Chapter 4: Prescription Drug Precautions and
Contraindications for Massage Therapy
By: John Vinacci
Learning objectives
ŠŠ Identify the most commonly prescribed pharmaceutical drugs by
their brand name.
ŠŠ Identify the most commonly prescribed pharmaceutical drugs by
their generic name.
ŠŠ Describe the conditions that the most commonly prescribed brand
name pharmaceutical drugs treat.
Introduction
According to Reportlinker.com, the global market for prescription
drugs is forecasted to exceed $900 billion dollars by 2015. With sales
that routinely exceed $300 billion dollars in the United States, it has
now become common for massage therapists to encounter a client
who is taking prescription drugs. However, few massage therapists
are equipped with even a rudimentary knowledge of prescribed drugs
and their effects. When it comes to many of today’s most popularly
prescribed drugs, though, there are often several effects a massage
therapist needs to consider before beginning a massage treatment.
Some commonly prescribed drugs, such as the anti-psychotic drug
Abilify, are contraindicated for a massage without a physician’s
referral. Unfortunately, this information is not a part of a typical
massage therapy school’s curriculum. Yet, this information is vital
not only to the practical application of massage, it is also a matter of
ethics. As it is among the responsibilities of a massage therapist to aid
a client’s health and well-being, it is also a massage therapist’s duty to
protect a client’s health and well-being by knowing when massage can
The most commonly prescribed medications in the United States
Brand name(s): Ability, Ablify Discmelt
Generic name(s): Aripirazole
Drug type: Anti-psychotic
Prescribed for: Manic depression / bi-polar disorder; schizophrenia;
also treats aggression and irritability in autistic children
Massage: Massage is contraindicated for this drug unless approved by
the client’s physician. Massage is contraindicated for clients approved
for massage but are experiencing a manic episode. Clients commonly
experiencing insomnia as a side effect of this drug can be treated with
effleurage or gentle rocking. If the client experiences nausea as a side
effect of this drug or if massage induces nausea, discontinue effleurage
or rocking. Clients experiencing dizziness as a side effect of this drug
may be aided by the use of tapotement. If dizziness persists or worsens
due to the massage, the client may need assistance standing.
Common drug side effects not contraindicated for massage include
headaches, blurred vision, earaches, trouble swallowing, abdominal
discomfort, nausea, muscle weakness, and muscle cramps.
Massage.EliteCME.com Page 39
2 CE Hours
ŠŠ Recognize which commonly prescribed pharmaceutical drugs
include precautions the massage therapist should consider before
performing a massage.
ŠŠ Recognize which commonly prescribed pharmaceutical drugs are
contraindicated for a massage without a physician’s referral.
ŠŠ Recognize which commonly prescribed pharmaceutical drugs do
not have any contraindications for a massage.
and cannot be practiced. For a massage therapist to have knowledge
of prescription medicines may also lend a massage therapist more
credibility, as well as work towards the credibility of the massage
therapy field in general.
The information provided in this course is designed to familiarize a
massage therapist with 50 of the most commonly prescribed drugs
in The United States as of early 2014. The drugs listed are given
alphabetically according to their most popular brand name(s) for
easy reference. Following the most common brand name(s) will be a
drug’s generic name(s) and its drug type. Then, the specific condition
or conditions the drug is prescribed for is given, followed by the most
necessary precautions for a massage therapist to consider. In some
instances, few precautions are necessary. In other instances, there
are a number of contraindications to consider, or, a massage may be
contraindicated altogether. Finally, less common drug side effects that
do not contraindicate a massage are given.
Brand name(s): Actos
Generic name(s): Pioglitazone
Drug type: Anti-hyperglycemic / anti-diabetic
Prescribed for: Type II diabetes
Massage: There are no precautions or contraindications for clients
taking this drug.
Common drug side effects not contraindicated for massage include
headaches, congested sinuses, sneezing, sore throat, coughing, muscle
pain, and weight gain.
Brand name(s): Adderall
Generic name(s): Amphetamine with dextroamphetamine
Drug type: Psychostimulants
Prescribed for: Attention deficit-hyperactivity disorder (ADHD);
narcolepsy
Massage: Clients experiencing severe headaches, hallucinations,
difficulty breathing, chest pain, an elevated heart rate, muscle twitches
or tremors, and/or extreme mood swings as a side effect of this
drug are contraindicated for massage and their physician should be
contacted. Clients commonly experience insomnia as a side effect
of this drug; encourage clients to extend their massage if this side
effect is chronic. The bodies of clients taking this drug may not be as
responsive to massage as they would be without the drug. Using the
various massage strokes more slowly may help achieve the desired
results. Clients experiencing a rash as a side effect of this drug are
locally contraindicated for massage and their physician should be
contacted after the massage. If the client experiences agitation as a side
effect of this drug, discontinue the massage.
Common drug side effects not contraindicated for massage include
mild headaches, blurred vision, a dry mouth, changes in taste
perception, abdominal pain, fever, chills, and restlessness.
Brand name(s): Advair Diskus, Advair HFA
Generic name(s): Fluticasone with salmeterol
Drug Type: Steroid (fluticasone) and bronchodilator (salmeterol)
Prescribed for: Asthma; chronic obstructive pulmonary disease
(COPD)
Massage: Clients taking this drug who exhibit any asthma symptoms
are contraindicated for massage. Clients taking this drug for more
than two weeks are contraindicated for deep tissue massage. Proceed
cautiously with stretches or traction. Clients experiencing dizziness
as a side effect of this drug may be aided by the use of tapotement. If
dizziness persists or worsens due to the massage, the client may need
assistance standing.
Common drug side effects not contraindicated for massage include
headaches, congested sinuses, sinus pain, coughing, a dry mouth, sore
throat, hoarseness, and nausea.
Brand name(s): Alimta
Generic name(s): Pemetrexed
Drug type: Anti-metabolites
Prescribed for: Lung cancer
Massage: Clients experiencing dizziness, confusion, trouble
concentrating, mouth sores, sore throat, increased thirst, difficulty
breathing, an elevated heart rate, muscle weakness, fever, chills,
swelling, unusual bleeding and/or rashes as a side effect of this
drug are contraindicated for massage and their physician should be
contacted. If the client experiences nausea as a side effect of this drug
or if massage induces nausea, discontinue effleurage or rocking. If the
client experiences depression as a side effect of this drug, discontinue
the massage.
