Informed Consent for Medications F-24277 Series - Psychotropic Medications

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Medication Brand Name (Word) Medication Generic Name (Word) PDF version Medication Category Last Revise Date
Blank Form Blank Form Blank Form Blank Form 07/01/2015
Blank Spanish Blank Form in Spanish Blank Spanish Blank Spanish 07/01/2015
  guanfacine guanfacine Attention Deficit/Hyperactivity Disorder/ADHD 05/08/2017
  phenobarbital phenobarbital Barbiturate and Barbiturate-Like Anticonvulsants 06/08/2017
  prochlorperazine prochlorperazine Antipsychotic Agent (Phenothiazine) Antiemetic 08/08/2016
  thioridazine thioridazine Antipsychotic Agent (Phenothiazine) 08/08/2016
Abilify, Abilify Maintena, Abilify Discmelt, Aristada aripiprazole Abilify, Abilify Maintena, Abilify Discmelt, Aristada Antipsychotic
Bipolar/Mood Stabilizing Agent
Adderall Adderall XR mixed salts of a single entity amphetamine Adderall Adderall Central Nervous System Stimulant 06/08/2017
Ambien, Ambien CR zolpidem Ambien, Ambien CR Sedative, Hypnotic 8/08/2016
Anafranil clomipramine Anafranil Antidepressant (tricyclic) 11/22/2017
Aricept donepezil Aricept Dementia/Alzheimer's Treatment 10/04/2016
Aristada aripiprazole lauroxil Aristada Atypical Antipsychotic 08/09/2018
Artane tryhexiphenidyl Artane Antidyskinetic 08/08/2016
Atarax hydroxyzine hydrochloride Atarax Antihistamine (sedative, antianxiety) 04/28/2017
Ativan lorazepam Ativan Antianxiety Agent (benzodiazepine) 11/10/2017
Aventyl, Pamelor nortriptyline Aventyl, Pamelor Antidepressant (tricyclic) 08/08/2016
Belsomra suvorexant Belsomra Sedative, Hypnotic 08/09/2018
Benadryl diphenhydramine Benadryl Antihistamine (sedative, antianxiety) 11/22/2016
BuSpar buspirone BuSpar Antianxiety Agent 11/22/2017
Catapres clonidine Catapres Alpha Adrenergic Agonist/Antihypertensive 10/04/2016
Celexa citalopram Celexa Antidepressant (SSRI) 07/10/2017
Clozaril clozapine Clozaril Atypical Antipsychotic Agent 08/09/2018
Cogentin benztropine Cogentin 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 Central Nervous System Stimulant 05/22/2017
Corgard nadolol Corgard Beta-Adrenergic Blocker 12/17/2010
Cylert pemoline Cylert Central Nervous System Stimulant 06/08/2017
Cymbalta duloxetine Cymbalta Antidepressant 08/16/2016
Dalmane flurazepam Dalmane Sedative, Hypnotic (Benzodiazepine) 11/10/2017
Daytrana methylphenidate transdermal Daytrana Central Nervous System Stimulant 06/08/2017
Depakene, Depakote valproic acid Depakene, Depakote Anticonvulsant/Mood Stabilizing Agent 06/08/2017
Depo-Provera medroxyprogesterone acetate Depo-Provera Progestin (for non-contraceptive use) (systemic) 04/28/2017
Desyrel trazodone Desyrel Antidepressant 12/20/2016
Dexedrine dextroamphetamine Dexedrine Central Nervous System Stimulant 04/28/2017
Effexor, Effexor XR venlafaxine Effexor, Effexor XR Antidepressant 04/28/2017
Elavil amitriptyline Elavil Antidepressant (tricyclic) 11/22/2017
Eskalith, Eskalith-CR, Lithobid lithium Eskalith, Eskalith-CR, Lithobid Mood – Stabilizing Agent 12/20/2017
Exelon rivastigimine Exelon Alzheimer Treatment 06/08/2017
Fanapt iloperidone Fanapt Antipsychotic Agent, Atypical 08/16/2016
Focalin, Focalin XR dexmethylphenidate Focalin, Focalin XR Central Nervous System Stimulant 04/28/2017
Gabitril tiagabine Gabitril Anticonvulsant 06/08/2017
Geodon ziprasidone Geodon Antipsychotic /Mood Stabilizing Agent 12/22/2016
Halcion triazolam Halcion Sedative, Hypnotic (benzodiazepine) 11/13/2017
Haldol haloperidol Haldol Antipsychotic Agent (phenothiazine) 12/20/2016
Inderal propranolol Inderal Beta-Adrenergic Blocker 06/08/2017
Invega paliperidone Invega Antipsychotic Agent (benzisoxazole) 12/20/2016
