Comprehensive Drug Information for Common Medications
1. Actos (pioglitazone)
Brand/Generic Name: Actos/pioglitazone
Dosage Forms: Oral tablets (15 mg, 30 mg, 45 mg)
Pharmacologic Category: Thiazolidinedione; PPAR-gamma agonist
FDA-Approved Indications: Type 2 diabetes mellitus
Dosage and Frequency: Initial: 15-30 mg once daily; Maximum: 45 mg once daily
Mechanism of Action: Improves insulin sensitivity by activating peroxisome proliferator-activated receptor-gamma (PPAR-gamma), increasing glucose utilization in peripheral tissues
Contraindications: Active liver disease; NYHA Class III/IV heart failure; diabetic ketoacidosis; history of bladder cancer; hypersensitivity
Adverse Effects: Fluid retention, weight gain, edema, heart failure exacerbation, bone fractures, bladder cancer risk, hypoglycemia (when used with insulin/sulfonylureas)
Drug Interactions: CYP2C8 inhibitors may increase pioglitazone levels; may decrease effectiveness of hormonal contraceptives
Patient Counseling Points:
- Take with or without food
- Monitor for signs of heart failure (shortness of breath, rapid weight gain, edema)
- Report any blood in urine or bladder symptoms
- Regular liver function monitoring required
2. Catapres (clonidine)
Brand/Generic Name: Catapres/clonidine
Dosage Forms: Oral tablets (0.1 mg, 0.2 mg, 0.3 mg); transdermal patches (0.1 mg, 0.2 mg, 0.3 mg per day)
Pharmacologic Category: Centrally acting alpha-2 agonist; antihypertensive
FDA-Approved Indications: Hypertension
Dosage and Frequency: Oral: Initial 0.1 mg twice daily; titrate by 0.1 mg/day at weekly intervals; usual range 0.1-0.8 mg/day in 2 divided doses 1
Mechanism of Action: Stimulates central alpha-2 adrenergic receptors, reducing sympathetic outflow from the brain
Contraindications: Hypersensitivity to clonidine
Adverse Effects: Sedation, dry mouth, dizziness, constipation, orthostatic hypotension, rebound hypertension with abrupt discontinuation
Drug Interactions: CNS depressants (enhanced sedation); beta-blockers (potential for rebound hypertension if clonidine discontinued while on beta-blocker)
Patient Counseling Points:
- Never abruptly discontinue; must be tapered to avoid dangerous rebound hypertension
- May cause drowsiness; avoid driving until effects known
- Take consistently with respect to meals
- May cause dry mouth
3. Cardura (doxazosin)
Brand/Generic Name: Cardura/doxazosin
Dosage Forms: Oral tablets (1 mg, 2 mg, 4 mg, 8 mg)
Pharmacologic Category: Alpha-1 blocker; antihypertensive
FDA-Approved Indications: Hypertension; benign prostatic hyperplasia (BPH)
Dosage and Frequency: Initial: 1 mg once daily; titrate gradually to 1-16 mg once daily 1
Mechanism of Action: Selectively blocks alpha-1 adrenergic receptors, causing vasodilation and relaxation of smooth muscle in the prostate
Contraindications: Hypersensitivity to doxazosin or quinazolines
Adverse Effects: Orthostatic hypotension (especially first-dose), dizziness, headache, fatigue, edema 2, 3
Drug Interactions: Enhanced hypotensive effects with other antihypertensives; PDE-5 inhibitors may increase risk of hypotension
Patient Counseling Points:
- Take first dose at bedtime to minimize orthostatic hypotension
- Rise slowly from sitting/lying position
- May cause dizziness; use caution with driving
- For BPH, symptom improvement may take 1-2 weeks
4. Desyrel (trazodone)
Brand/Generic Name: Desyrel/trazodone
Dosage Forms: Oral tablets (50 mg, 100 mg, 150 mg, 300 mg)