Common drug side effects not contraindicated for massage include
heartburn and abdominal discomfort.
Brand name(s): AndroGel (and other drugs with an Andro- prefix)
Generic name(s): Testosterone (as a topical)
Drug type: Steroid hormone
Prescribed for: Low testosterone levels
Massage: Clients experiencing a fever, nausea, stomach pain, and/or
any problems urinating as a side effect of this drug are contraindicated
for massage and their physician should be contacted. Note: These side
effects are rare; there are generally no precautions or contraindications
for clients taking this drug.
There are no other common drug side effects to consider.
Brand name(s): Atripla
Generic name(s): Efavirenz, emtricitabine, and tenofovir
Drug type: Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Prescribed for: Human immunodeficiency virus (HIV)
Massage: Clients experiencing hypoesthesia (a decreased sensitivity
to touch) as a side effect of this drug are contraindicated for massage.
Clients commonly experience dizziness as a side effect of this drug
and may need assistance lying and standing. Treat with tapotement.
Common drug side effects not contraindicated for massage include
headaches, abdominal discomfort, nausea, darkening of the hands or
feet, redistribution of body fat, drowsiness, and insomnia.
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Brand name(s): Avastin
Generic name(s): Bevacizumab
Drug type: Angiogenesis inhibitor
Prescribed for: Cancer; brain tumors
Massage: Clients experiencing severe headaches, confusion, vision or
speech problems, puffy eyes, mouth sores, chest pain, stomach pain
(accompanied by a fever), vomiting, nausea, pain or swelling in one or
both legs, fever, chills, missed menstrual periods, difficulty balancing,
and/or any problems urinating as a side effect of this drug are
contraindicated for massage and their physician should be contacted.
Common drug side effects not contraindicated for massage include
congested sinuses, changes in taste perception, mild sore throat, and a
loss of appetite.
Brand name(s): Avonex, Rebif
Generic name(s): Interferon beta-1a
Drug type: Anti-viral
Prescribed for: Multiple sclerosis (MS)
Massage: Massage is contraindicated for this drug unless approved
by the client’s physician. Massage is contraindicated if bruising
occurs during the massage; discontinue at once. Massage is locally
contraindicated for 8 hours at the injection site. Clients commonly
experience dizziness as a side effect of this drug and may need
assistance lying and standing. Treat with tapotement. Clients
experiencing constipation as a side effect of this drug may be aided by
a clockwise massage of the abdomen. This drug may induce headaches
that cannot be relieved by massage.
Common drug side effects not contraindicated for massage include
congested sinuses, abdominal discomfort, and anxiety.
Brand name(s): Celebrex
Generic name(s): Celecoxib
Drug type: Nonsteroidal anti-inflammatory drug (NSAID)
Prescribed for: Arthritis
Massage: Clients experiencing vision or speech problems, difficulty
breathing, chest pain, stomach pain, nausea, muscle pain, and/or
rashes and itching as a side effect of this drug are contraindicated for
massage and their physician should be contacted. Clients experiencing
hypoesthesia (a decreased sensitivity to touch) as a side effect of this
drug are contraindicated for massage. Clients experiencing swelling
in the arms or legs as a side effect of this drug can be treated with
lymphatic drainage. Clients commonly experience dizziness as a side
effect of this drug and may need assistance lying and standing. Treat
with tapotement.
Common drug side effects not contraindicated for massage include
headaches, congested sinuses, sore throat, nausea, and nervousness.
Brand name(s): Combivent, Combivent Respimat
Generic name(s): Albuterol with ipratropium
Drug type: Bronchiodiolators
Prescribed for: Chronic obstructive pulmonary disease (COPD)
Massage: Clients commonly experience insomnia as a side effect
of this drug; encourage clients to extend their massage if this side
effect is chronic. The bodies of clients taking this drug may not be as
responsive to massage as they would be without the drug. Using the
various massage strokes more slowly may help achieve the desired
results. Clients experiencing a rash as a side effect of this drug are
locally contraindicated for massage and their physician should be
contacted. Clients experiencing dizziness as a side effect of this drug
may be aided by the use of tapotement. If dizziness persists, the client
may need assistance standing.
Common drug side effects not contraindicated for massage include
headaches, blurred vision, nosebleeds, dry nasal passages, dry mouth,
coughing, an elevated heart rate, nausea, weight loss, muscle cramps,
and nervousness.
Brand name(s): Concerta, Metadate, Methylin, Ritalin
Generic name(s): Methylphenidate
Drug type: Psychostimulant
Prescribed for: Attention deficit hyperactivity disorder (ADHD)
Massage: Clients experiencing severe headaches, lightheadedness,
confusion, hallucinations, blurred vision, an elevated heart rate,
muscle twitches, fever, and/or behavioral changes as a side effect of
this drug are contraindicated for massage and their physician should
be contacted. Clients commonly experience insomnia as a side effect
of this drug; encourage clients to extend their massage if this side
effect is chronic. The bodies of clients taking this drug may not be as
responsive to massage as they would be without the drug. Using the
various massage strokes more slowly may help achieve the desired
results. Clients experiencing a rash as a side effect of this drug are
locally contraindicated for massage and their physician should be
notified. Clients commonly experience dizziness as a side effect of
this drug and may need assistance lying and standing. Treat with
tapotement.
Common drug side effects not contraindicated for massage include
mild headaches, abdominal pain, nausea, numbness or tingling in the
hands, sweating, and weight loss.
Brand name(s): Copaxone
Generic name(s): Glatiramer
Drug type: Immunomodulator
Prescribed for: Multiple sclerosis (MS)
Massage: Clients experiencing chest pain or an elevated heart rate as
a side effect of this drug are contraindicated for massage. Massage is
locally contraindicated for rashes or bruises that typically accompany
this drug’s use. If the client experiences nausea as a side effect of this
drug or if massage induces nausea, discontinue effleurage or rocking.
