Is a comparison guide for common medications used for side-effect management, such as constipation, nausea, anxiety, etc. that includes a cost comparison available? —Name withheld on request

In this third installment, the editors present information on medications indicated for managing anxiety. Patients with cancer are susceptible to anxiety as they cope with the stress of their diagnosis and treatment. The list below is not all-inclusive; it does not include those drugs indicated for generalized anxiety disorder, panic disorder, or other anxiety-related psychiatric disorders. Future installments of this chart will present information on other side-effect management medications. —The editors

TABLE 1. Nausea and vomiting medications.

Product or generic (brand name) Indication Contraindications Warnings/
Cautions
Interactions Adverse
reactions
Price for generics (brand)
Alprazolam (Xanax) Anxiety Acute narrow angle glaucoma
Concomitant itraconazole, ketoconazole
Not for use in untreated open-angle glaucoma

Reevaluate periodically

Change dose gradually

Withdrawal symptoms on abrupt cessation or dose reduction

Suicidal ideation

Psychosis

Mania

Renal, cardiovascular, hepatic, pulmonary dysfunction (monitor)

Obesity

Elderly

Debilitated

Labor and delivery

Pregnancy (Cat.D), nursing mothers: not recommended

See contraindications; other azole antifungals: not recommended

Potentiates CNS depression with alcohol, psychotropics, anticonvulsants, other CNS depressants

Potentiated by CYP3A inhibitors; reduce alprazolam dose; caution with cimetidine, nefazodone, fluvoxamine; caution with weaker CYP3A inhibitors (eg, fluoxetine, propoxyphene, oral contraceptives)

Antagonized by CYP3A inducers (eg, carbamazepine)

May increase levels of imipramine, desipramine

CNS depression

Impaired memory, coordination, or attention

Dysarthria

Ataxia

Arthralgia

Dyspnea

Paradoxical excitement

Increased salivation

Withdrawal seizures

Tremors

Decreased libido

Sexual dysfunction

$ ($$)
Buspirone Anxiety Concomitant MAOIs Severe renal or hepatic impairment: not recommended

Elderly

Labor & delivery

Pregnancy (Cat.B)

Nursing mothers: not recommended

Hypertensive crisis with MAOIs: see Contraindications

Avoid alcohol, large amounts of grapefruit juice

Caution with other CNS drugs

May potentiate haloperidol, diazepam, nefazodone

Potentiated by nefazodone, verapamil, diltiazem, erythromycin, itraconazole, ketoconazole, ritonavir, other CYP3A4 inhibitors (use lower initial dose)

Antagonized by rifampin, dexamethasone, phenytoin, phenobarbital, carbamazepine, other CYP3A4 inducers

Dizziness

GI upset

Headache

Nervousness

CNS or emotional effects

Nonspecific chest pain

Tinnitus

Dream disturbances

$
Clorazepate (Tranxene) Anxiety Acute narrow-angle glaucoma Drug alcohol abuse

Suicidal tendencies

Renal or hepatic disease

Change dose gradually

Therapy for >4 months

Monitor blood counts and hepatic function

Psychosis, depression, pregnancy, nursing mothers: not recommended

Potentiation of CNS depression with alcohol and other CNS depressants CNS depression

Dizziness

Ataxia

Memory impairment

GI disorders

Dry mouth

Blurred vision

Headache

Hallucinations

Tremor

Rash

Hypotension

Abnormal hepatic and renal tests

Decreased hematocrit

$ ($$)
Diazepam (Valium) Anxiety Acute narrow-angle glaucoma Not for use in untreated open-angle glaucoma

Inj not for use in shock, coma, acute alcohol intoxication, or obstetrical conditions

Discontinue if paradoxical reaction occurs

Drug or alcohol abuse

Depression

Suicidal tendencies

Renal or liver dysfunction

Avoid abrupt cessation

May increase tonic-clonic seizures

Reevaluate periodically

Monitor blood counts, liver function

Elderly

Debilitated

Psychosis, pregnancy, nursing mothers: not recommended

Potentiates CNS depression with alcohol, other CNS depressants (consider reducing opioid doses by at least 1/3)

