Informed Consent for Medications F-24277 Series: Psychotropic Medications

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Medication Brand Name
Word Version
Medication Generic Name
Word Version

Medication Name
PDF version

Medication Category Last Revise Date
Blank Form Blank Form Blank Form Blank Form 11/01/2016
Blank Spanish Blank Form in Spanish Blank Spanish Blank Spanish 11/01/2016
Tenex, Intuniv XR guanfacine Tenex, Intuniv XR Attention-Deficit/Hyperactivity Disorder (ADHD) 04/05/2021
No brand name available phenobarbital phenobarbital Barbiturate and Barbiturate-Like Anticonvulsants 06/08/2017
Compro prochlorperazine prochlorperazine Antipsychotic Agent (phenothiazine) Antiemetic 09/24/2019
Mellaril thioridazine thioridazine Antipsychotic Agent (phenothiazine) 10/30/2019
Abilify, Abilify Maintena, Abilify MyCite, Aristada, Aristada Initio aripiprazole Abilify, Abilify Maintena, Abilify MyCite, Aristada, Aristada Initio Antipsychotic, Antidepressant, Bipolar, Mood-Stabilizing Agent 08/19/2020
Adderall Adderall XR dextroamphetamine and amphetamine Adderall Adderall Central Nervous System Stimulant 05/27/2021
Ambien, Ambien CR zolpidem Ambien, Ambien CR Sedative, Hypnotic 09/24/2019
Anafranil clomipramine Anafranil Antidepressant (tricyclic) 10/06/2021
Aricept donepezil Aricept Dementia, Alzheimer's Treatment 05/20/2020
Aristada aripiprazole lauroxil Aristada Atypical Antipsychotic 08/09/2018
Artane trihexyphenidyl Artane Antidyskinetic 09/24/2019
Atarax hydroxyzine hydrochloride Atarax Antihistamine, Sedative, Antianxiety 04/09/2021
Ativan lorazepam Ativan Antianxiety Agent/Anticonvulsant (benzodiazepine) 10/11/2021
Aventyl, Pamelor nortriptyline Aventyl, Pamelor Antidepressant (tricyclic) 09/24/2019
Belsomra suvorexant Belsomra Sedative, Hypnotic 08/09/2018
Benadryl diphenhydramine Benadryl Antihistamine, Sedative, Antianxiety 05/20/2020
BuSpar buspirone BuSpar Antianxiety Agent 10/11/2021
Caplyta lumateperone Caplyta Antipsychotic 07/13/2020
Catapres clonidine Catapres Alpha Adrenergic Agonist, Antihypertensive 05/20/2020
Celexa citalopram Celexa Antidepressant (SSRI) 10/11/2021
Clozaril clozapine Clozaril Atypical Antipsychotic Agent 08/09/2018
Cogentin benztropine Cogentin Anticholinergic 10/29/2018
Adhansia XR; Aptensio XR; Concerta; Cotempla XR-ODT; Jornay PM; Metadate ER; Methylin; QuilliChew ER; Quillivant XR; Relexxii; Ritalin; Ritalin LA. methylphenidate Adhansia XR; Aptensio XR; Concerta; Cotempla XR-ODT; Jornay PM; Metadate ER; Methylin; QuilliChew ER; Quillivant XR; Relexxii; Ritalin; Ritalin LA. Central Nervous System Stimulant 05/27/2021
Corgard nadolol Corgard Beta-Adrenergic Blocker 10/29/2018
Cymbalta duloxetine Cymbalta Antidepressant 10/30/2019
Dalmane flurazepam Dalmane Sedative, Hypnotic (benzodiazepine) 11/10/2017
Daytrana methylphenidate transdermal Daytrana Central Nervous System Stimulant 05/27/2021
Depakote, Depakote DR, Depakote ER, Depakote Sprinkles valproic acid Depakote, Depakote DR, Depakote ER, Depakote Sprinkles Anticonvulsant, Mood-Stabilizing Agent 05/27/2021
Depo-Provera, Provera medroxyprogesterone acetate Depo-Provera, Provera Progestin (systemic, for non-contraceptive use) 03/23/2021
