(dye soe PEER a mide)
Life-threatening ventricular arrhythmias (eg, sustained ventricular tachycardia)
Hypersensitivity to disopyramide or any component of the formulation; cardiogenic shock; preexisting second- or third-degree heart block (except in patients with a functioning artificial pacemaker); congenital long QT syndrome; sick sinus syndrome
In the National Heart, Lung, and Blood Institutes Cardiac Arrhythmia Suppression Trial (CAST), a long-term, multicenter, randomized, double-blind study in patients with asymptomatic non-life-threatening ventricular arrhythmias who had an MI more than 6 days but less than 2 years previously, an excessive mortality or nonfatal cardiac arrest rate (7.7%) was seen in patients treated with encainide or flecainide compared with that seen in patients assigned to carefully matched placebo-treated groups (3%). The average duration of treatment with encainide or flecainide in this study was 10 months.
The applicability of the CAST results to other populations (eg, those without recent MI) is uncertain. Considering the known proarrhythmic properties of disopyramide and the lack of evidence of improved survival for any antiarrhythmic drug in patients without life-threatening arrhythmias, the use of disopyramide as well as other antiarrhythmic agents should be reserved for patients with life-threatening ventricular arrhythmias.
Ventricular arrhythmias: Oral: Note: Since newer agents with less toxicity are available, the use of disopyramide for this indication has fallen out of favor. Controlled release formulation not to be used when rapid achievement of disopyramide plasma concentrations is desired. A maximum dose up to 400 mg every 6 hours (immediate release) may be required for patients with severe refractory ventricular tachycardia.
<50 kg:
Immediate release: An initial loading dose of 200 mg may be administered if rapid onset is required. Maintenance dose: 100 mg every 6 hours
Controlled release: Maintenance dose: 200 mg every 12 hours
≥50 kg:
Immediate release: An initial loading dose of 300 mg may be administered if rapid onset is required. Maintenance dose: 150 mg every 6 hours. If rapid control is necessary and no response seen within 6 hours of loading dose, may increase maintenance dose to 200 mg every 6 hours.
Controlled release: Maintenance dose: 300 mg every 12 hours
Atrial fibrillation (maintenance of sinus rhythm) (off-label use; AHA/ACC/HRS [January, 2014]): Oral: Note: May be more desirable for patients with vagally-induced AF or hypertrophic cardiomyopathy associated with dynamic outflow tract obstruction; use in combination with a beta blocker or a non-dihydropyridine calcium channel blocker.
Immediate release: Usual dose: 100 to 200 mg every 6 hours
Controlled release: Usual dose: 200 to 400 mg every 12 hours
Hypertrophic cardiomyopathy (obstructive physiology) with or without atrial fibrillation (off-label use): Oral: Initial: Controlled release: 200 to 250 mg twice daily. If symptoms do not improve, increase by 100 mg/day at 2-week intervals to a maximum daily dose of 600 mg (Gersh, 2011; Sherrid, 2005).
Refer to adult dosing. Dose with caution, starting at the lower end of dosing range.
Arrhythmias: Oral: Immediate release:
<1 year: 10 to 30 mg/kg/24 hours in 4 divided doses
1 to 4 years: 10 to 20 mg/kg/24 hours in 4 divided doses
4 to 12 years: 10 to 15 mg/kg/24 hours in 4 divided doses
12 to 18 years: 6 to 15 mg/kg/24 hours in 4 divided doses
Manufacturers labeling:
Immediate release:
CrCl >40 mL/minute: 100 mg every 6 hours
CrCl 30 to 40 mL/minute: 100 mg every 8 hours
CrCl 15 to 30 mL/minute: 100 mg every 12 hours
CrCl <15 mL/minute: 100 mg every 24 hours
Controlled release:
CrCl >40 mL/minute: 200 mg every 12 hours
CrCl ≤40 mL/minute: Not recommended for use
Alternative recommendations (Aronoff, 2007): Immediate release:
CrCl >50 mL/minute: 100 to 200 mg every 8 hours
CrCl 10 to 50 mL/minute: 100 to 200 mg every 12 to 24 hours
CrCl <10 mL/minute: 100 to 200 mg every 24 to 48 hours
Dialysis: Not dialyzable (0% to 5%) by hemo- or peritoneal methods; supplemental dose is not necessary.
