A n t i p s
Aripiprazole (Abilify, Abilify DISCMELT)
Drug Classification: Antipsychotics
Use: Treatment of schizoprenia, acute & mixed
episodes associated w/ bipolar disorder.
Treatment of schizophrenia in adolescent
13-17 yr. Adjunctive treatment of major
depressive disorder in adult. Acute &
maintenance treatment of manic & mixed
episodes associated w/ bipolar disorder w/
or w/o psychotic features in childn 10-17
yr.
Action: Benzodiazepine; antianxiety agent
Caution: Elderly patients w/ dementia-related
psychosis. Increased suicidality in patients
w/ major depressive disorder. Neuroleptic
Malignant syndrome, tardive dyskinesia,
hyperglycemia, DM, orthostatic
hypotension, seizures/convulsions. May
impair ability to drive or operate
machinery.
Contraindication: Elderly patients with dementia-
related psychosis should not receive
Abilify. Do not take Abilify if you are
allergic to this medication or any of its
ingredients.
Interaction: ↑ CNS depression W/ EtOH, other
CNS depressants, narcotics, MAOIs,
anesthetics, antihistamines, theophylline,
herbs: kava kava, valerian; ↑ effect W/
OCPs, cimetidine, INH, disulfiram,
omeprazole, valproic acid, ciprofloxacin,
erythromycin, clarithromycin, phenytoin,
verapamil, grapefruit juice; ↑ risk OF
ketoconazole, itraconazole, digitalis tox, ↓
effectiveness OF levodopa; ↓ effect W/
carbamazepine, rifampin, rifabutin,
barbiturates, cigarette smoking.
Laboratory Values: ↑ Alk phos, may cause ↓ Hct
& neutropenia
y c h o t i
Nursing Intervention/Patient Education: Monitor
for resp depression; avoid abrupt D/C after
prolonged use
Chlorpromazine (Thorazine, Largactil)
Drug Classification: Antipsychotic, Antiemetic/
Phenothiazine
Use: The management of psychotic disorders
including manifestations of manic
depressive illness, manic phase and severe
behavioral problems in children; nausea
and vomiting due to stimulation of the
chemoreceptor trigger zone.
Action: Benzodiazepine; antianxiety agent
Caution: Resp depression, CNS impair, h/o of drug
dependence; avoid in hepatic impair
Contraindication: Preexisting CNS depression
Interaction: ↑ Effects W/ antidepressants,
antihistamines, anticonvulsants,
barbiturates, general anesthetics, MAOIs,
narcotics, phenothiazine cimetidine,
disulfiram, fluconazole, itraconazole,
ketoconazole, OCPs, INH, metoprolol,
propoxyphene, propranolol, valproic acid,
EtOH, grapefruit juice, kava kava, valerian;
↑ effects OF digoxin, phenytoin; ↓ effects
W/ aminophylline, antacids,
carbamazepine, theophylline, rifampin,
rifabutin, tobacco; ↓ effects OF levodopa
Laboratory Values: ↑ LFTs, alk phos, bilirubin,
triglycerides; ↓ granulocytes
Nursing Intervention/Patient Education: Do not
D/C abruptly; dilute PO conc in 2–4 oz of
Liq; risk of photosensitivity—use
sunscreen; risk of tardive dyskinesia; take
w/ food if GI upset; may darken urine
Clozapine (Clozaril, FazaClo)
c s
DrugClassification:Antipsychotic/Dibenzodiazepine
Derivative
Use: *Refractory severe schizophrenia*; childhood
psychosis; obsessive-compulsive disorder,
bipolar disorder
Action: “Atypical” TCA
Caution: [B, +/−] Monitor for psychosis &
cholinergic rebound
Contraindication: Uncontrolled epilepsy; comatose
state; WBC <3500 cells/mm3 and ANC
<2000 cells/mm3 before Rx or <3000
cells/mm3 during Rx
Interaction: ↑ Effects W/ clarithromycin,
cimetidine, erythromycin, fluoxetine,
paroxetine, quinidine, sertraline; ↑
depressant effects W/ CNS depressants,
EtOH; ↑ effects OF digoxin, warfarin; ↓
effects W/ carbamazepine, phenytoin,
primidone, phenobarbital, valproic acid,
St. John’s Wort, nutmeg, caffeine; ↓
effects OF phenytoin
Laboratory Values: Monitor WBCs; weekly CBC
mandatory 1st 6 mo, then qowk
Nursing Intervention/Patient Education: ↑ Risk of
developing agranulocytosis; avoid
activities where sudden loss of
consciousness could cause harm; benign
