{
  "version": "1.0.0",
  "source": {
    "title": "Heat and Medications: Guidance for Clinicians (CDC)",
    "url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
    "page_date": "Sept. 18, 2025",
    "checked_on": "2026-09-30",
    "checked_note": "Table rows and sentences copied from an Internet Archive capture (2026-09-28) of the CDC page dated Sept. 18, 2025, then checked row by row against the live CDC page by the project author on 2026-09-30. Entries with quote_status verified were confirmed in that pass."
  },
  "curation_key": {
    "keep": "On the CDC page. Quote checked by the project author against the live page.",
    "confirm": "No longer used; every entry was confirmed or dropped on 2026-09-30."
  },
  "classes": [
    {
      "id": "diuretics",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a water pill (diuretic)",
      "cdc_label": "Diuretics",
      "atc_prefixes": [
        "C03"
      ],
      "ingredients": [
        "acetazolamide"
      ],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "A water pill makes your body lose fluid and can dull your thirst, so in heat you can get dehydrated faster and feel faint or fall.",
      "watch_for": "Dizziness or feeling faint when you stand up, very dark urine, dry mouth, muscle cramps, confusion.",
      "ask_pharmacist": "Should I change how much water I drink on hot days?",
      "cdc_quote": "Electrolyte imbalance; Volume depletion, dehydration and increased risk of fainting and falls; Reduced thirst sensation",
      "cdc_examples": "Furosemide, Hydrochlorothiazide, Acetazolamide",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "C03 covers loop, thiazide, and potassium-sparing diuretics. Acetazolamide is classed S01EC (eye) in ATC, so it is matched by name.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "beta_blockers",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a blood pressure or heart medicine (beta blocker)",
      "cdc_label": "Beta blockers",
      "atc_prefixes": [
        "C07"
      ],
      "ingredients": [],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "A beta blocker can keep your body from sweating and from moving blood to the skin to cool off, and it lowers blood pressure, so you can overheat or feel faint.",
      "watch_for": "Feeling faint or dizzy, less sweating than usual on a hot day, feeling unusually hot or tired.",
      "ask_pharmacist": "What signs mean I am overheating, given that this medicine can hide sweating?",
      "cdc_quote": "Reduced superficial vasodilation; Decreased sweating; Reduced blood pressure, increased risk of fainting and falls",
      "cdc_examples": "Atenolol, Metoprolol, Propranolol",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "calcium_channel_blockers",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a blood pressure medicine (calcium channel blocker)",
      "cdc_label": "Calcium channel blocker",
      "atc_prefixes": [
        "C08"
      ],
      "ingredients": [],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "This blood pressure medicine can drop your blood pressure further in heat, when your body is already working to cool down, so you can feel faint or fall.",
      "watch_for": "Dizziness or feeling faint when standing, unusual weakness, muscle cramps.",
      "ask_pharmacist": "What should I do if I feel dizzy on a hot day while taking this?",
      "cdc_quote": "Decreased blood pressure, increased risk of fainting and falls; Electrolyte imbalance",
      "cdc_examples": "Amlodipine, Felodipine, Nifedipine",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "ace_inhibitors",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a blood pressure medicine (ACE inhibitor)",
      "cdc_label": "Angiotensin Converting Enzyme Inhibitor (ACEi)",
      "atc_prefixes": [
        "C09A",
        "C09B"
      ],
      "ingredients": [],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "This blood pressure medicine can lower your blood pressure further in heat and can dull your thirst, so you may not drink enough and may feel faint.",
      "watch_for": "Dizziness or feeling faint when standing, not feeling thirsty even on a hot day, very dark urine.",
      "ask_pharmacist": "Should I drink on a schedule on hot days rather than waiting until I feel thirsty?",
      "cdc_quote": "Decreased blood pressure, increased risk of fainting and falls; Reduced thirst sensation",
      "cdc_examples": "Enalapril, Lisinopril, Ramipril",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "arbs",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a blood pressure medicine (ARB)",
      "cdc_label": "Angiotensin II Receptor blockers (ARBs)",
      "atc_prefixes": [
        "C09C",
        "C09D"
      ],
      "ingredients": [],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "This blood pressure medicine can lower your blood pressure further in heat and can dull your thirst, so you may not drink enough and may feel faint.",