Invega Sustenna paliperidone Invega Sustenna Antipsychotic Agent (benzisoxazole) 8/15/2012
Invega Trinza   Invega Trinza Atypical Antipsychotic 05/09/2016
Klonopin clonazepam Klonopin Antianxiety Agent, Anticonvulsant (Benzodiazepine) 11/13/2017
Lamictal Lamictal, Lamictal XR lamotrigine Lamictal Anticonvulsant - Phenyltriazine 05/22/2017
Latuda lurasidone Latuda Antipsychotic /Mood Stabilizing Agent 02/24/2017
Lexapro escitalopram Lexapro Antidepressant (SSRI) 08/16/2016
Librium chlordiazepoxide Librium Antianxiety Agent (benzodiazepine) 11/13/2017
Loxitane loxapine Loxitane Antipsychotic Agent - dibenzoxazepine 12/20/2016
Ludiomil maprotiline Ludiomil Antidepressant 12/20/2016
Lunesta eszopiclone Lunesta Sedative/Hypnotic 08/16/2016
Luvox, Luvox CR fluvoxamine Luvox, Luvox CR Antidepressant 08/16/2016
Lyrica pregabalin Lyrica 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 Central Nervous System Stimulant 12/17/2010
Minipress prazosin Minipress Alpha Adrenergic Blocker (hypertension, Non-FDA approved use—Dream Disorder—PTSD) 09/01/2014
Moban molindone Moban Antipsychotic Agent—dihydroindolone 12/20/2016
Namenda, Namenda XR memantine Namenda, Namenda XR Alzheimer's Treatment 05/22/2017
Nardil phenelzine Nardil MAO Inhibitor 06/08/2017
Navane thiothixene Navane Antipsychotic Agent—thioxanthene 12/20/2016
Neurontin gabapentin Neurontin Anticonvulsant 05/22/2017
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 09/23/2016
Orap pimozide Orap Antipsychotic Agent 12/20/2016
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 05/08/2017
Prolixin fluphenazine Prolixin Antipsychotic Agent (phenothiazine) 08/16/2016
Prozac fluoxetine Prozac Antidepressant (SSRI) 08/16/2016
Remeron, Remeron SolTab Remeron, Remeron SolTab Antidepressant 12/20/2016
Restoril temazepam Restoril Sedative, Hypnotic (benzodiazepine) 11/13/2017
ReVia naltrexone ReVia Opioid antagonist 06/08/2017
Rexulti brexpiprazole Rexulti Antipsychotic /Mood Stabilizing Agent 02/24/2017
Risperdal, Risperdal Consta risperidone Risperdal, Risperdal Consta 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 Central Nervous System Stimulant 05/22/2017
Rozerem ramalteon Rozerem Sedative-hypnotic 12/20/2016
Saphris asenapine Saphris Antipsychotic / Antimanic 02/24/2017
Serax oxazepam Serax Antianxiety Agent (benzodiazepine) 11/13/2017
Seroquel, Seroquel XR quetiapine Seroquel, Seroquel XR Antipsychotic / Mood Stabilizing Agent 11/22/2016
Serzone nefazodone Serzone Antidepressant 12/20/2016
Sinequan doxepin Sinequan Antidepressant (tricyclic) 08/16/2016
Sonata zaleplon Sonata Sedative / Hypnotic 05/08/2017
Stelazine trifluoperazine Stelazine Antipsychotic Agent (phenothiazine) 05/08/2017
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 12/20/2016
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) 08/16/2016
Topamax topiramate Topamax Anticonvulsant, Migraine Headache Prevention 06/08/2017


chlorazepate Tranxene Antianxiety Agent (benzodiazepine) 11/13/2017
Trilafon perphenazine Trilafon Antipsychotic Agent (phenothiazine) 12/20/2016
Trileptal oxcarbazepine Trileptal Anticonvulsant 06/08/2017
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) 08/08/2016
Vraylar cariprazine Vraylar Anticonvulsant / Mood Stabilizing Agent 02/24/2017
Vyvanse lisdexamfetamine Vyvanse Central Nervous System Stimulant 05/22/2017
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
Zyban, Wellbutrin bupropion Zyban, Wellbutrin Antidepressant 07/01/2015
Zyprexa; Zyprexa Zydis;
Zyprexa for Injection, Zyprexa Relprevv
olanzapine Zyprexa; Zyprexa Zydis;
Zyprexa for Injection, Zyprexa Relprevv
Antipsychotic / Bipolar Agent 02/24/2/017
Last Revised: August 10, 2018