Abacavir Ziagen 1.

Hypersensitivity reactions (higher risk in

patients positive for HLA-B*5701 allele.
2. May cause lactic acidosis (nucleoside analogs in
general)
Adalimumab Humira May cause fatal infections (TNF inhibitors in
general).
May cause malignancies (young patients)
Evaluate tuberculosis risk
Alemtuzumab Campath Hematologic complications – cytopenia.
May cause serious infections.
Infusion reactions
amikacin Amikin Nephrotoxicity.
Caution when used with neuromuscular blockers.
Neurotoxicity
amiodarone Cordarone Hepatotoxicity.
Proarrhythmic effect.
Pulmonary toxicity.
Use only for life-threatening arrhythmias because
of toxicity.

amitriptyline Elavil Suicidal ideation.

amphotericin B Ambisome
Aripiprazole Abilify Suicidal ideation.
Higher mortality in demented elderly population
(stroke)
Atenolol Tenormin Should not suddenly withdrawal
Atomoxetine Strattera Caution in pediatrics (has led to suicides)
Baclofen Lioresal Should not suddenly withdrawal
Benazepril Lotensin Fetal harm in 2nd and 3rd trimesters, d/c if
pregnant
Bevacizumab Avastin May cause gastrointestinal perforation.
Avoid use in serious hemorrhage or recent
hemoptysis (may exacerbate)
Wound dehiscence/healing complications
Bleomycin Blenoxane Idiosyncratic reaction
Pulmonary fibrosis
Experienced physician
Bupropion Wellbutrin Suicidal ideation.
For smoking cessation, may cause depression
Candesartan Atacand Fetal harm in 2nd and 3rd trimesters, d/c if
pregnant
Captopril Capoten Fetal harm in 2nd and 3rd trimesters, d/c if
pregnant
Carbamazepine Tegretol May cause blood dyscrasias (which lead to
cytopenia)
Asians need test for HLA-B*1502 (positive
indicates higher risk for Stevens-Johnson
 syndrome and toxic epidermal necrolysis)
Celecoxib Celebrex Cardiovascular events
Gastrointestinal events
Contraindicated for heart surgery pain
Chlorambucil Leukeran Bone marrow suppression
May cause infertility and teratogenicity
May cause secondary malignancies
(chemotherapy in general)
Ciprofloxacin Cipro May cause tendon rupture
Exacerbates myasthenia gravis
Cisplatin Platinol Anaphylaxis
Ototoxicity
Renal toxicity
Carefully verify with doctor if dose > 100mg/m2
every 3-4 weeks
Experienced physician
Citalopram Celexa Suicidal ideation.

Clindamycin Cleocin May cause antibiotic associated colitis (C. diff

colitis)
Clonidine Catapres Dilute before epidural use
Clopidogrel Plavix Caution in low CYP2C19 activity
Clozapine Clozaril May cause agranulocytosis (therefore should only
use when failed at least 2 schizophrenia
therpaies)
Cardiovascular events
May cause orthostatic hypotension
May cause seizures
Higher mortality in demented elderly patients
(stroke)
Darbepoetin Aranesp Cardiovascular events
Should not use when intent is to cure cancer
patient; only use concurrently with
chemotherapy regimen and discontinue when
completed course.
Maintain hemoglobin 10-12 g/dL, should not go
higher.
APPRISE REMS – patient acknowledgement form
required (only for cancer)
Daunorubicin Cerubidine Bone marrow suppression
Myocardial toxicity
Be careful not to extravasate
Dose adjust in hepatic impairment
Dose adjust in renally impaired
Experienced physician

Diclofenac Voltaren Cardiovascular events

 Gastrointestinal events
Contraindicated for heart surgery pain
Didanosine Videx May cause pancreatitis
May cause lactic acidosis (nucleoside analogs in
general)
Divalproex Depakote May cause hepatic failure
May cause pancreatitis
Teratogenic
Docetaxel Taxotere May cause fluid retention
Should not be given when ANC < 1500/mm3 or
platelets < 100,000/mm3
Hypersensitivity reactions
Doses > 100 mg/m2 are suspicious
Avoid use in hepatic impairment
Doxepin Sinequan Suicidal ideation
Doxorubicin Adriamycin Bone marrow suppression
Myocardial toxicity
May cause secondary malignancy
Skin irritation/extravasation
Dose adjust in hepatic impairment
Experienced physician
Drospirenone/ethinyl estradiol Yasmin Cardiovascular events in smokers
Duloxetine Cymbalta Suicidal ideation
Emtricitabine Emtriva Not indicated for chronic hepatitis B
Enalapril Vasotec Fetal harm in 2nd and 3rd trimesters, d/c if
pregnant
Enoxaparin Lovenox Should not use with recent neuraxial
anesthesia/spinal puncture (may cause spinal
hematoma)
Epoetin alfa Epogen Cardiovascular events
Should not use when intent is to cure cancer
patient; only use concurrently with
chemotherapy regimen and discontinue when
completed course
Maintain hemoglobin 10-12 g/dL
Surgery patients need thrombotic prophylaxis
APPRISE REMS – patient acknowledgement form
required (only for cancer)
Escitalopram Lexapro Suicidal ideation.

