If you are taking medications or know of CFS patients taking medications that are not on this list please provide in bold or in colors in the list - thanks!
(BB)
Central Nervous System: Anti-anxiety Effect
___alprazolam (Xanax) 1 2 3 4 5 ___chlordiazepoxide (Librium) 1 2 3 4 5 ___diazepam (Valium) 1 2 3 4 5 ___lorazepam (Ativan) 1 2 3 4 5 ___meprobamate aspirin (Equagesic) 1 2 3 4 5 ___Other, specify___buspar_____________________ 1 2 3 4 5
Central Nervous System: Anti-depressant
___amitriptyline (Elavil, Endep) 1 2 3 4 5 ___bupropion (Wellbutrin, Wellbutrin SR) 1 2 3 4 5 ___citalopram (Celexa) 1 2 3 4 5 ___desipramine (Norpramin) 1 2 3 4 5 ___doxepin (Sinequan) 1 2 3 4 5 ___fluoxetine (Prozac, Prozac Weekly, Sarafem) 1 2 3 4 5 ___imipramine (Norfranil, Tipramine, Tofranil) 1 2 3 4 5 ___nortriptyline (Pamelor) 1 2 3 4 5 ___paroxetine (Paxil, Paxil CR) 1 2 3 4 5 ___sertraline (Zoloft) 1 2 3 4 5 ___venlafaxine (Effexor, Effexor XR) 1 2 3 4 5 ___Other, specify________________________ 1 2 3 4 5 REMERON, Desreyel (trazodone) Mclobomide, Nefazodone,
selegiline, phenelzine, Norpramin
Central Nervous System - Anti-seizure (anti-convulsants:
Anti-seizure ___carbamazepine (Atretol, Carbatrol, Epitol, 1 2 3 4 5 Tegretol, Tegretol-XR)
___clonazepam (Klonopin,Rivotril) 1 2 3 4 5 ___gabapentin (Neurontin) 1 2 3 4 5 ___oxcarbazepine (Trileptal) 1 2 3 4 5 ___phenytoin (Dilantin any kind) 1 2 3 4 5 ___LYRICA LAMICTAL (lamotrigine)
Depakote (divalproex sodium), Topamax (topiramate), Lyrica (pregabalin) , Clonidine
Central Nervous System: Hypnotic
Eszoplicone (Lunesta)
Stimulants
Dextroamphetamine, modafinil, pyridostigmine, Provigil (modafinil), Adderall (amphetamine salts), Ritalin (methylphenidate), Strattera (atomoxetine)
Benzodiazepines [
Alprazolam (Xanax, Xanor, Alprax, Ksalol, and Niravam), Temazepam (marketed under brand names Normison, Temtabs, Euhypnos, Restoril, Remestan, Tenox, Temaze and Norkotral; Clonazepam aka Klonopin
Central Nervous System: Miscellaneous
___chlorpromazine (Thorazine) 1 2 3 4 5 ___fluvoxamine maleate (Luvox) 1 2 3 4 5 ___pimozide (Orap) 1 2 3 4 5 ___zolpidem tartrate (Ambien) 1 2 3 4 5 ___Other, specify________________________ 1 2 3 4 5 Rameltron (Rozarem) - melatonin receptor agonist; Olanzapine ( Zyprexa) atypical antipsychotic also used for anxiety conditions, PTSD, Bateman uses for sleep, ,
Cardiovascular System:
___atenolol (Tenormin) 1 2 3 4 5
___clopidogrel bisulfate (Plavix) 1 2 3 4 5 ___digoxin (Digitek, Digoxin, Lanoxicaps, Lanoxin) 1 2 3 4 5 ___lidocaine (Xylocaine) 1 2 3 4 5 ___pravastatin sodium (Pravachol) 1 2 3 4 5 ___propranolol (Inderal, Inderal LA) 1 2 3 4 5 ___quinapril (Accupril) 1 2 3 4 5 ___timolol maleate (Blocadren) 1 2 3 4 5
____midodrine (ProAmatine) 1 2 3 4 5 ____fludrocortisone (florinef) 1 2 3 4 5 Topral
___Other, specify_Verapamil ER, Clonidine_______________________ 1 2 3 4 5 BYSTOLIC hydralazine
Gastrointestinal System (GI)
___loperamide (Imodium) 1 2 3 4 5 ___Meclizine(Antivert) 1 2 3 4 5 ___Misoprostol (Cytotec) 1 2 3 4 5 ___Rabeprazol sodium (Aciphex) 1 2 3 4 5 ___ranitidine (Zantac) 1 2 3 4 5 ___Other, specify__Chlordiazepoxide/Clinidium, Sucralfate, Ursodiol, Creon, Pankreaze, Zenpep______________________ 1 2 3 4 5 Prilosec
Non-steroidal Anti-inflammatory Drugs:
___celecoxib (Celebrex) 1 2 3 4 5
___etodolac (Lodine, Lodine XL) 1 2 3 4 5 ___ibuprofen (Advil, Excedrin IB, Motrin) 1 2 3 4 5 ___indomethacin (Indocin, Indocin SR) 1 2 3 4 5 ___naproxen (Aleve, Anaprox, Naprosyn) 1 2 3 4 5 ___rofecoxib (Vioxx) 1 2 3 4 5 ___Other, specify_]Emtec]________________ 1 2 3 4 5 MEDROL (Voltaren 1% Gel) Diclofenac
Meloxicam (mobic)
Non-narcotic Pain Relievers:
___acetaminophen (Tylenol, etc) 1 2 3 4 5 ___aspirin (any brand such as Bayer, Ecotrin, Empirin) 1 2 3 4 5 ___Excedrin (any kind except ExcedrinIB) 1 2 3 4 5 ___Fioricet 1 2 3 4 5 ___Fiorinal 1 2 3 4 5 ___Other, specify___Maxalt_____Axert______ Frova __________ 1 2 3 4 5 MIDRIN __Plaquenil 1 2 3 4 5 TORADOL, Clonidine
PARACETAMOL
Narcotic & Opioid Pain Relievers:
___butorphanol tartrate (Stadol, Stadol NS) 1 2 3 4 5 ___codeine 1 2 3 4 5
___Darvocet 1 2 3 4 5 ___Duragesic 1 2 3 4 5 ___Fioricet with codeine 1 2 3 4 5 ___Fiorinal with codeine 1 2 3 4 5 ___methadone (Dolophine, Methadose) 1 2 3 4 5 ___morphine (any kind including MS Contin) 1 2 3 4 5 ___oxycodone (OxyContin) 1 2 3 4 5 ___Percocet 1 2 3 4 5 ___Percodan 1 2 3 4 5 ___tramadol (Ultram) 1 2 3 4 5 ___Vicodin 1 2 3 4 5 ___Other, specify___Demerol_____________________ 1 2 3 4 5
Skeletal Muscle Relaxants:
___baclofen (Lioresal) 1 2 3 4 5
___carisoprodol(Soma) 1 2 3 4 5 ___cyclobenzaprine (Flexeril) 1 2 3 4 5 ___ methocarbamol (Robaxin) Skelaxin (metaxalone)
Norflex (orphenadrine) 1 2 3 4 5 ___Tizanidine ( Zanaflex )
Hormonal Drugs: ___
cortisone 1 2 3 4 5
___estrogen (Climara, Premarin) 1 2 3 4 5 ___levothyroxine (Levothroid, Levoxine,
Levoxyl, Synthroid) 1 2 3 4 5 ___prednisone 1 2 3 4 5 ___Other, specify_Liothyronine________________________ 1 2 3 4 5
progesterone, pregnenolone , Testosterone, DHEA
Anti-emetics
Granisetron, tropisetron and
ondansetron
Miscellaneous Drugs:
___Beconase 1 2 3 4 5 ___Enbrel 1 2 3 4 5 ___Fosamax 1 2 3 4 5 ___marijuana 1 2 3 4 5 ___pseudoephedrine (Sudafed) 1 2 3 4 5 ___Singulair 1 2 3 4 5 ___sumatriptan succinate (Imitrex) 1 2 3 4 5 ___Other, specify_Zopiclone _____dextroamphetamine
Pseudoephedrine-triprolidine (ram)__________________ 1 2 3 4 5 LOW-DOSE-NALTREXONE_____ NIASPAN eletriptan (Relpax) dihydroergotamine (Migranal with pump
Cannabinoids(THC)
dronabinol (marinol) --- nabilone (cesamet) --- sativex (liquid form for spraying in the cheek)
Antibiotics
Erythromyocin, azithromycin, clarithromycin, doxycycline, minocycline, tinidazole, amoxycillin, penicillin V, rocephin, rifampin, ciprofloxacin, paramomycin, vancomycin,
Antivirals:
Valcyte / Valtrex / Vistide / Valganciclovir / Valvacyclovir / Famciclovir
Acetylcholinase Inhibitors
Ganlantamine hydrobromide (Razadyne ER)
Immunomodulators:
Ampligen / Isoprinosine / Alpha Interferon / Injections of Staphylococcus toxoid / Nexavir / Immunovir (Isoprinosine),
Entanercept (Embrel) / IVIG (Immunoglobulins) / Zadaxin
Stem Cells - not sure what category this would be in....
List any over the counter (OTC) medication not noted:[/B] OTC 1_____Gravol____________________________ 1 2 3 4 5 OTC 2_Samento________________________________ 1 2 3 4 5 OTC 3_________________________________ 1 2 3 4 5 OTC 4_________________________________ 1 2 3 4 5 OTC 5_________________________________ 1 2 3 4 5
ANTI-SPASMODICS
(BB)
Central Nervous System: Anti-anxiety Effect
___alprazolam (Xanax) 1 2 3 4 5 ___chlordiazepoxide (Librium) 1 2 3 4 5 ___diazepam (Valium) 1 2 3 4 5 ___lorazepam (Ativan) 1 2 3 4 5 ___meprobamate aspirin (Equagesic) 1 2 3 4 5 ___Other, specify___buspar_____________________ 1 2 3 4 5
Central Nervous System: Anti-depressant
___amitriptyline (Elavil, Endep) 1 2 3 4 5 ___bupropion (Wellbutrin, Wellbutrin SR) 1 2 3 4 5 ___citalopram (Celexa) 1 2 3 4 5 ___desipramine (Norpramin) 1 2 3 4 5 ___doxepin (Sinequan) 1 2 3 4 5 ___fluoxetine (Prozac, Prozac Weekly, Sarafem) 1 2 3 4 5 ___imipramine (Norfranil, Tipramine, Tofranil) 1 2 3 4 5 ___nortriptyline (Pamelor) 1 2 3 4 5 ___paroxetine (Paxil, Paxil CR) 1 2 3 4 5 ___sertraline (Zoloft) 1 2 3 4 5 ___venlafaxine (Effexor, Effexor XR) 1 2 3 4 5 ___Other, specify________________________ 1 2 3 4 5 REMERON, Desreyel (trazodone) Mclobomide, Nefazodone,
selegiline, phenelzine, Norpramin
Central Nervous System - Anti-seizure (anti-convulsants:
Anti-seizure ___carbamazepine (Atretol, Carbatrol, Epitol, 1 2 3 4 5 Tegretol, Tegretol-XR)
