Many drugs used to treat neurologic conditions come with black box warnings. This type of labeling is required by the US Food and Drug Administration when a medication could cause illness or injury that may result in hospitalization or death. Many neurologists consider these warnings a communication tool that ensures that doctors and patients have a better understanding of the risks and benefits of a drug. Here, we list the drugs and the conditions for which they are prescribed and their side effects.
Epilepsy
Carbamazepine (Tegretol)
- Serious Side Effect: Life-threatening allergic reactions, aplastic anemia, agranulocytosis
Clobazam (Onfi)
- Serious Side Effect: Slowed breathing, addiction, overdose, death
Felbamate (Felbatol)
- Serious Side Effect: Aplastic anemia
Lamotrigine (Lamictal)
- Serious Side Effect: Life-threatening rash
Perampanel (Fycompa)
- Serious Side Effect: Psychiatric and behavioral problems
Phenytoin (Dilantin)
- Serious Side Effect: Low blood pressure and irregular heartbeats; cardiovascular risk
Topiramate (Topamax)
- Serious Side Effect: Increases the risk of suicidal thoughts
Valproate (Depakote)
- Serious Side Effect: Birth defects in pregnant women, pancreatitis, liver damage
Vigabatrin (Sabril)
- Serious Side Effect: Permanent vision damage
Migraine
Acetaminophen (Tylenol)
- Serious Side Effect: Skin reactions, liver injury
Amitriptyline (Elavil)
- Serious Side Effect: Increases the risk of suicidal thoughts
Angiotensin-receptor blockers
- Serious Side Effect: Pregnancy
Dihydroergotamine (DHE, Migranol)
- Serious Side Effect: Stroke
Diphenhydramine (Benadryl)
- Serious Side Effect: Heart problems, seizures, coma, death
Droperidol (Inapsine)
- Serious Side Effect: Cardiac arrest
Magnesium intravenously
- Serious Side Effect: Breathing difficulties
Non-steroidal anti-inflammatory drugs (Advil, Alleve, Bayer)
- Serious Side Effect: Cardiac events; can affect amniotic fluid during pregnancy
Onabotulinumtoxin A (Botox)
- Serious Side Effect: Problems swallowing, speaking or breathing; spread of toxin effects
Oral contraceptive pills
- Serious Side Effect: Stroke risk in women over 35
Topiramate (Topamax)
- Serious Side Effect: Increases risk of suicidal thoughts
Triptans
- Serious Side Effect: Increases risk of stroke
Multiple Sclerosis
Alemtuzumab (Lemtrada)
- Serious Side Effect: Autoimmune problems, infusion reactions, tears in artery walls, stroke, certain cancers, a rare brain infection called progressive multifocal leukoencephalopathy (PML), bleeding disorders, serious infections, inflammation of the liver
Cladribine (Mavenclad)
- Serious Side Effect: Cancer, birth defects
Methotrexate (Trexall)
- Serious Side Effect: Liver and lung problems, lymphoma, harming or ending a pregnancy, tumor lysis syndrome (cancer cells die and are released into the bloodstream)
Natalizumab (Tysabri)
- Serious Side Effect: PML
Rituxan (Truxima)
- Serious Side Effect: Fatal infusion-related reactions, severe mucocutaneous reactions, hepatitis b virus reactivation, and PML
Teriflunomide (Aubagio)
- Serious Side Effect: Severe liver injury
Neuromyelitis Optica, Myasthenia Gravis
Azathioprine (Imuran)
- Serious Side Effect: Cancer
Psychiatric Problems Related to Dementia and Other Neurologic Disorders
Quetiapine (Seroquel)
- Serious Side Effect: Increased mortality in older patients with dementia-related psychosis, suicidal thoughts and behaviors
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