Active Medications
Sources
Active Medications
[!danger] Major Documentation Gap Discovered (2026-05-04)
A handwritten prescription dated 2026-05-04 revealed 11 medications, of which 9 were previously undocumented in the wiki. This represents a critical medication reconciliation failure. No prescription PDFs had been ingested prior to this discovery.Previously undocumented medications:
- Insulin degludec (Tresiba) — basal insulin for diabetes
- Insulin glargine (Glin) — basal insulin for diabetes (DUAL basal insulin regimen — unusual)
- Linagliptin (Tradjenta) — DPP-4 inhibitor for diabetes
- Metformin (Glulucamio) — biguanide for diabetes
- Losartan (Lo) — ARB for hypertension / diabetic nephropathy
- Nifedipine — calcium channel blocker for hypertension
- Atorvastatin (Evitof) — statin for dyslipidemia (HIGH-RISK CYP3A4 interaction with posaconazole)
- Pregabalin (Pregaserve) — for neuropathic pain (presumed diabetic neuropathy, but no symptoms documented)
- Cholecalciferol (Dase) — vitamin D3 supplementation
- Serratiopeptidase (Macozac) — anti-inflammatory (indication unclear)
- Prednisolone (Predniod) — 15-day steroid course (indication unknown, HIGH diabetes risk)Critical safety concerns:
1. Posaconazole-atorvastatin interaction (CYP3A4) — 3–5× increased atorvastatin levels, rhabdomyolysis risk
2. Posaconazole-nifedipine interaction (CYP3A4) — 2–3× increased nifedipine levels, hypotension/edema risk
3. ~~Dual basal insulin regimen (degludec + glargine) — unusual, clarify which is active~~ RESOLVED 2026-05-06 — patient NOT taking glargine; Tresiba (degludec) is the only active basal insulin
4. ~~Prednisolone in diabetes — will worsen already-poor glucose control (fructosamine 310)~~ RESOLVED 2026-05-06 — patient NOT taking prednisolone
5. ~~Prednisolone in AML — infection risk during neutropenic periods~~ RESOLVED 2026-05-06 — patient NOT taking prednisolone
6. Pregabalin fall risk — age 81, dizziness/ataxia side effects
7. No BP monitoring documented — on 2 antihypertensives (losartan, nifedipine)
AML Chemotherapy + Supportive Care
| Medication | Dose | Route | Frequency | Indication | Prescriber |
|---|---|---|---|---|---|
| Azacitidine | Unknown | IV (confirmed Apr 2026) | 5 days per cycle (since at least Cycle 2, Jan 2026) | Aml | Bijay Prabhakaran Nair |
| Venetoclax | Reduced (posaconazole interaction) | Oral | Variable: 10 days (Cycle 2) → 5 days (Cycle 4+) | Aml | Ashwin V Nair |
| Acyclovir | Unknown | Oral | Unknown | Antiviral prophylaxis (Aml) | Bijay Prabhakaran Nair |
| Posaconazole | Unknown | Oral | Unknown | Antifungal prophylaxis (Aml) — also enables VEN dose reduction | Bijay Prabhakaran Nair |
| Renerve | 1 tablet | Oral | Once daily | Neuroprotection / B-vitamin complex (B12, B6, ALA, Folate) — confirmed by 2 clinic notes (Apr 29) | Unknown |
Diabetes Medications (Newly Documented 2026-05-04)
| Medication | Dose | Route | Frequency | Indication | Prescriber |
|---|---|---|---|---|---|
| Insulin Degludec (Tresiba) | 10 units | Subcutaneous | Once daily | Diabetes Mellitus — basal insulin | Unknown |
| Linagliptin (Tradjenta) | 5 mg | Oral | Once daily (morning, 1-0-0) | Diabetes Mellitus — DPP-4 inhibitor | Unknown |
| Metformin (Glulucamio) | 500 mg | Oral | Three times daily (1-1-1) | Diabetes Mellitus — biguanide | Unknown |
[!success] Dual Basal Insulin Question — RESOLVED (2026-05-06)
Clinic note 2026-05-06 confirms patient is NOT taking insulin glargine (Glin). Active basal insulin = Tresiba (degludec) only. Insulin glargine moved to Discontinued. See Insulin Glargine.
