PHARMASTE · TOP 300
Medication pocket review
Compare practical administration, monitoring and safety points across selected medication groups.
Expanded September 30, 2026. This focused review covers selected medicines from the growing collection; use the full cards for source-check dates and the exact product labels for context.
COMPARE · RECALL · APPLY
Keep the important differences close.
Selected comparisons and pocket-review points from across the collection. Try explaining each point before checking its source or returning to the full drug card.
Pain and inflammation pocket review
Quick recall
Acetaminophen: count every product. Tylenol Extra Strength 500-mg caplets direct no more than six in 24 hours for self-care; the 4,000-mg liver warning is not that product’s dosing target.
References: DailyMed label 1 · DailyMed label 2
Oral methotrexate for rheumatoid arthritis is once weekly. Confirm the weekly day, total milligrams, tablet strength, and folate plan before the first dose; daily-for-weekly errors have caused deaths.
References: DailyMed label 1
Hydroxychloroquine: actual body weight matters even when 400 mg is within a usual adult maintenance range. Retinal risk also increases with renal impairment, duration, and tamoxifen; keep baseline and follow-up eye assessments.
References: DailyMed label 1
Pregabalin: first choose the indication-specific regimen, then use the creatinine-clearance table. Taper over at least one week; opioids and respiratory impairment raise concern for serious breathing problems.
References: DailyMed label 1
Tramadol: fever, agitation, sweating, diarrhea, hyperreflexia, or clonus after adding an SSRI can signal serotonin syndrome. Its opioid activity does not describe its full interaction profile.
References: DailyMed label 1
Narcan 4 mg: give a dose, call 911, repeat every 2–3 minutes if needed with a new device, and stay until help arrives. Give another dose if marked sleepiness returns after initial improvement.
References: DailyMed label 1
Selected pain formulations: verify the product
| Product scope | Practical distinction |
|---|---|
| Ibuprofen prescription tablets | 400/600/800-mg tablet directions are not OTC 200-mg directions. |
| Naproxen base tablets | Verify naproxen versus naproxen sodium and the release form. |
| Meloxicam tablets | Other oral formulations are not automatically interchangeable at the same milligram strength. |
| Voltaren Arthritis Pain 1% gel | Four times daily: 2 g per upper-body area or 4 g per lower-body area; no more than two areas. |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3 · DailyMed label 4
Gout medicines: distinguish the treatment role
| Medicine | Role and key boundary |
|---|---|
| Allopurinol | Lowers urate production; titrate to response and use flare prophylaxis at initiation. Stop immediately for rash. |
| Febuxostat (Uloric) | Urate lowering when response to maximally titrated allopurinol is inadequate, it is not tolerated, or use is inadvisable; boxed CV-death warning. |
| Colchicine 0.6-mg tablets | Treats/prevents flares; renal/hepatic impairment plus a P-gp or strong CYP3A4 inhibitor is contraindicated. |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3
Muscle relaxants: indication and follow-up differ
| Selected oral medicine | Useful distinction |
|---|---|
| Baclofen tablets | MS/spinal-cord spasticity; reduce dose slowly when stopping. Review kidney function and sedation. |
| Cyclobenzaprine IR | Acute musculoskeletal spasm with rest/physical therapy; generally limited to 2–3 weeks. |
| Tizanidine (Zanaflex) | Spasticity; keep meal conditions/formulation consistent. Check aminotransferases at baseline and one month after maximum dose. |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3
Neurologic, ADHD, and sleep pocket review
Quick recall
Valproate plus topiramate: new lethargy, vomiting, or confusion warrants prompt assessment and ammonia testing even when liver enzymes are normal.
References: DailyMed label 1 · DailyMed label 2
Phenytoin: a normal total concentration can hide excess free drug with low albumin or renal impairment. Assess symptoms and obtain an unbound concentration.
References: DailyMed label 1
The 2025 AASM guideline conditionally suggests against standard pramipexole or ropinirole use for adult RLS because of augmentation. Existing users need individualized review and a supervised transition, not abrupt stopping.