Increased serum levels with cimetidine

Potentiated by sertraline

Inj: hypotension, muscle weakness with narcotics, barbiturates, alcohol

INTENSOL, oral: May be potentiated by phenothiazines, narcotics, barbiturates, MAOIs, other antidepressants

CNS depression

Ataxia

Memory impairment

Paradoxical excitement

Salivation changes

Neutropenia

Jaundice

Inj: apnea, cardiac arrest, venous thrombosis, phlebitis, status epilepticus (when treating petit mal)

$ ($$$$$)
Hydroxyzine pamoate (Vistaril) Short-term management of anxiety Early pregnancy Nursing mothers Therapy for >4 months
Elderly
Potentiates CNS depression with alcohol, other CNS depressants (eg, meperidine, barbiturates) Drowsiness

Dry mouth

Tremor

Convulsions

$ ($$)
Lorazepam (Ativan) Anxiety Acute narrow-angle glaucoma Therapy for >4 months

Avoid abrupt cessation

Change dose gradually

Discontinue if paradoxical reactions occurs

Drug or alcohol abuse

Depression

Suicidal tendencies

Renal, hepatic, or pulmonary dysfunction

Seizure disorder

Reevaluate periodically

Monitor blood counts, liver function with long-term use

Elderly

Debilitated

Psychosis, pregnancy, nursing mothers: not recommended

Potentiation of CNS depression with alcohol, other CNS depressants May be potentiated by probenecid or valproate (reduce lorazepam dose by 50%) CNS depression (esp. sedation)

Dizziness

Weakness

Unsteadiness

Transient memory impairment

Disorientation

Nausea

Headache

Sleep disturbances

Agitation

Abuse potential

$ ($$$$$)
Trifluoperazine Short-term (up to 12 weeks) treatment of nonpsychotic anxiety Coma

CNS or bone marrow depression

Blood dyscrasias

Liver disease

Discontinue 48 hrs before to at least 24 hrs after myelography

Cardiovascular disease

Epilepsy

Glaucoma

History of breast cancer

Exposure to extreme heat

Monitor blood, liver, and ocular function

Mental retardation

Elderly

Neonates: risk of extrapyramidal and/or withdrawal symptoms postdelivery (due to exposure during 3rd-trimester pregnancy)

Pregnancy, nursing mothers: not recommended

Potentiates CNS depression with alcohol, other CNS depressants

Potentiates phenytoin, propranolol, a-blockers

May be potentiated by propranolol

Antagonizes guanethidine, oral anticoagulants

Antagonized by anticholinergics

Orthostatic hypotension with thiazides

May cause false (+) PKU test

Adjust antiepileptic drugs

Tardive dyskinesia

Drowsiness

Blood dyscrasias

Jaundice

Hypotension

Retinopathy

May mask emetic signs of disease

Lowered seizure threshold

Rash

Anticholinergic effects

Insomnia

Extrapyramidal reactions

Agitation

Photosensitivity

Neuroleptic malignant syndrome

$
Key: $, <$30; $$, $100-$199; $$$, $200-$299; $$$$, $300-$399; $$$$$, >$400; CNS, central nervous system; GI, gastrointestinal; MAOI, monoamine oxidase inhibitors.
Sources:

Drug price information was obtained via search by generic and listed brand name. Healthcare Bluebook. https://healthcarebluebook.com/page_Default.aspx. Accessed March 24, 2015.

Indications, contraindications, warnings/cautions, interactions, and adverse effects information is from MPR Drug Database, accessed via MPR app. Accessed January 14, 2015.

To access Part 1 of this series, Comparison of constipation management medications, click here.

To access Part 2 of this series, Comparison of medications for managing nausea and vomiting, click here.