Before starting or changing any treatment, it is important that we meet for an office visit. The physician reviews your history, examines you, discusses test results, and explores several treatment alternatives. We use visual aids, including models or pictures of body parts, graphic test results, and written materials about treatment risks and benefits. These visual aids cannot be used over the telephone, nor are you available for examination over the telephone. Testing fees do not cover this office visit, and there is a separate charge. If you prefer, we can provide test reports to you or your physician, who can then discuss them with you and start treatment.

Before using any medicine, be sure to tell us about any changes in your medical problems, allergies to medicines, and other prescriptions. Do not take the medicine if you are pregnant or intend to become pregnant while using this medicine or if you are breast-feeding. Take the medicine only as directed by us, to produce maximum benefit with least side effects. A weekly pill-box is very helpful in ensuring you remember to take medicine daily. Any medicine can cause upset stomach. In that case, take the medicine with food, even for regular bedtime doses. Try to avoid alcohol while taking these medicines. Most of the side effects listed here are mild or uncommon. If you have an allergic rash, wheezing, or any unusual side effects, stop the medicine and call the office.

The possible side effects listed here are selective and do not cover all possible side effects. This information is to help you in making an informed decision to use medicines prescribed here. Your medicine may not be on this list. Please ask questions and seek clarifications before you use any medicines prescribed to you. We will discuss the medicine prescribed with you before giving you a prescription. Remember that you can always stop the medicine if you so choose. Your decision to take the medicine prescribed shows informed consent. Refusal to use the medicine shows an informed refusal after considering the risks of no treatment. If you use these medicines, close medical monitoring is a must, with regular office visits.

Generic medicines work just as well as the brand name for most patients, are a lot less expensive, and we usually allow substitution by a generic.

1 Medicines that decrease histamine activity: They may improve upper airway congestion. Newer medicines are less likely to cause sleepiness, but may cause dry mouth. They may need to be used daily rather than off and on. Examples: loratadine (Claritin), fexofenadine (Allegra).

2 Nasal steroids: They may improve upper airway congestion. They may not help immediately, and need to be taken daily. They may cause irritation in the nose, or even a bloody discharge. Examples: mometasone (Nasonex), fluticasone (Flonase).

3 Medicines that increase brain glutamate activity: These may improve sleep and control restless legs. Possible side effects: drowsiness, dizziness, clumsiness. Example: gabapentin (Neurontin). 

4 Medicines that increase brain dopaminergic activity: These may improve sleepiness and attention. Possible side effects: nervousness, insomnia, decreased appetite, weight loss, nausea, suppression of growth in children, abnormal movements or seizures, depression, irritability, psychosis, dizziness, headache, palpitations, increased blood pressure, or abdominal pain, and rare cases of sudden death. Methylphenidate (Methylin, Concerta) and amphetamines (Adderall, Dexedrine)  have high abuse potential and no refills are allowed. Monthly visits are required unless you have access to a mail order pharmacy for a 90 day supply. Amphetamines may produce brain damage.

5 Medicines that increase brain norepinephrinergic activity: These may improve attention, akertness, snoring and mood. Possible side effects: blurred vision, confusion, fainting, hallucinations, irregular heartbeat, problems in urinating, seizures, skin rash and itching, shakiness, nervousness and agitation, sore throat and fever, constipation, nausea and vomiting, dizziness, drowsiness, insomnia, dry mouth, unpleasant taste, weight gain or loss, headache, changed appetite, tiredness or weakness, decreased libido, impotence, depression. Rare cases of sudden death have been reported. With children, we may perform several ECGs. Examples: imipramine (Tofranil), protriptyline (Vivactil), bupropion (Wellbutrin). Atomoxetine (Strattera) is a selective medicine with fewer side effects (fatigue, decreased appetite, impotence, rare liver damage).

6 Medicines that decrease brain histamine activity: These may improve sleep and mood. Possible side effects: dry mouth, blurred vision, dizziness, drowsiness, difficulty urinating, constipation, weight gain. Examples: doxepin (Sinequan), amitriptyline (Elavil).

7 Medicines that increase brain serotonergic activity (at 5HT1 receptor): These may improve   alertness and mood. Possible side effects: drowsiness, diarrhea, nervousness, tremor, insomnia, delayed ejaculation, difficulty with erection. Examples: fluoxetine (Prozac), citalopram (Celexa).

8 Medicines that decrease brain serotonergic activity (at 5HT2A receptor): These may improve sleep. Possible side effects: dry mouth, blurred vision, drowsiness, dizziness, nausea, difficulty with or prolonged erection. Examples: trazodone (Desyrel), mirtazapine (Remeron).

9 Medicines that increase brain cholinergic activity: These medicines slow down the worsening of memory, reasoning and language in patients with degenerative dementia.  Possible side effects: nausea, vomiting, diarrhea, insomnia, fatigue, muscle cramps, decreased appetite. Example: donepezil (Aricept).

10 Medicines that increase brain wakefulness pathways: These may improve sleepiness and attention. Possible side effects: nervousness, insomnia, nausea, abnormal movements, depression, irritability, dizziness, headache, palpitations, increased blood pressure, or abdominal pain. Example: Modafinil (Provigil).

11 Medicines that stimulate brain dopamine receptors: These may reduce involuntary movements before and in sleep. Possible side effects: involuntary movements, psychosis, confusion, depression, sleepiness, body aches and pains, dizziness, seizures, nausea, palpitations. Examples: pramipexole (Mirapex), ropinirole (Requip).

12 Medicines that increase brain GABA (gamma-amino-butyric-acid) activity: These may control abnormal sleep behavior and seizures, or may improve sleep and attention. Some of them are controlled medicines and may become habit-forming. Possible side effects: blurred vision, clumsiness, dizziness, slurred speech, drowsiness, headache, nausea, psychosis, confusion, depression, agitation, decreased platelet count. Missing doses can precipitate seizures. Examples: clonazepam (Klonopin), lorazepam (Ativan), zolpidem (Ambien), divalproex (Depakote), gabapentin (Neurontin).