Make Safer Drug Choices High-Risk Medications and Formulary Alternatives
The list below may offer Florida Blue’s BlueMedicare plan members safer alternatives to High-Risk Medications (HRM). An HRM is a medication with a higher risk of having a serious side effect. The chart includes the category of the HRM, conditions they are used to treat and non-HRMs that are on the BlueMedicare Formulary. The BlueMedicare Formulary is a list of approved drugs that are covered by your plan. In many cases, there are multiple drugs used to treat the same condition. Complications from taking an HRM may include: • Falls • Longer hospital stays • Nursing home placement • Fractures • Staying sick longer • Physical, functional, and social decline
High-Risk Medications (HRM) Description Formulary Alternative Medications Associated with Adverse Drug Events
Antihistamines Allergic Conditions (first-generation) as single agent • Brompheniramine • Dexchlorpheniramine • Azelastine nasal spray • Triamcinolone Oint or as part of a • Carbinoxamine • Diphenhydramine • Fluticasone nasal spray combination • Chlorpheniramine • Doxylamine • Levocetirizine product • Clemastine • Hydroxyzine • Montelukast • Cyproheptadine • Promethazine • Nasonex Nasal Spray • Dexbrompheniramine • Triprolidine • Triamcinolone cream
Insomnia (difficulty sleeping) • Diphenhydramine • Hydroxyzine • Low Dose Trazodone • Doxylamine • Promethazine • Silenor • Rozerem Anxiety • Hydroxyzine • Buspirone • Paroxetine • Duloxetine • Sertraline • Escitalopram • Trimethobenzamide • Fluoxetine • Venlafaxine Nausea and Vomiting • Hydroxyzine • Scopolamine • Dronabinol • Ondansetron • Promethazine • Trimethobenzamide • Granisetron • Prochlorperazine Anorexia • Cyproheptadine • Dronabinol Parkinson’s Disease • Benztropine (Oral) • Amantadine • Ropinirol (Requip) • Trihexyphenidyl • Carbidopa/Levodopa • Selegiline • Pramipexole (Mariapex) Antithrombotics Prevent Blood Clots • Dipyridamole (oral short-acting , not as combination) • Aggrenox • Ticlopidine • Clopidogrel Anti-Infectives Depends on Type of Infection • Nitrofurantoin (chronic use or use in patients with • Amoxicillin-Clavulanate • Trimethoprim Creatinine clearance less than 60mL/min) • Ciprofloxacin • Bactrim DS • Ofloxacin Cardiovascular High Blood Pressure • Guanabenz • Amlodipine • Losartan • Guanfacine • Atenolol • Metoprolol • Methyldopa • Candesartan • Quinapril • Reserpine (greater than 0.1mg/day) • Hydrochlorothiazide • Ramipril • Lisinopril • Valsartan
Heart • Digoxin (greater than 0.125 mg/day) • Digoxin - Limit dose to • Lisinopril less than 0.125 mg/day • Losartan • Bisoprolol • Metoprolol • Carvedilol • Quinapril • Diltizem • Verapamil • Enalapril • Disopyramide • Consider discontinuing • Nifedipine (immediate release) • Nifedipine (extended release formulation) Central Nervous Depression System • Amitriptyline • Buproprion • Fluoxetine • Clomipramine • Duloxetine • Paroxetine • Doxepin (greater than 6mg/day) • Desipramine • Setraline • Imipramine • Escitalopram • Trazodone • Trimipramine
Insomnia (difficulty sleeping) • Amitriptyline • Low Dose Trazodone • Doxepin (greater than 6mg/day) • (Silenor) Low Dose Doxepin • Butisol • (Rozerem) Ramelteon • Nembutal • Phenobarbital • Seconal • Chloral hydrate • Doxylamine • Lunesta (more than 90 days per year) • Zolpidem (more than 90 days per year)
Nerve Pain • Amitriptyline • Duloxetine • Lidocaine patch • Imipramine • Desipramine • Lyrica • Gabapentin • Nortriptyline Antipsychotic • Thioridazine • Olanzapine • Risperidone • Quetiapine Seizure • Phenobarbital • Carbamazepine • Levetiracetam • Divalproex • Oxcarbazepine • Lamotrigine Dementia • Ergoloid mesylates • Donepezil • Rivastigmine • Galantamine
Cerebrovascular Insufficiency and Peripheral Vascular Disease • Isoxsuprine • Consult provider for alternatives
Hormones Thyroid hormone replacement • Dessicated Thyroid • Levothyroxine (Levoxyl) Hot Flashes Estrogen with or without Progesterone such as: • Escitalopram • Setraline • Climara • Premarin • Gabapentin • Venlafaxine • Combipatch • Prempro • Selective Serotonin Reuptake Inhibitors • FemHRT • Vivelle (SSRI) such as Fluoxetine and Paroxetine Bone Health • Estrogen with or without Progesterone (see above) • Alendronate • Ibandronate • Evista • Risedronate 150mg Vaginal Symptoms • Estrogen with or without Progesterone (see above) • Vaginal cream such as Estrace or Premarin
Appetite • Megestrol • Dronabinol Diabetes • Chlorpropamide • Glimepiride • Glyburide • Glipizide Nausea and Vomiting • Trimethobenzamide • Granisetron • Prochlorperazine • Promethazine • Ondansetron Pain Pain Moderate to Severe • Meperidine • Fentanyl • Morphine • Pentazocine • Hydrocodone/APAP • Tramadol • Oxycodone/APAP • Tramadol/APAP Pain Mild to Moderate • Fioricet with or without Codeine • Acetaminophen/Codeine • Fiorinal with or without Codeine • Celecoxib (Celebrex) • Indomethacin • Ketorolac Skeletal muscle Muscle Spasms relaxants • Carisoprodol • Baclofen • Chlorzoxazone Spasticity • Cyclobenzaprine • Baclofen • Methocarbamol • Tizanidine • Metaxalone • Orphenadrine
Disclaimer: The information contained herein is for informational purposes only and is neither intended nor construed to be medical advice and is not intended as a substitute for clinical judgment. Florida Blue is a PPO, RPPO and Rx (PDP) Plan with a Medicare contract. Florida Blue HMO is an HMO Plan with a Medicare contract. Enrollment in Florida Blue or Florida Blue HMO depends on contract renewal. Health coverage is offered by Blue Cross and Blue Shield of Florida, D/B/A Florida Blue. HMO coverage is offered by Health Options Inc., D/B/A Florida Blue HMO, an affiliate of Blue Cross and Blue Shield of Florida. These companies are Independent Licensees of the Blue Cross and Blue Shield Association.
Y0011_79773 0215R1 C: 02/2015