Manufacturers labeling:
Immediate release: 100 mg every 6 hours
Controlled release: 200 mg every 12 hours
Do not break or chew controlled release capsules. Administer around-the-clock rather than 4 times/day (ie, 12-6-12-6, not 9-1-5-9) to promote less variation in peak and trough serum levels. Should be taken on an empty stomach.
Should be taken on an empty stomach.
Store at 25 � �C (77 � �F); excursions permitted to 15 � �C to 30 � �C (59 � �F to 86 � �F).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, Oral:
Norpace: 100 mg, 150 mg
Generic: 100 mg, 150 mg
Capsule Extended Release 12 Hour, Oral:
Norpace CR: 100 mg, 150 mg
A 1 mg/mL oral suspension may be made with a tablet and Simple Syrup, NF. Crush one 100 mg tablet in a mortar and reduce to a fine powder. Add small portions of the vehicle and mix to a uniform paste; mix while adding the vehicle in incremental proportions to almost 100 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add quantity of vehicle sufficient to make 100 mL. Label "shake well " � and "refrigerate " �. Stable for 28 days.
A 10 mg/mL oral suspension may be made with tablets and Simple Syrup, NF. Crush ten 100 mg tablets in a mortar and reduce to a fine powder. Add small portions of the vehicle and mix to a uniform paste; mix while adding the vehicle in incremental proportions to almost 100 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add quantity of vehicle sufficient to make 100 mL. Label "shake well " � and "refrigerate " �. Stable for 28 days.
Nahata MC, Pai VB, and Hipple TF, Pediatric Drug Formulations, 5th ed, Cincinnati, OH: Harvey Whitney Books Co, 2004.AbobotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of AbobotulinumtoxinA. Monitor therapy
Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Monitor therapy
Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination
Amiodarone: May enhance the QTc-prolonging effect of Antiarrhythmic Agents (Class Ia). Amiodarone may increase the serum concentration of Antiarrhythmic Agents (Class Ia). Management: Avoid whenever possible. While considered contraindicated in some places, amiodarone U.S. prescribing information suggests that use could be considered under some circumstances, with careful monitoring. Reduce quinidine or procainamide dose by one third. Avoid combination
Analgesics (Opioid): Anticholinergic Agents may enhance the adverse/toxic effect of Analgesics (Opioid). Specifically, the risk for constipation and urinary retention may be increased with this combination. Monitor therapy
Androgens: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Exceptions: Danazol. Monitor therapy
Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Monitor therapy
Antidiabetic Agents: May enhance the hypoglycemic effect of Hypoglycemia-Associated Agents. Monitor therapy
Aprepitant: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
Beta-Blockers: Disopyramide may enhance the bradycardic effect of Beta-Blockers. Beta-Blockers may enhance the negative inotropic effect of Disopyramide. Exceptions: Levobunolol; Metipranolol. Monitor therapy
Bosentan: May decrease the serum concentration of CYP3A4 Substrates. Monitor therapy
Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Exceptions: Cannabidiol. Monitor therapy
Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Avoid combination
Clarithromycin: May enhance the hypoglycemic effect of Disopyramide. Clarithromycin may enhance the QTc-prolonging effect of Disopyramide. Clarithromycin may increase the serum concentration of Disopyramide. Avoid combination
Conivaptan: May increase the serum concentration of CYP3A4 Substrates. Avoid combination
CYP3A4 Inducers (Moderate): May decrease the serum concentration of CYP3A4 Substrates. Monitor therapy
CYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates. Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Consider therapy modification
CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates. Monitor therapy
CYP3A4 Inhibitors (Strong): May decrease the metabolism of CYP3A4 Substrates. Consider therapy modification
Dabrafenib: May decrease the serum concentration of CYP3A4 Substrates. Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects). Consider therapy modification
Deferasirox: May decrease the serum concentration of CYP3A4 Substrates. Monitor therapy
Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Avoid combination
Enzalutamide: May decrease the serum concentration of CYP3A4 Substrates. Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring. Consider therapy modification