___clonazepam (Klonopin,Rivotril) 1 2 3 4 5 ___gabapentin (Neurontin) 1 2 3 4 5 ___oxcarbazepine (Trileptal) 1 2 3 4 5 ___phenytoin (Dilantin any kind) 1 2 3 4 5 ___LYRICA LAMICTAL (lamotrigine)
Depakote (divalproex sodium), Topamax (topiramate), Lyrica (pregabalin) , Clonidine
Central Nervous System: Hypnotic
Eszoplicone (Lunesta)
Stimulants
Dextroamphetamine, modafinil, pyridostigmine, Provigil (modafinil), Adderall (amphetamine salts), Ritalin (methylphenidate), Strattera (atomoxetine)
Benzodiazepines [
Alprazolam (Xanax, Xanor, Alprax, Ksalol, and Niravam), Temazepam (marketed under brand names Normison, Temtabs, Euhypnos, Restoril, Remestan, Tenox, Temaze and Norkotral; Clonazepam aka Klonopin
Central Nervous System: Miscellaneous
___chlorpromazine (Thorazine) 1 2 3 4 5 ___fluvoxamine maleate (Luvox) 1 2 3 4 5 ___pimozide (Orap) 1 2 3 4 5 ___zolpidem tartrate (Ambien) 1 2 3 4 5 ___Other, specify________________________ 1 2 3 4 5 Rameltron (Rozarem) - melatonin receptor agonist; Olanzapine ( Zyprexa) atypical antipsychotic also used for anxiety conditions, PTSD, Bateman uses for sleep, ,
Cardiovascular System:
___atenolol (Tenormin) 1 2 3 4 5
___clopidogrel bisulfate (Plavix) 1 2 3 4 5 ___digoxin (Digitek, Digoxin, Lanoxicaps, Lanoxin) 1 2 3 4 5 ___lidocaine (Xylocaine) 1 2 3 4 5 ___pravastatin sodium (Pravachol) 1 2 3 4 5 ___propranolol (Inderal, Inderal LA) 1 2 3 4 5 ___quinapril (Accupril) 1 2 3 4 5 ___timolol maleate (Blocadren) 1 2 3 4 5
____midodrine (ProAmatine) 1 2 3 4 5 ____fludrocortisone (florinef) 1 2 3 4 5 Topral
___Other, specify_Verapamil ER, Clonidine_______________________ 1 2 3 4 5 BYSTOLIC hydralazine
Gastrointestinal System (GI)
___loperamide (Imodium) 1 2 3 4 5 ___Meclizine(Antivert) 1 2 3 4 5 ___Misoprostol (Cytotec) 1 2 3 4 5 ___Rabeprazol sodium (Aciphex) 1 2 3 4 5 ___ranitidine (Zantac) 1 2 3 4 5 ___Other, specify__Chlordiazepoxide/Clinidium, Sucralfate, Ursodiol, Creon, Pankreaze, Zenpep______________________ 1 2 3 4 5 Prilosec
Non-steroidal Anti-inflammatory Drugs:
___celecoxib (Celebrex) 1 2 3 4 5
___etodolac (Lodine, Lodine XL) 1 2 3 4 5 ___ibuprofen (Advil, Excedrin IB, Motrin) 1 2 3 4 5 ___indomethacin (Indocin, Indocin SR) 1 2 3 4 5 ___naproxen (Aleve, Anaprox, Naprosyn) 1 2 3 4 5 ___rofecoxib (Vioxx) 1 2 3 4 5 ___Other, specify_]Emtec]________________ 1 2 3 4 5 MEDROL (Voltaren 1% Gel) Diclofenac
Meloxicam (mobic)
Non-narcotic Pain Relievers:
___acetaminophen (Tylenol, etc) 1 2 3 4 5 ___aspirin (any brand such as Bayer, Ecotrin, Empirin) 1 2 3 4 5 ___Excedrin (any kind except ExcedrinIB) 1 2 3 4 5 ___Fioricet 1 2 3 4 5 ___Fiorinal 1 2 3 4 5 ___Other, specify___Maxalt_____Axert______ Frova __________ 1 2 3 4 5 MIDRIN __Plaquenil 1 2 3 4 5 TORADOL, Clonidine
PARACETAMOL
