Medications We Frequently See in Workers’ Comp Physician Reports

  By Robert G. Rassp, Esq.

The following chart lists the brand or common and chemical names of drugs we regularly see in our cases embedded in medical-legal reports, treating physician reports and subpoenaed medical records. Some physicians randomly use the brand names, and others use the chemical name, causing us mortals much frustration in determining exactly what drugs an injured worker is taking for what conditions. The information here can assist counsel in determining during a deposition of an injured worker or of a physician exactly what medication is person is taking and for what medical condition.

Some trends emerge when you see these medications. For example, drugs that are designated as an NSAID means that they are non-steroidal anti-inflammatory drugs, of which aspirin, naproxen and ibuprofen are commonly known. In virtually all NSAID drugs, FDA required warnings include heart attack, stroke, elevated blood pressure, kidney or liver toxicity and gastro-intestinal bleeding for long term use of these drugs.

Also, medications designated ending in “-am” or “-pam” are generally benzodiazepines, which are anti-anxiety drugs called anxiolytics or “tranquilizers”. We know them better as Valium®, Xanax® and others. These drugs are highly addictive, and counsel is warned about injured workers who are taking this class of drugs on a long-term basis. In fact, CMS (the Centers for Medicare and Medicaid Services) does not allow benzodiazepines to be included in Workers’ Compensation Medicare Set-Aside (WCMSA) arrangements at all because of dependency and addiction.

The same is true for sleep medications such as Ambien and Lunesta, which seem to be the sleeping pills “de jure” as of late. Most physicians should only prescribe a 10- to 15-day supply of these sedative drugs because of dependency that develops quickly for patients who rely on them for sleep disorders. Ambien, Lunesta and drugs like them are great for acute pain, acute depression or shock, such as a death of a loved one, but dependency and addiction are quick to follow. There also is increased risk of sleep walking for patients who are on these hypnotic drugs.

We have included the medications for hypertension, regardless of its class as a beta blocker, ACE inhibitor, angiotensin II receptor blocker, diuretic, or calcium channel blocker. All of these classes of drugs have various side effects including dizziness, chronic cough, loss of libido and frequent urination. The determination of which of these classes of drugs to prescribe depends upon the type of hypertension that is diagnosed, how bad it is and whether or not the heart is involved as well with its own problems.

Also included are the opiate based pain reducers, also called “opioid analgesics,” which are commonly seen in our cases, under a combination of the chemical and brand names. The number, names and types of opiate based narcotics are mind boggling, and it is no surprise that it is not unusual for injured workers to be on many of these drugs at the same time. For example, it is not unusual for an injured worker who has a chronic pain syndrome to be on a fentanyl patch at the same time as he or she is taking oral opiate based medications, such as Vicodin®. If you want to check out a drug that is not listed here, go to drugs.com and pay attention to the FDA references at the website.

We also included diabetes medications so that you can tell if someone is a diabetic, simply based on their intake of medication. So if you see in a medical record that someone is taking Glucophage (metformin), you can be sure that person has definitely been diagnosed as a diabetic. This is because there is no such thing as a preventative diabetic medication.

There are also drugs called “neuroleptics”, which were originally formulated as anti-seizure medications. Recent ones include gabapentin, also known as Neurontin® and pregabalin, also known as Lyrica®. These drugs, though originally formulated for use as anti-convulsive medications, also reduced nerve-based pain (burning type pain) and are now widely used for medical conditions that are thought to be neurogenic such as fibromyalgia, diabetic polyneuropathies and other chronic pain syndromes.

We are not including vitamins and dietary supplements even though some have known powerful effects and perhaps should be regulated as a drug. St. John’s Wort is a known anti-depressant, for example, but it can be purchased in any “health foods” section of a grocery store over the counter. In fact, some prescription anti-depressants warn users of those drugs not to take any dietary supplements with the drug. Some interesting research is emerging now on Omega 3 fish oil. Recent studies have shown that in moderate quantities, Omega 3 fish oil reduces aggression and hostility and also has cardio-protective properties.

Drugs change every year, and new ones emerge all the time as reformulated versions of earlier drugs. This is because of funky patent laws for the formulations of drugs, which last only seven years. A change in the isomer of a drug can buy a drug company additional time for a patent, for example.