temperature ↑ may occur during the 1st 3
wk of Rx
Fluphenazine (Prolixin, Permitil)
Drug Classification: Antipsychotic/Phenothiazine
Use: Schizophrenia
Action: Phenothiazine antipsychotic; blocks
postsynaptic mesolimbic dopaminergic
brain receptors
Caution:
Contraindication: Severe CNS depression, coma,
subcortical brain damage, blood
 dyscrasias, hepatic Dz, w/ caffeine, tannic
acid, or pectin-containing products
Interaction: ↑ Effects W/ antimalarials, BBs, CNS
depressants, EtOH, kava kava; ↑ effects
OF anticholinergics, BBs, nitrates; ↓
effects W/ antacids, caffeine, tobacco; ↓
effects OF anticonvulsants, guanethidine,
levodopa, sympathomimetics
Laboratory Values: ↑ LFTs, ↓ HMG, Hct, plts,
WBC
Nursing Intervention/Patient Education:
Photosensitivity—use sunblock; urine may
turn pink or red, ↑ risk of heatstroke in
hot weather; less sedative/hypotensive
than chlorpromazine
Haloperidol (Haldol)
Drug Classification: Antipsychotic/Butyrophenone
Use: Psychotic disorders, agitation, Tourette
disorders, hyperactivity in children
Action: Butyrophenone; antipsychotic, neuroleptic
Caution: ↑ Effects w/ SSRIs, CNS depressants, TCA,
indomethacin, metoclopramide; avoid
levodopa (↓ antiparkinsonian effects)
Contraindication: NAG, severe CNS depression,
coma, Parkinson Dz, BM suppression,
severe cardiac/hepatic Dz
Interaction: ↑ Effects W/ CNS depressants,
quinidine, EtOH; ↑ hypotension W/
antihypertensives, nitrates; ↑ Action: Piperazine phenothiazine
anticholinergic effects W/ antihistamines,
antidepressants, atropine, phenothiazine,
quinidine, disopyramide; ↓ effects W/
antacids, carbamazepine, Li, nutmeg,
tobacco; ↓ effects OF anticoagulants,
levodopa, guanethidine
Laboratory Values: ↑ LFTs
Nursing Intervention/Patient Education: ↑ Risk of
photosensitivity—use sunblock; do not
give decanoate IV; dilute PO conc liq w/
H2O/juice; monitor for EPS; ECG
monitoring w/ off-label IV use
Lithium Carbonate (Eskalith, Lithobid) Nursing Intervention/Patient Education: Take w/o
Drug Classification: Antipsychotic food; monitor for persistent cough
Use: Manic episodes of bipolar Dz*, augment
antidepressants, aggression, posttraumatic Olanzapine (Zyprexa, Zyprexa Zydis)
stress disorder Drug Classification: Antipsychotic/
Action: Effects shift toward intraneuronal Thienobenzodiazepine
metabolism of catecholamines Use: Bipolar mania, schizophrenia, psychotic
Caution: [D, −] Many drug interactions; avoid ACE disorders, acute agitation in schizophrenia
inhibitor or diuretics; thyroid Dz Action: Dopamine & serotonin antagonist
Contraindication: Severe renal impair or CV Dz, Caution: [C, −]
lactation Interaction: ↑ Effects W/ fluvoxamine; ↑ sedation
Interaction: ↑ W/ CNS depressants, EtOH; ↑ Szs W/
Effects OF TCA; ↑ effects W/ ACEIs, bumetanide, anticholinergics, CNS depressants; ↑
carbamazepine, ethacrynic acid, hypotension W/ antihypertensives,
fluoxetine, furosemide, methyldopa, diazepam; ↓ effects W/ activated
NSAIDs, phenytoin, phenothiazine, charcoal, carbamazepine, omeprazole,
probenecid, tetracyclines, thiazide rifampin, St. John’s wort, tobacco; ↓
diuretics, dandelion, juniper; ↓ effects W/ effects OF dopamine agonists, levodopa
acetazolamide, antacids, mannitol, Laboratory Values: ↑ LFTs
theophylline, urea, verapamil, caffeine Nursing Intervention/Patient Education: ↑ Risk of
Laboratory Values: ↑ Serum glucose, I-131 tardive dyskinesia, photosensitivity—use
uptake, WBC; ↓ uric acid, T3, T4 sunscreen, body temp impairment; takes
Nursing Intervention/Patient Education: Several weeks to titrate dose; smoking ↓ levels;
wk before full effects of med, ↑ fluid may be confused w/ Zyrtec
intake to 2–3 L/d
Paliperidone (Invega)
Molindone (Moban) Drug Classification:
Drug Classification: Antipsychotic Use: Schizophrenia
Use: Schizophrenia Action: Risperidone metabolite, antagonizes
dopamine & serotonin receptors
