Informed Consent for Medications F-24277 Series - Psychotropic Brand Name Medications

Background and Instructions
All pdf forms are approximately 17K 
About Using PDF Forms

You can sort on any column simply by clicking on the column heading.

Medication Brand Name (Word) Medication Generic Name (Word) PDF version Medication Category Last Revise Date

Blank Form

Blank Form

Blank Form (PDF, 139 KB)

Blank Form

07/01/2015

Blank Spanish

Blank Form in Spanish

Blank Spanish (PDF, 142 KB)

Blank Spanish

07/01/2015

 

chloral hydrate

chloral hydrate (PDF, 151 KB)

Sedative, Hypnotic

12/11/2015

  guanfacine guanfacine (PDF, 44 KB) Attention Deficit/Hyperactivity Disorder/ADHD 12/17/2010

 

phenobarbital

phenobarbital (PDF, 44 KB)

Barbiturate and Barbiturate-Like Anticonvulsants

12/17/2010

  prochlorperazine prochlorperazine (PDF, 162 KB) Antipsychotic Agent (Phenothiazine) Antiemetic 08/08/2016

 

thioridazine

thioridazine (PDF, 161 KB)

Antipsychotic Agent (Phenothiazine)

08/08/2016

Abilify, Abilify Maintena, Abilify Discmelt, Aristada

aripiprazole

Abilify, Abilify Maintena, Abilify Discmelt, Aristada

(PDF, 38 KB)
Antipsychotic
Antidepressant
Bipolar/Mood Stabilizing Agent

12/22/2016

Adderall Adderall XR mixed salts of a single entity amphetamine Adderall Adderall XR (PDF, 48 KB) Central Nervous System Stimulant

12/17/2010

Ambien, Ambien CR

zolpidem

Ambien, Ambien CR (PDF, 166 KB)

Sedative, Hypnotic

8/08/2016

Anafranil

clomipramine

Anafranil (PDF, 160 KB)

Antidepressant (tricyclic)

12/11/2015

Aricept donepezil Aricept (PDF, 156 KB) Dementia/Alzheimer's Treatment

10/04/2016

Aristada aripiprazole lauroxil Aristada (PDF, 174 KB) Atypical Antipsychotic 05/09/2016
Artane tryhexiphenidyl Artane (PDF, 157 KB) Antidyskinetic 08/08/2016

Ascendin

amoxapine

Ascendin (PDF, 156 KB)

Antidepressant (tricyclic)

12/11/2015

Atarax

hydroxyzine hydrochloride

Atarax (PDF, 46 KB)

Antihistamine (sedative, antianxiety)

12/17/2010

Ativan

lorazepam

Ativan (PDF, 156 KB)

Antianxiety Agent (benzodiazepine)

08/08/2016

Aventyl, Pamelor

nortriptyline

Aventyl, Pamelor (PDF, 160  KB)

Antidepressant (tricyclic)

08/08/2016

Belsomra suvorexant Belsomra (PDF, 179 KB) Sedative, Hypnotic 10/15/2015

Benadryl

diphenhydramine

Benadryl (PDF, 35 KB)

Antihistamine (sedative, antianxiety)

11/22/2016

BuSpar

buspirone

BuSpar (PDF, 154 KB)

Antianxiety Agent

12/11/2015

Catapres

clonidine

Catapres (PDF, 157 KB)

Alpha Adrenergic Agonist/Antihypertensive

10/04/2016

Celexa

citalopram

Celexa (PDF, 167 KB)

Antidepressant (SSRI)

12/11/2015

Clozaril

clozapine

Clozaril (PDF, 163 KB)

Atypical Antipsychotic Agent

05/09/2016

Cogentin benztropine Cogentin (PDF 30 KB) Antidyskinetic

2/08/2016

Concerta, Metadate CD, Metadate ER, Methylin, Methylin ER, Ritalin, Ritalin LA, Ritalin-SR

methylphenidate

Concerta, Metadate CD, Metadate ER, Methylin, Methylin ER, Ritalin, Ritalin LA, Ritalin-SR (PDF, 48 KB)