Cardiovascular Medications (Newly Documented 2026-05-04)
| Medication | Dose | Route | Frequency | Indication | Prescriber |
|---|---|---|---|---|---|
| Losartan (Lo) | 50 mg | Oral | Once daily (afternoon, 0-1-0) | Hypertension / diabetic nephropathy protection (presumed) | Unknown |
[!info] Nifedipine — NOT BEING TAKEN (Confirmed 2026-05-06)
Clinic note 2026-05-06 confirms patient is not taking nifedipine. Moved to discontinued. The posaconazole-nifedipine CYP3A4 interaction is therefore no longer active.[!info] Atorvastatin — NOT BEING TAKEN (Confirmed 2026-05-06)
Clinic note raw/clinic-notes/20260506_154838_note.md confirms patient is not taking atorvastatin. Moved to discontinued. The posaconazole-atorvastatin CYP3A4 interaction is therefore no longer active.Clinical gap: No statin currently active. Cardiovascular risk in diabetes warrants statin therapy. If a statin is to be restarted while on posaconazole, consider pravastatin or rosuvastatin (non-CYP3A4 metabolized — avoids interaction).
[!info] Posaconazole Drug Interactions — BOTH PREVIOUSLY FLAGGED INTERACTIONS NOW RESOLVED
- ~~Atorvastatin:~~ RESOLVED — patient not taking atorvastatin (confirmed 2026-05-06).
- ~~Nifedipine:~~ RESOLVED — patient not taking nifedipine (confirmed 2026-05-06).Remaining active posaconazole interaction: Venetoclax (intentional boosting strategy — dose already reduced accordingly).
Neuropathic Pain / Neurological (Newly Documented 2026-05-04)
| Medication | Dose | Route | Frequency | Indication | Prescriber |
|---|---|---|---|---|---|
| Pregabalin (Pregaserve) | 75 mg | Oral | Once daily (morning, 1-0-0) | Neuropathic pain — presumed diabetic neuropathy (NO symptoms documented) | Unknown |
- Age 81: High fall risk (dizziness, ataxia, somnolence side effects)
- 75 mg once daily is below minimum effective dose for diabetic neuropathy (standard: 150–600 mg/day in divided doses)
- No documented neuropathic pain symptoms, neurological exam, or neuropathy screening
Supplements (Newly Documented 2026-05-04; Mg dose confirmed 2026-05-06)
| Medication | Dose | Route | Frequency | Indication | Prescriber |
|---|---|---|---|---|---|
| Cholecalciferol (Vitamin D3, Dase) | 2000 IU | Oral | Once daily (morning, 1-0-0) | Vitamin D supplementation / deficiency prevention | Unknown |
| Serratiopeptidase (Macozac) | 100 mg | Oral | Unknown | Anti-inflammatory (indication unclear) | Unknown |
| Magnesium (oral supplement) | 400 mg | Oral | Three times daily (TID) — 1200 mg/day total | Magnesium — hypomagnesemia (chemo-related Mg wasting) — Mg normalized to 1.6 on this regimen | Unknown |
Discontinued
| Medication | Reason | Date Discontinued |
|---|---|---|
| Pegfilgrastim (Neulasta) | Significant bone pain — adverse reaction | 2026-03-30 |
| Magnesium (oral supplement) | REINSTATED 2026-05-06 — dose now documented: 400 mg TID. Moved back to active Supplements. Mg normalized to 1.6 mg/dL (May 4). Originally lapsed ~2026-04-06. | ~2026-04-06 (lapse); resumed by 2026-05-06 |
| Nifedipine 30 mg b.i.d. | Patient non-adherence — not taking (confirmed clinic note 2026-05-06) | 2026-05-06 |
| Atorvastatin (Evitof) | Patient non-adherence — not taking (confirmed clinic note 2026-05-06) | 2026-05-06 |