Clients using this drug are prone to frequent urination; prepare
treatment room accordingly for quick access to a bathroom.
Common drug side effects not contraindicated for massage include
double vision, sore throat, swelling in the hands and feet, fever, chills,
and muscle weakness.
Brand name(s): Crestor
Generic name(s): Rosuvastatin
Drug type: Statin
Prescribed for: High cholesterol and triglyceride levels
Massage: Clients experiencing confusion or fever as a side effect of
this drug are contraindicated for massage and their physician should be
contacted. Clients experiencing paresthesia (unusual sensations of the
skin with no visible cause) or bruising as a side effect of this drug are
contraindicated for massage where the paresthesia or bruising occurs;
however, massage is contraindicated if the paresthesia or bruising is
severe. Clients experiencing dizziness as a side effect of this drug may
be aided by the use of tapotement. If dizziness persists or worsens
due to the massage, the client may need assistance standing. Clients
experiencing constipation as a side effect of this drug may be aided by
a clockwise massage of the abdomen. This drug may induce headaches
that cannot be relieved by massage.
Common drug side effects not contraindicated for massage include
rhinitis, abdominal discomfort, nausea, muscle weakness, muscle pain,
joint pain, and anxiety.
Brand name(s): Cymbalta
Generic name(s): Duloxetine
Drug type: Serotonin-norepinephrine re-uptake inhibitor (SNRI)
Prescribed for: Depression; anxiety disorders; diabetic neuropathy;
fibromyalgia; musculoskeletal pain
Massage: Client’s experiencing headaches, confusion,
lightheadedness, hallucinations, an elevated heart rate, difficulty
breathing, skin reactions (particularly itching, yellowing, bruising, red
Massage.EliteCME.com Page 41
or purple rashes, pain, or swelling), stomach pain, vomiting, nausea,
a loss of appetite, fever, sensitive reflexes, rigid muscles, muscle
weakness, agitation, and/or any difficulty urinating as a side effect of
this drug are contraindicated for massage and their physician should be
contacted.
Common drug side effects not contraindicated for massage include a
dry mouth and drowsiness.
Brand name(s): Diovan
Generic name(s): Valsartan
Drug type: Angiotensin receptor blocker (ARB)
Prescribed for: Hypertension
Massage: Clients experiencing lightheadedness, difficulty
breathing, increased thirst, a loss of appetite, an elevated heart rate,
decreased urination, and/or swelling as a side effect of this drug are
contraindicated for massage and their physician should be contacted.
Clients commonly experience dizziness as a side effect of this drug
and may need assistance lying and standing. Treat with tapotement.
Common drug side effects not contraindicated for massage include
headaches, blurred vision, congested sinuses, sneezing, sore throat,
coughing, abdominal discomfort, back pain, joint paint, mild rashes,
and mild itching.
Brand name(s): Diovan HCT
Generic name(s): Valsartan with hydrochlorothiazide
Drug type: Angiotensin II receptor blocker (valsartan) and diuretic
(hydrochlorothiazide)
Prescribed for: High blood pressure
Massage: Clients commonly experience dizziness and sleepiness as
a side effect of this drug and may need assistance lying and standing.
Treat with tapotement. Clients using this drug are prone to frequent
urination; prepare treatment room accordingly for quick access to a
bathroom.
Common drug side effects not contraindicated for massage include
rhinitis, blurred vision, headaches, congested sinuses, sore throat,
coughing, abdominal pain, nausea, lower back pain, joint pain, mild
rashes, and swelling.
Brand name(s): Eloxatin
Generic name(s): Oxaliplatin
Drug type: Anti-neoplastic
Prescribed for: Colon cancer; rectal cancer
Massage: Massage is contraindicated for this drug unless approved
by the client’s physician. Clients who have developed blood clot as
a side effect of this drug are contraindicated for massage. Massage,
if allowed, is better for the client to receive on weeks the drug is
not administered. On weeks the drug is administered, massage is
contraindicated for at least 48 hours afterwards. Deep tissue massage
is contraindicated for clients taking this drug. Client’s experiencing
severe headaches, confusion, vision problems, eye pain, jaw pain,
mouth sores, sore throat, increased thirst, speech problems, difficulty
breathing, chest pain, easy bruising, pale skin, pain or redness where
the drug was administered, fever, chills, and/or any unusual bleeding
as a side effect of this drug are contraindicated for massage and their
physician should be contacted. Clients experiencing dizziness as a side
effect of this drug may be aided by the use of tapotement. If dizziness
persists, client may need assistance standing. Clients experiencing
constipation as a side effect of this drug may be aided by a clockwise
massage of the abdomen.
Common drug side effects not contraindicated for massage include
headaches, coughing, changes in taste perception, heartburn,
abdominal pain, muscle pain, joint pain, hair loss, a loss of appetite,
and weight gain.
Brand name(s): Enbrel
Generic name(s): Etanercept
Drug type: Anti-rheumatic
Prescribed for: Arthritis conditions
Massage: Clients experiencing chest pain, muscle pain, joint
pain, fever, chills, and/or swelling as a side effect of this drug are
contraindicated for massage. Massage is locally contraindicated for
72 hours at the injection site. Clients experiencing dizziness as a side
effect of this drug may be aided by the use of tapotement. If dizziness
persists or worsens due to the massage, the client may need assistance
standing.
Common drug side effects not contraindicated for massage include
headaches, congested sinuses, sinus pain, abdominal discomfort, and
nausea.
Brand name(s): Epogen
Generic name(s): Epoetin alfa
Drug type: Hematopoietic
Prescribed for: Anemia
Massage: Massage is contraindicated for this drug unless approved
by the client’s physician. Deep tissue massage is contraindicated
for this drug. Massage is locally contraindicated for 24 hours at the
injection site. Clients experiencing paresthesia (unusual sensations
of the skin with no visible cause) as a side effect of this drug are
locally contraindicated for massage. Clients experiencing a rash as
a side effect of this drug are locally contraindicated for massage and
their physician should be contacted. Clients commonly experience
dizziness as a side effect of this drug and may need assistance lying
and standing. Treat with tapotement.