Desyrel trazodone Desyrel Antidepressant 10/11/2021
Dexedrine, Zenzedi, ProCentra dextroamphetamine Dexedrine, Zenzedi, ProCentra Central Nervous System Stimulant 03/23/2021
Effexor, Effexor XR venlafaxine Effexor, Effexor XR Antidepressant 04/05/2021
Elavil amitriptyline Elavil Antidepressant (tricyclic) 11/22/2017
Eskalith, Eskalith CR, Lithobid lithium Eskalith, Eskalith CR, Lithobid Mood-Stabilizing Agent 07/13/2020
Exelon rivastigmine Exelon Alzheimer's Treatment 05/27/2021
Fanapt iloperidone Fanapt Antipsychotic Agent, Atypical 10/30/2019
Focalin, Focalin XR dexmethylphenidate Focalin, Focalin XR Central Nervous System Stimulant 04/05/2021
Gabitril tiagabine Gabitril Anticonvulsant 05/27/2021
Geodon ziprasidone Geodon Antipsychotic, Mood-Stabilizing Agent 08/20/2020
Halcion triazolam Halcion Sedative, Hypnotic (benzodiazepine) 06/18/2020
Haldol haloperidol Haldol Antipsychotic Agent (phenothiazine) 07/13/2020
Inderal, Inderal XL, Hemangeol, InnoPran XL propranolol, propranolol XR Inderal, Inderal XL, Hemangeol, InnoPran XL Beta-Adrenergic Blocker 05/27/2021
Invega paliperidone Invega Antipsychotic Agent (benzisoxazole) 07/13/2020
Invega Sustenna paliperidone Invega Sustenna Antipsychotic Agent (benzisoxazole) 10/29/2018
Invega Trinza paliperidone palmitate Invega Trinza Atypical Antipsychotic 05/09/2016
Klonopin clonazepam Klonopin Antianxiety Agent, Anticonvulsant (benzodiazepine) 11/13/2017
Lamictal, Lamictal XR lamotrigine Lamictal, Lamictal XR Anticonvulsant (phenyltriazine) 05/13/2021
Latuda lurasidone Latuda Antipsychotic, Mood-Stabilizing Agent 04/05/2021
Lexapro escitalopram Lexapro Antianxiety, Antidepressant (SSRI) 06/17/2020
Librium chlordiazepoxide Librium Antianxiety Agent (benzodiazepine) 11/13/2017
Loxitane loxapine Loxitane Antipsychotic Agent (dibenzoxazepine) 07/13/2020
Ludiomil maprotiline Ludiomil Antidepressant 07/13/2020
Lunesta eszopiclone Lunesta Sedative, Hypnotic 06/17/2020
Luvox, Luvox CR fluvoxamine Luvox, Luvox CR Antidepressant 10/30/2019
Lyrica pregabalin Lyrica Anticonvulsant 10/29/2018
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 Central Nervous System Stimulant 05/22/2017
Minipress prazosin Minipress Alpha Adrenergic Blocker 10/29/2018
Moban molindone Moban Antipsychotic Agent (dihydroindolone) 08/20/2020
Namenda, Namenda XR memantine Namenda, Namenda XR Alzheimer's Treatment 04/13/2021
Nardil phenelzine Nardil MAO Inhibitor 06/08/2017
Navane thiothixene Navane Antipsychotic Agent (thioxanthene) 08/20/2020
Neurontin, Gralise gabapentin Neurontin, Gralise Anticonvulsant 04/05/2021
Norpramin desipramine Norpramin Antidepressant (tricyclic) 08/09/2018
Nuedexta dextromethorphan hydrobromide/quinidine sulfate Nuedexta Antipsychotic, Antidepressant, Bipolar, Mood-Stabilizing Agent 03/13/2017
Nuplazid pimavanserin Nuplazid Atypical Antipsychotic 05/20/2020
Orap pimozide Orap Antipsychotic Agent 08/20/2020
Parnate tranylcypromine Parnate MAO Inhibitor 06/08/2017
Paxil, Paxil CR, Pexeva paroxetine Paxil, Paxil CR, Pexeva Antidepressant (SSRI) 12/20/2016
Periactin cyproheptadine Periactin Antihistamine 07/10/2017
Pristiq desvenlafaxine Pristiq Antidepressant 04/16/2021