Central Nervous System Stimulant

12/17/2010

Corgard

nadolol

Corgard (PDF, 46 KB)

Beta-Adrenergic Blocker

12/17/2010

Cylert

pemoline

Cylert (PDF, 102 KB)

Central Nervous System Stimulant

12/17/2010

Cymbalta duloxetine Cymbalta (PDF, 36 KB) Antidepressant 08/16/2016

Dalmane

flurazepam

Dalmane (PDF, 36 KB)

Sedative, Hypnotic

08/08/2016

Daytrana methylphenidate transdermal Daytrana (PDF, 48 KB) Central Nervous System Stimulant 12/17/2010

Depakene, Depakote

valproic acid

Depakene, Depakote (PDF, 50 KB)

Anticonvulsant/Mood Stabilizing Agent

12/17/2010

Depo-Provera medroxyprogesterone acetate Depo-Provera (PDF, 49 KB) Progestin (for non-contraceptive use) (systemic)

12/17/2010

Desyrel

trazodone

Desyrel (PDF, 36 KB)

Antidepressant

12/20/2016

Dexedrine

dextroamphetamine

Dexedrine (PDF, 48 KB)

Central Nervous System Stimulant

12/17/2010

Effexor, Effexor XR

venlafaxine

Effexor, Effexor XR (PDF, 48 KB)

Antidepressant

12/17/2010

Elavil

amitriptyline

Elavil (PDF, 155 KB)

Antidepressant (tricyclic)

12/11/2015

Eskalith, Eskalith-CR, Lithobid

lithium

Eskalith, Eskalith-CR, Lithobid (PDF, 35 KB)

Mood – Stabilizing Agent

12/20/2017

Exelon rivastigimine Exelon (PDF, 50 KB) Alzheimer Treatment

12/17/2010

Fanapt iloperidone Fanapt (PDF, 36 KB) Antipsychotic Agent, Atypical 08/16/2016
Focalin, Focalin XR dexmethylphenidate Focalin, Focalin XR (PDF, 49 KB) Central Nervous System Stimulant 12/17/2010
Gabitril tiagabine Gabitril (PDF, 53 KB) Anticonvulsant 12/17/2010

Geodon

ziprasidone

Geodon (PDF, 35 KB)

Antipsychotic /Mood Stabilizing Agent

12/22/2016

Halcion

triazolam

Halcion (PDF, 39 KB)

Sedative, Hypnotic

12/20/2016

Haldol

haloperidol

Haldol (PDF, 36 KB)

Antipsychotic Agent (phenothiazine)

12/20/2016

Inderal

propranolol

Inderal (PDF, 51 KB)

Beta-Adrenergic Blocker

12/17/2010

Invega paliperidone Invega (PDF, 35 KB) Antipsychotic Agent (benzisoxazole) 12/20/2016
Invega Sustenna paliperidone Invega Sustenna (PDF, 39 KB) Antipsychotic Agent (benzisoxazole) 8/15/2012
Invega Trinza   Invega Trinza (PDF, 175 KB) Atypical Antipsychotic 05/09/2016

Klonopin

clonazepam

Klonopin (PDF, 168 KB)

Anticonvulsant - Benzodiazepine

05/09/2016

Lamictal lamotrigine Lamictal (PDF, 50 KB) Anticonvulsant - Phenyltriazine

12/17/2010

Latuda lurasidone Latuda (PDF, 42 KB) Antipsychotic /Mood Stabilizing Agent 02/24/2017
Lexapro escitalopram Lexapro (PDF, 36 KB) Antidepressant (SSRI)

08/16/2016

Librium

chlordiazepoxide

Librium (PDF, 160 KB)

Antianxiety Agent (benzodiazepine)

12/11/2015

Loxitane

loxapine

Loxitane (PDF, 35 KB)

Antipsychotic Agent - dibenzoxazepine

12/20/2016

Ludiomil

maprotiline

Ludiomil (PDF, 35 KB)

