning signs; bronchospasm remains possible despite beta1 selectivity.

Counseling

• Do not stop suddenly without a taper plan.
• Report fainting, unusually slow pulse, or breathing difficulty.

Names and formulations

• Inderal LA: extended-release oral capsule

Formulation distinction: Once-daily Inderal LA is not a simple milligram-for-milligram substitute for immediate-release propranolol; retitration may be needed.

Major safety and monitoring

• Contraindicated with bronchial asthma, sinus bradycardia, and greater-than-first-degree heart block.
• Abrupt withdrawal can worsen angina and trigger myocardial infarction.
• Can mask hypoglycemia warning signs and contribute to severe or prolonged hypoglycemia.

Counseling

• Take consistently and do not stop suddenly.
• This migraine-prevention product does not treat a migraine already underway.

Names and formulations

• Cardizem CD: once-daily extended-release oral capsule

Formulation distinction: Diltiazem immediate-release, extended-release, and injectable products have different schedules and uses; verify the exact formulation.

Major safety and monitoring

• Monitor pulse and blood pressure; bradycardia, atrioventricular block, and hypotension can occur.
• May worsen heart failure in patients with impaired ventricular function.
• Peripheral edema and hepatic injury are additional concerns.

Counseling

• Avoid alcohol with Cardizem CD because it may accelerate drug release.
• Report fainting, unusually slow pulse, or worsening breathlessness.

Names and formulations

• Verapamil hydrochloride ER: generic extended-release oral tablet; other release systems differ

Formulation distinction: The cited ER tablet is taken with food. Verify product-specific timing and splitting instructions before changing formulations.

Major safety and monitoring

• Monitor pulse, blood pressure, and atrioventricular conduction.
• Contraindicated in severe left ventricular dysfunction. Certain conduction disorders are also contraindications unless a functioning ventricular pacemaker is present.
• Constipation is common; worsening heart failure can occur.

Counseling

• Report fainting, slow pulse, or new breathlessness.
• Ask before crushing or splitting an extended-release product.

Names and formulations

• Entresto: oral tablet; Entresto Sprinkle contains oral pellets

Formulation distinction: Contains an ARB already. Tablet strengths show both components; oral pellets have separate administration instructions.

Major safety and monitoring

• Boxed warning: fetal toxicity.
• Angioedema can compromise the airway; contraindicated with previous ACE-inhibitor- or ARB-related angioedema.
• Monitor blood pressure, potassium, and kidney function.

Counseling

• Report pregnancy promptly; seek emergency care for tongue or throat swelling.
• Confirm that the previous ACE inhibitor or ARB has been discontinued.

Names and formulations

• Hydralazine hydrochloride: generic oral tablet

Formulation distinction: Multiple daily doses are often required. Food increases exposure, so maintain a consistent relationship to meals.

Major safety and monitoring

• Can cause a lupus-like syndrome, including glomerulonephritis.
• Monitor blood pressure and pulse for hypotension and reflex tachycardia; coronary artery disease is a labeled contraindication.
• CBC and antinuclear antibody testing are advised before and periodically during prolonged treatment; assess neuropathy symptoms.

Counseling

• Report new joint pain, fever, chest pain, or persistent malaise.
• Report numbness or tingling and take doses on the prescribed schedule.

Names and formulations

• Catapres-TTS: transdermal system replaced every seven days

Formulation distinction: Patches deliver drug over seven days; therapeutic levels may take two to three days after initial application, so switching requires planning.

Major safety and monitoring

• Abrupt discontinuation can cause severe rebound hypertension.
• Monitor for bradycardia, hypotension, sedation, and dry mouth.
• Application-site reactions or contact sensitization can occur; report a significant rash.

Counseling

• Remove the old patch, rotate clean intact application sites, and follow the weekly schedule.
• Do not stop suddenly; fold used patches adhesive-to-adhesive and keep away from children and pets.

Names and formulations

• Isosorbide mononitrate ER: generic extended-release oral tablet

Formulation distinction: ER dosing is generally in the morning. Maintain the prescribed schedule to limit nitrate tolerance; do not crush or chew.