Caution: [C, ?] NAG Caution: [C; ?/−] w/ Bradycardia, ↓ K+/Mg2+,
Contraindication: Drug/EtOH CNS depression, renal/hepatic impair
coma Contraindication: Risperidone hypersensitivity, w/
Interaction: ↑ Effects W/ antihypertensives; ↑ phenothiazines, ranolazine, ziprasidone,
hyperkalemia W/ K-sparing diuretics, K prolonged QT, h/o arrhythmia
supls, salt substitutes, trimethoprim; ↑ Interaction: ↑ Risk of prolongation of QT interval
effects OF insulin, Li; ↓ effects W/ ASA, W/ class 1A & class III antiarrhythmics,
NSAIDs chlorpromazine, thioridazine, gatifloxacin,
Laboratory Values: ( Lipid profile, fasting glucose, moxifloxacin, EtOH; ↓ effects OF levodopa
HgA1c; may ↑ prolactin; ↑ Serum K+, & other dopamine agonists
BUN, Cr Laboratory Values: ↑ Serum glucose, LFTs
Nursing Intervention/Patient Education: Do not
chew/cut/crush pill; monitor for
orthostatic effects & renal Fxn esp in
elderly
Perphenazine (Trilafon)
Drug Classification: Antipsychotic,
Antiemetic/Phenothiazine
Use: Psychotic disorders, severe N, intractable
hiccups
Action: Phenothiazine, blocks brain dopaminergic
receptors
Caution: [C, ?/−] NAG, severe ↑/↓BP
Contraindication: henothiazine sensitivity, BM
depression, severe liver or cardiac Dz
Interaction: ↑ Effects W/ antidepressants; ↑
effects OF anticholinergics,
antidepressants, propranolol, phenytoin;
↑ CNS effects W/ CNS depressants, EtOH;
↓ effects W/ antacids, Li, phenobarbital,
caffeine, tobacco; ↓ effects OF levodopa,
Li
Laboratory Values: ↑ Serum cholesterol, glucose,
LFTs; ↓ HMG, plts, WBCs
Nursing Intervention/Patient Education: Take oral
dose w/ food; risk of photosensitivity—use
sunblock
Prochlorperazine (Compazine)
Drug Classification: Antiemetic, Antipsychotic/
Phenothiazine
Use: N/V, agitation, & psychotic disorders
Action: Phenothiazine; blocks postsynaptic
dopaminergic CNS receptors
Caution: [C, +/−] NAG, severe liver/cardiac Dz
Contraindication: Phenothiazine sensitivity, BM
suppression; age <2 y or wgt <9 kg
Interaction: ↑ Effects W/ chloroquine,
indomethacin, narcotics, procarbazine,
SSRIs, pyrimethamine; ↑ effect OF
antidepressants, BBs, EtOH; ↓ effects W/
antacids, anticholinergics, barbiturates,
tobacco; ↓ effects OF guanethidine,
levodopa, Li
Laboratory Values: False(+) urine bilirubin,
amylase, phenylketonuria, ↑ serum
prolactin
Nursing Intervention/Patient Education: N D/C
abruptly; risk of photosensitivity—use
sunblock; urine may turn pink/red
Quetiapine (Seroquel, Seroquel XR)
Drug Classification : Antipsychotic
Uses: Acute exacerbations of schizophrenia
Action: Serotonin & dopamine antagonism
Caution: [C, −] CI: Component allergy
Interactions: ↑ Effects W/ azole antifungals,
cimetidine, macrolides, EtOH; ↑ effects
OF antihypertensives, lorazepam; ↓
effects W/ barbiturates, carbamazepine,
glucocorticoids, phenytoin, rifampin,
thioridazine; ↓ effects OF dopamine
antagonists, levodopa
Labs: ↑ LFTs, cholesterol, triglycerides
NIPE: ↑ Risk of cataract formation, tardive
dyskinesia; take w/o regard to food; ↓
body temp regulation
Risperidone, Oral (Risperdal, Risperdal M-Tab)
Drug Classification: Antipsychotic
Uses: Psychotic disorders (schizophrenia),
dementia of the elderly, bipolar disorder,
mania, Tourette disorder, autism
Action: Benzisoxazole antipsychotic
Caution: [C, −], ↑ BP w/ antihypertensives,
clozapine
CI: Component allergy
Interactions: ↑ Effects W/ clozapine, CNS
depressants, EtOH; ↑ effects OF
antihypertensives; ↑ effects W/
carbamazepine; ↓ effects OF levodopa
Labs: ↑ LFTs, serum prolactin
NIPE: ↑ Risk photosensitivity—use sunblock,
extrapyramidal effects; may alter body
temp regulation; several wks to see effect
Thioridazine (Mellaril)
Drug Classification : Antipsychotic/Phenothiazine
Action: Phenothiazine antipsychotic
Caution:[C, ?] Phenothiazines, QTc-prolonging
agents, Al CI: Phenothiazine sensitivity
Interactions: ↑ Effects W/ BBs; ↑ effects OF