      "watch_for": "Dizziness or feeling faint when standing, not feeling thirsty even on a hot day, very dark urine.",
      "ask_pharmacist": "Should I drink on a schedule on hot days rather than waiting until I feel thirsty?",
      "cdc_quote": "Decreased blood pressure, increased risk of fainting and falls; Reduced thirst sensation",
      "cdc_examples": "Valsartan, Losartan",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "The CDC lists ACE inhibitors and ARBs in one row. Split here so the card can name the class the person actually takes; the quote is the shared row text.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "arni",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a heart failure medicine (ARNI)",
      "cdc_label": "Angiotensin Receptor-Neprilysin Inhibitors (ARNIs), combination drug including ARB",
      "atc_prefixes": [],
      "ingredients": [
        "sacubitril"
      ],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "This heart medicine includes an ARB, which can lower blood pressure further in heat and dull your thirst. The CDC says it may carry the same added risk as an ARB taken with a water pill.",
      "watch_for": "Dizziness or feeling faint when standing, not feeling thirsty on a hot day, very dark urine.",
      "ask_pharmacist": "I take this with other heart or blood pressure medicines. What should I watch for on hot days?",
      "cdc_quote": "See ARBs. Angiotensin Receptor-Neprilysin Inhibitors (ARNIs) may carry the same additive risk.",
      "cdc_examples": "Sacubitril/Valsartan",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "Sacubitril has no ATC code of its own; the combination is C09DX04. Matched by ingredient name so an Entresto chip triggers both the ARB card (via valsartan) and this one.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "antiplatelets",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a blood thinner (anti-platelet medicine)",
      "cdc_label": "Anti-platelet medications",
      "atc_prefixes": [
        "B01AC"
      ],
      "ingredients": [],
      "exclude_ingredients": [
        "aspirin"
      ],
      "exclude_atc_prefixes": [],
      "why": "This blood thinner can reduce how well your body moves blood to the skin to cool off, so it is harder to get rid of heat.",
      "watch_for": "Feeling unusually hot, headache, feeling faint.",
      "ask_pharmacist": "Is there anything about this medicine I should know for very hot days?",
      "cdc_quote": "Reduced superficial vasodilation",
      "cdc_examples": "Clopidogrel, Aspirin",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "Aspirin is excluded here because it has its own entry combining both CDC rows.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "nitrates",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a chest pain medicine (nitrate)",
      "cdc_label": "Nitrates",
      "atc_prefixes": [
        "C01DA"
      ],
      "ingredients": [],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "A nitrate lowers blood pressure, and heat lowers it too, so together you can feel faint or fall.",
      "watch_for": "Dizziness or feeling faint, especially when standing up or after a dose.",
      "ask_pharmacist": "What should I do if I feel faint on a hot day after taking this?",
      "cdc_quote": "Worsened hypotension",
      "cdc_examples": "Glyceryl Trinitrate, Isosorbide Mononitrate",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "lithium",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a mood stabilizer (lithium)",
      "cdc_label": "Mood stabilizer: Lithium",
      "atc_prefixes": [
        "N05AN"
      ],
      "ingredients": [
        "lithium"
      ],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "Lithium makes you lose water, and if you get dehydrated in heat the lithium in your blood can rise to a harmful level.",
      "watch_for": "Feeling faint, very dark urine, shaking hands, upset stomach, confusion, unusual drowsiness.",
      "ask_pharmacist": "Should my lithium level be checked more often in hot weather, and what should I do if I get dehydrated?",
      "cdc_quote": "Diabetes insipidus induced water loss and risk for fainting, falls; Electrolyte imbalance; Risk for toxicity in setting of dehydration because of narrow therapeutic index",
      "cdc_examples": "Lithium",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "antipsychotics",
      "enabled": true,
      "curation": "keep",
      "plain_name": "an antipsychotic",
      "cdc_label": "Antipsychotics",
      "atc_prefixes": [
        "N05A"
      ],
      "ingredients": [],
      "exclude_ingredients": [
        "lithium"
      ],
      "exclude_atc_prefixes": [
        "N05AN"
      ],
      "why": "This medicine can keep your body from sweating and from sensing heat properly, so you can overheat without feeling it.",
      "watch_for": "Hot, dry skin with little sweat, confusion, feeling very hot or weak.",
