Medication Checklist

 

I just completed a modification of my Medication Checklist that I have been using for the past 20 years.  The intent of the checklist was provided and easy way for patients I was seeing to recall any medications that had been treated with in the past. There was not attempt to classify the medications in a more precise manner.  I found it was successful for its intended purpose and allowed for a discussion of other potentially useful medications as well as the limitations of this kind of classification.  As an example, there are overlap categories between antipsychotic medications and mood stabilizers as well as anxiolytics and antidepressants.

My last update was 5 years ago.  Since then, there have been 24 additions, but very few in terms of new medications.  Most of the changes have all been changes in drug formulations (sustained release, combination medications, a new transdermal patch, and longer acting injectable medications.  I included one GLP-1A agonist – tirzepatide (Zepbound, Mounjaro) because it has a new indication for obstructive sleep apnea and sleep medicine is a growing subspeciality in psychiatry. 

I included a new category of Agitation, because dexmedetomidine has that indication.  The only other medications typically in that class are antipsychotics and mood stabilizers but it is far from inclusive.  In acute care psychiatry, most of the medication used to treat this problem are not FDA approved but are from the same classes as the approved drugs.  The only exception are benzodiazepine drugs that are often combined with antipsychotics. 

The time domain for this list is about 40 years. That means there are several older medications on the list that are no longer manufactured or prescribed. It is useful to retain them because many people coming in for new assessments may have been exposed to them over the years. 

Gepirone is an interesting addition.  I posted previously about how azapirones (buspirone and gepirone) seemed to be neglected compounds in psychiatry. Despite buspirone having an anxiety disorder only indication, gepirone was approved for depression in 2023. The current package insert says it is indicated for depression only.  It is a once-a-day dosing but it has a QTc prolongation warning and may require more intensive medical monitoring for that reason.

Viloxazine is a selective norepinephrine reuptake inhibitor (SNRI) that is structurally dissimilar to atomoxetine – an earlier SNRI used to treat Attention Deficit-Hyperactivity Disorder.  

The most significant new medication is likely to be Xanomeline trospium chloride (Cobenfy).  It is a new antipsychotic medication with a novel mechanism of action. Xanomeline is a CNS M1 and M4 muscarinic acetylcholine receptors agonist.  Trospium is a muscarinic acetylcholine receptor antagonist primarily in the peripheral tissues making it a first in class medication.   

The medication sheet contains several medications that are used to treat symptoms and medication wide effects.  There is a total of 142 medications (not counting various reformulations of the same compound). 

I am currently working on reclassifying the medication on this sheet by two different systems – the Anatomical Therapeutic Chemical (ATC) classification system based on more formal indications and the Neuroscience-based Nomenclature (NbN) based on purported mechanisms of action.  At some point I will also try to put them all on a timeline based on when they were FDA approved.

In the meantime, the list can be accessed and printed out.  It is setup to fit on both sides of a standard piece of paper.  During an interview if a person has a difficult time recalling medications – I will show them the list and point out the section that is most likely relevant.  I never include it in the medical record, but use it as part of my notes to record the clinical encounter or check pharmacy records.    

Let me know what you think and if I missed anything.

 

George Dawson, MD, DFAPA

 

The Medication Checklist can be downloaded at this link.