anticholinergics, antihypertensives,
antihistamines, CNS depressants, nitrates,
EtOH; ↓ effects W/ barbiturates, Li,
tobacco; ↓ effects OF levodopa
Labs: ↑ Serum LFTs; ↓ HMG, Hct, plts, WBC
NIPE: ↑ Risk of photosensitivity—use sunblock,
take w/ food; N D/C abruptly; ↓ temp
regulation; urine color change to reddish
brown; avoid EtOH, dilute PO conc in 2–4
oz Liq
Thiothixene (Navane)
Drug Classification: Antipsychotic/Thioxanthene
Uses: Psychosis
Action: Antagonizes dopamine receptors
Caution: [C, ?] Avoid w/ ↑ QT interval or meds
that can ↑ QT
CI: Phenothiazine sensitivity Drowsiness, EPS most
common; ↓ BP, dizziness, drowsiness,
neuroleptic malignant synd, Szs, skin
discoloration, photosensitivity,
constipation, sexual dysfunction, blood
dyscrasias, pigmentary retinopathy,
hepatic impair
Interactions: ↑ Effects W/ BBs; ↑ effects OF
anticholinergics, antihistamines,
antihypertensives, CNS depressants,
nitrates, EtOH; ↓ effects W/ barbiturates,
Li, tobacco, caffeine; ↓ effects OF
levodopa
Labs: ↑ LFTs
NIPE: ↑ Risk of photosensitivity—use sunblock; Labs: ↑ Glucose; monitor electrolytes
take w/ food; N D/C abruptly; ↓ temp NIPE: May take weeks before full effects, take w/
regulation; darkens urine color; dilute PO food, ↑ risk of tardive dyskinesia
conc immediately before use

Trifluoperazine (Stelazine)
Drug Classification: Antipsychotic/Phenothiazine
Uses: Psychotic disorders
Action: Phenothiazine; blocks postsynaptic CNS
dopaminergic receptors
Caution: [C, ?/−]
CI: h/o Blood dyscrasias; phenothiazine sensitivity
Interactions: ↑ CNS depression W/ barbiturates,
benzodiazepines, TCAs, EtOH; ↑ effects
OF antihypertensives, propranolol, ↓
effects OF anticoagulants ↓ effects W/
antacids
Labs: ↑ LFTs; ↓ WBCs
NIPE: ↑ Risk of photosensitivity—use sunblock;
urine color may change to pink to reddish-
brown; PO conc must bediluted to 60 mL
or more prior to administration; requires
several wk for onset of effects

Ziprasidone (Geodon)
Drug Classification: Antipsychotic/Piperazine
Derivative
Uses: Schizophrenia, acute agitation
Action: Atypical
Caution: [C, −] w/ ↓ Mg2+, ↓ K+
CI: QT prolongation, recent MI, uncompensated
HF, meds that ↑ QT
Interactions: ↑ Effects W/ ketoconazole; ↑ effects
OF antihypertensives; ↑ CNS depression
W/ anxiolytics, sedatives, opioids, EtOH;
TCAs, thioridazine; risk of prolonged QT
W/ cisapride, chlorpromazine,
clarithromycin, diltiazem, erythromycin,
levofloxacin, mefloquine, pentamidine,
TCAs, thioridazine; ↓ effects W/
amphetamines, carbamazepine; ↓ effects
OF levodopa
 A n t i
Amitriptyline (Elavil)
Drug Classification: Antidepressant/TCA
Uses: Depression (not bipolar depression)
peripheral neuropathy, chronic pain,
tension HAs
Action: TCA; ↓ reuptake of serotonin &
norepinephrine by presynaptic neurons
Caution: CV Dz, Szs [D,+/−] NAG, hepatic impair
CI: w/ MAOIs or w/in 14 d of use, during acute MI
recovery
Interactions: ↓ Effects W/ carbamazepine,
phenobarbital, rifampin, cholestyramine,
colestipol, tobacco; ↑ effects W/
cimetidine, quinidine, indinavir, ritonavir,
CNS depressants, SSRIs, haloperidol, OCPs,
BBs, phenothiazines, EtOH, evening
primrose oil; ↑ effects OF amphetamines,
anticholinergics, epinephrine,
hypoglycemics, phenylephrine
Labs: ↑ Glucose, false ↑ carbamazepine levels
NIPE: ↑ Photosensitivity—use sunscreen; ↑
appetite & craving for sweets; ND/C
abruptly; may turn urine blue-green
Bupropion Hydrobromide (Aplenzin)
Drug Classification: Aminoketon
WARNING: ↑ Suicide risk in pts <24 y w/ major
depressive/other psychiatric disorders;
not for ped use
Uses: Depression
Action: Aminoketone, ? action
Caution: [C, −] w/ Drugs that ↓ Sz threshold, ↑ w/
CYP2D6-metabolized meds
CI: Sz disorder, bulimia, anorexia nervosa, w/in 14
d of MAOIs, other forms of bupropion,
abrupt D/C of EtOH, or sedatives
Interactions: ↑ effects W/ stimulants & meds