      "ask_pharmacist": "What signs mean I am overheating, given that this medicine can hide sweating?",
      "cdc_quote": "Impaired sweating; Impaired temperature",
      "cdc_examples": "Haloperidol, Olanzapine, Quetiapine, Risperidone",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "N05A includes lithium (N05AN); excluded so lithium gets its own card.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "ssri",
      "enabled": true,
      "curation": "keep",
      "plain_name": "an antidepressant (SSRI)",
      "cdc_label": "Selective Serotonin Reuptake Inhibitors (SSRI)",
      "atc_prefixes": [
        "N06AB"
      ],
      "ingredients": [],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "This antidepressant can make you sweat more, so you lose fluid faster in heat and can get dehydrated.",
      "watch_for": "Sweating much more than usual, very dark urine, dizziness, headache.",
      "ask_pharmacist": "Since this can make me sweat more, how much extra should I drink on hot days?",
      "cdc_quote": "Increased sweating",
      "cdc_examples": "Fluoxetine, Sertraline",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "snri",
      "enabled": true,
      "curation": "keep",
      "plain_name": "an antidepressant (SNRI)",
      "cdc_label": "Serotonin and Norepinephrine Reuptake Inhibitors (SNRI)",
      "atc_prefixes": [],
      "ingredients": [
        "venlafaxine",
        "duloxetine",
        "desvenlafaxine",
        "levomilnacipran"
      ],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "This antidepressant can make you sweat more, so you lose fluid faster in heat and can get dehydrated.",
      "watch_for": "Sweating much more than usual, very dark urine, dizziness, headache.",
      "ask_pharmacist": "Since this can make me sweat more, how much extra should I drink on hot days?",
      "cdc_quote": "Increased sweating",
      "cdc_examples": "Duloxatine, Venlafaxine (as spelled on the CDC page)",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "SNRIs sit under ATC N06AX with unrelated antidepressants, so they are matched by name. The CDC names duloxetine and venlafaxine; desvenlafaxine and levomilnacipran are the other US SNRIs. Learner to confirm the wider reading or narrow to the two named.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "tricyclics",
      "enabled": true,
      "curation": "keep",
      "plain_name": "an antidepressant (tricyclic)",
      "cdc_label": "Tricyclic antidepressants (TCAs)",
      "atc_prefixes": [
        "N06AA"
      ],
      "ingredients": [],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "This antidepressant can keep your body from sweating, so you can overheat without cooling down.",
      "watch_for": "Hot, dry skin with little sweat, confusion, feeling very hot or weak.",
      "ask_pharmacist": "What signs mean I am overheating, given that this medicine can hide sweating?",
      "cdc_quote": "Decreased sweating",
      "cdc_examples": "Amitriptyline, Clomipramine",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "topiramate",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a seizure or migraine medicine",
      "cdc_label": "Antiseizure medications: Topiramate",
      "atc_prefixes": [],
      "ingredients": [
        "topiramate"
      ],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "Topiramate can keep your body from sweating, so you can overheat without cooling down.",
      "watch_for": "Hot, dry skin with little sweat, feeling very hot, confusion.",
      "ask_pharmacist": "What signs mean I am overheating, given that this medicine can hide sweating?",
      "cdc_quote": "Decreased sweating",
      "cdc_examples": "Topiramate",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "oxcarbazepine",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a seizure medicine",
      "cdc_label": "Antiseizure medications: Oxcarbazepine",
      "atc_prefixes": [],
      "ingredients": [
        "oxcarbazepine"
      ],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "Oxcarbazepine can make you sweat and urinate more, so you lose fluid faster in heat and can get dehydrated.",
      "watch_for": "Sweating much more than usual, very dark urine, dizziness, confusion.",
      "ask_pharmacist": "How much extra should I drink on hot days while taking this?",
      "cdc_quote": "Increased sweating; Increased urination",
      "cdc_examples": "Oxcarbazepine",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "carbamazepine",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a seizure medicine",
      "cdc_label": "Antiseizure medications: Carbamazepine",
      "atc_prefixes": [],
      "ingredients": [
        "carbamazepine"
      ],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "Carbamazepine can cause dizziness and weakness, especially after a dose increase, and heat can make that worse.",
      "watch_for": "Dizziness, unsteadiness, unusual weakness, especially after a dose change.",
      "ask_pharmacist": "My dose changed recently. Is there anything to watch for on hot days?",