Antidepressant

12/20/2016

Lunesta eszopiclone Lunesta (PDF, 38 KB) Sedative/Hypnotic 08/16/2016

Luvox, Luvox CR

fluvoxamine

Luvox, Luvox CR (PDF, 37 KB)

Antidepressant

08/16/2016

Lyrica pregabalin Lyrica (PDF, 159 KB) Anticonvulsant/Pain Reliever 11/09/2015

Metadate CD, Metadate ER, Methylin, Methylin ER, Concerta, Ritalin, Ritalin LA, Ritalin-SR

methylphenidate

Metadate CD, Metadate ER, Methylin, Methylin ER, Concerta, Ritalin, Ritalin LA, Ritalin-SR (PDF, 48 KB)

Central Nervous System Stimulant

12/17/2010

Minipress

prazosin

Minipress (PDF, 156 KB)

Alpha Adrenergic Blocker (hypertension, Non-FDA approved use—Dream Disorder—PTSD)

09/01/2014

Moban

molindone

Moban (PDF, 34 KB)

Antipsychotic Agent—dihydroindolone

12/20/2016

Namenda memantine Namenda (PDF, 46 KB) Alzheimer's Treatment 12/17/2010

Nardil

phenelzine

Nardil (PDF, 49 KB)

MAO Inhibitor

12/17/2010

Navane

thiothixene

Navane (PDF, 36 KB)

Antipsychotic Agent—thioxanthene

12/20/2016

Neurontin

gabapentin

Neurontin (PDF, 51 KB)

Anticonvulsant

12/17/2010

Norpramin

desipramine

Norpramin (PDF, 163 KB)

Antidepressant (tricyclic)

05/09/2016

Nuplazid pimavanserin Nuplazid (PDF, 126 KB) Atypical Antipsychotic 09/23/2016

Orap

pimozide

Orap (PDF, 36  KB)

Antipsychotic Agent

12/20/2016

Parnate

tranylcypromine

Parnate (PDF, 48 KB)

MAO Inhibitor

12/17/2010

Paxil, Paxil CR, Pexeva

paroxetine

Paxil, Paxil CR, Pexeva (PDF, 38 KB)

Antidepressant (SSRI)

12/20/2016

Pristiq desvenlafaxine Pristiq (PDF, 48 KB) Antidepressant 12/17/2010

Prolixin

fluphenazine

Prolixin (PDF, 37 KB)

Antipsychotic Agent (phenothiazine)

08/16/2016

Prozac

fluoxetine

Prozac (PDF, 38 KB)

Antidepressant (SSRI)

08/16/2016

Remeron, Remeron SolTab

mirtazapine

Remeron, Remeron SolTab (PDF, 37 KB)

Antidepressant

12/20/2016

Restoril

temazepam

Restoril (PDF, 41 KB)

Sedative, Hypnotic

12/20/2016

ReVia

naltrexone

ReVia (PDF, 48 KB)

Opioid antagonist

12/17/2010

Rexulti brexpiprazole Rexulti (PDF, 44 KB) Antipsychotic /Mood Stabilizing Agent 02/24/2017

Risperdal, Risperdal Consta

risperidone

Risperdal, Risperdal Consta (PDF, 39 KB)

Antipsychotic /Mood Stabilizing Agent

02/24/2017

Ritalin, Ritalin LA, Ritalin-SR, Concerta, Metadate CD, Metadate ER, Methylin, Methylin ER

methylphenidate

Ritalin, Ritalin LA, Ritalin-SR, Concerta, Metadate CD, Metadate ER, Methylin, Methylin ER (PDF, 37 KB)

Central Nervous System Stimulant

12/20/2017

Rozerem ramalteon Rozerem (PDF, 37 KB) Sedative-hypnotic 12/20/2016
Saphris asenapine Saphris (PDF, 35 KB) Antipsychotic / Antimanic 02/24/2014

Serax

oxazepam

Serax (PDF, 35 KB)

Antianxiety Agent (benzodiazepine)

12/20/2016

Seroquel, Seroquel XR

quetiapine

Seroquel, Seroquel XR (PDF, 38 KB)