Major safety and monitoring

• Headache is common and can be dose related.
• Severe hypotension, dizziness, or syncope can occur, especially with volume depletion.
• Continuous nitrate exposure can produce tolerance; increasing doses is not a reliable solution.

Counseling

• Use the separately prescribed rescue plan for an acute angina episode.
• Rise slowly and do not change dose timing to avoid headaches without advice.

Names and formulations

• Nitrostat: sublingual tablet

Formulation distinction: Let the tablet dissolve under the tongue or in the cheek; it is not a swallowed maintenance tablet. Keep in the original tightly capped glass bottle.

Major safety and monitoring

• Severe hypotension or syncope can occur; administer at rest, preferably seated.
• Headache and dizziness are common.
• Contraindicated with severe anemia, increased intracranial pressure, circulatory failure or shock, and certain interacting drugs.

Counseling

• Follow the prescribed chest-pain emergency plan; seek urgent help for pain that is different or persists.
• Do not chew or swallow the tablet; keep rescue medication accessible.

Names and formulations

• Hydrochlorothiazide: generic oral tablet; often abbreviated HCTZ

Formulation distinction: Also appears in many combination tablets; reconcile all ingredients to avoid unintended duplication.

Major safety and monitoring

• Monitor sodium, potassium, magnesium, kidney function, and volume status.
• May raise uric acid and glucose; gout can worsen.
• Acute eye pain or sudden vision changes may indicate angle-closure glaucoma and require urgent evaluation.

Counseling

• Report severe weakness, muscle cramps, faintness, or reduced urine output.
• Protect skin from sun exposure and obtain recommended skin checks because of the labeled nonmelanoma skin-cancer risk.

Names and formulations

• Thalitone: oral tablet; product-specific bioavailability

Formulation distinction: Thalitone has enhanced bioavailability and should not be substituted directly with other chlorthalidone formulations.

Major safety and monitoring

• Monitor sodium, potassium, magnesium, kidney function, and blood pressure.
• Volume depletion can cause hypotension and kidney injury.
• Can raise uric acid, glucose, and calcium; monitor for gout and relevant metabolic changes.

Counseling

• Report marked dizziness, thirst, weakness, or muscle cramps.
• Confirm the product when filling or transferring a prescription.

Names and formulations

• Aldactone: oral tablet

Formulation distinction: Take consistently in relation to food; kidney function and indication influence starting dose and titration.

Major safety and monitoring

• Check potassium within one week of initiation or titration and regularly thereafter; hyperkalemia can be serious.
• Monitor kidney function, volume status, and blood pressure.
• Gynecomastia can occur; avoid use in pregnancy because of potential effects on male fetal development.

Counseling

• Avoid potassium supplements or potassium salt substitutes unless specifically directed.
• Report severe weakness, palpitations, or troublesome breast enlargement.

Names and formulations

• Inspra: oral tablet

Formulation distinction: Hypertension has additional contraindications beyond those applying to post-infarction heart failure; do not transfer eligibility rules between indications.

Major safety and monitoring

• Check potassium before treatment, within the first week, at one month after initiation or adjustment, and periodically.
• Contraindicated when starting potassium exceeds 5.5 mEq/L or creatinine clearance is 30 mL/min or less.
• Hypertension-specific exclusions include type 2 diabetes with microalbuminuria and creatinine clearance below 50 mL/min.

Counseling

• Do not add potassium supplements or salt substitutes without approval.
• Report palpitations, dizziness, vomiting, or diarrhea.

Names and formulations

• Torsemide: generic oral tablet; do not infer other product indications

Formulation distinction: Once-daily oral dosing is usual, but the dose depends on the indication and response; loop diuretics are not equivalent milligram for milligram.

Major safety and monitoring

• Monitor blood pressure, volume status, and kidney function for excessive diuresis.
• Monitor sodium, potassium, magnesium, and glucose; electrolyte depletion and metabolic changes can occur.
• Tinnitus or hearing loss may occur, especially with high doses or severe kidney impairment.