      "cdc_quote": "Dizziness and weakness, especially after increased dose",
      "cdc_examples": "Carbamazepine",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "anticholinergic_antihistamines",
      "enabled": true,
      "curation": "keep",
      "plain_name": "an older allergy or sleep medicine (antihistamine)",
      "cdc_label": "Antihistamines with anticholinergic properties",
      "atc_prefixes": [],
      "ingredients": [
        "promethazine",
        "doxylamine",
        "diphenhydramine"
      ],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "This older antihistamine can keep your body from sweating and from controlling its temperature, so you can overheat.",
      "watch_for": "Hot, dry skin with little sweat, confusion, feeling very hot or drowsy.",
      "ask_pharmacist": "Is there a different allergy or sleep medicine that is safer on hot days?",
      "cdc_quote": "Decreased sweating; Impaired thermoregulation",
      "cdc_examples": "Promethazine, Doxylamine, Diphenhydramine",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "Narrower reading: only the three the CDC names. Other first-generation antihistamines (chlorpheniramine, hydroxyzine) are not included unless the learner adds them.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "nsaids",
      "enabled": true,
      "curation": "keep",
      "plain_name": "an anti-inflammatory pain reliever (NSAID)",
      "cdc_label": "Nonsteroidal anti-inflammatory drugs (NSAIDS)",
      "atc_prefixes": [
        "M01AB",
        "M01AC",
        "M01AE",
        "M01AG",
        "M01AH"
      ],
      "ingredients": [],
      "exclude_ingredients": [
        "aspirin"
      ],
      "exclude_atc_prefixes": [],
      "why": "If you get dehydrated in heat, this pain reliever can harm your kidneys.",
      "watch_for": "Very dark urine or much less urine than usual, swelling, feeling faint.",
      "ask_pharmacist": "On very hot days, is there a pain reliever that is easier on my kidneys?",
      "cdc_quote": "Kidney injury with dehydration",
      "cdc_examples": "NSAIDs",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "M01AX (other) is left out because it holds glucosamine and similar; the listed prefixes cover the common NSAIDs.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "aspirin",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a pain reliever and blood thinner",
      "cdc_label": "Aspirin",
      "atc_prefixes": [],
      "ingredients": [
        "aspirin"
      ],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "Aspirin can reduce how well your body moves blood to the skin to cool off, and if you get dehydrated in heat it can harm your kidneys.",
      "watch_for": "Very dark urine or much less urine than usual, feeling unusually hot, feeling faint.",
      "ask_pharmacist": "Is there anything about aspirin I should know for very hot days?",
      "cdc_quote": "Reduced superficial vasodilation (anti-platelet row); Increased heat production with overdose; Kidney injury with dehydration (analgesic row)",
      "cdc_examples": "Aspirin",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "The CDC table lists aspirin twice, under anti-platelets and under analgesics. One entry here with both quotes.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "acetaminophen",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a pain and fever reliever",
      "cdc_label": "Acetaminophen",
      "atc_prefixes": [],
      "ingredients": [
        "acetaminophen"
      ],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "Severe heat illness can injure the liver, and that raises the risk of liver harm from acetaminophen.",
      "watch_for": "Nausea, pain in the upper right belly, yellowing skin or eyes, unusual tiredness after a very hot day.",
      "ask_pharmacist": "Is there anything about acetaminophen I should know for very hot days?",
      "cdc_quote": "Heat related liver injury increase risk for acetaminophen hepatoxicity",
      "cdc_examples": "Acetaminophen",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "Confirmed on the CDC table by the project author on 2026-09-30.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "sulfonamides",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a sulfa antibiotic",
      "cdc_label": "Antibiotics: Sulfonamides",
      "atc_prefixes": [
        "J01EC",
        "J01EE"
      ],
      "ingredients": [
        "sulfamethoxazole",
        "sulfadiazine"
      ],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "If you get dehydrated in heat, this antibiotic can harm your kidneys.",
      "watch_for": "Very dark urine or much less urine than usual, pain in your side or back.",
      "ask_pharmacist": "How much should I drink while taking this antibiotic on hot days?",
      "cdc_quote": "Kidney injury risk with dehydration",