References: Reference 1 · DailyMed label 2 · DailyMed label 3
Donepezil: remain at 5 mg for 4–6 weeks before 10 mg. Memantine IR: with Cockcroft–Gault CrCl 5–29 mL/min, the target is 5 mg twice daily.
References: DailyMed label 1 · DailyMed label 2
Atomoxetine with a strong CYP2D6 inhibitor such as fluoxetine: consider titration only after 4 weeks if the starting dose is tolerated and symptoms remain inadequately improved.
References: DailyMed label 1
Lorazepam after ongoing use needs a patient-specific gradual taper. Zolpidem complex sleep behavior instead requires immediate discontinuation and no rechallenge.
References: DailyMed label 1 · DailyMed label 2
Release system: what may be opened or seen afterward
| Product | Practical distinction |
|---|---|
| Tegretol-XR | Swallow intact with meals; never crush or chew. Do not use a damaged tablet or one without a release portal. |
| Dilantin extended capsules | Once-daily 300 mg is a selected adult option after control on divided 100-mg capsules totaling 300 mg/day; do not transfer it to free-acid forms. |
| Concerta | Swallow whole with liquid; never split, crush, or chew. The empty shell may be visible in stool. |
| Adderall XR | May open and sprinkle the entire capsule on applesauce; swallow immediately without chewing or storing. |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3 · DailyMed label 4
Migraine: prevention and acute-dose limits are different tasks
| Selected product | Practical distinction |
|---|---|
| Topiramate IR | Prevention, not rescue. CrCl below 70 mL/min/1.73 m² calls for one-half of the usual adult dose. |
| Depakote delayed-release | Prevention, not rescue. Contraindicated for migraine prevention in pregnancy or without effective contraception in patients of childbearing potential. |
| Sumatriptan oral | Acute adult migraine. Mild/moderate hepatic impairment limits one dose to 50 mg; severe impairment is contraindicated. |
| Rizatriptan ODT | With propranolol, adult doses are 5 mg, at least 2 hours apart, maximum 15 mg/24 hours; branded Maxalt-MLT 5 mg is no longer marketed. |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3 · DailyMed label 4
Dopaminergic therapy: indication changes the dosing question
| Medicine | Practical distinction |
|---|---|
| Pramipexole IR | Parkinson disease and RLS use different schedules. For Parkinson disease with CrCl 15 to <30 mL/min, start 0.125 mg once daily. |
| Ropinirole IR | Parkinson disease starts three times daily; RLS starts once daily 1–3 hours before bed. Earlier or spreading RLS symptoms suggest augmentation. |
| Carbidopa/levodopa IR | Review meal protein and iron when benefit changes. Do not abruptly withdraw therapy. |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3
Genitourinary, reproductive and gastrointestinal comparisons
Quick recall
PDE5 inhibitors are contraindicated with nitrates. After tadalafil, even a life-threatening need for nitrates requires at least 48 hours from the last dose and close medical supervision. Viagra labeling does not establish a safe nitrate time after sildenafil. Chest pain after either needs immediate care and disclosure of the last dose.
References: DailyMed label 1 · DailyMed label 2
A systemic estradiol patch still requires endometrial-risk assessment. In a postmenopausal patient with a uterus, consider a progestogen and investigate persistent or recurrent unexplained bleeding; patch placement does not remove systemic estrogen precautions.
References: DailyMed label 1
Prometrium oral capsules contain peanut oil and are contraindicated with peanut allergy. Bedtime dosing helps address dizziness and drowsiness. Its July 2026 label has cardiovascular and breast-cancer warnings but no boxed warning; do not copy a warning format from an older label or another hormone product.
References: DailyMed label 1
Linzess age limits changed: current labeling includes functional constipation from age 2 at 72 mcg daily and IBS-C from age 7 at 145 mcg daily. Use is contraindicated below age 2; severe diarrhea calls for holding treatment and rehydration.
References: DailyMed label 1
MiraLAX without electrolytes: usual OTC dose from age 17 is 17 g once daily, dissolved fully in 4–8 oz of beverage, for no more than 7 days without clinician direction. Do not combine with starch-based dysphagia thickeners.