Estradiol patch Estraderm Risk of dementia in post-menopausal women

Estrogen/progestin
Estrogen/progestin patch
Risk of endometrial carcinoma
Caution in cardiovascular disease
Carefully weight risk vs benefits (should use with
shortest duration possible)
Seasonale Cardiovascular events in smokers
Ortho Evra May cause thromboembolism (patch > oral
 contraceptives)
Cardiovascular risk in smokers
estrogen/progestin ring NuvaRing Cardiovascular events in smokers
estrogens, conjugated Premarin Risk of dementia
Risk of endometrial carcinoma
Caution in cardiovascular disease
Carefully weigh risk vs benefits
Etanercept Enbrel May cause serious infections
May cause malignancies (young patients)
May activate tuberculosis
Ethinyl estradiol/norgestimate Ortho Tri- Cardiovascular events in smokers
Cyclen
Etoposide VePesid Bone marrow suppression
Experienced physician
Fentanyl Duragesic Respiratory depression
Caution when used with CYP3A4 inhibitors

fluoxetine Prozac Suicidal ideation

flutamine Eulexin May cause liver failure

fosinopril Monopril Fetal harm in 2nd and 3rd trimesters, d/c if

pregnant
furosemide Lasix May cause fluid and electrolyte imbalance
ganciclovir Cytovene May cause blood dyscrasias (cytopenias)
Carcinogenic and teratogenicity
Do not use outside indications

Hydrocodone/ibuprofen Vicoprofen Cardiovascular events

Gastrointestinal events
Contraindicated for heart surgery pain
ibuprofen Motrin Cardiovascular events
Gastrointestinal events
Contraindicated for heart surgery pain
Idarubicin Idamycin Bone marrow suppression
Myocardial toxicity
Careful not to extravasate
Dose adjust in hepatic impairment
Dose adjust in renally impaired
Experienced physician
indomethacin Indocin Cardiovascular events
Gastrointestinal events
Contraindicated for heart surgery pain
infliximab Remicade May cause infections (TNF-inhibitors in general)
May cause malignancies (young patients)
May activate tuberculosis
Irbesartan Avapro Fetal harm in 2nd and 3rd trimesters, d/c if
 pregnant
ketorolac Toradol May cause bleeding
Cardiovascular events
Gastrointestinal events
Hypersensitivity
Contraindicated in major surgery pain
Contraindicated in renally impaired
Do not use with other NSAIDs
Dose adjust in elderly
Contraindicated when giving birth periprocedurally
Dose adjust when < 50 kg
Caution in pediatrics
Pediatrics: no oral ketorolac
Only use for < 5 days
lamivudine Epivir Not indicated for chronic hepatitis B
lamotrigine Lamictal May cause life-threatening skin rashes
levofloxacin Levaquin Tendon rupture
May exacerbate myasthenia gravis
levothyroxine Synthroid Do not use for weigh reduction
lisinopril Zestril Fetal harm in 2nd and 3rd trimesters, d/c if
pregnant
lithium Lithane Requires frequent level monitoring
losartan Cozaar Fetal harm in 2nd and 3rd trimesters, d/c if
pregnant
medroxyprogesterone Provera May cause bone degradation
Risk of dementia in post-menopausal women
Use with caution in cardiovascular disease
Use > 2 years only when failed other birth control
Birth control does not stop sexual infection
meloxicam Mobic Cardiovascular events
Gastrointestinal events
Contraindicated for heart surgery pain
metformin Glucophage Rarely causes lactic acidosis in renally impaired
methotrexate Rheumatrex May cause acute kidney injury
Bone marrow suppression
Dermatologic reactions
May cause severe diarrhea
Hepatotoxicity
May cause lymphomas
Opportunistic infections
May cause pneumonitis
Tumor lysis syndrome
Dose adjust for ascites
Dose adjust for renally impaired
Use caution with NSAIDs
Teratogenic
Radiotherapy increases necrosis risk
 Experienced physician

