Contraindications/Black Box Warnings - Neuro/Psych

Question 1

Benztropine

Answer 1

Hypersensitivity, use in patients <3 y of age

Question 2

Carbamazepine

Answer 2

Hypersensitivity to carbamazepine, history of bone marrow depression, MAOIs, nefazodone; Agranulocytosis; aplastic anemia; dermatological reactions (especially in Asians); screen for HLA-B*15:02

Question 3

Carbidopa/Levodopa

Answer 3

Hypersensitivity to carbidopa or levodopa, narrow-angle glaucoma, concurrent MAOI or linezolid

Question 4

Dexmethylphenidate

Answer 4

Hypersensitivity to amphetamines, MAOI use, drug dependence, glaucoma, tics, or history of Tourette syndrome; Abuse and dependence

Question 5

Divalproex

Answer 5

Hypersensitivity, hepatic disease, urea cycle disorders; Hepatotoxicity, patients with mitochondrial disease, teratogenicity, pancreatitis

Question 6

Donepezil

Answer 6

Hypersensitivity to drug or piperidine derivatives

Question 7

Eletriptan

Answer 7

Hypersensitivity to eletriptan, cerebrovascular syndromes, hemiplegic or basilar migraine, ischemic bowel disease, ischemic heart disease, peripheral vascular disease, severe hepatic impairment, uncontrolled HTN

Question 8

Eszopiclone

Answer 8

Hypersensitivity, history of complex sleep behavior; Risk of complex sleep behaviors (sleepwalking, sleep driving, etc)

Question 9

Gabapentin

Answer 9

Hypersensitivity

Question 10

Guanfacine

Answer 10

Hypersensitivity

Question 11

Lacosamide

Answer 11

Hypersensitivity

Question 12

Lamotrigine

Answer 12

Hypersensitivity; Serious skin reactions

Question 13

Levetiracetam

Answer 13

Hypersensitivity

Question 14

Lisdexamfetamine

Answer 14

Hypersensitivity/idiosyncrasy to sympathomimetic amines, MAOIs, symptomatic cardiovascular disease or advanced arteriosclerosis, moderate-severe HTN, hyperthyroidism, glaucoma, agitated states, history of drug dependence; Risk of abuse, misuse, diversion

Question 15

Memantine

Answer 15

Hypersensitivity

Question 16

Metaxalone

Answer 16

Hypersensitivity; significantly impaired renal or hepatic function

Question 17

Methylphenidate

Answer 17

Hypersensitivity to amphetamines, anxiety, agitation, concurrent MAOIs, drug dependence, glaucoma, tics or history of Tourette syndrome, HTN, angina, heart failure, concurrent halogenated anesthetics; Abuse and dependence potential

Question 18

Modafinil

Answer 18

Hypersensitivity

Question 19

Oxcarbazepine

Answer 19

Hypersensitivity

Question 20

Phenobarbital

Answer 20

Hypersensitivity to barbiturates, marked liver function impairment, respiratory disease with evidence of dyspnea or obstruction, history of sedative or hypnotic addiction, personal or family history of acute intermittent porphyria; Concomitant use with opioids, dependence and withdrawal, abuse (IV only)

Question 21

Phentermine

Answer 21

Hypersensitivity to this medication or other sympathomimetic amines, use in agitated states, cardiovascular disease, history of drug abuse, glaucoma, moderate to severe HTN, hyperthyroidism

Question 22

Phenytoin

Answer 22

Hypersensitivity to phenytoin, sinus bradycardia, AV block; Hypotension and arrhythmias with IV administration

Question 23

Pramipexole

Answer 23

Hypersensitivity

Question 24

Pregabalin

Answer 24

Hypersensitivity

Question 25

Rizatriptan

Answer 25

Cerebrovascular syndromes, hemiplegic or basilar migraine, ischemic bowel disease, ischemic heart disease, peripheral vascular disease, severe hepatic impairment, uncontrolled HTN, MAOI, ergot alkaloids

Question 26

Ropinirole

Answer 26

Hypersensitivity

Question 27

Topiramate

Answer 27

Hypersensitivity, alcohol use for the ER formulation (within 6 h prior to and 6 h after administration)

Question 28

Trazodone

Answer 28

Hypersensitivity, use of MAOI; Suicidal ideation, not for use in children

Question 29

Varenicline

Answer 29

Hypersensitivity

Question 30

Zolpidem

Answer 30

Hypersensitivity, history of complex sleep behavior; Risk of complex sleep behaviors (sleepwalking, sleep driving, etc)

Question 31

Sumatriptan

Answer 31

Hypersensitivity, cerebrovascular syndromes, hemiplegic or basilar migraine, ischemic bowel disease, ischemic heart disease, peripheral vascular disease, severe hepatic impairment, uncontrolled HTN, MAOIs, ergot alkaloids

Question 32

Amitriptyline

Answer 32

Hypersensitivity, concurrent MAOI or MAOI use in last 14 d, use during acute recovery period after MI, coadministration of cisapride; Suicidality, not approved for children <12 y of age

