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10 Alarming Medications!!!
Why it's important?
Product knowledge will help you to do proper counseling, by giving you a high level of confidence.
Helps you taking proper & right decisions.
What do you need to know??
Table on page 2
Where can I get more details?
Going back to accredited websites:
www.drugs.com & www.rxlist.com, Middle east medical index, drug information handbook, medication leaflet.
Your DIC is here to help you 
Factsheets for those medications, you can use this as a tool while counseling your patient 
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Medication
1. Digoxin
2. Warfarin
3. Theophyllin
Key tips
Dosing tips
Indication
Main interaction
Overdose signs
 Maintain adequate
amounts of potassium in
diet to decrease risk of
hypokalemia
(hypokalemia may
increase risk of digoxin
toxicity)
 Monitor heart rate (not
to get below 60 beats/
minute)

Divided every 12 hours
in infants and children
<10 years of age. Give
once daily to children
>10 years of age and
adults.
 Congestive heart
failure
 tachyarrhythmia


 Nausea
 bradycardia
 Yellow to green vision
 Do not change dietary
habits once stabilized on
Maximum dose is
warfarin therapy
10mg/day
 Avoid Foods high in
vitamin K (e.g., beef liver,
pork liver, green tea, and Can be given to infants
leafy green vegetables) as as well as adults.
they inhibit anticoagulant
effect.
 Should be taken with
water 1 hour before or 2
hours after meals.
 Avoid smoking (smoking
may interfere with drug
absorption as well as
exacerbate condition for
which medication is
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Daily maintenance
dose for adults: – Oral:
0.125-0.5 mg, children
dose calculated based
on body weight.
Given once daily.
Doses usually given
twice daily.
Given to infants as well
as adults



Amiodarone.
Antifungals except
Miconazole
Macrolides
St John's wort
Sucralfate
 Co-enzyme Q10
 contraceptives
 Cranberry
 PPI
 Azole antifungals
 Ginkgo Biloba
 Ginseng
 Green tea
 Macrolides
 Omega-3
 Orlistat
 St John's Wort
Treatment of
Benzodiazepines
symptoms and
Macrolide Antibiotics
reversible airway except Azithromycin
obstruction
Ciprofloxacin
Blood thinner
Unusual bleeding or bruising (e.g., bleeding
gums, nosebleed, blood in urine, dark stool,
bloody emesis, heavier than usual menses, or
menstrual irregularities.
Vitamin K is the Antidote (Konakion in Jodan)






Tachycardia
Seizures
Nausea & repetitive vomiting
Tremor
Nervousness
Disorientation.
prescribed). If you are
smoking when dosage is
prescribed; inform
prescriber if you stop
smoking (dosage may
need to be adjusted to
prevent toxicity).
 Avoid dietary stimulants
(e.g., caffeine, tea, colas,
or chocolate; may
increase adverse side
effects).
 Maintain adequate
hydration unless
instructed to restrict
fluid intake.
4. Cyclosporine
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Doses usually divided
 You will be susceptible
twice daily.
to infection (avoid
crowds and exposure to
Can be given to
infection and do not
children
have any vaccinations
without consulting
prescriber).
 Monitor BP regularly.
 Avoid excessive
exposure to sun
 Practice good oral
hygiene to reduce gum
inflammation; see a
dentist regularly during
treatment.
 Do not change one
brand of cyclosporine
for another; any changes
must be done by your
prescriber
 Prophylaxis of
Organ rejection
 Severe Active
Rheumatoid
 Psoriasis
 Ophthalmic
emulsion to
increase tears
production












Androgens
Antacids
Azole Antifungals
Echinacea
Grapefruit Juice
Macrolide
Antibiotics
Metoclopramide
Metronidazole
NSAIDs
St John's Wort
Vaccine
(inactivated & live)
Grapefruit juice

Anxiety

Diarrhea & Vomiting

Perspiration

Weak pulse & Irregular pulse

Slurred speech

Seizure

Paresthsia

Change in taste

Dysphagia

Hypertension

Loss of appetite
5. Phenytoin
6. Valproic acid
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Take exactly as directed,
preferably on an empty
stomach.
Follow recommended diet,
avoid alcohol, and maintain
adequate hydration unless
instructed to restrict fluid
intake.
May cause gum or mouth
soreness (use good oral
hygiene and have frequent
dental exams)
May cause drowsiness,
dizziness, nervousness, or
headache (use caution when
driving or engaging in tasks
that require alertness until
response to drug is known)
 Do not use alcohol and
other prescription or
OTC medications
(especially pain
medications, sedatives,
antihistamines, or
hypnotics) without
consulting prescriber.
 Maintain adequate
hydration unless
instructed to restrict
fluid intake.
Doses can be divided in
2-3 doses.
Anticonvulsant
Can be given to infants
as well as for adults.
Regular release and
delayed release
formulations are
usually given in 2-4
divided doses/day
Not recommended for
children younger than
10 years.
Anticonvulsant
 Acetaminophen:
 Hyperreflexia or hyporeflexia
may increase the
 Abnormal gait (bradykinesia, truncal
metabolism of
ataxia - Ataxia is very typical
Acetaminophen.
presentation for patients with elevated
This may 1)
phenytoin levels.
diminish the effect
 Respiratory distress
of acetaminophen;
 Tremor (intention)
and 2) increase the
 Irritability or agitation
risk of liver damage
 Confusion
 Alcohol

