Section 3 (Adult Medication)

Introduction to Specific Psychiatric Medications

The following list of psychiatric medications represents those medications that are most frequently prescribed for adults. The great majority of these psychiatric medications are formulary drugs. However, some of these psychiatric medications are non-formulary and require TAR authorization.

With each medication and/or medication section, there are standard clinical indications, treatment guidelines, adverse reactions, and the drug-drug interactions. The clinician is advised to be fully educated on all of these areas.

In the rare and/or atypical patient, the clinician may choose to deviate from these specific prescribing guidelines. In these situations, the clinician should document the rationale and medical justification of any deviation from the prescribing medication practice. This deviation should be documented and explained in the clinician's progress notes.

The clinician should document careful and frequent follow-up of the clinical effectiveness of any variation from these prescribing guidelines. In addition, the clinician may want to support his or her medical justification with a consultation from another clinician; and that clinician should report the consultation in a separate progress note.

These prescribing guidelines will be reviewed and updated by the Prescribing Guidelines Committee on a yearly basis or more frequently if indicated. Each January the committee will review the list of specific psychiatric medication, evaluating the need for medication additions or deletions. The committee will closely consider any newly approved psychiatric medication. Suggested additions or deletions should be forwarded to the Adult Outpatient Quality Improvement psychiatrist.

Each January, the Prescribing Guidelines Committee will also review the clinical indications, treatment guidelines, adverse reactions and drug-drug interactions for each psychiatric medication. The Committee will utilize the Physician Desk Reference, the psychiatric literature, and the psychiatric textbooks as part of this review process. The contents for this section are listed below.

Major Tranquilizers (Antipsychotics) - Section 3.1

Low Potency & Low Dose Major Tranquilizers 3.1.1

Chlorpromazine, Mesoridazine, Thioridazine, Fluphenazine, Haloperidol,

Loxapine, Molindone, Perhenazine, Thioxthixene, Trifluoperazine

Atypical Major Tranquilizers

Clozapine 3.1.2.1

Excerpts from HCA BH Clozapine P & P 3.1.2.7

Olanzapine 3.1.2.2

Risperidone 3.1.2.2

Quetiapine 3.1.2.2

Antidepressants - Section 3.2

SSRI's & Dopaminergic Acting Medications 3.2.1.1

Citalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline,

Bupropion 3.2.1.2

Nefazadone 3.2.1.3

Tricyclics and Tetracyclics 3.2.2.1

Amitriptyline, Nortriptyline, Protriptyline, Doxepin, Desipramine, Imipramine,

Trimipramine, Clomipramine, Amoxapine, Maprotiline

Trazodone 3.2.2.2

Venlafaxine 3.2.2.3

Mirtazapine 3.2.2.4

MAOI Medications 3.2.3

Phenelzine, Tranylcypromine

Anti-anxiety (Sedative -hypnotics) - Section 3.3

Benzodiazepines 3.3.1

Alprazolam, Clonazepam, Oxazepam, Triazolam, Flurazepam, Temazepam

Non-Benzodiazepines

Buspirone 3.3.2

Mood Stabilizers - Section 3.4

Lithium Preparations 3.4.1

Anticonvulsants

Carbamazepine 3.4.2

Valproate 3.4.3

Gabapentin, Lamotrogine, Topiramate, Tiagabine, Ethosuximide 3.4.4

Side Effects Medications- Section 3.5

Amantadine 3.5.1

Anticholinergics 3.5.1.3

Antihistamines 3.5.1.5

Adjunctive Medications - Section 3.6

Thyroid Hormones 3.6.1

Antihypertensives / Beta Blockers 3.6.2

Dual Diagnosis Medications

Disulfiram 3.6.3

Naltrexone 3.6.3.1

Sympathomimetics - Section 3.7.1