metabolized by CYP2D6
d e p r e s
NIPE: Do not cut/crush/chew, avoid EtOH, N D/C
abruptly
Bupropion Hydrochloride (Wellbutrin, Wellbutrin
SR, Wellbutrin XL, Zyban)
Drug Classification: Aminoketone
WARNING: Closely monitor for worsening
depression or emergence of suicidality,
increased suicidal behavior in young adults
Uses: Depression, smoking cessation adjunct,
ADHD
Action: Weak inhibitor of neuronal uptake of
serotonin & norepinephrine; ↓ neuronal
dopamine reuptake
Caution: [C, ?/−] CI: Sz disorder, h/o anorexia
nervosa or bulimia, MAOI, w/in 14 d,
abrupt D/C of EtOH or sedatives
Interactions: ↑ Effects W/ cimetidine, levodopa,
MAOIs; ↑ risk of Szs W/ EtOH,
phenothiazines, antidepressants,
theophylline, TCAs, or abrupt withdrawal
of corticosteroids, benzodiazepines
Labs: ↓ Prolactin level
NIPE: Drug may cause Szs; take 3–4 wk for full
effect; N EtOH or CNS depressants; N
abrupt D/C; SR and XR do not cut/chew/
crush
Citalopram (Celexa)
Drug Classification: Antidepressant/SSRI
WARNING: Closely monitor for worsening
depression or emergence of suicidality,
particularly in pts <24 y
Uses: *Depression*
Action: SSRI
CI: MAOI or w/in 14 d of MAOI use
Interactions: ↑ Effects W/ azole antifungals,
cimetidine, Li, macrolides, EtOH; ↑ effects
s a n t s
OF BBs, carbamazepine, CNS drugs,
warfarin; ↓ effects W/ carbamazepine; ↓
effects OF phenytoin; may cause fatal Rxn
W/ MAOIs
Labs: ↑ LFTs; May cause ↓ Na+/SIADH; NIPE: N
PRG, breast-feeding, use barrier
contraception
Desipramine (Norpramin)
Drug Classification: Antidepressant/TCA
WARNING: Closely monitor for worsening
depression or emergence of suicidality
Uses: Endogenous depression, chronic pain,
peripheral neuropathy
Action: TCA; ↑ synaptic serotonin or
norepinephrine in CNS
Caution: [C, ?/−] CV Dz, Sz disorder,
hypothyroidism, elderly, liver impair
CI: MAOIs w/in 14 d; during AMI recovery phase
Interactions: ↑ Effects W/ cimetidine, diltiazem,
fluoxetine, indinavir, MAOIs, paroxetine,
propoxyphene, quinidine, ritonavir
ranitidine, EtOH, grapefruit juice; ↑
effects OF Li, sulfonylureas; ↓ effects W/
barbiturates, carbamazepine rifampin,
tobacco
NIPE: Full effect of drug may take 4 wk; blue-green
urine; risk of photosensitivity—use
sunblock & avoid sunlight
Desvenlafaxine (Pristiq)
Drug Classification: Serotonin-Norepinephrine
Reuptake Inhibitor (SNRI)
WARNING: Monitor for worsening or emergence
of suicidality, particularly in ped,
adolescent, and young adult pts
Uses: Major depressive disorder
Action: Selective serotonin and norepinephrine
reuptake inhibitor
Caution: [C, ±/M] CI: Hypersensitivity, MAOI w/ or
w/in 14 d of stopping MAOI
Interactions: ↑ Effects W/ CYP3A4 inhibitors; ↑
effects OF anticoagulants; ↓ effects OF
CYP3A4 substrates
NIPE: Tabs should be taken whole, allow 7 d after
stopping before starting an MAOI; N
ETOH; caution with other serotonergics
and CNS active drugs
Doxepin (Adapin)
Drug Classification: Antidepressant/TCA
WARNING: Closely monitor for worsening
depression or emergence of suicidality
Uses: Depression, anxiety, chronic pain
Action: TCA; ↑ synaptic CNS serotonin or
norepinephrine
Caution: [C, ?/−] w/ EtOH abuse, elderly, w/ MAOI
CI: NAG, urinary retention, MAOI use w/in 14 d, in
recovery phase of MI
Interactions: ↑ Effects W/ fluoxetine, MAOIs,
albuterol, CNS depressants,
nticholinergics, propoxyphene, quinidine,
EtOH, grapefruit juice; ↑ effects OF
carbamazepine, anticoagulants,
amphetamines, thyroid drugs,
sympathomimetics; effects W/ ascorbic
acid, cholestyramine, tobacco; ↓ effects
OF bretylium, guanethidine, levodopa
Labs: ↑ Serum bilirubin, alk phos, glucose
NIPE: Risk of photosensitivity—use sunblock, urine
may turn blue-green, may take 4–6 wk for
full effect
Duloxetine (Cymbalta)
Drug Classification: Antidepressant/SSNRI
WARNING: Antidepressants may ↑ risk of
suicidality; consider risks/benefits of use.