References: DailyMed label 1
Lialda requires renal checks before treatment and periodically thereafter. NSAIDs increase concern for nephrotoxicity; azathioprine or mercaptopurine increases concern for blood disorders and calls for CBC/platelet monitoring if combined. New cramps, bloody diarrhea and fever after starting mesalamine may be acute intolerance.
References: DailyMed label 1
BPH medicines: mechanism and follow-up differ
| Selected product | Core action | Follow-up or handling point |
|---|---|---|
| Tamsulosin capsules | Alpha-1 blockade relaxes prostate and bladder-neck smooth muscle. | Take after the same meal; restart 0.4 mg after several missed days. Tell the eye surgeon about current or prior use. |
| Proscar 5 mg | Type II 5-alpha-reductase inhibition lowers DHT. | New PSA baseline after at least 6 months; evaluate a confirmed rise. Pregnant people should not handle crushed or broken tablets. |
| Avodart 0.5 mg | Type I and II 5-alpha-reductase inhibition lowers DHT. | New PSA baseline after at least 3 months; no blood donation until at least 6 months after the last dose. |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3
Overactive-bladder options: choose the relevant safety check
| Oral product | Dosing limit or administration | Safety focus |
|---|---|---|
| Oxybutynin ER | Swallow whole; adult maximum 30 mg/day. An empty shell may pass in stool. | Antimuscarinic effects, confusion, constipation, urinary retention and overheating. |
| Solifenacin tablets | Maximum 5 mg daily with severe renal impairment, Child-Pugh B or strong CYP3A4 inhibitors. | Avoid urinary/gastric retention and uncontrolled narrow-angle glaucoma; assess QT risk. |
| Myrbetriq tablets | Adult eGFR 15–29 or Child-Pugh B: maximum 25 mg daily. Tablets and granules are not mg-for-mg substitutes. | Monitor BP and retention; not recommended with severe uncontrolled hypertension. |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3
Contraceptive interruptions: CDC 2024 rules are method-specific
| Situation | Action | Additional protection or follow-up |
|---|---|---|
| Junel Fe: at least 2 consecutive active pills missed (48 hours or more) | Take the most recent missed active pill, discard older missed pills and continue the pack. | Condoms or abstinence until 7 consecutive active-pill days; last-active-week misses require omitting the iron-pill interval. Assess EC when indicated. |
| After levonorgestrel 1.5-mg emergency contraception | Start or resume ongoing contraception immediately. | Condoms or abstinence for 7 days; pregnancy test if no withdrawal bleed within 3 weeks. |
| Repeat DMPA injection is late | CDC permits injection up to 15 weeks after the last without additional protection; routine interval remains 13 weeks. | After 15 weeks, be reasonably certain there is no pregnancy; use 7 days of condoms or abstinence and consider EC other than ulipristal when appropriate. |
References: Reference 1 · Reference 2 · Reference 3 · DailyMed label 4 · DailyMed label 5 · DailyMed label 6
Mental health and neurologic pocket review
Quick recall
Citalopram: 20 mg/day is the maximum in adults older than 60, hepatic impairment, CYP2C19 poor metabolizers, or concurrent CYP2C19 inhibitors. Normal electrolytes do not remove these limits.
References: DailyMed label 1
Buspirone: take consistently with food or consistently without food. It does not protect against benzodiazepine withdrawal.
References: DailyMed label 1
Lamotrigine: valproate requires a slower, lower starting regimen. After a prolonged interruption, reassess titration before resuming the old dose; stop at the first rash unless clearly unrelated.
References: DailyMed label 1
Gabapentin: give at least 2 hours after aluminum/magnesium antacids. Opioids and respiratory impairment raise concern for serious respiratory depression.
References: DailyMed label 1
Duloxetine: avoid with GFR below 30 mL/min, chronic liver disease/cirrhosis or substantial alcohol use; a labeled pain indication does not remove these restrictions.
References: DailyMed label 1
New uncontrollable gambling or shopping on aripiprazole needs prompt review. A prolonged erection over 4 hours on trazodone needs immediate discontinuation and emergency care.
