Pharmacy & Therapeutics - April 2008 - (Page 216) DRUG FORECAST choice.53–55 Notably, alternative therapeutics are available for other contraindicated medications (Table 2).56 For example, Tylenol Cold Daytime and Nighttime are contraindicated because of their inclusion of pseudoephedrine and dextromethorphan; however, Tylenol Cold Relief as well as the nighttime formula contains acetamino- Table 1 Medications Contraindicated for Patients Using the Selegiline Transdermal System Class Narcotic analgesics Analgesics Example of a Contraindicated Drug* Meperidine (Demerol) Tramadol (Ultram) Methadone (e.g., Dolophine) Propoxyphene (e.g., Darvon, Darvocet) Cyclobenzaprine (Flexeril) Dextromethorphan (active ingredient in Zicam Cold and Flu, Coricidin HBP Cough/Cold (for high blood pressure), Tylenol Cold Daytime and Night-time, Mucinex DM), Benadryl Allergy and Cold Caplets Pseudoephedrine (active ingredient in Tylenol Cold, Sudafed Tablets) Phenylephrine (active ingredient in Zicam Cold and Flu, Benadryl allergy/sinus headache) Phenylpropanolamine Ephedrine Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (Paxil) Venlafaxine (Effexor) Duloxetine (Cymbalta) Imipramine (Tofranil) Amitriptyline (Elavil) Mirtazapine (Remeron) Oral selegiline (Eldepryl) Isocarboxazid (Marplan) Phenelzine (Nardil) Tranylcypromine (Parnate) Buspirone (BuSpar) Bupropion HCl (Wellbutrin and Zyban) St. John’s wort Carbamazepine (e.g., Tegretol, Biston, Calepsin, Carbatrol) Oxcarbazepine (Trileptal) Dextroamphetamine (e.g., Dexedrine) DL-amphetamine (Benzedrine) Dexmethylphenidate (Focalin) Methylphenidate (e.g., Ritalin) Evidence Level for Class† Probable Not noted‡ Muscle relaxant Antitussive agents (found in cold and cough medications) Vasoconstrictors (found in cold products and weight-reducing preparations) Not noted‡ Suspected Established Selective serotonin reuptake inhibitors Dual serotonin and norepinephrine reuptake inhibitors Tricyclic antidepressants Tetracyclic antidepressant Monoamine oxidase inhibitors Probable Probable Suspected Not noted‡ Not noted‡ Antianxiety agent Amino ketone agent Herbals Antiepileptics Amphetamines Methylphenidates Not noted‡ Suspected Not noted‡ Suspected Suspected Suspected * The recommended washout period for contraindicated medications is about one to two weeks (four to five half-lives) before and two weeks after STS treatment. One exception is fluoxetine, which requires a five-week washout period prior to STS therapy. Note that more rapid switches of one to eight days have also been performed safely for monoamine oxidase inhibitors. † Level of evidence for interaction with MOAI class based on Facts and Comparisons 4.0, in which “established” = proven to occur in well-controlled studies; “probable” = very likely but not proven clinically; “suspected” = may occur, some good data, but needs more study; “possible” = could occur, but data are limited. ‡ Evidence level not noted by Facts and Comparisons 4.0. 216 P&T® • April 2008 • Vol. 33 No. 4
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