Closely monitor for clinical worsening,
suicidality, or behavior changes
Uses: Depression, DM peripheral neuropathic
pain, generalized anxiety disorder (GAD)
Action: Selective serotonin & norepinephrine
reuptake inhibitor (SSNRI)
CI: MAOI use w/in 14 d, w/ thioridazine, NAG,
hepatic Insuff
Interactions: ↑ Effects OF flecainide, propafenone,
phenothiazines, TCAs; ↑ effects W/
cimetidine, fluvoxamine, quinolones; ↑
risk OF hypertensive crisis W/ MAOIs w/in
14 d of taking duloxetine
Labs:? ↑ LFTs
NIPE: ↑ Risk of liver damage W/ EtOH use; N D/C
drug abruptly; swallow whole; monitor BP
Escitalopram (Lexapro)
Drug Classification: Antidepressant/SSRI
WARNING: Closely monitor for worsening
depression or emergence of suicidality,
particularly in ped pts
Uses: Depression, anxiety
Action: SSRI Dose:
Caution: [C, +/−] Serotonin synd use w/
escitalopram, NSAID, ASA or other drugs
affecting coagulation associated w/ ↑
bleeding risk
CI: w/ or w/in 14 d of MAOI Disp: Tabs 5, 10, 20
mg; soln 1 mg/mL
Interactions: ↑ Risk of serotonin synd W/
linezolid; ↑ risk of bleeding W/
anticoagulants, ASA, NSAIDs; may ↑ CNS
effects W/ CNS depressants
NIPE: N D/C abruptly; full effects may take 3 wk;
take w/o regard to food; may cause ↑
appetite & wgt gain
Fluoxetine (Prozac, Sarafem)
Drug Classification: Antidepressant/SSRI
WARNING: Closely monitor for worsening
depression or emergence of suicidality,
particularly in ped pts
Uses: Depression, obsessive-compulsive disorder
(OCD), panic disorder, bulimia (Prozac)
*PMDD (Sarafem)*
Action: SSRI
CI: MAOI/thioridazine (wait 5 wk after D/C before
MAOI)
Interactions: ↑ Effects W/ CNS depressants,
MAOIs, EtOH, St. John’s wort; ↑ effects
OF alprazolam, BBs, carbamazepine,
clozapine, cardiac glycosides, diazepam,
dextromethorphan, loop diuretics,
haloperidol, phenytoin, Li, ritonavir,
thioridazine, tryptophan, warfarin,
sympathomimetic drugs; ↓ effects W/
cyproheptadine; ↓ effects OF buspirone,
statins
Labs: ↑ LFTs, BUN, Cr, urine albumin
NIPE: ↑ Risk of serotonin synd W/ St. John’s wort;
may take >4 wk for full effects
Fluvoxamine (Luvox)
Drug Classification: Antidepressant/SSRI
WARNING: Closely monitor for worsening
depression or emergence of suicidality,
particularly in ped pts
Uses: *Obsessive-compulsive disorder (OCD)*
Action: SSRI
Caution: [C, ?/−]
Interactions (MAOIs, phenothiazines, SSRIs,
serotonin agonists, others)
CI: MAOI w/in 14 d
Interactions: ↑ Effects W/ melatonin, MAOIs; ↑
effects OF BBs, benzodiazepines,
methadone, carbamazepine, haloperidol,
Li, phenytoin, TCAs, theophylline,
warfarin, St. John’s wort; ↑ risks of
serotonin synd W/ buspirone,
dexfenfluramine, fenfluramine, tramadol,
nefazodone, sibutramine, tryptophan; ↓
effects W/ buspirone, cyproheptadine,
tobacco; ↓ effects OF buspirone, HMG-
CoA reductase inhibitors
NIPE: N MAOIs for 14 d before start of drug; N
EtOH
Imipramine (Tofranil)
Drug Classification: Antidepressant/TCA
WARNING: Close observation for suicidal thinking
or unusual changes in behavior
Uses: *Depression, enuresis*, panic attack, chronic
pain
Action: TCA; ↑ CNS synaptic serotonin or
norepinephrine
Caution: [D, ?/−] CI: Use w/ MAOIs, NAG, acute
recovery from MI, PRG, CHF, angina, CV
Dz, arrhythmias
Interactions: ↑ Effects W/ amiodarone,
anticholinergics, BBs, cimetidine,
diltiazem, Li, OCPs, quinidine,
phenothiazine, ritonavir, verapamil, EtOH,
evening primrose oil; ↑ effects OF CNS
depressants, hypoglycemics, warfarin; ↑
risk of serotonin synd W/ MAOIs; ↓
effects W/ tobacco; ↓ effects OF clonidine
Labs: ↑ Serum glucose, LFTs
NIPE: D/C 48 h before surgery; D/C MAOIs 2 wk
before admin this drug; 4–6 wk for full
effects; take w/ food; less sedation than
amitriptyline
Mirtazapine (Remeron, Remeron SolTab)
Drug Classification: Tetracyclic Antidepressant