      "cdc_examples": "Sulfonamides",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "J01EA (trimethoprim alone) is left out; J01EE covers the sulfamethoxazole-trimethoprim combination. Sulfasalazine (a bowel medicine) is not included; narrower reading.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "indinavir",
      "enabled": true,
      "curation": "keep",
      "plain_name": "an HIV medicine",
      "cdc_label": "Antiretrovirals: Indinavir",
      "atc_prefixes": [],
      "ingredients": [
        "indinavir"
      ],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "If you get dehydrated in heat, this medicine can harm your kidneys.",
      "watch_for": "Very dark urine or much less urine than usual, pain in your side or back.",
      "ask_pharmacist": "How much should I drink on hot days while taking this?",
      "cdc_quote": "Kidney injury risk with dehydration",
      "cdc_examples": "Indinavir",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "Confirmed on the CDC table by the project author on 2026-09-30.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "levothyroxine",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a thyroid medicine",
      "cdc_label": "Thyroid replacement: Levothyroxine",
      "atc_prefixes": [],
      "ingredients": [
        "levothyroxine"
      ],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "This thyroid medicine can make you sweat more, so you lose fluid faster in heat.",
      "watch_for": "Sweating much more than usual, very dark urine, feeling faint.",
      "ask_pharmacist": "Is there anything about this medicine I should know for very hot days?",
      "cdc_quote": "Excessive sweating",
      "cdc_examples": "Levothyroxine",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "Confirmed on the CDC table by the project author on 2026-09-30.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "stimulants",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a stimulant (ADHD medicine)",
      "cdc_label": "Stimulants",
      "atc_prefixes": [],
      "ingredients": [
        "amphetamine",
        "dextroamphetamine",
        "lisdexamfetamine",
        "methamphetamine",
        "methylphenidate",
        "dexmethylphenidate",
        "cocaine"
      ],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "A stimulant raises your body temperature, so heat can push it higher than is safe.",
      "watch_for": "Feeling very hot, fast heartbeat, headache, confusion.",
      "ask_pharmacist": "Is there anything about this medicine I should know for very hot days?",
      "cdc_quote": "Increased body temperature (Amphetamine, Methylphenidate); Reduced sweating; Reduced dilation of skin blood vessels; Impaired heat perception (Cocaine)",
      "cdc_examples": "Cocaine; Amphetamine, Methylphenidate",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "Matched by name because ATC N06BA also holds non-stimulants such as atomoxetine and modafinil. MDMA and alcohol are on the CDC table but are not medicines people type from a bottle; left out.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "laxatives",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a laxative",
      "cdc_label": "Laxatives (mentioned in the page text, not the table)",
      "atc_prefixes": [
        "A06A"
      ],
      "ingredients": [],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "A laxative makes you lose fluid, so in heat you can get dehydrated faster and feel faint.",
      "watch_for": "Dizziness or feeling faint, very dark urine, muscle cramps.",
      "ask_pharmacist": "Should I use this differently on hot days?",
      "cdc_quote": "Volume depletion, hypotension, or reduced cardiac output with increased risk of fainting and falls, as a result of reduced renal blood flow and/or kidney injury from nephrotoxic drugs (non-steroidal anti-inflammatory drugs [NSAIDs], diuretics, beta blockers, TCAs, laxatives)",
      "cdc_examples": "",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "Named in the CDC page text (not the table). Confirmed and enabled by the project author on 2026-09-30.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "opiates",
      "enabled": true,
      "curation": "keep",
      "plain_name": "an opioid pain medicine",
      "cdc_label": "Opiates (mentioned in the page text, not the table)",
      "atc_prefixes": [
        "N02A"
      ],
      "ingredients": [],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "This medicine can make you drowsy and dull your thirst, so in heat you may not notice you are overheating or need to drink.",
      "watch_for": "Unusual drowsiness or confusion on a hot day, not feeling thirsty, feeling faint.",
      "ask_pharmacist": "Is there anything about this medicine I should know for very hot days?",
      "cdc_quote": "Sedation or cognitive impairment with increased risk of falls and reduced thirst sensation (e.g., opiates, benzodiazepines, typical and atypical antipsychotic medications, antidepressants, anticonvulsants)",