References: DailyMed label 1 · DailyMed label 2
Selected oral formulations: handling changes the dose delivered
| Product | Practical administration point |
|---|---|
| Effexor XR | Whole capsule, or entire contents on applesauce; swallow immediately without chewing and follow with water. Take with food. |
| Cymbalta | Swallow whole; do not open, crush, chew or sprinkle. |
| Risperdal solution | Measure with oral syringe. May mix with water, coffee, orange juice or low-fat milk; avoid cola and tea. |
| Lithobid | Swallow the extended-release tablet whole; do not crush or chew. |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3 · DailyMed label 4
MAOI antidepressant switches: the direction matters
| Medicine | After MAOI → before this medicine | After this medicine → before MAOI |
|---|---|---|
| Fluoxetine | At least 14 days | At least 5 weeks |
| Venlafaxine XR | At least 14 days | At least 7 days |
| Escitalopram | At least 14 days | At least 14 days |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3
A safety check to keep on the follow-up plan
| Medicine | Monitoring focus |
|---|---|
| Olanzapine | Fasting glucose and lipids at baseline and periodically; weight regularly. |
| Venlafaxine XR | Control hypertension first; check blood pressure before and regularly during treatment. |
| Lithium | Timed lithium concentrations plus clinical toxicity assessment, renal function and thyroid function. |
| Risperidone | Ask about galactorrhea, menstrual changes, sexual symptoms and abnormal movements. |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3 · DailyMed label 4
Infectious diseases: administration, interactions, and practical distinctions
Quick recall
A cefuroxime axetil tablet-to-suspension switch needs a new formulation-appropriate regimen: matching milligrams does not establish equivalent exposure.
References: DailyMed label 1
Macrobid is for lower-tract uncomplicated cystitis. Fever with flank pain or vomiting calls for prompt reassessment; it is not a pyelonephritis treatment.
References: DailyMed label 1
New tendon pain on a fluoroquinolone: stop the drug, rest the tendon, and promptly arrange an alternative with the prescriber.
References: DailyMed label 1 · DailyMed label 2
Take Cleocin HCl capsules with a full glass of water and remain upright for at least 30 minutes; report significant diarrhea even after treatment ends.
References: DailyMed label 1
For acute uncomplicated influenza in adults with normal kidney function, oseltamivir treatment is 75 mg twice daily for 5 days; do not copy a contact’s once-daily prevention schedule.
References: DailyMed label 1
Oral terbinafine requires confirmation of nail fungus and hepatic assessment. Chronic or active liver disease is a contraindication; visible nail recovery takes time.
References: DailyMed label 1
Absorption instructions are drug-specific
| Medicine/formulation | Practical instruction |
|---|---|
| Cefdinir capsules | Separate iron and aluminum/magnesium antacids by at least 2 hours before or after. |
| Cefuroxime axetil tablets | Give at least 1 hour before or 2 hours after short-acting antacids; avoid PPIs and H2 blockers per label. |
| Ciprofloxacin immediate-release | Give at least 2 hours before or 6 hours after multivalent-cation products. |
| Levofloxacin tablets | Separate relevant antacids, iron, zinc, or sucralfate by at least 2 hours before or after. |
| Macrobid | Take with food; avoid magnesium trisilicate antacids. |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3 · DailyMed label 4 · DailyMed label 5
High-priority interaction checks
| Medicine | Check | Response |
|---|---|---|
| Clarithromycin | Simvastatin or lovastatin | Do not coadminister; resolve an alternative or a statin hold with the prescriber. |
| Ciprofloxacin | Tizanidine | Contraindicated combination; select a compatible regimen. |
| Metronidazole | Warfarin | Careful INR monitoring; adjust anticoagulant as needed. |
| Azithromycin | QT-prolonging drugs and low potassium/magnesium | Reassess cardiac risk and correct reversible factors. |
| Oral terbinafine | CYP2D6 substrates | Monitor and consider substrate dose reduction; effects can persist after terbinafine stops. |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3 · DailyMed label 4 · DailyMed label 5
Match the target and formulation
| Medicine | Target or limit | Formulation point |
|---|---|---|
| Acyclovir / valacyclovir | Herpes-virus indications; renal dosing matters | Separate drug regimens; do not exchange milligram for milligram. |
| Oseltamivir | Influenza A/B; treatment differs from prevention | Commercial suspension is 6 mg/mL. |
| Nystatin oral suspension | Oral candidiasis; not systemic mycoses | Retain in the mouth before swallowing. |
| Oral terbinafine | Confirmed dermatophyte nail infection | Tablet courses differ for fingernails and toenails; topical products are different. |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3 · DailyMed label 4 · DailyMed label 5
Endocrine, bone and gastrointestinal comparisons
Quick recall
SGLT2 users with vomiting, abdominal pain or breathlessness need assessment for ketoacidosis even without marked hyperglycemia. For these three products, withhold at least 3 days if possible before surgery/prolonged fasting; restart when stable and eating.