 Antacids
 Ciprofloxacin
 Contraceptives
 Doxycycline
 Folic Acid
 Mebendazole
 Pyridoxine vit. B6
 Avoid evening
primrose (seizure
threshold
decreased).
 Avoid valerian, St
John's wort, gotu
kola (may increase
CNS depression).
Avoid evening primrose GI upset with nausea and vomiting is the most
(seizure threshold
common presentation of patients with valproic
decreased).
acid overdose, closely followed by CNS
symptoms of decreased level of consciousness
and confusion.
7. Lithium
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 If you have diabetes,
monitor serum glucose
closely (valproic acid will
alter results of urine
ketones).
 ou may experience
nervousness; decreased
appetite; insomnia;
headache; sleepiness or
dizziness (use caution
when driving or
engaging in tasks
requiring alertness until
response to drug is
known)
 May cause hair loss.
 Maintain adequate
hydration unless
instructed to restrict
fluid intake (especially in
summer)
 Avoid changes in sodium
content (eg, low sodium
diets); reduction of
sodium can increase
lithium toxicity
 Limit caffeine intake
(diuresis can increase
lithium toxicity).
 You may experience
decreased appetite or
altered taste sensation
(small frequent meals
may help maintain
nutrition)
Doses can be divided
to 3-4 doses.
Not to be given for
children younger than
6 years.
 Bipolar
depression
 Mania
 post-traumatic
stress disorder,
 conduct
disorder in
children
 Aggression
 NSAIDs except
Sulindac
 Sibutramine
(absolute
Contraindication)
Early signs of lithium toxicity, such as nausea,
vomiting, diarrhea, drowsiness, muscle
weakness, tremor, lack of coordination, blurred
vision, or ringing in your ears.
8. Carbamazepine
Administer tablets in 2 It is recommended that
3 divided doses daily
the carbamazepine
and suspension in 4
suspension dosage form
divided doses daily
not be administered at
the same time with
Can be given to
other liquid medicinal
children as well as
agents or diluents.
adults.
Should be administered
with meals
 Extended release tablet
should be administered
with meals; swallow
whole, do not crush or
chew.
 Do not change the brand
you are using.
Maximum recommended
doses:
Children 12-15 years: 1000
mg/day
Children >15 years: 1200
mg/day
Adults: 1600 mg/day;
however, some patients
have required up to 1.62.4 g/day
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 Epilepsy
 Pain relief of
trigeminal or
glossopharynge
al neuralgia
 Treatment of
resistant
schizophrenia
 ethanol
withdrawal,
 restless leg
syndrome,
 post-traumatic
stress disorders
 Diabetic
neuropathy









Azole Antifungals.
Benzodiazepines
Contraceptives
Macrolide
Antibiotics except
Azithromycin
Mebendazole
Avoid evening
primrose (seizure
threshold
decreased).
Avoid valerian
Avoid St John's wort
Avoid gotu kola
(may increase CNS
depression)
The first signs and symptoms appear after 1-3
hours, Neuromuscular are the most prominent
signs, Impairment of consciousness ranging in
severity to deep coma. Convulsions, especially in
small children. Motor restlessness, muscular
twitching, tremor, athetoid movements,
opisthotonos, ataxia, drowsiness, dizziness,
mydriasis, nystagmus, adiadochokinesia, ballism,
psychomotor disturbances, dysmetria. Initial
hyperreflexia, followed by hyporeflexia.
9. Haloperidol







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It may take 2-3
weeks to achieve
desired results.
Do not take within 2
hours of any antacid
Avoid alcohol or
caffeine and other
prescription or OTC
medications not
approved by
prescriber.
Maintain adequate
hydration unless
instructed to restrict
fluid intake.
Avoid skin contact
with medication;
may cause contact
dermatitis (wash
immediately with
warm, soapy water)
You may experience
excess drowsiness,
restlessness,
dizziness, or blurred
vision (use caution
driving or when
engaging in tasks
requiring alertness
until response to
drug is known)
Monitor glucose
levels.

Doses are
divided in 2-3 doses.

Not given to
children under 3
years.
 Schizophrenia
 Tourette's
disorder in
children and
adults
 Severe
behavioral
problems in
children
 psychosis/agita
tion related to
Alzheimer's
dementia
 Adjunctive
treatment of
ethanol
dependence
Alcohol
Ciprofloxacin
Avoid valerian, St
John's wort, gotu kola
(may increase CNS
depression)
Overdose symptoms may include extreme
drowsiness, feeling like you might pass out,
tremors, and uncontrolled muscle movements in
your eyes, tongue, jaw, or neck.
10. Insulin






Do not share pens,
cartridges, or
needles with others.
This medication is
used to control
diabetes; it is not a
cure.
It is imperative to
follow other
components of
prescribed
treatment (eg, diet
and exercise
regimen).
Take exactly as
directed. Do not
change dose or
discontinue unless
advised by
prescriber
Always carry quick
source of sugar with
you.
Monitor glucose
levels as directed by
prescriber.
Can be given to infants
as well as adults.
Can be divided in
multiple doses.

DM
Beta-blockers (may
mask hypoglycemic
signs except for
sweating)
Use caution with
alfalfa, aloe, bilberry,
bitter melon, burdock,
celery, damiana,
fenugreek, garcinia,
garlic, ginger, ginseng
(American), gymnema,
marshmallow, stinging
nettle; may increase
risk of hypoglycemia.
Hypoglycemia, coma.
 Kindly note that what is listed in the table above is NOT everything!! But it is the most common.
 Also note for the interaction part I made sure that you get to know the medications that is usually dispensed without prescription.
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