Counseling

• Report fainting, severe weakness, or new hearing changes.
• Ask before adding regular over-the-counter NSAIDs.

Names and formulations

• Crestor: oral tablet

Formulation distinction: Can be taken once daily with or without food. Severe kidney impairment and Asian ancestry affect starting-dose recommendations.

Major safety and monitoring

• Assess unexplained muscle pain or weakness for myopathy or rhabdomyolysis.
• Consider liver tests before initiation and when clinically indicated; acute liver failure or decompensated cirrhosis is a contraindication.
• Monitor lipid response; glucose and HbA1c can increase.

Counseling

• Report persistent muscle symptoms, dark urine, or jaundice.
• Discuss pregnancy promptly; breastfeeding is not recommended during treatment.

Names and formulations

• Zetia: oral tablet

Formulation distinction: Usually 10 mg once daily, with or without food; bile acid sequestrants require dose separation.

Major safety and monitoring

• Liver enzyme elevations can occur; assess as clinically indicated, especially with combination therapy.
• Myopathy and rhabdomyolysis have been reported; evaluate muscle symptoms.
• Combination therapy carries the accompanying statin or fibrate restrictions; use is not recommended with moderate or severe hepatic impairment.

Counseling

• Report unexplained muscle pain, weakness, or signs of liver injury.
• If a dose is missed, take it when remembered without doubling the next dose.

Names and formulations

• Zocor: oral tablet

Formulation distinction: Take once daily in the evening. Do not newly start or titrate to simvastatin 80 mg; this dose is restricted to patients who have tolerated it chronically without muscle toxicity.

Major safety and monitoring

• Myopathy and rhabdomyolysis risk increases with higher doses and interacting medicines.
• Check liver enzymes before treatment and when clinically indicated; acute liver failure or decompensated cirrhosis is a contraindication.
• Report pregnancy promptly for treatment reassessment; breastfeeding is not recommended during treatment.

Counseling

• Report unexplained muscle pain, weakness, or dark urine promptly.
• Avoid grapefruit juice and check every new prescription for interactions.

Names and formulations

• Pravastatin: generic oral tablet; current brand availability not asserted

Formulation distinction: Once-daily tablets may be taken at any time of day with or without food. Severe renal impairment requires a lower starting dose and a lower maximum dose.

Major safety and monitoring

• Monitor for muscle toxicity; pravastatin still has clinically important interactions.
• Check liver enzymes before treatment and when clinically indicated.
• Reassess treatment promptly if pregnancy occurs; breastfeeding is not recommended during therapy.

Counseling

• Report unexplained muscle pain or weakness.
• Separate from bile acid sequestrants: at least one hour before or four hours after.

Names and formulations

• Lovastatin: generic immediate-release oral tablet

Formulation distinction: This card covers immediate-release tablets, taken with meals; the usual once-daily schedule is with the evening meal. Do not transfer these directions to another release formulation.

Major safety and monitoring

• Myopathy and rhabdomyolysis risk increases with dose and interacting medicines.
• Monitor for liver injury; active liver disease or unexplained persistent transaminase elevations are contraindications in this product label.
• Report pregnancy promptly: most pregnant patients should discontinue statins after clinician review, with individualized exceptions for very high cardiovascular risk. Breastfeeding during statin treatment is not recommended.

Counseling

• Take the prescribed tablet with food and avoid grapefruit juice.
• Report muscle pain, marked weakness, or dark urine promptly.

Names and formulations

• Livalo: oral tablet

Formulation distinction: Maximum labeled dose is 4 mg once daily. Moderate or severe renal impairment, including hemodialysis, requires a lower starting dose and a 2 mg daily maximum.

Major safety and monitoring

• Monitor for myopathy and rhabdomyolysis.
• Check liver enzymes before treatment and when clinically indicated.
• Report pregnancy promptly for reassessment; breastfeeding is not recommended during therapy.