WARNING: ↑ Risk of suicidal thinking and
behavior in children, adolescents, and
young adults w/ major depression and
other psychological disorders. Not for
peds
Uses: *Depression*
Action: α2-Antagonist antidepressant, ↑ WARNING: ↑ Suicide risk in pts <24 y w/ major
norepinephrine & 5-HT
Caution: [C, ?] Has anticholesterol effects, w/ Sz,
clonidine, CNS depressant use, CYP1A2,
CYP3A4 inducers/inhibitors
CI: MAOIs w/in 14 d
Interactions: ↑ Effects W/ CNS depressants,
fluvoxamine; ↑ risk of HTN crisis W/
MAOIs
Labs: ↑ ALT, cholesterol, triglycerides
NIPE: Handle rapid tabs w/ dry hands, do not cut
or chew; do not ↑ dose at intervals of less
than 1–2 wk
Nefazodone
Drug Classification: Antidepressant/Serotonin
Modulator
WARNING: Fatal hep & liver failure possible, D/C if
LFTs >3× ULN, do not retreat; closely
monitor for worsening depression or
suicidality, particularly in ped pts
Uses: *Depression*
Action: ↓ Neuronal uptake of serotonin &
norepinephrine
Caution: [C, M]
CI: w/ MAOIs, pimozide, carbamazepine,
alprazolam; active liver Dz
Interactions: ↑ Risk of hypotension W/
antihypertensives, nitrates; ↑ effects OF
alprazolam, CCB, digoxin, HMG-CoA
reductase inhibitors, triazolam; ↑ risk of
QT prolongation W/ astemizole, cisapride,
pimozide; ↑ risk of serious and/or fatal
Rxn W/ MAOIs; ↓ effects OF propranolol
Labs: ↑ LFTs, cholesterol; ↓ Hct
NIPE: Take w/o food; may take 2–4 wk for full
therapeutic effects; monitor HR, BP
Nortriptyline (Pamelor)
Drug Classification: Antidepressant/TCA
depressive/other psychological disorders
esp during 1st mo of Tx; risk ↓ pts >65 y;
observe all pts for clinical symptoms; not
for ped use
Uses: *Endogenous depression*
Action: TCA; ↑ synaptic CNS levels of serotonin
and/or norepinephrine
CI: TCA allergy, use w/ MAOI
Interactions: ↑ Effects W/ antihistamines, CNS
depressants, cimetidine, fluoxetine, OCP,
phenothiazine, quinidine, EtOH; ↑ effects
OF anticoagulants; ↑ risk of HTN W/
clonidine, levodopa, sympathomimetics;
↓ effects W/ barbiturates,
carbamazepine, rifampin
Labs: ↑ Serum bilirubin, alk phos
NIPE: Concurrent use W/ MAOIs have resulted in
HTN, Szs, death; ↑ risk of photosensitivity
—use sunscreen; max effect may take >2–
3 wk
Paroxetine (Paxil, Paxil CR, Pexeva)
Drug Classification: Antidepressant/SSRI
WARNING: Closely monitor for worsening
depression or emergence of suicidality,
particularly in children, adolescents, &
young adults; not for use in peds
Uses: *Depression, obsessive-compulsive disorder,
panic disorder, social anxiety disorder*,
PMDD
Action: SSRI
Caution: [D, ?/] ↑ Bleeding risk
CI: w/ MAOI, thioridazine, pimozide
Interactions: ↑ Risk of QT prolongation W/
pimozide, thioridazine; ↑ effects W/
cimetidine; ↑ effects OF BBs,
dexfenfluramine, dextromethorphan,
fenfluramine, haloperidol, MAOIs,
theophylline, TCAs, warfarin, St. John’s
wort, EtOH; ↓ effects W/ cyproheptadine,
phenobarbital, phenytoin; ↓ effects OF
digoxin, phenytoin Labs: ↑ Alk phos,
bilirubin, glucose
NIPE: Take w/o regard to food; may take up to 4
wk for full effect; N D/C Abruptly
Phenelzine (Nardil)
Drug Classification: Antidepressant/MAOI
WARNING: Antidepressants increase the risk of
suicidal thinking & behavior in children &
adolescents w/ major depressive disorder
& other psychological disorders; not for
peds use
Uses: *Depression*, bulimia
Action: MAOI
Caution: [C, −] Interacts w/ SSRI, ergots, triptans
CI: CHF, h/o liver Dz, pheochromocytoma
Interactions: ↑ HTN Rxn W/ amphetamines,
fluoxetine, levodopa, metaraminol,
phenylephrine, phenylpropanolamine,
pseudoephedrine, reserpine, sertraline,
tyramine, EtOH, foods W/ tyramine,
caffeine, tryptophan; ↑ effects OF
barbiturates, narcotics, sedatives,
sumatriptan, TCAs, ephedra, ginseng