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3
Pioglitazone can worsen heart failure through fluid retention; initiation in NYHA class III–IV is contraindicated. Gemfibrozil lowers the pioglitazone maximum to 15 mg daily.
References: DailyMed label 1
Fever or severe sore throat on methimazole: hold doses, seek urgent CBC with differential and clinical assessment, and restart only when cleared. Thyroid tests do not evaluate agranulocytosis.
References: DailyMed label 1 · Reference 2
After prolonged prednisone use, symptom improvement does not prove adrenal recovery. Arrange a gradual, individualized withdrawal plan and flag recent use during illness or surgery.
References: DailyMed label 1
Baqsimi is a single-use nasal rescue dose and does not require inhalation. Give it promptly, call emergency help, and use a new device after 15 minutes without response while waiting for help.
References: DailyMed label 1
SGLT2 renal thresholds depend on the indication
| Product | Glycemic use | Other adult indications |
|---|---|---|
| Jardiance | Not recommended below eGFR 30 mL/min/1.73 m² for glycemic control. | 10 mg daily for labeled heart-failure/CKD outcomes; assess the exact indication and label limitations. |
| Farxiga | Not recommended below eGFR 45; start 5 mg daily when eligible. | 10 mg daily; do not initiate below eGFR 25. If eGFR later falls below 25, continuation for labeled risk reduction is permitted. |
| Invokana | Usual maximum 100 mg daily at eGFR 30 to below 60; UGT inducers have separate instructions. | Below eGFR 30, do not initiate; selected treated adults with albuminuria above 300 mg/day may continue 100 mg for the labeled kidney/cardiovascular indication. |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3
Injection timing and missed-dose decisions
| Selected product | Usual timing | Key action |
|---|---|---|
| Humalog solution | Within 15 minutes before or immediately after a meal. | U-100/U-200 pen windows show units; no conversion. U-200 is not for pumps. |
| NovoLog solution | Within 5–10 minutes before a meal. | For injection with NPH, draw NovoLog first and inject immediately; never mix in a pump. |
| Tresiba | Adult: once daily at any time. Pediatric: same time daily. | Adult missed dose: take when remembered during waking hours; at least 8 hours between injections. Children: contact clinician. |
| Trulicity | Once weekly. | Take a missed dose only when at least 72 hours remain before the next scheduled dose. |
| Victoza | Once daily, independent of meals. | After more than 3 days without it, restart at 0.6 mg and retitrate with the prescriber. |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3 · DailyMed label 4 · DailyMed label 5
Oral administration: food, posture and separation
| Selected product | Administration rule | Why it matters |
|---|---|---|
| Fosamax tablet | On arising with 6–8 oz plain water; wait at least 30 minutes for food/other medicines; upright at least 30 minutes and until after first food. | Supports absorption and reduces esophageal injury. |
| Protonix tablet vs granules | Tablet: whole, with or without food. Granules: applesauce/apple juice about 30 minutes before a meal; do not chew. | Formulation changes the instructions. |
| Pepcid prescription tablets | With or without food; adjust dose when creatinine clearance is below 60 mL/min. | Renal accumulation increases adverse-effect risk. |
| Carafate tablets | Empty stomach; antacids at least 30 minutes apart. For digoxin, give digoxin 2 hours before sucralfate. | Binding intervals are medicine-specific; the antacid interval is not universal. |
References: DailyMed label 1 · DailyMed label 2 · DailyMed label 3 · DailyMed label 4