      "cdc_examples": "",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "Named in the CDC page text (not the table). Confirmed and enabled by the project author on 2026-09-30.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "benzodiazepines",
      "enabled": true,
      "curation": "keep",
      "plain_name": "an anxiety or sleep medicine (benzodiazepine)",
      "cdc_label": "Benzodiazepines (mentioned in the page text, not the table)",
      "atc_prefixes": [
        "N05BA",
        "N05CD",
        "N03AE"
      ],
      "ingredients": [],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "This medicine can make you drowsy and dull your thirst, so in heat you may not notice you are overheating or need to drink.",
      "watch_for": "Unusual drowsiness or confusion on a hot day, not feeling thirsty, feeling faint.",
      "ask_pharmacist": "Is there anything about this medicine I should know for very hot days?",
      "cdc_quote": "Sedation or cognitive impairment with increased risk of falls and reduced thirst sensation (e.g., opiates, benzodiazepines, typical and atypical antipsychotic medications, antidepressants, anticonvulsants)",
      "cdc_examples": "",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "Named in the CDC page text (not the table). Confirmed and enabled by the project author on 2026-09-30.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "apixaban",
      "enabled": true,
      "curation": "keep",
      "plain_name": "a blood thinner (anticoagulant)",
      "cdc_label": "Apixaban (mentioned in the page text, not the table)",
      "atc_prefixes": [],
      "ingredients": [
        "apixaban"
      ],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "If you get dehydrated in heat, your body may clear this medicine more slowly, and the amount in your blood can rise.",
      "watch_for": "Unusual bruising or bleeding, very dark urine, feeling faint.",
      "ask_pharmacist": "Is there anything about this medicine I should know if I get dehydrated on a hot day?",
      "cdc_quote": "Toxicity from reduced clearance of medications with a narrow therapeutic index (e.g., apixaban, carbamazepine, and lithium)",
      "cdc_examples": "",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "Named in the CDC page text (not the table). Confirmed and enabled by the project author on 2026-09-30.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "antacids",
      "enabled": true,
      "curation": "keep",
      "plain_name": "an antacid",
      "cdc_label": "Antacids (mentioned in the page text, not the table)",
      "atc_prefixes": [
        "A02A"
      ],
      "ingredients": [],
      "exclude_ingredients": [],
      "exclude_atc_prefixes": [],
      "why": "Some antacids can upset the balance of salts in your body, which heat and sweating can make worse.",
      "watch_for": "Muscle cramps, weakness, confusion.",
      "ask_pharmacist": "Is there anything about this antacid I should know for very hot days?",
      "cdc_quote": "Electrolyte imbalance (e.g., diuretics, beta blockers, calcium channel blockers, antacids, laxatives, lithium, and trimethoprim-sulfamethoxazole)",
      "cdc_examples": "",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "note": "Named in the CDC page text (not the table). Confirmed and enabled by the project author on 2026-09-30.",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    }
  ],
  "combinations": [
    {
      "id": "diuretic_plus_raas",
      "enabled": true,
      "requires_all": [
        [
          "diuretics"
        ],
        [
          "ace_inhibitors",
          "arbs",
          "arni"
        ]
      ],
      "text": "You take a water pill together with an ACE inhibitor, ARB, or ARNI. The CDC says this combination may significantly increase the risk of harm from heat. Go over it with your pharmacist.",
      "ask_pharmacist": "I take a water pill with a blood pressure medicine. What should I watch for on hot days?",
      "cdc_quote": "Certain combinations of medications, such as an angiotensin converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB) with a diuretic, may significantly increase risk of harm from heat exposure. Angiotensin Receptor-Neprilysin Inhibitors (ARNIs) may carry the same additive risk.",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    }
  ],
  "storage": [
    {
      "id": "insulin",
      "enabled": true,
      "atc_prefixes": [
        "A10A"
      ],
      "ingredients": [],
      "text": "Keep insulin in the refrigerator, and never leave it in a hot car. Heat can make it less effective.",
      "cdc_quote": "Insulin, which should be stored in a refrigerator, may become less effective if left in the heat for prolonged periods.",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page",
      "name_contains": [
        "insulin"
      ],
      "note": "Matched by ATC A10A and by any ingredient name containing \"insulin\", because RxClass carries no ATC code for some insulins (for example insulin isophane)."
