Now · Medications

Medications

13 scheduled · ~23 PRN. Heavy but coherent once foundational history is folded in (AFib + Watchman, Tourette's, mini-stroke) — and a touch lighter after the 6/8 update: Vistaril off, trazodone stopped, losartan added for BP.

Last full reconciliation 2026-06-08 per NP Alyssa (The Recovery Team) — call notes. BP regimen changed after a mid-June ER visit (med-change copy pending) — see Current meds. Baseline: Haven Doctor's Orders PDF, 2026-05-26 (original PDF →).

📍 New: the October 2025 pre-crisis baseline, reconciled against today — corrects what olanzapine and the cardiac block actually are, surfaces a ventricular-arrhythmia history, and reframes the tic story.

💊 New: the CVS pharmacy pull (2026-06-16) — full med → prescriber map (surfaced his Apollo Beach doctors), what's active vs. lapsing vs. removed, and the doses that differ from this list.

At a glance

🫀 Cardiovascular (6 scheduled)

Post-Watchman + post-stroke + CAD + HTN · BP 150–160 (post-ER under-dosing fix)

  • Aspirin 81 mg AM
  • Clopidogrel 75 mg AM
  • Atorvastatin 40 mg HS
  • Metoprolol 50 mg BID
  • Amlodipine 5 mg AM
  • Losartan 25 mg ⭐ new 6/8 — BP trial
  • Clonidine 0.1 mg BID PRN — taper done 5/30

🧠 Psychiatric scheduled (3)

Tourette's · nerve pain + mood

  • Olanzapine 10 mg HS — Tourette's (was: mood)
  • Duloxetine 40 mg BID (80 mg/day) — nerve pain + mood (was: depression; not a tic drug)
  • NAC 300 mg AM — inflammation (was: tics); tics still under-covered per Dad (5/27) — push dose escalation + neuro consult

😴 Sleep stack (4 active)

Lightened 6/8 — consolidation underway

  • Melatonin 5 mg HS — scheduled
  • Olanzapine 10 mg HS
  • Trazodone 50 mg HS PRN — stopped (unused >1 wk)
  • Vistaril 50 mg q6h PRN — discontinued 6/8
  • Valerian 500 mg PRN
  • Passion flower 1500 mg PRN

Two agents down from the 6/8 update — good direction off the fall-risk cocktail.

🧴 GI

Pantoprazole + ~10 PRN agents

  • Pantoprazole 40 mg AM — unchanged (confirmed 6/8)
  • PRN: Mylanta, Pepto, Miralax, Colace, Loperamide
  • PRN: Dicyclomine, Calcium carbonate, Milk of Magnesia
  • PRN: Ondansetron PO + IM

🤕 Pain

Non-opioid path

  • Lidocaine 4% patch nightly PRN — back pain
  • Acetaminophen 500 mg q6h PRN
  • Ibuprofen 200 mg PRN — bleed risk on DAPT, prefer acetaminophen

💊 Supplements

Standard substance-use protocol

  • Multivitamin
  • Thiamine 100 mg AM — Wernicke's prophylaxis
  • Vitamin C 500 mg PRN

Detailed breakdown

Per-drug concerns + monitoring asks live in the legacy detail page, kept for now while we polish the new template.

Full per-drug breakdown →

📋 Open questions for the care team

Priority-ordered, most safety-critical first. Answered items are greyed at the bottom.

  1. Kindling prophylaxis: still no gabapentin (or other anticonvulsant) in the regimen. The load-bearing safety ask given his kindling vulnerability — flagged 4+ sessions. Why not?
  2. A dedicated tic med is sitting unused: Oct 2025 lists haloperidol 0.5 mg "Treat Tourette's" — prescribed but not taken. With Xanax (the de facto tic suppressant) gone and tics now at self-injury (raw tongue), the tic regimen needs to be built intentionally — neuro referral + a modern agent (aripiprazole / VMAT2) + CBIT + botox for the tongue tic.
  3. BP — 150–160 after the mid-June under-dosing fix. Ran 160+ and triggered the crisis; TRT found his BP meds under-dosed, the ER stabilized him, and it's run 150–160 since (still elevated). On amlodipine + metoprolol + losartan. Get the resulting med-change copy. Is duloxetine (raises BP) contributing? Recheck cadence + threshold to escalate?
  4. Amlodipine was halved since Oct 2025: 10 → 5 mg. Did cutting it feed the BP elevation? Revisit alongside the losartan trial.
  5. Ventricular arrhythmia history (Oct 2025 baseline): amiodarone was prescribed for ventricular arrhythmias (stopped over vision problems) — deeper than the AFib we'd documented. Confirm with cardiology; it raises the QT stakes on olanzapine + duloxetine + any tic antipsychotic.
  6. EKG on file? Likely from April ER admission. Confirm + repeat cadence on olanzapine (QT baseline — ties to the arrhythmia history above).
  7. Watchman implant date: determines when DAPT steps down to aspirin alone.
  8. Discontinuation roadmap for olanzapine + duloxetine.
  9. MOUD path: no buprenorphine / naltrexone visible. Long-acting naltrexone (Vivitrol) before IOP.
  10. Bipolar screen given Baker Act + SNRI start.
  11. Quetiapine vs olanzapine trade given the metabolic baseline.
  12. NAC dose escalation: 300 mg/day is sub-research (600–1200 mg BID for tics + craving).
  13. Vascepa (icosapent ethyl) evaluation (high SCD-risk omega + TG 237 + CAD).
  14. Lp(a) — missing from 2025 baseline.
  15. DEXA scan: baseline for the osteoporosis vector.
  16. Sleep stack consolidation roadmap for Phase 2.
  17. Ketamine / Spravato if duloxetine doesn't land within 6–8 weeks.
  18. ADHD + migraine dropped: Quelbree (viloxazine, ADHD) and Nurtec (rimegepant, migraine) were both active Oct 2025 and are gone now. Re-address if symptoms return.
  19. Allergies — verified on file. Aspirin (historical, tolerated post-CABG), epinephrine (not a true allergy), shellfish (anaphylactic, cardiac-arrest history).
  20. GeneSight (CYP2D6) for duloxetine — back. CYP2D6 intermediate → duloxetine runs high (don't escalate; lower or switch — Pristiq bypasses CYP2D6). Also UGT2B15 poor (Ativan/oxazepam accumulate; Xanax/Klonopin gene-clean). Full read →
  21. CYP2C19 PGx for clopidogrel — answered. CYP2C19 ultrarapid (*17/*17) → activates clopidogrel fully, not a non-responder. Share with cardiology. GeneSight →