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N54 Neurology
Common Medications
Toronto Notes 2019
Common Medications
Table 25. Common Medications – Major Issues
Indications
Parkinson’s Disease
Mechanism of Action/Class
Dopamine precursor
Dopamine agonist
MAOB inhibitor
Acetylcholinesterase inhibitor
Triptan (selective 5-hydroxytryptamine receptor agonist)
Ergot (5-HT1D receptor agonist)
Anticonvulsant
β-blocker
Anticonvulsant for partial ± 2o generalization, generalized tonic-clonic
Anticonvulsant for partial, tonic-clonic, status epilepticus
Anticonvulsant for partial or generalized, absence seizures
Anticonvulsant for absence seizures
Anticoagulant (direct thrombin inhibitor)
Anticoagulant (Factor Xa inhibitor)
Anticoagulant (Factor Xa inhibitor)
Generic Name
levodopa + carbidopa
bromocriptine
selegiline
pyridostigmine
sumatriptan
dihydroergotamine
topiramate
propranolol
carbamazepine
phenytoin
valproic acid
ethosuximide
dabigatran
rivaroxaban apixaban
Trade Name
Sinemet®
Parlodel®
Eldepryl®
Mestinon®
Imitrex®
Migranal®
Topamax®
Inderal®
Tegretol®
Dilantin®
Depakene® Apo- Valproic®
Zarontin®
Pradaxa®
Xarelto® Eliquis®
Dosing
Carbidopa 25 mg/levodopa 100 mg PO tid
Maximum 200 mg carbidopa and 2,000 mg levodopa
per day
1.25 mg PO bid, increase by 2.5 mg/d q2-4wk, up to 10-30 mg PO tid
5 mg PO bid
600 mg/d PO divided in 5-6 doses
Range 60-1,500
mg/d
25-100 mg PO prn, maximum 200 mg/d
Nasal spray 0.5 mg/spray, maximum 4 sprays/d
25 mg OD PO (in evening); may increase weekly by 25 mg/d to a max 50 mg bid
80 mg/d divided every 6-8 h; increase by 20-40 mg/ dose every 3-4 wk to max 160-240 mg/d in divided doses q6-8h
Start at 100-200 mg PO OD- tid, increase by 200 mg/d up to 800-1,200 mg/d
100 mg PO tid, maintenance dose up to
200 mg PO tid
SE: 10-15 mg/kg IV loading dose then maintenance doses of 100 mg PO or
IV q6-8h
10-15 mg/kg/d PO in divided doses, increase incrementally until therapeutic dose to max of 60 mg/kg/d
500 mg/d PO, increase by 250 mg every
4-7 d to max 1.5 g/d in divided doses
110 mg PO bid or 150 mg PO bid
15 mg PO daily or 20 mg PO daily
2.5 mg PO bid or 5 mg PO bid
Contraindications
Narrow-angle glaucoma, use of MAO inhibitor in last
14 d, history of melanoma or undiagnosed skin lesions
Concomitant use of potent inhibitors of CYP3A4, uncontrolled HTN, ischemic heart disease, peripheral vascular disease; caution with renal or hepatic disease
Concomitant use of meperidine or tricyclic antidepressants
GI or GU obstruction
Hemiplegic/basilar migraine, ischemic heart disease, CVD, uncontrolled HTN, use of ergotamine/5-HT1 agonist in past 24 h, use of MAO inhibitor in last 14 d, severe hepatic disease
Hemiplegic/basilar migraine, high-dose ASA therapy, uncontrolled HTN, ischemic heart disease, peripheral vascular disease, severe hepatic or renal dysfunction, use of triptans in last 24 h, use of MAO inhibitors in last 14 d
Uncompensated CHF, severe bradycardia or heart block, severe COPD or asthma
History of bone marrow depression, hepatic disease, hypersensitivity to the drug, use of MAO inhibitor in last 14 d
Hypersensitivity, pregnancy, breastfeeding; caution with P-450 interactions
Hypersensitivity, hepatic disease, urea cycle disorders
Hypersensitivity (succinimides)
CrCl <30 mL/min, significant hemostatic impairment or CNS lesions within 6 mo with high risk of bleeding
Concomitant anticoagulant, hepatic disease, pregnancy, strong CYP3A4 and P-gp inhibitors e.g. itraconazole, ritonavir
Active bleeding, gastrointestinal bleeding, recent cerebral infarction, active peptic ulcer disease with recent bleeding, hepatic disease with coagulopathy
Side Effects
Nausea, hypotension, hallucinations, dyskinesias in last 14 d, history of melanoma or undiagnosed skin lesions
Hypotension, N/V, dizziness, constipation, diarrhea, abdominal cramps, H/A, nasal congestion, drowsiness, hallucinations
H/A, insomnia, dizziness, nausea, dry mouth, hallucinations, confusion, orthostatic hypotension, increased akinesia, risk of hypertensive crisis with tyramine-containing foods
Nausea, vomiting, diarrhea, abdominal cramps, increased peristalsis, increased salivation, increased bronchial secretions, miosis, diaphoresis, muscle cramps, fasciculations, muscle weakness
Vertigo, chest pain, flushing, sensation of heat, hypertensive crisis, peripheral vascular disease, coronary artery vasospasm, cardiac arrest, nausea, vomiting, H/A, hyposalivation, fatigue
Coronary artery vasospasm, transient myocardial ischemia, myocardial infarction, ventricular tachycardia, ventricular fibrillation; may cause significant rebound H/A
Sedation, mood disturbance, cognitive dysfunction, anorexia, nausea, diarrhea, paresthesias, metabolic acidosis, glaucoma, SJS/TEN
Fatigue, cognitive dysfunction, disturbed sleep, rashes, dyspepsia, dry eyes, heart failure, bronchospasm, risk of acute tachycardia and HTN if withdrawal
Drowsiness, H/A, unsteadiness, dizziness, N/V, skin rash, agranulocytosis/aplastic anemia (rare)
Hypotension, SJS/TEN, SLE-type symptoms, gingival hypertrophy, peripheral neuropathy, H/A, blood dyscrasias, nystagmus, N/V, constipation, sedation, teratogenic
Hepatic failure, H/A, somnolence, alopecia, N/V, diarrhea, tremor, diplopia, thrombocytopenia, hypothermia, pancreatitis, encephalopathy
CNS depression, blood dyscrasias, SLE, SJS, GI symptoms
Dyspepsia, gastritis, bleeding
Bleeding
Bleeding (conjunctival, gastrointestinal, gingival, contusion, hematoma, epistaxis, hematuria)
Myasthenia Gravis
Acute Migraine
Migraine Prophylaxis
Epilepsy
Stroke Prevention in Atrial Fibrillation