Representative from medicine chiming in here.
That much ondansetron on top of diphenoxylate, modafinil, and oxybutynin will mean your intestines effectively stop functioning entirely. You'll end up with a pseudo-obstruction faster than you can fucking blink. That's pretty much lethal. Replace with metoclopramide or you'll fucking regret it.
Why are you using famotidine? What clinical purpose does this serve? Use a PPI instead, H2 inhibitors have a bunch of effects you probably don't want. I suggest pantoprazole since it can be administered IV more easily.
Suzetrigine is completely novel. No idea what the fuck it interacts with. Titrate up to ensure you don't fucking kill them.
100mg of pregabalin will interact with the diazepam so badly that they'll probably just fucking die. Again, titrate as needed, but most likely this is a useless drug. Start with 25mg and titrate up.
1mg of kratom is functionally homeopathic. Remove it. Replace with like... a nitrazine or something.
...And maybe add a PRN of naloxone. Just in case.
Nebivolol means at best there's no point adding formotorol as it won't do anything, and at worst the formoterol will fucking kill you via precipitated bronchospasm. Remove one or the other, but don't have both - it's a lose-lose proposition.
Probably add a steroid here. If you're adding a LABA like formoterol then you CANNOT prescribe it independently, LABAs must ALWAYS be prescribed with either an ICS or a LAMA - a LAMA if they have COPD and an ICS if they have asthma.
Oxybutynin isn't a counteraction for spironolactone, they make each other worse. Oxybutynin doesn't prevent diuresis, it just prevents bladder voiding - the diuretic effect still functions but now they're going to go into urinary retention immediately, which might kill them or cause severe renal damage. DO NOT use oxybutynin without a clear clinical indication, it's a dangerous drug in a person like this who's on IV fluids. Just put an indwelling catheter in and drain it out regularly.
Spiro is a good shout here honestly, but I'd suggest switching to cyproterone and then switching diazepam to something like oxazepam (less intense on the liver). Spironolactone messes with potassium too much, given everything else.
Why are you using modafinil? Clinical indication??? Use lisdexamphetamine.
You're going to need so much more sugar than that.
Remove the diphenoxylate, it's going to kill them lol. No clinical purpose - just attach them to a colonic drain tube or a colostomy.
Methylphenidate, I dunno, 2mg is pretty low compared to the other things here. Either replace it with a different stimulant or dump it.
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