Generic drugs are supposed to have the same bio-activity as the brand name but some do not, especially psychotropic and heart medications. This is because of filler products that generic manufacturers use as part of a medication. Sometimes, for example, the coating of a generic drug dissolves at a different rate than the brand named drug, causing a difference in bio-availability of the active ingredient.

BRAND NAME

CHEMICAL NAME

GENERAL USE

Proventil, Ventolin

albuterol

asthma, RADS

Xanax

alprazolam

anti-anxiety (anxiolytic)

Elavil, Endep

amitriptyline

tricyclic antidepressant

Norvasc

amlodipine

blood pressure med

Abilify

aripripazole

antidepressant

Tenormin

atenolol

blood pressure med

Lipitor

atorvastatin

cholesterol reducer

Lotensin

benazepril

blood pressure med

Wellbutrin, Zyban

bupropion

antidepressant, anti-smoking

Buspar

buspirone

anti-anxiety (not a benzo)

Ativan

carazapam

anti-anxiety (anxiolytic)

Tegretol

carbamazepine

anti-seizure, nerve pain

Soma

carisoprodol

pain reducer

Celebrex

celecoxib

anti-inflammatory

Keflex

cephalexin

antibiotic

Librium

chlordiazepoxide

antipsychotic (bipolar disorder)

Thorazine

chlorpromazine

amphetamine

Tagamet

cimetidine

anti-ulcer, GERD

Cipro, Ciloxan

ciprofloxacin

antibiotic

Klonopin

clonozepam

anti anxiety (anxiolytic)

Plavix

clopidogel

anti-coagulent

Flexeril

cyclobenzaprine

muscle relaxant

Valium

diazepam

anti anxiety (anxiolitic)

Cataflam, Voltaren

diclofenac

pain reliever

Dolobid

diflunisal

anti-inflammatory

Cardizem, Cartia, Dilacor

diltiazem

heart

Benylin DM, Dexalone

dextromethorphan

cough suppressant, sleep

Benadryl, Nytol

diphenhydramine

anti-histamine, sleep

Depakote

divalproex

anti-seizure

Aricep

donepezil

anti-dementia -Alzheimers

Sinequan, Zonalon

doxepin

anti-depression, anxiety

Cymbalta

duloxetine

anti-depressant, pain

Vasotec

enalapril

blood pressure, heart

Lovenox

enoxaparin

blood thinner for DVT

Lexapro

escitalopram

anti-depressant

Nexium

esomeprazole

anti-ulcer, GERD

Lunesta

eszopiclone

sedative (hypnotic) sleep

Lodine

etodolac

NSAID

Pepcid

famotidine

anti-ulcer, GERD

Actiq, Duragesic, Sublimaze

fentanyl

opiate pain reducer

Allegra

fexofenadine

anti-allergy

Prozac, Sarafem

fluoxetine

anti-depressant (SSRI)

Dalmane

flurazepam

anti-anxiety (anxiolytic)

Ansaid, Ocufen

flurbiprofen

NSAID

Luvox

fluvoxamine

anti-depressant (SSRI)

Monopril

fosinopril

blood pressure

Lasix

furosemide

heart

Neurontin

gabapentin

anti-seizure, nerve pain

Glucotrol

glipizide

diabetes (oral med)

Diabeta, Glynase, Micronase

glyburide

diabetes (oral med)

Robitussin

guaifenesin

cough, fibromyalgia

Haldol

haloperidol

anti-psychotic (schiz)

Hydrodiuril, Esidrix

hydrochlorothiaz

ide“HCTZ” blood pressure med

Dilaudid, Opana

hydromorphone

opiate pain reducer

Plaquenil

hydroxychloroqui

neconnective tissue diseases

Vistaril

hydroxyzine

antihistamine, depression

Advil, Motrin, Nuprin

ibuprofen

NSAID

Tofranil

imipramine

anti-psychotic

Indocin

indomethacin

blood thinner

Humulin, Novolin

insulin

diabetes

Novolog, Lantus, Humalog

insulin

diabetes

Accutane

isotretinoin

vitamin A, acne treatment

Orudis, Oruvail

ketoprofen

NSAID

Toradol

ketorolac

opiate pain reliever

Prevacid

lansoprazole

anti ulcer, GERD

Keppra

levetiracetam

anti-seizure

Xylocaine

lidocaine

numbing agent

Zestril, Prinivil

lisinopril

blood pressure

Alavert, Claritin

loratadine

allergy

Ativan

lorazepam

anti-anxiety (anxiolytic)