Question 33

Aripiprazole

Answer 33

Hypersensitivity; Dementia, suicidality

Question 34

Atomoxetine

Answer 34

Hypersensitivity, concomitant use of MAOIs or use within 2 wk, narrow-angle glaucoma, pheochromocytoma, severe cardiac or vascular disorders in which condition would be expected to deteriorate with clinically important increases in BP or HR; Suicidality in children and adolescents

Question 35

Buspirone

Answer 35

Hypersensitivity

Question 36

Bupropion

Answer 36

Seizure disorder, history of anorexia/bulimia, use of MAOI within 14 d, patients undergoing abrupt discontinuation of ethanol, benzodiazepines, barbiturates, or antiepileptics; Suicidality; neuropsychiatric reactions

Question 37

Citalopram

Answer 37

Hypersensitivity, concomitant use of pimozide, MAOIs; Suicidal ideation; not approved for use in children

Question 38

Clonazepam

Answer 38

Hypersensitivity to benzodiazepines, narrow-angle glaucoma, liver disease; Concurrent use with opioids, abuse, misuse, and addiction, dependence and withdrawal reactions

Question 39

Desvenlafaxine

Answer 39

Hypersensitivity, MAOI use; Suicidality, not for use in children, not for bipolar disorder

Question 40

Doxepin

Answer 40

Hypersensitivity, MAOI use, glaucoma, severe urinary retention; Suicidality

Question 41

Duloxetine

Answer 41

Hypersensitivity, MAOI, TCA, linezolid use, uncontrolled glaucoma; Suicidality; not approved for children

Question 42

Escitalopram

Answer 42

Hypersensitivity, concurrent MAOI use; Suicidality

Question 43

Fluoxetine

Answer 43

Hypersensitivity, concomitant pimozide, thioridazine, or MAOIs; Suicidality; approved in children (>7 y of age, OCD; >8 y of age, MDD)

Question 44

Lithium

Answer 44

Severe debilitation, dehydration, or sodium depletion, significant cardiovascular disease, significant renal impairment, concomitant diuretic therapy; level monitoring required ## Footnote Lithium level monitoring required

Question 45

Lurasidone

Answer 45

Hypersensitivity, concurrent strong CYP3A4/5 inducers and inhibitors ## Footnote Dementia (increased mortality), suicidality

Question 46

Mirtazapine

Answer 46

Hypersensitivity, concurrent use or use within 14 d of MAOI, linezolid, IV methylene blue use; Suicidality, not for use in children

Question 47

Nortriptyline

Answer 47

Hypersensitivity to nortriptyline or other TCAs, MAOI concurrent use or use within 14 d, use during acute recovery period after MI, patient using linezolid or IV methylene blue; Suicidality

Question 48

Olanzapine

Answer 48

Hypersensitivity; Mortality in elderly patients with dementia-related psychosis, DRESS

Question 49

Paroxetine

Answer 49

Hypersensitivity, concomitant use of thioridazine or MAOIs, pregnancy; Suicidality

Question 50

Quetiapine

Answer 50

Hypersensitivity; Mortality in elderly with dementia, suicidality, not approved for children <10 y of age

Question 51

Risperidone

Answer 51

Hypersensitivity, agents that increase QTc interval; Mortality in elderly with dementia, DRESS

Question 52

Sertraline

Answer 52

Hypersensitivity, concomitant use of pimozide, thioridazine, or MAOIs; Suicidality

Question 53

Venlafaxine

Answer 53

Hypersensitivity, MAOIs; Suicidal ideation, not approved in children

Question 54

Vilazodone

Answer 54

Hypersensitivity, concurrent use of MAOI; Suicidal thinking and suicidal behavior, not approved for children

Question 55

Ziprasidone

Answer 55

Hypersensitivity, acute or recent AMI, uncompensated heart failure; QTc prolongation, including congenital long QTc syndrome, concomitant administration of other drugs that cause QTc prolongation; Elderly patients with dementia are at increased risk of death, not approved for dementia related psychosis

Question 56

Alprazolam

Answer 56

Hypersensitivity to benzodiazepines, narrow-angle glaucoma, concurrent ketoconazole, or itraconazole; Concurrent use with opioids, abuse potential, withdrawal reactions

Question 57

Diazepam

Answer 57

Hypersensitivity to benzodiazepines, narrow-angle glaucoma, severe liver disease, myasthenia gravis, sleep apnea, respiratory insufficiency, children <6 mo; Concurrent use with opioids, addiction and dependence and withdrawal reactions

Question 58

Lorazepam

Answer 58

Hypersensitivity to benzodiazepines, narrow-angle glaucoma; Concurrent use with opioids

Question 59

Temazepam

Answer 59

Hypersensitivity to benzodiazepines, narrow-angle glaucoma, pregnancy; Concurrent use with opioids

Question 60

Triazolam

Answer 60

Hypersensitivity to benzodiazepines, concurrent strong CYP3A4/5 inhibitors Pharmacogenetics; Concurrent use with opioids; abuse, misuse and addiction, which can lead to overdose or death; dependence, which can lead to withdrawal reactions

Question 61

Clobazam

Answer 61

Hypersensitivity; Concurrent use with opioids, abuse and addition, dependence and withdrawal reactions