topiramateAdjunctive therapyBrands: Topamax, Trokendi XR, Qudexy XR | Epilepsy; migraine prophylaxis (label). Common off-label use includes alcohol use disorder and weight mitigation (clinical). View labelExact | Psychiatric off-label use generally starts low (often 25 mg nightly) and increases in weekly steps to reduce cognitive and paresthesia burden (clinical). | Broad-mechanism antiepileptic and migraine-preventive agent (includes voltage-gated sodium-channel effects, enhanced GABA activity, AMPA/kainate antagonism, and carbonic anhydrase inhibition). In psychiatry it is sometimes used off label for alcohol use disorder, binge-eating disorder, and to mitigate antipsychotic-associated weight gain, balancing potential benefit against cognitive and metabolic adverse effects. | Not extensively metabolized; metabolites formed via hydroxylation, hydrolysis, and glucuronidation (label). | Single-dose mean 21 h | No | — | - Neurocognitive and functional monitoring (attention, word-finding, daytime function, driving safety) (label/clinical).
- Metabolic acidosis/kidney stone risk review; consider serum bicarbonate in higher-risk patients and counsel on hydration (label/clinical).
- Pregnancy-intent and contraception review, especially at higher doses or when oral contraceptives are used (label/clinical).
- Mood and suicidality monitoring when baseline risk is elevated (label/class).
| No | 2025-12-30 |
|---|
| Treatment of alcohol dependence; blockade of the effects of exogenously administered opioids in the management of opioid dependence (label). View labelExact | Alcohol dependence: 50 mg once daily was used in placebo-controlled outpatient trials for up to 12 weeks as an adjunct to psychosocial methods (label). | Opioid receptor antagonist used for alcohol dependence and for opioid dependence relapse prevention via opioid blockade; requires an opioid-free period to avoid precipitated withdrawal and has hepatotoxicity cautions at higher doses. | Extensive hepatic metabolism (first pass) | Single-dose mean 4 h | No | — | - Liver function testing (baseline and follow-up), especially with alcohol-related liver disease (label/clinical).
- Opioid exposure screening and documentation of opioid-free verification strategy (label/clinical).
- Monitoring for nausea, dizziness, and fatigue that can affect adherence and function (clinical).
- Perioperative/acute pain planning because opioid analgesia may be ineffective while naltrexone is active (clinical).
| No | 2026-02-12 |
|---|
metforminAdjunctive therapyBrands: Glucophage, Glucophage XR, Fortamet, Glumetza | Type 2 diabetes mellitus; adjunct to diet and exercise for glycemic control (label). Common off-label use includes mitigation of antipsychotic-associated weight gain and metabolic risk (clinical). View labelExact | Label initiation commonly starts at 500 mg once or twice daily with meals, then increases in weekly steps as tolerated; total daily maximum varies by formulation/manufacturer (label). | Biguanide antihyperglycemic that reduces hepatic glucose production and improves insulin sensitivity; does not typically cause hypoglycemia as monotherapy. In psychiatry it is commonly used off label to help mitigate antipsychotic-associated weight gain and metabolic risk. | Not metabolized; eliminated by renal filtration and active tubular secretion (label). | Single-dose mean 6.2 h | No | — | - Baseline and periodic renal function (eGFR/creatinine) to guide dosing and continuation (label).
- Metabolic monitoring (weight, waist circumference, fasting glucose/A1c, lipids) integrated with antipsychotic monitoring workflows (clinical).
- Vitamin B12 level assessment when symptoms or prolonged treatment suggests deficiency (label/clinical).
- Review for high-risk contexts for lactic acidosis (dehydration, sepsis, hypoxemia, heavy alcohol use) and pause therapy during acute illness when risk rises (label/clinical).
| No | 2025-12-30 |
|---|
bupropionAdjunctive therapyBrands: WELLBUTRIN | MDD; seasonal affective disorder; smoking cessation (SR). View labelExact | XL: start 150 mg qAM for 3–7 days, increase to 300 mg qAM; may increase to 450 mg qAM if needed. | Norepinephrine–dopamine reuptake inhibitor (NDRI). | CYP2B6 | Steady-state mean 21 h | No | — | - Blood pressure at baseline and after dose changes, especially when nicotine replacement is used.
- Seizure risk factors (eating disorder history, alcohol/benzodiazepine withdrawal, electrolyte disturbances) before initiation and at follow-up.
- Sleep and anxiety during early titration; dose timing and titration speed are common levers for tolerability.
- Mood elevation or agitation in bipolar-spectrum illness; coordinate prevention plans via the bipolar disorder hub.
- Medication list review to ensure only one bupropion-containing product is active (to reduce accidental dose escalation across brands).
| No | 2026-02-12 |
|---|