Etravirine: May decrease the serum concentration of Disopyramide. Monitor therapy
Fingolimod: May enhance the arrhythmogenic effect of Antiarrhythmic Agents (Class Ia). Avoid combination
Fosaprepitant: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
Fosphenytoin: Disopyramide may enhance the QTc-prolonging effect of Fosphenytoin. Fosphenytoin may decrease the serum concentration of Disopyramide. Management: Seek alternatives when possible. Monitor patients receiving this combination closely for evidence of QT interval prolongation or changes in cardiac rhythm, as well as for decreased serum concentrations/therapeutic effects of disopyramide. Consider therapy modification
Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates. Avoid combination
Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Monitor therapy
Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Avoid combination
Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Avoid combination
Herbs (Hypoglycemic Properties): May enhance the hypoglycemic effect of Hypoglycemia-Associated Agents. Monitor therapy
Highest Risk QTc-Prolonging Agents: May enhance the QTc-prolonging effect of other Highest Risk QTc-Prolonging Agents. Avoid combination
Hypoglycemia-Associated Agents: May enhance the hypoglycemic effect of other Hypoglycemia-Associated Agents. Monitor therapy
Idelalisib: May increase the serum concentration of CYP3A4 Substrates. Avoid combination
Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination
Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Monitor therapy
Itraconazole: May increase the serum concentration of Disopyramide. Avoid combination
Ivabradine: May enhance the QTc-prolonging effect of Highest Risk QTc-Prolonging Agents. Avoid combination
Ivacaftor: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
Ketoconazole (Systemic): May increase the serum concentration of Disopyramide. Avoid combination
Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Avoid combination
Lidocaine (Systemic): Disopyramide may enhance the arrhythmogenic effect of Lidocaine (Systemic). Disopyramide may increase the serum concentration of Lidocaine (Systemic). Specifically, the unbound/free fraction of lidocaine. Monitor therapy
Lidocaine (Topical): Disopyramide may enhance the arrhythmogenic effect of Lidocaine (Topical). Disopyramide may increase the serum concentration of Lidocaine (Topical). Specifically, the unbound/free fraction of lidocaine. Monitor therapy
Luliconazole: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
Lurasidone: May enhance the QTc-prolonging effect of Disopyramide. Management: Consider alternatives to disopyramide in patients with acute lurasidone overdose. If disopyramide treatment cannot be avoided, monitor for excessive QTc interval prolongation. Consider therapy modification
Macrolide Antibiotics: May enhance the QTc-prolonging effect of Disopyramide. Macrolide Antibiotics may decrease the metabolism of Disopyramide. Exceptions: Azithromycin (Systemic); Fidaxomicin; Roxithromycin; Spiramycin. Avoid combination
MAO Inhibitors: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Monitor therapy
MiFEPRIStone: May enhance the QTc-prolonging effect of Highest Risk QTc-Prolonging Agents. Avoid combination
Mitotane: May decrease the serum concentration of CYP3A4 Substrates. Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane. Consider therapy modification
Moderate Risk QTc-Prolonging Agents: May enhance the QTc-prolonging effect of Highest Risk QTc-Prolonging Agents. Avoid combination
Netupitant: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
OnabotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of OnabotulinumtoxinA. Monitor therapy
Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination
Palbociclib: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
Pegvisomant: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Monitor therapy
PHENobarbital: May decrease the serum concentration of Disopyramide. Monitor therapy
Phenytoin: May decrease the serum concentration of Disopyramide. Monitor therapy
Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Avoid combination
Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Consider therapy modification
Propafenone: May enhance the arrhythmogenic effect of Antiarrhythmic Agents (Class Ia). Management: Concurrent use of propafenone with quinidine, amiodarone, or other class IA or class III antiarrhythmics should be avoided. Treatment with such agents should be withheld for at least 5 half-lives prior to initiation of propafenone. Avoid combination
