Gagandeep Singh, M.D., LLC – Medication History Form

If you have ever taken any of the following medications, please indicate the dates, dosage, and how helpful they were. Your best approximation of dates and dosage is helpful, even if you are unsure.

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Antidepressants

Prozac (fluoxetine)

Zoloft (sertraline)

Luvox (fluvoxamine)

Paxil (paroxetine)

Celexa (citalopram)

Lexapro (escitalopram)

Effexor (venlafaxine)

Cymbalta (duloxetine)

Pristiq (desvenlafaxine)

Wellbutrin (bupropion)

Desyrel (trazodone)

Remeron (mirtazapine)

Serzone (nefazodone)

Anafranil (clomipramine)

Pamelor (nortrptyline)

Tofranil (imipramine)

Elavil (amitriptyline)

Vivactil (protriptyline)

Sinequan (doxepin)

Surmontil (trimipramine)

Norpramin (desipramine)

Asendin (amoxapine)

Nardil (phenelzine)

Parnate (trancylpromine)

Antipsychotics (used for a variety of reasons, including mood stabilization and impulsivity/aggression)

Risperdal (risperidone)

Invega (paliperidone)

Seroquel (quetiapine)

Zyprexa (olanzapine)

Geodon (ziprasidone)

Abilify (aripiprazole)

Clozaril (clozapine)

Haldol (haloperidol)

Thorazine (chlorpromazine)

Prolixin (fluphenazine)

Trilafon (perphenazine)

Stelazine (trifluoperazine)

Mellaril (thioridazine)

Serentil (mesoridazine)

Navane (thiotixene)

Loxatine (loxapine)

Moban (molindone)

Sleep Medications:

Lunesta (eszopiclone)

Ambien (zolpidem)

Sonata (zaleplon)

Anxiety Medications

Xanax (alprazolam)

Ativan (lorazepam)

Restoril (temazepam)

Klonopin (clonazepam)

Valium (diazepam)

Serax (oxazepam)

Buspar (buspirone)

Librium (chlordiazepoxide)

Atarax/Vistaril (hydroxyzine)

Mood Stabilizers:

Lithium Carbonate

Depakote (valproate)

Depakene (valproate)

Tegretol (carbamazepine)

Trileptal (oxcarbazepine)

Lamictal (lamotrigine)

Topamax (topiramate)

Neurontin (gabapentin)

ADHD Medications

Strattera (atomoxetine)

Vyvanse (lisdexamfetamine)

Adderall/XR (amphetamine)

Concerta (methylphenidate)

Methylin (methylphenidate)

Dexosyn (methamphetamine)

Ritalin/SR/LA (methylphenidate)

Metadate ER/CD (methylphenidate)

Daytrana Patch (methylphenidate)

Focalin/XR (desmethylphenidate)

Dexedrine (dextroamphetamine)

Dextrostat (dextroamphetamine)

Other (s)

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