Common drug side effects not contraindicated for massage include
congested sinuses, sneezing, sore throat, coughing, nausea, muscle
spasms, muscle pain, joint pain, bone pain, weight loss, and insomnia.
Brand name(s): Gleevec
Generic name(s): Imatinib
Drug type: Tyrosine-kinase inhibitor
Prescribed for: Leukemia; digestive system tumors
Massage: Massage is contraindicated for this drug unless approved by
the client’s physician. Deep tissue massage is contraindicated for this
drug. Clients experiencing widespread rash or itching as a side effect
of this drug are contraindicated for massage. If the client experiences
nausea as a side effect of this drug or if massage induces nausea,
discontinue effleurage or rocking.
Common drug side effects not contraindicated for massage include
headaches, congested sinuses, sinus pain, abdominal pain, muscle
cramps, muscle pain, and joint pain.
Brand name(s): Herceptin
Generic name(s): Trastuzumab
Drug type: Monoclonal antibody
Prescribed For: Malignant cancer
Massage: Deep tissue massage is contraindicated for this drug.
Massage is contraindicated on days the drug is administered due to its
toxic effects. Clients experiencing paresthesia (unusual sensations of
the skin with no visible cause) as a side effect of this drug are locally
contraindicated for massage. If paresthesia is severe, massage is
contraindicated. Clients experiencing dizziness as a side effect of this
drug may be aided by the use of tapotement. Dizziness should not be
severe enough for the client to require assistance standing.
Common drug side effects not contraindicated for massage include
headaches, rhinitis, congested sinuses, sore throat, changes in taste
perception, nausea, and insomnia.
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Brand name(s): Humalog
Generic name(s): Insulin lispro
Drug type: Insulin analog
Prescribed for: Type I diabetes
Massage: Massage is contraindicated for this drug unless approved
by the client’s physician. Massage is locally contraindicated at the
most recent injection site. Clients experiencing hives, rashes or itching
as a side effect of this drug are locally contraindicated for massage.
Clients experiencing respiratory stress, sweating or a rapid pulse are
contraindicated for massage and their physicians should be contacted.
Clients taking this drug commonly experience hypoglycemia; the
client should be instructed to eat a snack or light meal before their
massage to prevent its occurrence. Keep a quick source of sugar on
hand such as orange juice, soda, or candy should the client show any
signs of blurred vision, dizziness, confusion, trouble concentrating, an
elevated heart rate, nausea, and/or sweating.
There are no other common drug side effects to consider.
Brand name(s): Humira, Humira Pen, Humira Pen Crohn’s Disease
Starter Package
Generic name(s): Adalimumab
Drug type: Anti-rheumatic
Prescribed for: Arthritis conditions; Crohn’s Disease
Massage: Massage is contraindicated for this drug unless approved by
the client’s physician. Massage is locally contraindicated for 48 hours
at the injection site. Clients using this drug may have a decrease in
immune function; schedule this client’s massage first to avoid cross-
contamination between clients.
Common drug side effects not contraindicated for massage include
headaches, congested sinuses, sinus pain, abdominal discomfort,
muscle cramps, muscle pain, and joint pain.
Brand name(s): Incivek
Generic name(s): Telaprevir
Drug type: Anti-viral
Prescribed for: Hepatitis C
Massage: If the client experiences nausea as a side effect of this
drug or if massage induces nausea, discontinue effleurage or rocking.
Clients experiencing rashes or itching as a side effect of this drug are
locally contraindicated for massage and their physician should be
notified.
Common drug side effects not contraindicated for massage include
changes in taste perception and lethargy.
Brand name(s): Januvia
Generic name(s): Sitagliptin
Drug type: Anti-hyperglycemic
Prescribed for: Type II diabetes
Massage: Clients experiencing severe stomach pain that extends to
their back or an elevated heart rate as a side effect of this drug are
contraindicated for massage and their physician should be contacted.
Clients experiencing red or purple rashes as a side effect of this drug
are locally contraindicated for massage and their physician should be
contacted. Clients experiencing constipation as a side effect of this
drug may be aided by a clockwise massage of the abdomen.
Common drug side effects not contraindicated for massage include
headaches, congested sinuses, sore throat, and joint pain.
Brand name(s): Lantus, Lantus OptiClik Cartridge, Lantus Solostar
Pen
Generic name(s): Insulin glargine
Drug type: Insulin analog
Prescribed for: Type II diabetes
Massage: Massage is contraindicated for this drug unless approved
by the client’s physician. Massage is locally contraindicated for 24
hours at the injection site. Clients experiencing rashes or itching as a
side effect of this drug are locally contraindicated for massage. Clients
taking this drug commonly experience hypoglycemia; the client
should be instructed to eat a snack or light meal before their massage
to prevent its occurrence. Keep a quick source of sugar on hand such
as orange juice, soda, or candy should the client show any signs of
blurred vision, dizziness, confusion, trouble concentrating, an elevated
heart rate, nausea, and/or sweating.
There are no other common drug side effects to consider.
Brand name(s): Levemir, Levemir FlexPen
Generic name(s): Insulin detemir
Drug type: Insulin
Prescribed for: Type I and II diabetes
Massage: Massage is contraindicated for this drug unless approved
by the client’s physician. Massage is locally contraindicated at the
most recent injection site. Clients experiencing hives, rashes or itching
as a side effect of this drug are locally contraindicated for massage.
Clients experiencing respiratory stress, sweating or a rapid pulse are
contraindicated for massage and their physicians should be contacted.
Clients taking this drug commonly experience hypoglycemia; the
client should be instructed to eat a snack or light meal before their
massage to prevent its occurrence. Keep a quick source of sugar on
hand such as orange juice, soda, or candy should the client show any
signs of blurred vision, dizziness, confusion, trouble concentrating, an
elevated heart rate, nausea, and/or sweating.
There are no other common drug side effects to consider.