Pharmacologic Category: Serotonin modulator; antidepressant
FDA-Approved Indications: Major depressive disorder
Dosage and Frequency: Initial: 150 mg/day in divided doses; increase by 50 mg/day every 3-4 days; Maximum: 400 mg/day outpatient, 600 mg/day inpatient 4
Mechanism of Action: 5-HT2A and 5-HT2C receptor antagonist and selective serotonin reuptake inhibitor 4
Contraindications: Hypersensitivity; use of MAOIs within 14 days
Adverse Effects: Sedation (most common), dizziness, dry mouth, priapism (rare but serious), orthostatic hypotension 4
Drug Interactions: MAOIs (serotonin syndrome); CYP3A4 inhibitors may increase levels; additive effects with CNS depressants
Patient Counseling Points:
- Take after meals to reduce dizziness
- May cause drowsiness; avoid driving until effects known
- Seek immediate medical attention for erection lasting >4 hours
- Therapeutic response may begin within 1 week for some patients 4
5. Amaryl (glimepiride)
Brand/Generic Name: Amaryl/glimepiride
Dosage Forms: Oral tablets (1 mg, 2 mg, 4 mg)
Pharmacologic Category: Sulfonylurea; antidiabetic
FDA-Approved Indications: Type 2 diabetes mellitus
Dosage and Frequency: Initial: 1-2 mg once daily with breakfast; Maintenance: 1-4 mg once daily; Maximum: 8 mg/day 5
Mechanism of Action: Stimulates insulin release from pancreatic beta cells; may have extrapancreatic effects improving insulin sensitivity 5
Contraindications: Type 1 diabetes; diabetic ketoacidosis; hypersensitivity to sulfonylureas
Adverse Effects: Hypoglycemia (10-20% of patients), weight gain, GI disturbances, rash, liver enzyme elevations 5
Drug Interactions: CYP2C9 inhibitors increase levels; beta-blockers may mask hypoglycemia symptoms; NSAIDs may enhance hypoglycemic effect
Patient Counseling Points:
- Take with first meal of the day
- Recognize and respond to hypoglycemia symptoms
- Regular blood glucose monitoring required
- Avoid alcohol (disulfiram-like reaction)
6. Coreg/Coreg CR (carvedilol)
Brand/Generic Name: Coreg, Coreg CR/carvedilol
Dosage Forms: Immediate-release tablets (3.125 mg, 6.25 mg, 12.5 mg, 25 mg); extended-release capsules (10 mg, 20 mg, 40 mg, 80 mg)
Pharmacologic Category: Combined alpha- and beta-blocker; antihypertensive
FDA-Approved Indications: Hypertension, heart failure, left ventricular dysfunction after MI
Dosage and Frequency:
- Immediate-release: Initial 3.125 mg twice daily; titrate to 12.5-50 mg twice daily 1
- Extended-release: Initial 10 mg once daily; titrate to 20-80 mg once daily
Mechanism of Action: Blocks beta-1, beta-2, and alpha-1 adrenergic receptors, reducing cardiac output and peripheral resistance
Contraindications: Decompensated heart failure requiring IV inotropes; bronchial asthma/bronchospasm; cardiogenic shock; severe bradycardia/heart block
Adverse Effects: Dizziness, fatigue, hypotension, bradycardia, weight gain, hyperglycemia
Drug Interactions: CYP2D6 inhibitors increase levels; may mask hypoglycemia symptoms in diabetics; digoxin levels may increase
Patient Counseling Points:
- Take with food to minimize orthostatic hypotension
- Never abruptly discontinue; requires gradual tapering
- May mask symptoms of hypoglycemia in diabetics
- Report worsening shortness of breath or weight gain
7. Proscar/Propecia (finasteride)
Brand/Generic Name: Proscar, Propecia/finasteride
Dosage Forms: Oral tablets (Proscar: 5 mg; Propecia: 1 mg)
Pharmacologic Category: 5-alpha reductase inhibitor