Counseling

• Take consistently with or without food.
• Report unexplained muscle pain or weakness and check before adding new medicines.

Names and formulations

• Fenofibrate: Amneal 54-mg and 160-mg oral tablets

Formulation distinction: The selected 54-mg/160-mg tablets are taken with meals. Strengths and food directions differ among fenofibrate products; verify the actual dispensed formulation.

Major safety and monitoring

• Monitor liver enzymes and kidney function; severe renal impairment, active liver disease, and preexisting gallbladder disease are contraindications.
• Can cause myopathy, especially with a statin or other risk factors.
• Gallstones and a rise in serum creatinine can occur.

Counseling

• Take this tablet formulation with food.
• Report unexplained muscle pain, jaundice, or persistent abdominal pain.

Names and formulations

• Lopid: oral tablet

Formulation distinction: The labeled adult regimen is taken in two divided doses, 30 minutes before the morning and evening meals.

Major safety and monitoring

• Contraindicated in hepatic dysfunction, severe renal dysfunction, and preexisting gallbladder disease.
• Statin combinations can cause severe myopathy and rhabdomyolysis; the simvastatin combination is contraindicated.
• Monitor lipids, liver tests, and muscle symptoms.

Counseling

• Take before the morning and evening meals as directed.
• Report muscle pain or weakness promptly and review new medicines before use.

Names and formulations

• Lovaza: oral capsule containing EPA and DHA ethyl esters

Formulation distinction: Contains EPA and DHA; its composition and labeled indications differ from icosapent ethyl. Swallow capsules whole.

Major safety and monitoring

• LDL cholesterol can rise; monitor LDL and triglycerides.
• Use caution with fish or shellfish allergy.
• Recurrent atrial fibrillation/flutter may be more frequent in susceptible patients.

Counseling

• Do not chew, crush, dissolve, or open capsules.
• Report new palpitations or unusual bleeding.

Names and formulations

• Vascepa: oral capsule containing an EPA ethyl ester

Formulation distinction: The labeled daily dose is 4 g, divided into two doses taken with food. Capsule count depends on the supplied strength.

Major safety and monitoring

• Increased risk of atrial fibrillation/flutter requiring hospitalization.
• Bleeding risk is increased, particularly with antithrombotic therapy.
• Use caution in fish or shellfish allergy; pancreatitis-risk reduction has not been established.

Counseling

• Swallow capsules whole with food.
• Report palpitations, shortness of breath, or unusual bleeding.

Names and formulations

• Repatha: subcutaneous injection; device-specific instructions apply

Formulation distinction: For many adult indications, the regimen is 140 mg every two weeks or 420 mg monthly; homozygous familial hypercholesterolemia has distinct instructions. Device and injection count must match the dose.

Major safety and monitoring

• Serious hypersensitivity, including angioedema, can occur.
• Injection-site reactions can occur; monitor LDL response.
• Check the exact presentation for natural-rubber/latex information.

Counseling

• Refrigerate and follow the dispensed device instructions; do not freeze or shake.
• Rotate injection sites and seek urgent help for swelling or difficulty breathing.

Names and formulations

• Praluent: subcutaneous injection

Formulation distinction: Adult starting schedules for hypercholesterolemia include 75 mg every two weeks or 300 mg every four weeks; other doses and pediatric weight-based schedules require the exact label.

Major safety and monitoring

• Serious hypersensitivity reactions, including angioedema and hypersensitivity vasculitis, can occur.
• Monitor injection-site reactions and LDL response.
• When using every-four-week dosing, LDL can vary through the interval.

Counseling

• Keep refrigerated and follow pen-specific preparation and storage instructions.
• Rotate injection sites and obtain urgent help for severe allergic symptoms.

Names and formulations

• Nexletol: oral tablet

Formulation distinction: Take once daily with or without food. Check lipids within eight to twelve weeks after initiation.

Major safety and monitoring

• Can increase uric acid and precipitate gout; assess uric acid as clinically indicated.
• Tendon rupture can occur; risk is increased in certain patients and with some concomitant drugs.
• Monitor for hypersensitivity.