methylphenidate Ritalin Drug abuse

metoclopramide Reglan May cause irreversible tardive dyskinesia with
prolonged use
metoprolol Lopressor Should not suddenly withdrawal
metronidazole Flagyl Possibly carcinogenic (animal data)
mirtazapine Remeron Suicidal ideation
morphine sulfate Roxanol Should not consume alcohol
Do not use extended-release as needed
High concentration of solution
Narcotic abuse
Caution with intrathecal route
naproxen Naprosyn Cardiovascular events
Gastrointestinal events
Contraindicated for heart surgery pain
nabumetone Relafen Cardiovascular events
Gastrointestinal events
Contraindicated for heart surgery pain
norepinephrine Levophed Extravasation may cause skin necrosis
nortriptyline Pamelor Suicidal ideation
olanzapine Zyprexa Higher mortality in dementia
Delirium/sedation syndrome (E.R. intramuscular)
olmesartan Benicar Fetal harm in 2nd and 3rd trimesters, d/c if
pregnant
oxycodone Oxycontin Watch out for drug interactions
Controlled-release tablet (swallow whole)
Narcotic abuse
paclitaxel Taxol Bone marrow suppression
Hypersensitivity reactions
Experienced physician
paroxetine Paxil Suicidal ideation.

phenytoin Dilantin Infusions > 50 mg/min (adults) may cause

hypotension
pioglitazone Actos May cause or exacerbate heart failure
procainamide Procan Blood dyscrasias
Drug-induced lupus with long-term use
CAST trial (should only use for life-threatening
arrhythmias, risk may outweigh benefit otherwise)
promethazine Phenergan Serious tissue injury if injected
Caution in pediatrics (also contraindicated in < 2
year olds)
propoxyphene/APAP Darvocet-N Overdose
Drug interactions
withdrawn from market because of
 cardiovascular events
propanolol Inderal Should not suddenly withdrawal
quetiapine Seroquel Suicidal ideation
Higher mortality in demented elderly (stroke)
quinapril Accupril Fetal harm in 2nd and 3rd trimesters, d/c if
pregnant
raloxifene Evista Increased risk of stroke in patients with
cardiovascular risk factors
May cause DVT or PE
risperidone Risperdal Higher mortality in demented elderly patients
rituximab Rituxan Infusion reactions
May cause mucocutaneous reactions
May cause progressive multifocal
leukoencephalopathy
Tumor lysis syndrome
rosiglitazone Avandia May cause heart failure
REMS: May cause heart attack and stroke
salmeterol/fluticasone Advair Diskus Risk of asthma-related deaths with salmeterol
Caution in pediatrics (growth suppression and
asthma-related complications)
selegiline Eldepryl Suicidal ideation
sertraline Zoloft Suicidal ideation

spironolactone Aldactone Tumorigenic

spironolactone/HCTZ Aldactazide Tumorigenic
Do not use as initial therapy
Tacrolimus Prograf Increased infection susceptibility
(immunosuppressives in general)
May cause malignancies
Experienced physician
Tamoxifen Nolvadex Gynecologic carcinogen
May cause thromboembolic events - stroke, PE, etc
Telithromycin Ketek Contraindicated in patients with myasthenia
gravis
Tobramycin Nebcin Nephrotoxicity
Neurotoxicity
Trazadone Desyrel Suicidal ideation
Tretinoin Retin A May cause differentiation syndrome
Many patients develop leukocytosis
Teratogenic
Experienced physician
Triamterene/HCTZ Dyazide May cause hyperkalemia
Valsartan Diovan Fetal harm in 2nd and 3rd trimesters, d/c if
pregnant
Venlafaxine Effexor Suicidal ideation
Vinblastine Velban Experienced physician
 NOT for intrathecal use (patient will die!)
Vesicant
Vincristine Oncovin NEVER for intrathecal administration
Vesicant
Warfarin Coumadin Bleeding
Zidovudine Retrovir May cause hematologic complications
(cytopenias)
Myopathies with prolonged use
May cause lactic acidosis (nucleoside analogs in
general)
Ziprasodine Geodon Higher mortality in demented elderly patients
(stroke)