Antipsychotic / Mood Stabilizing Agent

11/22/2016

Serzone

nefazodone

Serzone (PDF, 39 KB)

Antidepressant

12/20/2016

Sinequan

doxepin

Sinequan (PDF, 37 KB)

Antidepressant (tricyclic)

08/16/2016

Sonata zaleplon Sonata (PDF, 50 KB) Sedative / Hypnotic 12/17/2010

Stelazine

trifluoperazine

Stelazine (PDF, 49 KB)

Antipsychotic Agent (phenothiazine)

12/17/2010

Strattera atomoxetine Strattera (PDF, 162 KB) Central Nervous System Agent 11/25/2015
Suboxone & Suboxone Film Strips buprenorphine and naloxone sublingual tablet & film Suboxone & Suboxone Film Strips (PDF, 48 KB) Maintenance treatment of opioid dependence 4/20/2012
Symbyax olanzapine + fluoxetine Symbyax (PDF, 52  KB) Antipsychotic / Antidepressant 12/20/2016

Symmetrel

amantadine

Symmetrel (PDF, 163 KB)

Antidyskinetic

02/08/2016

Tegretol

carbamazepine

Tegretol (PDF, 38 KB)

Anticonvulsant / Mood Stabilizing Agent

02/09/2016

Tenormin

atenolol

Tenormin (PDF, 154 KB)

Beta-Adrenergic Blocker

11/25/2015

Thorazine

chlorpromazine

Thorazine (PDF, 156 KB)

Antipsychotic Agent (phenothiazine)

12/11/2015

Tofranil

imipramine

Tofranil (PDF, 36 KB)

Antidepressant (tricyclic)

08/16/2016

Topamax topiramate Topamax (PDF, 52 KB) Anticonvulsant, Migraine Headache Prevention 12/17/2010

Tranxene

chlorazepate

Tranxene (PDF, 161 KB)

Antianxiety Agent (benzodiazepine)

05/09/2016

Trilafon

perphenazine

Trilafon (PDF, 36 KB)

Antipsychotic Agent (phenothiazine)

12/20/2016

Trileptal oxcarbazepine Trileptal (PDF, 58 KB) Anticonvulsant

12/17/2010

Valium

diazepam

Valium (PDF, 155 KB)

Antianxiety Agent (benzodiazepine)

05/09/2016

Viibryd valizodone Viibryd (PDF, 55 KB) Antidepressant 05/01/2013

Visken

pindolol

Visken (PDF, 52 KB)

Beta-Adrenergic Blocker

12/17/2010

Vistaril

hydroxyzine

Vistaril (PDF, 157 KB)

Antihistamine (sedative, antianxiety)

08/08/2016

Vivactil

protriptyline

Vivactil (PDF, 157 KB)

Antidepressant (tricyclic)

07/01/2015
Vraylar cariprazine Vraylar (PDF, 43 KB) Anticonvulsant / Mood Stabilizing Agent 02/24/2017
Vyvanse lisdexamfetamine Vyvanse (PDF, 46 KB) Central Nervous System Stimulant 12/17/2010

Wellbutrin, Zyban

bupropion

Wellbutrin, Zyban (PDF, 161 KB)

Antidepressant

07/01/2015

Xanax

alprazolam

Xanax (PDF, 158 KB)

Antianxiety Agent (benzodiazepine)

07/01/2015

Zoloft

sertraline

Zoloft (PDF, 170 KB)

Antidepressant (SSRI)

07/01/2015

Zyban, Wellbutrin

bupropion

Zyban, Wellbutrin (PDF, 161 KB)

Antidepressant

12/17/2010

Zyprexa, Relprevv olanzapine Zyprexa, Relprevv (PDF, 45 KB) Antipsychotic / Bipolar Agent 07/01/2015

Zyprexa, Zyprexa Zydis, Zyprexa for Injection

olanzapine

Zyprexa, Zyprexa Zydis, Zyprexa for Injection (PDF, 36 KB)

Antipsychotic / Bipolar Agent

9/20/2012

Last Revised: February 24, 2017