Counseling

• Report a painful swollen joint or tendon pain.
• Stop the medicine and seek prompt care for suspected tendon rupture.

Names and formulations

• Leqvio: subcutaneous injection administered by a healthcare professional

Formulation distinction: The labeled dose is given initially, again at three months, then every six months by a healthcare professional.

Major safety and monitoring

• Serious hypersensitivity, including anaphylaxis and angioedema, has been reported.
• Injection-site reactions can occur; monitor LDL response.
• Do not infer a drug-specific cardiovascular event-reduction indication from LDL lowering alone.

Counseling

• Keep scheduled administration visits.
• Contact the clinic about missed appointments; rescheduling depends on how late the dose is.

Names and formulations

• Lanoxin: oral tablet

Formulation distinction: Dose selection depends on lean body weight, kidney function, age, and interacting medicines. Measure serum levels just before a dose or at least six hours after the preceding dose.

Major safety and monitoring

• Narrow therapeutic margin; monitor kidney function, potassium, magnesium, pulse, and concentrations when indicated.
• Toxicity can cause nausea, vomiting, visual disturbances, bradycardia, or other arrhythmias.
• Hypokalemia and hypomagnesemia increase susceptibility to toxicity.

Counseling

• Report persistent nausea, visual changes, fainting, or a markedly slow pulse.
• Do not double a missed dose or change formulations without checking instructions.

Names and formulations

• Pacerone: oral tablet

Formulation distinction: Its long half-life means adverse effects and interactions can persist for weeks after discontinuation.

Major safety and monitoring

• Boxed warning: potentially fatal pulmonary and hepatic toxicity and worsening arrhythmias.
• Obtain baseline pulmonary assessment, chest imaging, liver tests, thyroid assessment, and ECG; continue indicated monitoring.
• Bradycardia, thyroid dysfunction, and visual injury are important additional risks.

Counseling

• Report new cough, breathlessness, jaundice, fainting, or visual changes promptly.
• Avoid grapefruit juice and use sun protection.

Names and formulations

• Flecainide: generic oral tablet

Formulation distinction: Selection and titration require ECG and clinical assessment; kidney or liver dysfunction can increase exposure.

Major safety and monitoring

• Boxed warning includes increased mortality after myocardial infarction in the CAST population and proarrhythmia.
• Do not use for routine suppression of benign ventricular ectopy; avoid use after recent myocardial infarction.
• Monitor PR/QRS conduction, heart-failure symptoms, and concentrations when indicated.

Counseling

• Report fainting, new palpitations, or worsening breathlessness.
• Do not take extra doses for symptoms unless a clinician has provided a specific plan.

Names and formulations

• Betapace / Betapace AF: oral tablet

Formulation distinction: Initiation or reinitiation requires a facility with continuous ECG monitoring and resuscitation capability. Calculate creatinine clearance to select the dosing interval.

Major safety and monitoring

• Boxed warning: QT prolongation and life-threatening proarrhythmia, including torsades de pointes.
• Correct potassium and magnesium abnormalities; serum potassium below 4 mEq/L is a contraindication.
• Monitor ECG/QT, kidney function, pulse, and blood pressure; bronchial asthma is a contraindication.

Counseling

• Do not independently restart after an interruption or double missed doses.
• Report fainting, palpitations, or severe diarrhea/vomiting that could disturb electrolytes.

Names and formulations

• Ranolazine: generic extended-release oral tablet

Formulation distinction: Take extended-release tablets whole; do not crush, break, or chew. May be taken with or without meals.

Major safety and monitoring

• Can prolong QT; review other QT-prolonging medicines and patient risk factors.
• Contraindicated with strong CYP3A inhibitors, CYP3A inducers, and liver cirrhosis.
• Monitor kidney function in moderate or severe renal impairment; acute renal failure has occurred in severe impairment.

Counseling

• Keep the prescribed plan for sudden chest pain.
• Report fainting or significant dizziness and check new medicines for interactions.