Cozaar

losartan

heart/blood pressure

Provera

medroxyprogesterone

hormone replacement

Mobic

meloxicam

anti inflammatory

Demerol

meperidine

opiate pain reducer

Glucophage

metformin

diabetes (oral med)

Dolophine

methadone

opiate pain/opiate antagonist

Robaxin

methocarbamol

muscle relaxant

Rheumatrex

methotrexate

rheumatoid arthritis

Ritalin, Concerta

methylphenidate

amphetamine for ADHD

Medrol

methylprednisone

steriodal anti-inflam

Lopressor, Toprol

metoprolol

blood pressure

Remeron

mirtazapine

teracyclic anti-depression

Provigil

modafinil

stimulant to stay awake

Singulair

montelukast

anti-allergy

MS Contin

morphine

opiate pain reducer

Avelox

moxifloxacin

antibiotic

Relafen

nabumetone

NSAID

Narcan

naloxone

opiate antagonist (used for drug overdoses)

Aleve, Naprosyn

naproxen

NSAID

Procaria, Adalat

nifedipine

heart/blood pressure

Zyprexa

olanzapine

anti-psychotic (all kinds)

Prilosec

omeprazole

anti-ulcer/GERD

Zofran

ondonsetron

anti nausea

Tamiflu

oseltamivir

anti flu virus

Daypro

oxaprozin

NSAID

Serax

oxazepam

anti-anxiety (anxiolytic)

Oxycontin, Oxyir

oxycodone

opiate pain reducer

Paxil

paroxetine

anti-depressant (SSRI)

Dilantin

phenytoin

anti-seizure

Actos

pioglitazone

diabetic (oral)

Feldine

piroxicam

NSAID

Pravachol

pravastatin

cholesterol reducer

Minipress

prazosin

blood pressure

Deltasone

prednisone

steroid anti-inflammatory

Lyrica

pregabalin

anti-seizure, neuro pain

Darvon, Dolene

propoxyphene

opiate pain reducer

Darvocet

propoxyphine

same as Darvon with Tylenol

Inderal

propranolol

blood thinner

Seroquil

quetiapine

antipsychotic (schizo)

Accupril

quinapril

blood pressure

Cardioquin

quinidine

heart arrhythmia

Zantac

ranitidine

anti acid, GERD

Risperdal

risperidone

anti psychotic (schizo)

Avandia

rosiglitazone

diabetes

Serevent

salmeterol

asthma

Advair

sameterol with fluticaso

neasthma

Zoloft

setraline

anti-depressant (SSRI)

Viagra

sildenafil

erectile dysfunction

Zocor

simvastatin

cholesterol reducer

Clinoril

sulindac

NSAID

Imitrex

sumatriptan

migraine headaches

Prograf

tacrolimus

anti rejection med

Restoril

temazapam

anti-anxiety (anxiolytic)

Topamax

topiramate

migraine headaches, seizures

Ultram

tramadol

pain med (not opiate)

Desyrel

trazodone

sleeping aid, anti-depress

Halcion

triazolam

hypnotic, anti-anxiety

Diovan

valsartan

blood pressure

Levitra

vardenafil

erectile dysfuntion

Effexor

venlafaxine

anti-depressant

Coumadin

warfarin

blood thinner

Ambien

zolpidem

sedative (hypnotic) for sleep

© Copyright 2011 LexisNexis. All rights reserved. This article was excerpted from The Lawyer’s Guide to the AMA Guides and California Workers’ Compensation, by Robert G. Rassp, Esq.
Editor's Note: The new 2012 Edition of The Lawyer's Guide to the AMA Guides and California Workers' Compensation will be on sale in January 2012.