QTc-Prolonging Agents (Indeterminate Risk and Risk Modifying): May enhance the QTc-prolonging effect of Highest Risk QTc-Prolonging Agents. Management: Avoid such combinations when possible. Use should be accompanied by close monitoring for evidence of QT prolongation or other alterations of cardiac rhythm. Consider therapy modification
Quinolone Antibiotics: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Quinolone Antibiotics may diminish the therapeutic effect of Blood Glucose Lowering Agents. Specifically, if an agent is being used to treat diabetes, loss of blood sugar control may occur with quinolone use. Monitor therapy
Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Monitor therapy
RifAMPin: May decrease the serum concentration of Disopyramide. Monitor therapy
RimabotulinumtoxinB: Anticholinergic Agents may enhance the anticholinergic effect of RimabotulinumtoxinB. Monitor therapy
Salicylates: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Monitor therapy
Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid using drugs with substantial anticholinergic effects in patients receiving secretin whenever possible. If such agents must be used in combination, monitor closely for a diminished response to secretin. Consider therapy modification
Selective Serotonin Reuptake Inhibitors: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Monitor therapy
Siltuximab: May decrease the serum concentration of CYP3A4 Substrates. Monitor therapy
Simeprevir: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
St Johns Wort: May decrease the serum concentration of CYP3A4 Substrates. Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Consider therapy modification
Stiripentol: May increase the serum concentration of CYP3A4 Substrates. Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any CYP3A4 substrate used with stiripentol requires closer monitoring. Consider therapy modification
Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Monitor therapy
Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Avoid combination
Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates. Monitor therapy
Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Monitor therapy
Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination
Verapamil: May enhance the adverse/toxic effect of Disopyramide. Of particular concern is the potential for profound depression of myocardial contractility. Avoid combination
Vinflunine: May enhance the QTc-prolonging effect of Highest Risk QTc-Prolonging Agents. Avoid combination
ECG, blood pressure, urinary retention, CNS anticholinergic effects (confusion, agitation, hallucinations, etc); disopyramide drug level (if available)
Frequency not always defined. The most common adverse effects are related to cholinergic blockade. The most serious adverse effects of disopyramide are hypotension and cardiac failure.
>10%:
Gastrointestinal: Xerostomia (32%), constipation (11%)
Genitourinary: Urinary hesitancy (14% to 23%)
1% to 10%:
Cardiovascular: Cardiac conduction disturbance, cardiac failure, chest pain, edema, hypotension, syncope
Central nervous system: Dizziness, fatigue, headache, malaise, myasthenia, nervousness
Dermatologic: Generalized dermatosis, pruritus, skin rash
Endocrine & metabolic: Hypokalemia, increased serum cholesterol, increased serum triglycerides, weight gain
Gastrointestinal: Abdominal distention, anorexia, bloating, diarrhea, flatulence, nausea, vomiting
Genitourinary: Impotence (1% to 3%), urinary frequency, urinary retention, urinary urgency
Neuromuscular & skeletal: Myalgia
Ophthalmic: Blurred vision, xerophthalmia
Respiratory: Dry throat, dyspnea
<1% (Limited to important or life-threatening): Agranulocytosis, atrioventricular block, cardiac arrhythmia (new or worsened; proarrhythmic effect), cholestatic jaundice, dysuria, gynecomastia, hepatotoxicity, hypoglycemia, increased blood urea nitrogen, increased serum creatinine, increased serum transaminases, insomnia, paresthesia, peripheral neuropathy, psychosis, psychotic reaction, respiratory distress, skin bluster (toxic), systemic lupus erythematosus (rare; generally in patients previously receiving procainamide), thrombocytopenia
Heart failure: Tmax and Cmax are increased.
Concerns related to adverse effects:
- Hypotension: May occur during the initiation of therapy; monitor closely.