    },
    {
      "id": "inhalers",
      "enabled": true,
      "atc_prefixes": [
        "R03A",
        "R03B"
      ],
      "ingredients": [],
      "text": "Keep inhalers out of hot places like a car. In extreme heat they can malfunction or burst.",
      "cdc_quote": "Inhalers, for example, can burst in hot environments, such as car trunks on hot days.",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    },
    {
      "id": "epinephrine_autoinjector",
      "enabled": true,
      "atc_prefixes": [],
      "ingredients": [
        "epinephrine"
      ],
      "text": "Keep your epinephrine auto-injector out of the heat. It may not work properly or may deliver less medicine after being hot.",
      "cdc_quote": "EpiPens may malfunction or deliver less epinephrine when exposed to heat.",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page"
    }
  ],
  "storage_general": {
    "text": "Do not leave any medicine in a car or other place that gets very hot.",
    "cdc_quote": "Counsel patients not to leave medications in a car or other places that can get excessively hot.",
    "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
    "checked_on": "2026-09-30",
    "quote_status": "verified",
    "verified_on": "2026-09-30",
    "verified_by": "project author, against the live CDC page"
  },
  "never_stop": {
    "text": "Never stop or change a medicine on your own. Talk to your pharmacist or doctor.",
    "cdc_quote": "Remind patients to avoid abruptly stopping any medications without having a plan in place.",
    "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
    "checked_on": "2026-09-30",
    "quote_status": "verified",
    "verified_on": "2026-09-30",
    "verified_by": "project author, against the live CDC page",
    "note": "The page also says dose or schedule changes should be individualized, but that sentence is not adjacent to this one, so only the adjacent sentence is quoted."
  },
  "warning_signs": {
    "heading": "Call 911 if",
    "intro": "Heat stroke is a severe medical emergency. Signs of heat stroke:",
    "signs": [
      "Throbbing headache",
      "Confusion or slurred speech",
      "Nausea or dizziness",
      "Body temperature above 103 F",
      "Hot, red, dry or damp skin",
      "Rapid, strong pulse",
      "Fainting or loss of consciousness"
    ],
    "action": "Call 911 or get the person to a hospital right away. Do not give fluids.",
    "also": "Get medical help right away if someone with heat exhaustion vomits, or if symptoms get worse or last longer than 1 hour.",
    "source_title": "National Weather Service: Heat Cramps, Exhaustion, Stroke (list attributed to the CDC)",
    "source_url": "https://www.weather.gov/safety/heat-illness",
    "checked_on": "2026-09-30",
    "quote_status": "verified",
    "verified_by": "project author",
    "note": "The CDC signs-and-symptoms link used in the draft returned not found; the NWS page carries the CDC list."
  },
  "excluded_rows": {
    "note": "The CDC table also lists MDMA (and alternatives) and alcohol. They are left out of this file because they are not prescriptions a person would type from a bottle.",
    "rows": [
      "Hallucinogens: Methylenedioxy-methamphetamine (MDMA) (and alternatives)",
      "Alcohol"
    ]
  },
  "sun_notes": [
    {
      "id": "sun_sensitizing",
      "enabled": true,
      "heading": "Sun and your skin",
      "atc_prefixes": [
        "J01AA",
        "J01MA"
      ],
      "ingredients": [
        "flucytosine",
        "griseofulvin",
        "voriconazole",
        "metronidazole"
      ],
      "text": "This medicine can make your skin burn much more easily in the sun and cause a sunburn-like rash. The CDC recommends avoiding sun, wearing protective clothing and a hat, and using broad-spectrum sunscreen with SPF 30 or higher.",
      "ask_pharmacist": "What sun protection do I need while taking this?",
      "cdc_quote": "Antifungal medications like flucytosine, griseofulvin, and voriconazole and antibiotics like metronidazole, tetracyclines and fluoroquinolones can increase sun sensitivity and lead to a sunburn-like rash. For patients on these medications, sun avoidance, protective clothing and hats, and broad-spectrum sunscreen that filters out UVA and UVB rays, with an SPF of 30 or higher, are recommended.",
      "cdc_url": "https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html",
      "checked_on": "2026-09-30",
      "quote_status": "verified",
      "verified_on": "2026-09-30",
      "verified_by": "project author, against the live CDC page",
      "note": "Shown as its own note rather than a heat card, because the CDC describes a sun reaction, not a heat reaction. J01AA = tetracyclines, J01MA = fluoroquinolones."
    }
  ]
}