Prolixin fluphenazine Prolixin Antipsychotic – First Generation (Typical); Phenothiazine Derivative 06/17/2020
Prozac fluoxetine Prozac Antidepressant (SSRI) 06/17/2020
Remeron, Remeron SolTab mirtazapine Remeron, Remeron SolTab Antidepressant 08/25/2020
Restoril temazepam Restoril Sedative, Hypnotic (benzodiazepine) 11/13/2017
ReVia naltrexone ReVia Opioid antagonist 06/08/2017
Rexulti brexpiprazole Rexulti Antipsychotic, Mood-Stabilizing Agent 06/18/2020
Risperdal, Risperdal Consta risperidone Risperdal, Risperdal Consta Antipsychotic, Mood-Stabilizing Agent 04/16/2021
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 Central Nervous System Stimulant 05/22/2017
Rozerem ramelteon Rozerem Sedative, Hypnotic 08/21/2020
Saphris, Secuado asenapine Saphris, Secuado Antipsychotic, Antimanic 06/25/2020
Serax oxazepam Serax Antianxiety Agent (benzodiazepine) 11/13/2017
Seroquel, Seroquel XR quetiapine Seroquel, Seroquel XR Antipsychotic, Mood-Stabilizing Agent 06/25/2020
Serzone nefazodone Serzone Antidepressant 08/25/2020
Sinequan doxepin Sinequan Antidepressant (tricyclic), Antianxiety, Sleep Aid 06/17/2020
Sonata zaleplon Sonata Sedative, Hypnotic 04/16/2021
Stelazine trifluoperazine Stelazine Antipsychotic Agent (phenothiazine) 04/16/2021
Strattera atomoxetine Strattera Central Nervous System Agent 12/22/2017
Suboxone & Suboxone Film Strips buprenorphine and naloxone sublingual tablet & film Suboxone & Suboxone Film Strips Maintenance treatment of opioid dependence 06/08/2017
Symbyax olanzapine + fluoxetine Symbyax Antipsychotic, Antidepressant 08/25/2020
Symmetrel amantadine Symmetrel Antidyskinetic 08/09/2018
Tegretol carbamazepine Tegretol Anticonvulsant, Mood-Stabilizing Agent 08/09/2018
Tenormin atenolol Tenormin Beta-Adrenergic Blocker 12/22/2017
Thorazine chlorpromazine Thorazine Antipsychotic Agent (phenothiazine) 03/30/2018
Tofranil imipramine Tofranil Antidepressant (tricyclic) 05/20/2020
Topamax topiramate Topamax Anticonvulsant, Migraine Headache Prevention 05/28/2021
Tranxene clorazepate Tranxene Antianxiety Agent (benzodiazepine) 11/13/2017
Trilafon perphenazine Trilafon Antipsychotic Agent (phenothiazine) 08/25/2020
Trileptal oxcarbazepine Trileptal Anticonvulsant 06/08/2017
Trintellix vortioxetine Trintellix Antidepressant 12/04/2019
Valium diazepam Valium Antianxiety Agent, Antispastic, Anticonvulsive (benzodiazepine) 11/13/2017
Viibryd vilazodone Viibryd Antidepressant 08/16/2017
Visken pindolol Visken Beta-Adrenergic Blocker 06/08/2017
Vistaril hydroxyzine Vistaril Antihistamine, Sedative, Antianxiety 10/30/2019

Vivitrol, Revia

naltrexone Vivitrol, Revia Opioid Blocker 05/28/2021
Vraylar cariprazine Vraylar Anticonvulsant, Mood-Stabilizing Agent 06/18/2020
Vyvanse lisdexamfetamine Vyvanse Central Nervous System Stimulant 05/28/2021
Wellbutrin, Zyban bupropion Wellbutrin, Zyban Antidepressant 09/07/2017
Xanax alprazolam Xanax Antianxiety Agent (benzodiazepine) 11/13/2017
Zoloft sertraline Zoloft Antidepressant (SSRI) 07/10/2017
Zyprexa; Zyprexa Zydis;
Zyprexa for Injection, Zyprexa Relprevv
olanzapine Zyprexa; Zyprexa Zydis;
Zyprexa for Injection, Zyprexa Relprevv
Antipsychotic, Bipolar Agent 04/16/2021
Last Revised: October 11, 2021