| Anxiety disorders or short-term relief of anxiety symptoms (label). View labelExact | Start 7.5 mg twice daily (or 5 mg three times daily); increase by ~5 mg/day every 2–3 days as tolerated. | Non-benzodiazepine anxiolytic; 5-HT1A partial agonist (azapirone). | CYP3A4 | Single-dose range 2–3 h | No | — | - Follow-up within 2–4 weeks is commonly used to assess adherence, side effects, and whether anxiety symptoms are trending in the right direction.
- Dizziness and activation are commonly tracked during titration; slower titration can help if patients feel “wired” or unsteady.
- Interacting medications (CYP3A4 inhibitors/inducers) and food consistency (grapefruit) are worth reviewing when response changes.
- If no meaningful benefit after an adequate trial, stopping and switching or augmenting is common rather than continuing indefinitely.
| No | 2025-12-28 |
|---|
| Anxiety symptoms (label); pruritus; pre/postoperative sedation (label varies by product). View labelExact | Anxiety/acute distress (off label patterns vary): 25–50 mg every 6–8 hours as needed; consider 10–25 mg starting doses in older adults or high fall risk. | First-generation antihistamine (H1 antagonist) with sedating and anxiolytic effects; anticholinergic/antiemetic properties. | Hepatic | No | | - Sedation, falls, and driving impairment are often reassessed after initiation and during dose changes—especially in older adults.
- Anticholinergic effects (constipation, urinary retention, confusion) are commonly monitored; total anticholinergic burden is minimized when possible.
- QT risk: QT-prolonging co-medications and electrolytes are typically reviewed, and baseline ECGs are often considered when risk factors stack.
- If use becomes frequent, the diagnosis is often revisited and plans may shift toward long-term anxiety treatment rather than continued PRN escalation.
| No | 2025-12-28 |
|---|
propranololAdjunctive therapyBrands: INDERAL, INDERAL LA | Hypertension; angina pectoris; atrial fibrillation ventricular rate control; post-MI mortality reduction; migraine prophylaxis; essential tremor; hypertrophic subaortic stenosis; pheochromocytoma adjunct (label). View labelExact | Label dosing varies widely by indication (hypertension, arrhythmias, migraine prophylaxis). In psychiatric use, dose selection should be tied to the specific target symptom and the patient’s cardiopulmonary risk.
Performance anxiety (off label): low single doses taken before a time-limited event are common; start low and confirm tolerability with a trial dose (monitor heart rate, blood pressure, and dizziness). | Nonselective beta-adrenergic receptor blocker (beta-1/beta-2 antagonism). | CYP2D6, CYP1A2, CYP2C19, Glucuronidation | Single-dose range 3–6 h | No | — | - Check baseline heart rate, blood pressure, and asthma/COPD history before starting.
- Monitor bradycardia, hypotension, dizziness, and fatigue after dose changes.
- Reassess mood and sleep after initiation; discontinue or adjust if adverse effects outweigh benefit.
- Taper rather than stopping abruptly after sustained use, especially in coronary disease risk.
| No | 2025-12-29 |
|---|
pregabalinAdjunctive therapyBrands: LYRICA, LYRICA CR | Neuropathic pain (diabetic peripheral neuropathy, postherpetic neuralgia, spinal cord injury); fibromyalgia; adjunctive therapy for partial-onset seizures (label). Off-label psychiatry use includes anxiety symptoms and insomnia adjuncts. View labelExact | For off-label anxiety/sleep use, start low and titrate slowly over days to weeks based on sedation, dizziness, and functional impact.
Avoid rapid escalation or “chasing tolerance,” especially in patients with substance use risk; reassess diagnosis and first-line therapies instead. | Alpha-2-delta (α2δ) ligand that modulates voltage-gated calcium channels and reduces excitatory neurotransmitter release. | Negligible metabolism; eliminated primarily unchanged (label). | Single-dose mean 6.3 h | No | | - Check renal function (eGFR/CrCl) before starting and after clinical changes that may reduce clearance.
- Monitor sedation, dizziness, and driving/fall risk during titration.
- Track weight and assess peripheral edema; reassess if dyspnea or rapid weight change occurs.
- Screen for misuse/diversion signals (early refills, escalating doses, co-use with opioids/alcohol).
- Taper rather than stopping abruptly after sustained use.
| No | 2025-12-29 |
|---|