Brand name(s): Lidoderm, AneCream, Bactine, LidaMantle,
Lidocream, Lidosense5, LMX 4, LMX 4 with Tegaderm, LMX 5,
Medi-Quik Spray, Senatec, Xylocaine Jelly, Xylocaine Topical,
Zilactin-L
Generic name(s): Lidocaine
Drug type: Local anesthetic
Prescribed for: Shingles; skin irritations
Massage: Clients experiencing blurred vision, confusion, drowsiness,
an elevated heart rate, tremors, seizures, and/or rashes or hives as
a side effect of this drug are contraindicated for massage and their
physician should be contacted. Clients experiencing a decrease in local
pain sensitivity as an effect of this drug are not contraindicated for
massage, but less pressure should be used in the areas of the drug’s
application. Warning: Massaging the area in which the drug has been
applied may result in decreased proprioception in the fingers/hands/
forearm of the massage therapist.
Common drug side effects not contraindicated for massage include
headaches, changes in taste perception, anxiety, and depression.
Brand name(s): Lipitor
Generic name(s): Atorvastatin
Drug type: Statin
Prescribed for: High cholesterol and triglyceride levels
Massage: Clients experiencing confusion, memory problems, blurred
vision, a dry mouth, increased thirst, abdominal pain, a loss of appetite,
muscle pain, muscle weakness, fever, swelling, frequent urination,
and/or dark urine as a side effect of this drug are contraindicated
for massage and their physician should be contacted. Clients taking
this drug may be resistant to the relaxing effect of massage upon the
muscles.
Common drug side effects not contraindicated for massage include
mild headaches and mild nausea.
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Brand name(s): Lovenox
Generic name(s): Enoxaparin
Drug type: Anti-coagulant
Prescribed for: Prevention of blood clots (DVTs)
Massage: Clients diagnosed with a blood clot are contraindicated
for massage. Clients taking this drug to prevent blot clots are
contraindicated for massage unless approved by the client’s
physician. Deep tissue massage is contraindicated for this drug.
Clients experiencing a rash or itching as a side effect of this drug are
contraindicated for massage and their physician should be contacted.
Massage is locally contraindicated for 5 hours at the injection site.
Common drug side effects not contraindicated for massage include
swelling in the hands or feet, fever, and nausea.
Brand name(s): Lucentis
Generic name(s): Ranibizumab
Drug type: Monoclonal antibody
Prescribed for: Macular degeneration
Massage: Due to the pressure the can be placed upon the orbicularis
oculi when the client is prone, a face cradle should not be used for
clients taking this drug. Clients experiencing headaches, confusion,
eye pain or irritation, eye swelling, bleeding from the eyes, vision
problems, or weakness or numbness on one side of the body as a side
effect of this drug are contraindicated for massage and their physician
should be contacted.
Common drug side effects not contraindicated for massage include
sinus pain, sore throat, coughing, and joint pain.
Brand name(s): Lyrica
Generic name(s): Pregabalin
Drug type: Anti-convulsant
Prescribed for: Seizures; fibromyalgia; diabetic neuropathy
Massage: Clients experiencing muscle pain, muscle weakness, or
muscle tenderness as a side effect of this drug are contraindicated for
massage and their physician should be contacted. Clients commonly
experience dizziness as a side effect of this drug and may need
assistance lying and standing. Treat with tapotement.
Common drug side effects not contraindicated for massage include a
dry mouth, constipation, loss of coordination, memory problems, and
drowsiness.
Brand name(s): Namenda, Namenda XR
Generic name(s): Memantine
Drug type: NMDA receptor antagonists
Prescribed for: Alzheimer’s disease
Massage: Clients commonly experience dizziness and sleepiness as
a side effect of this drug and may need assistance lying and standing.
Treat with tapotement. Clients experiencing a rash as a side effect of
this drug are locally contraindicated for massage and their physician
should be contacted. Clients experiencing constipation as a side effect
of this drug may be aided by a clockwise massage of the abdomen.
Clients using this drug are prone to frequent urination; prepare
treatment room accordingly for quick access to a bathroom.
Common drug side effects not contraindicated for massage include eye
irritation, an elevated heart rate, swelling in the hands or feet, muscle
weakness, joint pain, weight loss, and anxiety.
Brand name(s): Nasonex
Generic name(s): Mometasone nasal
Drug type: Steroid hormone
Prescribed for: Nasal polyps; seasonal allegies
Massage: Clients experiencing flu-like symptoms such as chest
pain or tightness, chills, congestion, coughing, eye discharge,
headaches, fever, stomach pain, muscle or bone pain, or wheezing are
contraindicated for massage and their physician should be contacted.
Clients experiencing a rash are locally contraindicated for massage.
There are no other common drug side effects to consider.
Brand name(s): Nexium
Generic name(s): Esomeprazole
Drug type: Proton pump inhibitor
Prescribed for: Gastroesophageal reflux disease; excess stomach acid
Massage: There are no precautions for clients taking this drug. Clients
experiencing constipation as a side effect of this drug may be aided by
a clockwise massage of the abdomen. This drug may induce headaches
that cannot be relieved by massage.
Common drug side effects not contraindicated for massage include a
dry mouth, abdominal discomfort, nausea, and drowsiness.
Brand name(s): Neulasta
Generic name(s): Pegfilgrastim
Drug type: Granulocyte colony stimulating factor
Prescribed for: To increase white blood cell count
Massage: Massage is contraindicated for this drug unless approved
by the client’s physician. Massage is locally contraindicated for 24
hours at the injection site. Clients experiencing dizziness as a side
effect of this drug may be aided by the use of tapotement. If dizziness
persists or worsens due to the massage, the client may need assistance
standing. Clients experiencing constipation as a side effect of this drug
may be aided by a clockwise massage of the abdomen.
Common drug side effects not contraindicated for massage include
arm or leg pain, and bone pain.
Brand name(s): NovoLog, NovoLog FlexPen, NovoLog PenFill,
NovoLog 70/30
Generic name(s): Insulin aspart
Drug type: Insulin analog
Prescribed for: Type I diabetes
Massage: Massage is contraindicated for this drug unless approved by
the client’s physician. Massage is locally contraindicated for 3 hours
at the injection site. If the client is using NovoLog 70/30, massage
is locally contraindicated for 24 hours at the injection site. Clients
experiencing rashes or itching as a side effect of this drug are locally
contraindicated for massage and their physician should be contacted.