Narcotic & Opioid Pain Relievers:
___butorphanol tartrate (Stadol, Stadol NS) 1 2 3 4 5 ___codeine 1 2 3 4 5
___Darvocet 1 2 3 4 5 ___Duragesic 1 2 3 4 5 ___Fioricet with codeine 1 2 3 4 5 ___Fiorinal with codeine 1 2 3 4 5 ___methadone (Dolophine, Methadose) 1 2 3 4 5 ___morphine (any kind including MS Contin) 1 2 3 4 5 ___oxycodone (OxyContin) 1 2 3 4 5 ___Percocet 1 2 3 4 5 ___Percodan 1 2 3 4 5 ___tramadol (Ultram) 1 2 3 4 5 ___Vicodin 1 2 3 4 5 ___Other, specify___Demerol_____________________ 1 2 3 4 5
Skeletal Muscle Relaxants:
___baclofen (Lioresal) 1 2 3 4 5
___carisoprodol(Soma) 1 2 3 4 5 ___cyclobenzaprine (Flexeril) 1 2 3 4 5 ___ methocarbamol (Robaxin) Skelaxin (metaxalone)
Norflex (orphenadrine) 1 2 3 4 5 ___Tizanidine ( Zanaflex )
Hormonal Drugs: ___
cortisone 1 2 3 4 5
___estrogen (Climara, Premarin) 1 2 3 4 5 ___levothyroxine (Levothroid, Levoxine,
Levoxyl, Synthroid) 1 2 3 4 5 ___prednisone 1 2 3 4 5 ___Other, specify_Liothyronine________________________ 1 2 3 4 5
progesterone, pregnenolone , Testosterone, DHEA
Anti-emetics
Granisetron, tropisetron and
ondansetron
Miscellaneous Drugs:
___Beconase 1 2 3 4 5 ___Enbrel 1 2 3 4 5 ___Fosamax 1 2 3 4 5 ___marijuana 1 2 3 4 5 ___pseudoephedrine (Sudafed) 1 2 3 4 5 ___Singulair 1 2 3 4 5 ___sumatriptan succinate (Imitrex) 1 2 3 4 5 ___Other, specify_Zopiclone _____dextroamphetamine
Pseudoephedrine-triprolidine (ram)__________________ 1 2 3 4 5 LOW-DOSE-NALTREXONE_____ NIASPAN eletriptan (Relpax) dihydroergotamine (Migranal with pump
Cannabinoids(THC)
dronabinol (marinol) --- nabilone (cesamet) --- sativex (liquid form for spraying in the cheek)
Antibiotics
Erythromyocin, azithromycin, clarithromycin, doxycycline, minocycline, tinidazole, amoxycillin, penicillin V, rocephin, rifampin, ciprofloxacin, paramomycin, vancomycin,
Antivirals:
Valcyte / Valtrex / Vistide / Valganciclovir / Valvacyclovir / Famciclovir
Acetylcholinase Inhibitors
Ganlantamine hydrobromide (Razadyne ER)
Immunomodulators:
Ampligen / Isoprinosine / Alpha Interferon / Injections of Staphylococcus toxoid / Nexavir / Immunovir (Isoprinosine),
Entanercept (Embrel) / IVIG (Immunoglobulins) / Zadaxin
Stem Cells - not sure what category this would be in....
List any over the counter (OTC) medication not noted:[/B] OTC 1_____Gravol____________________________ 1 2 3 4 5 OTC 2_Samento________________________________ 1 2 3 4 5 OTC 3_________________________________ 1 2 3 4 5 OTC 4_________________________________ 1 2 3 4 5 OTC 5_________________________________ 1 2 3 4 5
ANTI-SPASMODICS
thanks
