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.
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| 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. |
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To access Part 1 of this series, Comparison of constipation management medications
To access Part 2 of this series, Comparison of medications for managing nausea and vomiting
