| Adjunctive therapy in partial seizures (epilepsy); postherpetic neuralgia (label). Off-label psychiatry use includes anxiety symptoms and insomnia adjuncts. View labelExact | In psychiatric practice, a bedtime dose is often used initially for sleep maintenance or nocturnal anxiety, with slower titration based on next-day sedation and dizziness.
If daytime dosing is used for persistent somatic anxiety, daytime doses are added cautiously and driving/fall risk is reassessed; gabapentin is often not framed as an indefinite “PRN calming” medication. | Alpha-2-delta (α2δ) ligand that modulates voltage-gated calcium channels and reduces excitatory neurotransmitter release. | Not appreciably metabolized (label). | Single-dose range 5–7 h | No | | - Renal function (eGFR/CrCl) before starting and after clinical changes that may reduce clearance.
- Sedation, dizziness, gait instability, and driving/fall risk during titration.
- Reassess for peripheral edema and weight changes over weeks to months.
- Misuse/diversion signals (early refills, dose escalation, co-use with opioids/alcohol).
- Tapering rather than abrupt stopping after sustained daily use.
| No | 2026-02-12 |
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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 |
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| 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 |
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lorazepamAdjunctive therapyBrands: ATIVAN, LOREEV XR | Anxiety disorders; insomnia due to anxiety/stress (label varies by product). View labelExact | Anxiety (label ranges vary): typically 1–3 mg/day in divided doses; titration is typically cautious based on sedation and fall risk. | Benzodiazepine; positive allosteric modulator of GABA-A receptors. | Glucuronidation | Single-dose mean 12 h | No | | - Functional benefit and safety are reassessed at each renewal; open-ended continuation without documented goals is generally avoided.
- Sedation, falls, and driving impairment are monitored—especially in older adults and when other CNS depressants are present.
- For catatonia, follow-up is often frequent, with coordinated escalation pathways (medical evaluation and ECT readiness when response is incomplete).
- If discontinuing after more than brief use, gradual tapering and monitoring for withdrawal symptoms and rebound anxiety are typical.
| No | 2026-02-20 |
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