The Drugs

Here is a list of common neurology medications and side-effects. Most drugs can produce adverse effects such as fatigue, headache, dizziness, and GI upset (nausea, abdominal pain, diarrhea). All drugs may produce allergic reactions.

(1) Ischemic stroke.

Hydralazine
Metoprolol
Alteplase
Aspirin
Clopidogrel
​Statins
ACE inhibitors
ATII receptor blockers
Dihydropyridine Ca blockers
Thiazide diuretics
Enoxaparin
Warfarin
Dabigatran
Rivaroxaban
Apixaban
Citalopram

Dizziness, palpitations.
Sexual dysfunction, limb ischemia.
Bleeding, angioedema, anaphylaxis.
Gut bleed (especially with alcohol), Reye's syndrome if >16 years.
Gut, skin bruising.
Cognitive impairment, diabetes, myalgia/myositis/myopathy.
​Cough, hyperkalemia.
Hyperkalemia.
Peripheral edema.
​Hypokalemia, worsens gout.
Fever, bleeding, thrombocytopenia.
Bleeding, skin necrosis, purple toe syndrome, TERATOGEN.
Bleeding (less than warfarin overall, less ICH, more gut bleeds), slight MI increase.
Bleeding (less than warfarin overall, less ICH, more gut bleeds).
​Bleeding (less than warfarin overall, less ICH, more gut bleeds).
Sexual dysfunction, weight gain.

(2) Seizures and epilepsy.

Naloxone
Flumazenil
Benzodiazepines
Phenytoin
Carbamazepine
Valproate
Lamotrigine
Topiramate
Levetiracetam
Lacosamide
Zonisamide
​Clobazam

Only if opioids present - sweating, trembling, flushing, vomiting.
Vomiting.
Drowsiness, cognitive impairment, respiratory depression, TERATOGEN.
Toxic epidermal necrosis, ataxia, marrow suppression, TERATOGEN.
Ataxia, aplastic anemia, agranulocytosis, reduced contraceptive effectiveness.
Tremor, weight gain, thrombocytopenia, TERATOGEN.
Rash, ataxia, reduced contraceptive effectiveness.
Cognitive impairment, tingling, weight loss, reduced contraceptive effectiveness.
Depression, agitation.
Ataxia.
Drowsiness, agitation, depression.
Drowsiness, fever, drooling, constipation.

(3) Movement disorders.

Selegiline
​Rasagiline
​Ropinirole
Pramipexole
​Levodopa
Entacapone
​Tolcapone
​Amantadine
​Rasagiline
​Donepezil
​Domperidone
Clozapine
​Quetiapine
Baclofen
Primidone
Zolendronate

Nausea, orthostatic hypotension, confusion.
​Same as selegiline.
​Same as selegiline, fluctuations, dyskinesias, compulsions, sleep attacks.
Same as pramipexole.
Same as selegiline, fluctuations, dyskinesias.
Same as selegiline, diarrhea, peak-dose dyskinesia.
Same as entacapone, hepatotoxicity (fortnightly monitoring).
​Livedo reticularis, ankle edema, hallucinations, confusion.
​Nausea, headache, drowsiness, anorexia.
Nausea, headache, strange dreams, back pain.
Cardiotoxicity.
Drowsiness, hypotension, sialorrhea, agranulocytosis (weekly monitoring).
Drowsiness, hypotension.
Drowsiness, vomiting, seizures.
Drowsiness, ataxia.
Jaw osteonecrosis, esophagitis.

(4) Demyelination.

Prednisolone
Methylprednisolone
Glatiramer acetate
Interferons
Natalizumab
Alemtuzamab
Fingolimod
Dimethyl fumarate
Teriflunomide

Weight gain, diabetes, hypertension, osteoporosis, ulcers, cataracts.
Short course only - agitation, sleep disturbance.
Flu symptoms, injection site reactions.
Flu symptoms, hepatotoxic, skin necrosis, depression.
Same as IVIg, 1/10,000 (JC -ve) to 1/100 (JC +ve plus two years on drug) risk PML.
Fever, major cardiac and respiratory complications.
​Fatigue, headache, first-dose bradycardia, macular edema, 1/100,000 risk PML.
Nausea, diarrhea, flushing, abdominal pains, 1/100,000 risk PML.
​GI upset, headache, alopecia, hepatotoxic, TERATOGEN.

(5)  Nerve and muscle disease.

IVIg
Rituximab​
​Immunomodulatories
Azathioprine
Mycophenolate
Cyclosporine
Cyclophosphamide
Methotrexate
​Riluzole
Pyridostigmine
Amitriptyline
Nortriptyline
Gabapentin
​Pregabalin

Infusion site reaction, infection, small risk of anaphylaxis or major complication.
​Same as IVIg.
GI upset, marrow suppression, TERATOGEN in all.
Rash, pancreatitis.
Esophagitis, gastritis, hepatotoxic.
Hepatotoxic, renal failure, cancer.
Hemorrhagic cystitis, alopecia, AML.
Mouth ulcers, hepatotoxicity, renal failure, pulmonary fibrosis.
Nausea, weakness.
​​Salivation, facial flushing, urinary frequency, diarrhea.
​Dry mouth, dizziness, urinary retention, constipation.
​​Same as amitriptyline, but lower incidence of adverse effects.
Drowsiness, peripheral edema, weight gain.
Same as gabapentin.

(6) Headache.

Nimodipine
Ceftriaxone
Ampicillin
Vancomycin
Ibuprofen
Indomethacin
Triptans
Aminophylline

Dihydropyridine calcium blocker adverse effects.
Leukopenia, rash, diarrhea.
Rash, diarrhea.
Thrombophlebitis, leukopenia, thrombocytopenia, red man syndrome.
Slight GI bleeding, renal failure.
​Slight GI bleeding, ulcers, renal failure.
​Avoid if cardiac problems, basilar/hemiplegic migraine, MAOIs/SSRIs.
​Tachyarrhythmias, seizures (treat with beta-blocker).

(7) Delirium, dementia, and vertigo/ataxia.

Acyclovir
Metoclopramide
​Prochlorperazine (stemetil)
Promethazine (phenergan)

Same as IVIg.
Movement disorders (may worsen Parkinson's), neuroleptic malignant syndrome.
Same as metoclopramide.
​Same as metoclopramide.

Blueprints