Clients taking this drug commonly experience hypoglycemia; the
client should be instructed to eat a snack or light meal before their
massage to prevent its occurrence. Keep a quick source of sugar on
hand such as orange juice, soda, or candy should the client show any
signs of blurred vision, dizziness, confusion, trouble concentrating,
sweating, nausea and/or an elevated heartbeat.
There are no other common drug side effects to consider.
Brand name(s): Oxycontin, Oxecta, Oxyfast, OxyIR, Percolone,
Roxicodone, Roxicodone Intensol, M-Oxy, ETH-Oxydose,
Endocodone, Dazidox
Generic name(s): Oxycodone
Drug type: Opioid
Prescribed for: Chronic pain relief
Massage: Deep tissue massage is contraindicated for this drug.
Massage strokes should be kept at a medium to fast pace so as not to
increase the drug’s relaxing effects upon the central nervous system.
Increase time spent stretching the client to achieve desired outcomes.
Clients experiencing dizziness as a side effect of this drug may be
aided by the use of tapotement. Dizziness should not be severe enough
for the client to require assistance standing.
Common drug side effects not contraindicated for massage include
headaches, a dry mouth, nausea, a loss of appetite, constipation,
sweating, and itching.
Page 44 Massage.EliteCME.com
Brand name(s): Plavix
Generic name(s): Clopidogrel
Drug type: Anti-platelet
Prescribed for: Atherosclerotic
Massage: Clients experiencing any bleeding while prescribed this
drug are contraindicated for massage. Deep tissue massage that
results in bruising should be discontinued at once; proceed with light
pressure. Clients experiencing dizziness as a side effect of this drug
may be aided by the use of tapotement. If dizziness persists or worsens
due to the massage, the client may need assistance standing. Clients
experiencing constipation as a side effect of this drug may be aided by
a clockwise massage of the abdomen.
Common drug side effects not contraindicated for massage include
rhinitis, coughing, rashes, and itching.
Brand name(s): Remicade
Generic name(s): Infliximab
Drug type: Monoclonal antibody anti-inflammatory
Prescribed for: Arthritis conditions; Crohn’s Disease
Massage: Clients experiencing bruising as a side effect of this drug
are contraindicated for deep tissue massage. Clients experiencing
constipation as a side effect of this drug may be aided by a clockwise
massage of the abdomen. Clients experiencing dizziness as a side
effect of this drug may be aided by the use of tapotement. If dizziness
persists or worsens due to the massage, the client may need assistance
standing.
Common drug side effects not contraindicated for massage include
headaches, rhinitis, congested sinuses, sinus pain, coughing,
abdominal discomfort, joint pain, and rashes.
Brand name(s): Revatio
Generic name(s): Sildenafil
Drug type: Vasodialator and muscle relaxant
Prescribed for: Pulmonary arterial hypertension
Massage: Massage is contraindicated for this drug until its effects
have subsided, typically 4 hours after it is taken. Clients experiencing
lightheadedness, vision problems, hearing problems, difficulty
breathing, chest pain or pain spreading to the arm or shoulder, an
irregular heart rate, swelling of the hands or feet, and/or unusual
bleeding as a side effect of this drug are contraindicated for massage
and their physician should be contacted. This drug may induce
headaches that cannot be relieved by massage.
Common drug side effects not contraindicated for massage include
redness of the face, neck, and chest, nasal congestion, abdominal pain,
lower back pain, and memory problems.
Brand name(s): Rituxan
Generic name(s): Rituximab
Drug type: Monoclonal antibody
Prescribed for: Lymphoma; leukemia; autoimmune disorders;
transplant rejection
Massage: Clients experiencing headaches, lightheadedness, vision
problems, earaches, swelling of the tongue or throat, mouth sores,
chest pain, an elevated heart rate, difficulty breathing, lower back
pain, skin conditions (particularly rashes, blistering, hives, itching,
peeling, or pus), fever, chills, sensitive reflexes, rigid muscles, muscle
weakness, a weak pulse, and/or any blood in their urine as a side effect
of this drug are contraindicated for massage and their physician should
be contacted. Clients experiencing dizziness as a side effect of this
drug may be aided by the use of tapotement. Dizziness should not be
severe enough for the client to require assistance standing.
Common drug side effects not contraindicated for massage include
abdominal discomfort, nausea, and sweating.
Brand name(s): Seroquel
Generic name(s): Quetiapine
Drug type: Anti-psychotic
Prescribed for: Schizophrenia; bi-polar disorder
Massage: Massage is contraindicated for this drug unless approved
by the client’s physician. Deep tissue massage is not contraindicated
but should be used with great care. Clients experiencing rashes or
itching as a side effect of this drug are locally contraindicated for
massage and their physician should be contacted. Clients commonly
experience dizziness and sleepiness as a side effect of this drug and
may need assistance lying and standing. Treat with tapotement. Clients
experiencing constipation as a side effect of this drug may be aided
by a clockwise massage of the abdomen. If the client experiences
agitation as a side effect of this drug, discontinue the massage.
Common drug side effects not contraindicated for massage include
a rhinitis, earaches, congested sinuses, a dry mouth, sore throat,
abdominal discomfort, stomach pain, nausea, sweating, increased
appetite, and weight gain.
Brand name(s): Seroquel XR
Generic name(s): Quetiapine
Drug type: Anti-psychotic
Prescribed for: Schizophrenia; bi-polar disorder
Massage: Massage is contraindicated for this drug unless approved
by the client’s physician. Deep tissue massage is not contraindicated
but should be used with great care. Clients experiencing rashes or
itching as a side effect of this drug are locally contraindicated for
massage and their physician should be notified. Clients commonly
experience dizziness and sleepiness as a side effect of this drug and
may need assistance lying and standing. Treat with tapotement. Clients
experiencing constipation as a side effect of this drug may be aided by
a clockwise massage of the abdomen. This drug may induce headaches
that cannot be relieved by massage. If the client experiences agitation
as a side effect of this drug, discontinue the massage.
Common drug side effects not contraindicated for massage include
rhinitis, ear pain, dry mouth, sore throat, abdominal discomfort,
abdominal pain, fever, chills, muscle weakness, sweating, an increased
appetite, and weight gain.