FDA-Approved Indications: Proscar: BPH; Propecia: male pattern baldness
Dosage and Frequency: Proscar: 5 mg once daily; Propecia: 1 mg once daily
Mechanism of Action: Inhibits conversion of testosterone to dihydrotestosterone (DHT), reducing prostate size and stimulating hair growth
Contraindications: Pregnancy (women should not handle crushed tablets); hypersensitivity; children
Adverse Effects: Sexual dysfunction (decreased libido, erectile dysfunction), gynecomastia, depression
Drug Interactions: Few significant interactions; terazosin may increase finasteride levels 6
Patient Counseling Points:
- May take 3-6 months to see full effects
- Women who are pregnant should not handle crushed tablets
- Continue treatment for sustained benefit
- May affect PSA test results; inform physician of use
8. Remeron (mirtazapine)
Brand/Generic Name: Remeron/mirtazapine
Dosage Forms: Oral tablets (15 mg, 30 mg, 45 mg); orally disintegrating tablets (15 mg, 30 mg, 45 mg)
Pharmacologic Category: Tetracyclic antidepressant; alpha-2 antagonist
FDA-Approved Indications: Major depressive disorder
Dosage and Frequency: Initial: 15 mg once daily at bedtime; titrate every 1-2 weeks; effective range: 15-45 mg once daily 4
Mechanism of Action: Enhances norepinephrine and serotonin neurotransmission by blocking alpha-2 presynaptic adrenoceptors; antagonizes 5-HT2 and 5-HT3 receptors 4
Contraindications: Use of MAOIs within 14 days; hypersensitivity
Adverse Effects: Sedation (most common), increased appetite, weight gain, dizziness, dry mouth, constipation, transient liver enzyme elevations 4
Drug Interactions: MAOIs (serotonin syndrome); additive effects with CNS depressants; may increase effects of warfarin
Patient Counseling Points:
- Take at bedtime to minimize daytime sedation
- Improvement may begin within 1-2 weeks
- May increase appetite and cause weight gain
- Avoid alcohol consumption
9. Glucotrol/Glucotrol XL (glipizide)
Brand/Generic Name: Glucotrol, Glucotrol XL/glipizide
Dosage Forms: Immediate-release tablets (5 mg, 10 mg); extended-release tablets (2.5 mg, 5 mg, 10 mg)
Pharmacologic Category: Sulfonylurea; antidiabetic
FDA-Approved Indications: Type 2 diabetes mellitus
Dosage and Frequency:
- Immediate-release: Initial 5 mg once daily before breakfast; Maintenance: 2.5-40 mg daily in 1-2 divided doses
- Extended-release: Initial 5 mg once daily; Maintenance: 5-20 mg once daily
Mechanism of Action: Stimulates insulin release from pancreatic beta cells
Contraindications: Type 1 diabetes; diabetic ketoacidosis; hypersensitivity to sulfonylureas
Adverse Effects: Hypoglycemia, weight gain, GI disturbances, rash, photosensitivity
Drug Interactions: CYP2C9 inhibitors increase levels; beta-blockers may mask hypoglycemia symptoms; NSAIDs may enhance hypoglycemic effect
Patient Counseling Points:
- Take immediate-release 30 minutes before meals
- Do not crush or chew extended-release tablets
- Recognize and respond to hypoglycemia symptoms
- Regular blood glucose monitoring required
10. Inderal/Inderal LA (propranolol)
Brand/Generic Name: Inderal, Inderal LA/propranolol
Dosage Forms: Oral tablets (10 mg, 20 mg, 40 mg, 60 mg, 80 mg); extended-release capsules (60 mg, 80 mg, 120 mg, 160 mg); oral solution (4 mg/mL, 8 mg/mL)
Pharmacologic Category: Non-selective beta-blocker
FDA-Approved Indications: Hypertension, angina, arrhythmias, migraine prophylaxis, essential tremor, hypertrophic subaortic stenosis, pheochromocytoma