Labs: ↓ Glucose, false(+) ↑ in bilirubin & uric acid
NIPE: 2–4 wk for effect; avoid tyramine-containing
foods (eg, cheeses)
Selegiline, Transdermal (Emsam)
Drug Classification: Anti-Parkinson Agent/MAO B
Inhibitor
WARNING: May ↑ risk of suicidal thinking &
behavior in children & adolescents w/
major depression disorder
Uses: *Depression*
Action: MAOI
CI: Tyramine-containing foods w/ 9- or 12-mg
doses; serotonin-sparing agents
Caution: [C, −] ↑ Carbamazepine & oxcarbazepine
levels
Interactions: ↑ Risk of serotonin synd W/
dextroamphetamine, dextromethorphan,
fenfluramine, meperidine,
methylphenidate, sibutramine,
venlafaxine; ↑ risk of hypertension W/
dextroamphetamine, levodopa,
methylphenidate, SSRIs, tyramine-
containing foods, EtOH, ephedra, ginseng,
ma-huang, St. John’s wort
NIPE: N EtOH & tyramine-containing foods; rotate
site; see oral form
Sertraline (Zoloft)
Drug Classification: Antidepressant/SSRI
WARNING: Closely monitor pts for worsening
depression or emergence of suicidality,
particularly in ped pts
Uses: *Depression, panic disorders, obsessive–
compulsive disorder (OCD), posttraumatic
stress disorder (PTSD)*, social anxiety
disorder, eating disorders, premenstrual
disorders
Action: ↓ Neuronal uptake of serotonin
Caution: [C, ?/−] w/ Haloperidol (serotonin synd),
sumatriptan, linezolid, hepatic impair
CI: MAOI use w/in 14 d; concomitant pimozide
Interactions: ↑ Effects W/ cimetidine, tryptophan,
St. John’s wort; ↑ effects OF
benzodiazepines, phenytoin, TCAs,
warfarin, EtOH; ↑ risk of serotonin synd
W/ MAOIs
Labs: ↑ LFTs, triglycerides, ↓ uric acid
NIPE: N D/C abruptly; take w/o regard to food
Trazodone (Desyrel)
Drug Classification: Antidepressant
WARNING: Closely monitor for worsening
depression or emergence of suicidality,
particularly in pts <24 y
Uses: *Depression*, hypnotic, augment other
antidepressants
Action: Antidepressant; ↓ reuptake of serotonin &
norepinephrine
Caution: [C, ?/−]
CI: Component allergy Disp: Tabs 50, 100, 150, 300
mg SE: Dizziness, HA, sedation,
N, xerostomia, syncope, confusion, tremor, hep,
EPS
Interactions: ↑ Effects W/ fluoxetine,
phenothiazines; ↑ risk of serotonin synd
W/ MAOIs, SSRIs, venlafaxine, St. John’s
wort; ↑ CNS depression W/ barbiturates,
CNS depressants, opioids, sedatives, EtOH;
↑ hypotension W/ antihypertensive,
neuroleptics; nitrates, EtOH; ↑ effects OF
clonidine, digoxin, phenytoin; ↓ effects
W/ potent CYP3A4 inducers
(carbamazepine); CYP3A4 inhibitors to ↑
trazodone concentrations (nefazodone,
ritonavir, indinavir, ketoconazole,
itraconazole)
NIPE: Take w/ food; ↑ fluids to 2–3 L/d; N D/C
abruptly; ↑ risk of priapism; takes 1–2 wk
for symptom improvement
Venlafaxine (Effexor, Effexor XR)
Drug Classification: Antidepressant/Serotonin,
Norepinephrine, & Dopamine Reuptake
Inhibitor
WARNING: Monitor for worsening depression or
emergence of suicidality, particularly in
ped pts
Uses: *Depression, generalized anxiety*, social
anxiety disorder; panic disorder*,
obsessive-compulsive disorder, chronic
fatigue synd, ADHD, autism
Action: Potentiation of CNS neurotransmitter
activity
Caution: [C, ?/−]
CI: MAOIs
Interactions: ↑ Effects W/ cimetidine,
desipramine, haloperidol, MAOIs; ↑ risk
of serotonin synd W/ sumatriptan,
trazodone, St. John’s wort
NIPE: XR caps swallow whole—N chew; take w/
food; N use EtOH; N D/C abruptly; D/C
MAOI 14 d before start of this drug; ↑
fluids to 2–3 L/d; may take 2–3 wk for full
effects; frequent edema & wgt gain

Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES
Heritage City of Vigan

COLLEGE OF NURSING

Central Nervous System Agents

In Partial Fulfillment of the Requirements
of the Subject
Seminar in Nursing

Submitted to:
RHENE A. GAZMEN, RN
Instructor

Submitted by:
MA. LORRAINE B. ENCARNACION
BSN IV – E
December 16, 2010