Brand name(s): Singulair
Generic name(s): Montelukast
Drug type: Anti-asthmatic
Prescribed for: Asthma; seasonal allergies
Massage: Clients experiencing a widespread rash as a side effect
of this drug are contraindicated for massage. Clients experiencing
dizziness as a side effect of this drug may be aided by the use of
tapotement. Dizziness should not be severe enough for the client to
require assistance standing. This drug may induce headaches that
cannot be relieved by massage.
Common drug side effects not contraindicated for massage include
congested sinuses, tooth pain, sore throat, coughing, heartburn,
abdominal discomfort, abdominal pain, and nausea.
Brand name(s): Spiriva
Generic name(s): Tiotropium
Drug type: Anti-cholinergic bronchodilator
Prescribed for: Bronchitis; chronic obstructive pulmonary disease
(COPD)
Massage: Clients experiencing chest pain or tightness, an elevated
heart rate, and/or difficulty breathing as a side effect of this drug are
contraindicated for massage and their physician should be contacted
immediately.
Common drug side effects not contraindicated for massage include
rhinitis, congested sinuses, nosebleeds, a dry mouth, sore throat,
abdominal discomfort, and muscle pain.
Massage.EliteCME.com Page 45
Brand name(s): Suboxone
Generic name(s): Buprenorphine with naloxone
Drug type: Opioid (buprenorphine) and anti-opioid (naloxone)
Prescribed for: Narcotic/opiate addiction
Massage: Clients experiencing confusion, blurred vision, speech
problems, an elevated heart rate, difficulty breathing, nausea, stomach
pain, muscle pain, muscle weakness, coordination problems, and/or
itching as a side effect of this drug are contraindicated for massage
and their physician should be contacted. Deep tissue massage is
contraindicated for client’s taking this drug due to the client’s reduced
sensitivity to pain. Massage is locally contraindicated for 1 hour at the
injection site. Clients experiencing constipation as a side effect of this
drug may be aided by a clockwise massage of the abdomen. Clients
commonly experience dizziness as a side effect of this drug and may
need assistance lying and standing. Treat with tapotement.
Common drug side effects not contraindicated for massage include
headaches, rhinitis, mouth pain, itching, and sweating.
Brand name(s): Symbicort
Generic name(s): Budesonide with formoterol
Drug type: Steroid (budesonide) and bronchodilator (formoterol)
Prescribed for: Asthma; chronic obstructive pulmonary disease
(COPD)
Massage: Clients experiencing blurred vision, mouth sores, sore
throat, difficulty breathing, asthma, chest pain, chest tightness, an
elevated heart rate, easy bruising, fever, and/or chills as a side effect
of this drug are contraindicated for massage and their physician should
be contacted immediately. Clients taking this drug for more than two
weeks are contraindicated for deep tissue massage. Proceed cautiously
with stretches or traction. The bodies of clients taking this drug may
not be as responsive to massage as they would be without the drug.
Using the various massage strokes more slowly may help achieve the
desired results. Clients experiencing dizziness as a side effect of this
drug may be aided by the use of tapotement. If dizziness persists, the
client may need assistance standing.
Common drug side effects not contraindicated for massage include
headaches, congested sinuses, nausea, abdominal discomfort, muscle
pain, joint pain and weight gain.
Brand name(s): TriCor, Antara, Fenoglide, Lipidil Supra, Lipidil EZ,
Lipidil Micro, Lipofen, Lofibra, Triglide
Generic name(s): Fenofibrate
Drug type: Anti-lipemic
Prescribed for: High cholesterol and triglyceride levels
Massage: Clients experiencing paresthesia (unusual sensations
of the skin with no visible cause) as a side effect of this drug are
contraindicated for deep tissue massage where the paresthesia occurs;
however, massage is contraindicated if the paresthesia is severe.
Clients experiencing dizziness as a side effect of this drug may be
aided by the use of tapotement. If dizziness persists, the client may
need assistance standing. Clients experiencing a rash as a side effect of
this drug are locally contraindicated for massage and their physician
should be contacted. Clients experiencing constipation as a side effect
of this drug may be aided by a clockwise massage of the abdomen.
Common drug side effects not contraindicated for massage include
headaches, earaches, rhinitis, blurred vision, eye soreness, coughing,
irregular heart rate, increased appetite, abdominal pain, nausea, and
insomnia.
Brand name(s): Truvada
Generic name(s): Emtricitabine with tenofovir
Drug type: Nucleoside reverse transcriptase inhibitors (NNRTI)
Prescribed for: Human immunodeficiency virus (HIV)
Massage: Clients experiencing neuropathy or parasthesia (unusual
sensations of the skin with no visible cause) as a side effect of this
drug are locally contraindicated for massage and their physician should
be contacted.
Common drug side effects not contraindicated for massage include
headaches, abdominal discomfort, nausea, redistribution of body fat,
rashes, itching, insomnia, and anxiety.
Brand name(s): Viagra
Generic name(s): Sildenafil
Drug type: Vasodialator and muscle relaxant
Prescribed for: Erectile Dysfunction
Massage: Massage is contraindicated for this drug until its effects
have subsided, between 4 and 12 hours depending on the client.
Clients experiencing lightheadedness, vision problems, hearing
problems, difficulty breathing, chest pain or pain spreading to the arm
or shoulder, an irregular heart rate, swelling of the hands or feet, and/
or unusual bleeding as a side effect of this drug are contraindicated
for massage and their physician should be contacted. This drug may
induce headaches that cannot be relieved by massage.
Common drug side effects not contraindicated for massage include
redness of the face, neck, and chest, nasal congestion, abdominal pain,
lower back pain, and memory problems.
Brand name(s): Vyvanse
Generic name(s): Lisdexamfetamine
Drug type: Psychostimulant
Prescribed for: Attention deficit hyperactivity disorder (ADHD)
Massage: Clients experiencing severe headaches, lightheadedness,
confusion, hallucinations, blurred vision, chest pain, an elevated heart
rate, muscle twitches and/or behavioral changes as a side effect of this
drug are contraindicated for massage and their physician should be
contacted. Clients commonly experience insomnia as a side effect of
this drug; encourage clients to extend their massage if this side effect
is chronic.