Dosage and Frequency:
- Hypertension: Initial 80 mg/day in divided doses; Maintenance: 120-240 mg/day
- Extended-release: 80-160 mg once daily 1
Mechanism of Action: Non-selective beta-adrenergic receptor blocker (beta-1 and beta-2)
Contraindications: Cardiogenic shock; sinus bradycardia; heart block greater than first degree; bronchial asthma; severe COPD
Adverse Effects: Bradycardia, fatigue, dizziness, bronchospasm, hypotension, sleep disturbances, sexual dysfunction
Drug Interactions: CYP1A2, CYP2C19, CYP2D6 inhibitors increase levels; may mask hypoglycemia symptoms; calcium channel blockers may enhance bradycardia
Patient Counseling Points:
- Never abruptly discontinue; requires gradual tapering over 1-2 weeks 7
- May mask symptoms of hypoglycemia in diabetics
- Avoid driving until effects known
- Extended-release capsules should be swallowed whole
11. Flomax (tamsulosin)
Brand/Generic Name: Flomax/tamsulosin
Dosage Forms: Oral capsules (0.4 mg)
Pharmacologic Category: Alpha-1 blocker; selective for prostate
FDA-Approved Indications: Benign prostatic hyperplasia (BPH)
Dosage and Frequency: Initial and maintenance: 0.4 mg once daily; may increase to 0.8 mg once daily if needed after 2-4 weeks
Mechanism of Action: Selectively blocks alpha-1A adrenergic receptors in the prostate, reducing smooth muscle tone
Contraindications: Hypersensitivity to tamsulosin
Adverse Effects: Orthostatic hypotension, dizziness, retrograde ejaculation, rhinitis, asthenia
Drug Interactions: CYP3A4 and CYP2D6 inhibitors increase levels; other alpha-blockers may enhance hypotensive effects; PDE-5 inhibitors may increase risk of hypotension
Patient Counseling Points:
- Take 30 minutes after the same meal each day
- May cause dizziness; use caution with driving
- May cause abnormal ejaculation
- Inform surgeons before cataract surgery (intraoperative floppy iris syndrome)
12. Wellbutrin/SR/XL (bupropion)
Brand/Generic Name: Wellbutrin, Wellbutrin SR, Wellbutrin XL/bupropion
Dosage Forms: Immediate-release tablets (75 mg, 100 mg); sustained-release tablets (100 mg, 150 mg, 200 mg); extended-release tablets (150 mg, 300 mg, 450 mg)
Pharmacologic Category: Aminoketone antidepressant; norepinephrine-dopamine reuptake inhibitor
FDA-Approved Indications: Major depressive disorder; seasonal affective disorder (XL only); smoking cessation (as Zyban)
Dosage and Frequency:
- Immediate-release: Initial 100 mg twice daily; Maximum 450 mg/day in divided doses
- Sustained-release: Initial 150 mg once daily; Maximum 400 mg/day in divided doses
- Extended-release: Initial 150 mg once daily; Maximum 450 mg once daily 4
Mechanism of Action: Inhibits reuptake of dopamine and norepinephrine; no effect on serotonin 4
Contraindications: Seizure disorder; current/prior diagnosis of bulimia or anorexia; use of MAOIs within 14 days; abrupt discontinuation of alcohol or sedatives
Adverse Effects: Seizures (dose-dependent), agitation, insomnia, headache, dry mouth, nausea, constipation, tremor 4
Drug Interactions: MAOIs; CYP2B6 inhibitors increase levels; may lower seizure threshold with other medications that do the same
Patient Counseling Points:
- Do not crush, chew, or split SR/XL tablets
- Take early in the day to minimize insomnia
- Onset of antidepressant effect typically in 2 weeks 4
- Avoid alcohol consumption (lowers seizure threshold)
- Limit single doses to prevent seizure risk