| Insulin Glargine (Glin) 10 units | Patient non-adherence — not taking (confirmed clinic note 2026-05-06) | 2026-05-06 |
| Prednisolone (Predniod) | Patient non-adherence — not taking (confirmed clinic note 2026-05-06) | 2026-05-06 |
| Simvastatin (generic) 10 mg bedtime | Replaced by atorvastatin — statin upgrade | Between 2022–2026 (date unknown) |
| Menorease (herbal menopausal supplement) | Unknown | Between 2022–2026 (date unknown) |
| Vitamin E / Evitol 400 mg | Unknown — antioxidant role may overlap with Renerve | Between 2022–2026 (date unknown) |
| Pregmerve (multivitamin/folate) | Likely replaced by Renerve (more targeted B-vitamin complex) | Between 2022–2026 (date unknown) |
Clinical Notes
[!info] Last chemo cycle: 2026-04-06 to 2026-04-13 (Cycle 4+). AZA 5 days + VEN 5 days. Schedule evolution: AZA has been 5 days since at least Cycle 2 (Jan 19). VEN reduced from 10 days (Cycle 2) to 5 days (Cycle 4+). Patient is currently in post-chemo inter-cycle period.
[!info] Posaconazole–Venetoclax interaction: Posaconazole (strong CYP3A4 inhibitor) requires venetoclax dose reduction to 50–100 mg (from standard 400 mg). This pharmacokinetic interaction is intentionally used in India as a cost-reduction strategy. See Posaconazole and Venetoclax.
[!success] Oral magnesium supplement ACTIVE at 400 mg TID (1200 mg/day) — confirmed 2026-05-06. Dose now documented for the first time. Supplement lapsed ~2026-04-06 (supply ran out); Mg dropped to nadir 1.2 mg/dL (Apr 20). Supplement was resumed and with 400 mg TID, Mg normalized to 1.6 mg/dL (May 4, first normal). 400 mg TID is the maximum recommended oral dose. See Magnesium Oral and Magnesium.
Medication Reconciliation Summary (2026-05-06)
Total active medications: 13 (nifedipine removed 2026-05-06a, atorvastatin removed 2026-05-06b, insulin glargine removed 2026-05-06c, prednisolone removed 2026-05-06d; magnesium-oral reinstated 2026-05-06e with dose 400 mg TID)
By category:
- AML chemotherapy + supportive care: 5
- Diabetes medications: 3 (insulin degludec, linagliptin, metformin — insulin glargine confirmed not taken)
- Cardiovascular medications: 1 (losartan only — nifedipine and atorvastatin both confirmed not taken)
- Neuropathic pain: 1
- Supplements: 3 (cholecalciferol, serratiopeptidase, magnesium oral 400 mg TID — dose now documented)
- Short-course steroids: 0 (prednisolone confirmed not being taken — moved to discontinued)
Documentation sources:
- Handwritten prescription 2026-05-04: 11 medications
- Clinic notes Apr 29: Renerve (1 medication)
- AML treatment context: Azacitidine, venetoclax, acyclovir, posaconazole (4 medications)
Polypharmacy alert: 13 active medications in an 81-year-old patient. Fall risk, drug interactions, and adherence challenges are significant concerns.
Adherence pattern: Four medications on written prescription confirmed NOT being taken (nifedipine, atorvastatin, insulin glargine, prednisolone). Prescriber notification warranted. Adherence to all other prescribed medications is unconfirmed.
Last updated: 2026-05-06 — magnesium oral supplement reinstated to active (status: discontinued → active); dose documented for the first time: 400 mg TID (1200 mg/day) per clinic note 20260506_155027_note.md. Active medication count: 12 → 13.