Common drug side effects not contraindicated for massage include a
dry mouth, changes in taste perception, abdominal pain, nausea, and a
loss of appetite.
Brand name(s): Zetia
Generic name(s): Ezetimibe
Drug type: Anti-lipemic
Prescribed for: High cholesterol
Massage: Clients experiencing dizziness as a side effect of this drug
may be aided by the use of tapotement. Dizziness should not be severe
enough for the client to require assistance standing.
Common drug side effects not contraindicated for massage include
headaches, congested sinuses, coughing, abdominal pain, muscle pain,
and joint pain.

Appendix
Because of the various outlets from which clients may procure their Interferon beta 1a – Avonex, Rebif
medications, clients may be more familiar with a brand name drug’s Insulin detemir – Levemir, Levemir FlexPen
generic name. For easy referencing, this section alphabetically lists the Insulin glarine – Lantus, Lantus OptiClik Cartridge, Lantus Solostar
generic names for each prescription drug in this course followed by Pen
each drug’s brand name. Lidocaine – Lidoderm, AneCream, Bactine, LidaMantle, Lidocream,
Lidosense5, LMX 4, LMX 4 with Tegaderm, LMX 5, Medi-Quik
Adalimumab – Humira, Humira Pen
Spray, Senatec, Xylocaine Jelly, Xylocaine Topical, Zilactin-L
Albuterol with ipratropium – Combivent
Insulin lispro – Humalog
Amphetamine with dextroamphetamine – Adderall
Lisdexamfetamine – Vyvanse
Aripirazole – Ability
Methylphenidate – Concerta, Metadate, Methylin, Ritalin
Bevacizumab – Avastin
Mometasone nasal – Nasonex
Budesonide with formoterol – Symbicort
Montelukast – Singulair
Buprenorphine with naloxone – Suboxone
Oxalipatin – Eloxatin
Celecoxib – Celebrex
Pemetrexed – Alimta
Clopidogrel – Plavix
Pioglitazone – Actos
Duloxetine - Cymbalta
Quetiapine – Seroquel, Seroquel XR
Efavirenz – Atripla
Rituximab – Rituxin
Emtricitabine – Atripla
Rosuvastatin – Crestor
Emtricitabine with tenofovir – Truvada
Sildenafil – Vaigra, Revatio (check with client for reason prescribed as
Epoetin alfa – Epogen
each medication is prescribed for different dysfunctions)
Etanercept – Enbral
Sitagliptin - Januvia
Ezetimibe – Zetia
Telaprevir – Incivek
Fenofibrate – TriCor, Antara, Fenoglide, Lipidil Supra, Lipidil EZ,
Tenofovir – Atripla
Lipidil Micro, Lipofen, Lofibra, Triglide
Testosterone (as a topical) – AndroGel
Fluticasone with salmeterol – Advair Diskus
Tiotropium – Spiriva
Glatiramer – Copaxone
Transtuzumab – Herceptin
Imatinib – Gleevec
Valsartan – Diovan
Infliximab – Remicabe
Valsartan with hydrochlorothiazide – Diovan HCT

References
ŠŠ Reportlinker.com. [Internet]. (2014). Prescription Drug Industry Market Research & Statistics. ŠŠ Wible, J. (2009). Drug handbook for massage therapists. (1st ed.). Baltimore, MD: Lippincott
Retrieved from http://www.reportlinker.com/ci02264/Prescription-Drug.html Williams & Wilkins.
ŠŠ Drugs.com [Internet]. (2013). Top 100 drugs for 2013 by sales. Retrieved from http://www.drugs.
com/stats/top100/2013/sales
ŠŠ Griffith, H. W. (2012). Complete guide to prescription and nonprescription drugs. (1st ed.). New
York, NY: Penguin Group
ŠŠ National Library of Medicine [Internet]. (2013). Drugs, supplements, and herbal information.
Retrieved from http://www.nlm.nih.gov/medlineplus/druginformation.html

Page 46 Massage.EliteCME.com
 PRESCRIPTION DRUG PRECAUTIONS AND
CONTRAINDICATIONS FOR MASSAGE THERAPY
Final Examination Questions
Select the best answer for each question and mark your answers
online at Massage.EliteCME.com.

1. What is Abilify prescribed for? 7. What type of drug might be prescribed for an arthritis condition?
a. High cholesterol and triglyceride levels. a. Anti-rheumatic.
b. To increase white blood cell count. b. Anti-fungal.
c. Manic depression / bipolar disorder. c. Anti-asthmatic.
d. Type II diabetes. d. Anti-coagulant.

2. What should a massage therapist do when a client taking Adderall 8. Anti-hyperglycemics are a drug type prescribed for which
becomes agitated? condition?
a. Use soothing strokes such as effleurage. a. Arthritis.
b. Discontinue the session. b. Diabetes.
c. Use stimulating strokes such as tapotement. c. Fibromyalgia.
d. Call for emergency response. d. Attention deficit hyperactivity disorder (ADHD).

3. Which of these prescribed drugs contraindicate massage for a 9. What common side effect associated with Namenda is not
client unless approved by the client’s physician? contraindicated for massage?
a. Atripla. a. Dizziness.
b. Avastin. b. Fever.
c. Avonex. c. Joint pain.
d. Celebrex. d. Abdominal pain.

4. What is Celebrex prescribed for? 10. What type of massage stroke can be used to treat the drowsiness or
a. Multiple sclerosis. dizziness associated with the prescription drug Seroquel?
b. Arthritis. a. Effleurage.
c. Anxiety. b. Compressions.
d. Prevention of blood clots (DVT’s). c. Vibration.
d. Tapotement.
5. Why may a client who is prescribed Combivent need assistance
standing?
a. The client may experience dizziness while taking the drug.
b. The client may experience dizziness because they are not
taking this drug.
c. The client may experience muscle weakness while taking this
drug.
d. The client may experience muscle weakness if they are not
taking this drug.

6. What is Cymbalta prescribed for?

a. Hypertension.
b. Multiple sclerosis.
c. Nasal polyps.
d. Depression.

MIL02PDE16

Massage.EliteCME.com Page 47