- Proarrhythmic effects: Watch for proarrhythmic effects; may cause QTc prolongation and subsequent torsade de pointes; avoid use in patients with diagnosed or suspected congenital long QT syndrome. Monitor and adjust dose to prevent QTc prolongation. Increases in QTc >25% over baseline should result in cessation or reduction in disopyramide dosing. Because of the risk of QTc prolongation and arrhythmias, disopyramide should be initiated within the hospital with cardiac monitoring. In patients with pre-existing cardiovascular disease, the incidence of proarrhythmic effects and mortality may be increased with Class Ia antiarrhythmic agents.
Disease-related concerns:
- Atrial fibrillation/flutter: Appropriate use: In patients with atrial fibrillation or flutter, block the AV node before initiating.
- BPH/urinary retention: Do not use in patients with BPH and/or urinary retention due to significant anticholinergic effects.
- Conduction disturbances: Use with caution in patients with bundle branch block or heart block.
- Electrolyte imbalance: Correct electrolyte disturbances, especially hypokalemia or hypomagnesemia, prior to use and throughout therapy.
- Glaucoma: Do not use in patients with glaucoma due to significant anticholinergic effects.
- Heart failure (HF): Use with caution or avoid in patients with any degree of left ventricular dysfunction or history of HF; may precipitate or exacerbate condition.
- Hepatic impairment: Use with caution in patients with hepatic impairment; reduced dosage recommended.
- Myasthenia gravis: Do not use in patients with myasthenia gravis due to significant anticholinergic effects.
- Renal impairment: Use with caution in renal impairment; reduced dosage recommended. The controlled release form is not recommended for CrCl ≤40 mL/minute.
- Wolff-Parkinson-White syndrome: Use with caution in patients with Wolff-Parkinson-White syndrome.
Concurrent drug therapy issues:
- Drugs with QT prolongation potential: Avoid concurrent use with other drugs known to prolong QTc interval or decrease myocardial contractibility.
Other warnings/precautions:
- CAST trial: [U.S. Boxed Warning]: In the Cardiac Arrhythmia Suppression Trial (CAST), recent (>6 days but <2 years ago) myocardial infarction patients with asymptomatic, non-life-threatening ventricular arrhythmias did not benefit and may have been harmed by attempts to suppress the arrhythmia with flecainide or encainide. An increased mortality or nonfatal cardiac arrest rate (7.7%) was seen in the active treatment group compared with patients in the placebo group (3%). The applicability of the CAST results to other populations is unknown. Antiarrhythmic agents should be reserved for patients with life-threatening ventricular arrhythmias.
C
Adverse events have been observed in animal reproduction studies. Disopyramide levels have been reported in human fetal blood. Disopyramide may stimulate contractions in pregnant women. In a case report, disopyramide use in the third trimester resulted in painful uterine contractions after the first dose and hemorrhage after the second dose (Abbi, 1999).
Class Ia antiarrhythmic: Decreases myocardial excitability and conduction velocity; reduces disparity in refractory between normal and infarcted myocardium; possesses anticholinergic, peripheral vasoconstrictive, and negative inotropic effects
60% to 83%
Vd: Children: 1 L/kg; Adults: 0.8-2 L/kg
Hepatic; N-dealkylation to the active metabolite N-despropyldisopyramide (or mono-N-dealkylated [MND] metabolite) and other inactive metabolites
Urine (~50% as unchanged drug; ~20% as MND; 10% other metabolites); feces (10% to 15%)
Clearance: Children: 3.76 mL/minute/kg (greater than adults)
0.5-3.5 hours
Serum: Immediate release: Within 2 hours; Controlled release: 4-7 hours
Immediate release: 1.5-8.5 hours
Children: 3.15 hours; Adults: 4-10 hours (prolonged with heart failure and hepatic or renal impairment)
Concentration dependent: 20% to 60%
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience headache, constipation, dry mouth, nasal dryness, dry eyes, loss of strength and energy, bloating, flatulence, nausea, or muscle weakness. Have patient report immediately to prescriber angina, bradycardia, tachycardia, arrhythmia, severe dizziness, passing out, shortness of breath, excessive weight gain, swelling of arm or leg, blurred vision, or difficult urination (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.