diff --git a/src/lib/ai/coach/activity/screen.ts b/src/lib/ai/coach/activity/screen.ts
index a8bd3d4e1..12c084009 100644
--- a/src/lib/ai/coach/activity/screen.ts
+++ b/src/lib/ai/coach/activity/screen.ts
@@ -36,6 +36,8 @@ export interface ActivityScreenContext {
   userMessage?: string;
   /** Scheduled doses, which the dose screen lets through. */
   scheduleDoses?: readonly number[];
+  /** The schedule's medication names, which count as medication nouns. */
+  medicationNames?: readonly string[];
 }
 
 /** Markdown emphasis, headings and list marks, which the trail never renders. */
@@ -58,7 +60,10 @@ function cut(text: string, max: number): string {
 
 function passes(text: string, ctx: ActivityScreenContext): boolean {
   try {
-    if (screenCoachReply(text, ctx.locale, ctx.scheduleDoses).block) {
+    if (
+      screenCoachReply(text, ctx.locale, ctx.scheduleDoses, ctx.medicationNames)
+        .block
+    ) {
       return false;
     }
     if (detectRefusal({ message: text, locale: ctx.locale }).refuse) {
diff --git a/src/lib/ai/coach/outbound-guard.ts b/src/lib/ai/coach/outbound-guard.ts
index 10d21bf9f..53d4d1df1 100644
--- a/src/lib/ai/coach/outbound-guard.ts
+++ b/src/lib/ai/coach/outbound-guard.ts
@@ -58,14 +58,22 @@ export interface CoachOutboundDecision {
  * N mg" is trusted only when N is a dose the user is on. Omitted by the
  * non-Coach callers (nudge / reaction-line), which keep the phrase-anchored
  * Guard I behaviour.
+ *
+ * `medicationNames` optionally makes the person's own medication names count
+ * as medication nouns in the dose-change class, so "skip the Eliquis" or
+ * "take an extra ramipril" blocks like "skip your dose". Omitted, the class
+ * still knows the dosage-form words, the drug-class words and the common
+ * generic-name stems.
  */
 export function screenCoachReply(
   reply: string,
   locale: Locale,
   scheduleDoses?: readonly number[],
+  medicationNames?: readonly string[],
 ): CoachOutboundDecision {
   const decision = screenModelOutput(reply, locale, CONVERSATIONAL_CONTRACTS, {
     scheduleDoses,
+    medicationNames,
   });
   return {
     block: decision.block,
diff --git a/src/lib/ai/coach/turn/__tests__/reply-guards-named-meds.test.ts b/src/lib/ai/coach/turn/__tests__/reply-guards-named-meds.test.ts
new file mode 100644
index 000000000..79e79f00e
--- /dev/null
+++ b/src/lib/ai/coach/turn/__tests__/reply-guards-named-meds.test.ts
@@ -0,0 +1,91 @@
+/**
+ * The turn's medication names reach the outbound dose screen: the Coach reply
+ * and the trail text both treat a scheduled brand name as a medication noun,
+ * so "skip the Eliquis" is replaced with the dose fallback.
+ */
+import { beforeEach, describe, expect, it, vi } from "vitest";
+
+const findMany = vi.fn();
+vi.mock("@/lib/db", () => ({
+  prisma: { coachMessage: { findMany: (...a: unknown[]) => findMany(...a) } },
+}));
+vi.mock("@/lib/auth/audit", () => ({ auditLog: vi.fn() }));
+vi.mock("@/lib/ai/coach/reminders", () => ({
+  parseRememberSentinel: (prose: string) => ({ prose, reminder: null }),
+  captureReminderFromSentinel: vi.fn(),
+}));
+
+import { guardReply } from "../reply-guards";
+import type { TurnContext } from "../context";
+import type { ModelOutcome } from "../model";
+import type { TurnConversation } from "../types";
+import { COACH_OUTBOUND_DOSE_BLOCK_EN } from "@/lib/ai/coach/outbound-guard";
+import { screenActivityTitle } from "@/lib/ai/coach/activity/screen";
+
+const SKIP = "Skip the Eliquis tomorrow before the race.";
+
+function run(content: string, medicationNames: string[]) {
+  const model = {
+    ok: true,
+    result: { content },
+    toolTrace: [],
+    toolResultPayloads: [],
+    inventoryPayloads: [],
+    noToolsSnapshotPayloads: [],
+    inventory: [],
+    steps: [],
+    results: [],
+    forcedFinal: false,
+  } as unknown as Extract<ModelOutcome, { ok: true }>;
+  const ctx = {
+    scheduleDoses: [],
+    medicationNames,
+    aboutMe: null,
+    turnContext: { guidedBlock: "", includeFullSnapshot: false },
+    snapshot: { referenceGrounding: null },
+  } as unknown as TurnContext;
+  const conversation: TurnConversation = {
+    conversationId: "conv1",
+    priorTurns: [],
+    priorUserMessages: [],
+    priorToolFigures: [],
+    priorSummary: null,
+  };
+  return guardReply({
+    userId: "u1",
+    locale: "en",
+    conversation,
+    ctx,
+    toolMode: true,
+    model,
+  });
+}
+
+describe("guardReply — the schedule's medication names", () => {
+  beforeEach(() => {
+    findMany.mockReset();
+    findMany.mockResolvedValue([]);
+  });
+
+  it("replaces a skip of a scheduled brand with the dose fallback", async () => {
+    const out = await run(SKIP, ["Eliquis 5 mg"]);
+    if (!out.ok) throw new Error(out.code);
+    expect(out.reply.replyText).toBe(COACH_OUTBOUND_DOSE_BLOCK_EN);
+  });
+
+  it("leaves the same sentence alone when the brand is not on the schedule", async () => {
+    const out = await run(SKIP, []);
+    if (!out.ok) throw new Error(out.code);
+    expect(out.reply.replyText).toBe(SKIP);
+  });
+});
+
+describe("screenActivityTitle — the schedule's medication names", () => {
+  it("drops a trail title that skips a scheduled brand", () => {
+    const ctx = { locale: "en" as const, figures: () => [] };
+    expect(screenActivityTitle(SKIP, ctx)).toBe(SKIP);
+    expect(
+      screenActivityTitle(SKIP, { ...ctx, medicationNames: ["Eliquis"] }),
+    ).toBeNull();
+  });
+});
diff --git a/src/lib/ai/coach/turn/context.ts b/src/lib/ai/coach/turn/context.ts
index 5eb51c3dd..b7e3ce1c0 100644
--- a/src/lib/ai/coach/turn/context.ts
+++ b/src/lib/ai/coach/turn/context.ts
@@ -31,6 +31,7 @@ import {
 } from "@/lib/ai/coach/chat-request-builder";
 import { buildWorkoutEvidenceSection } from "@/lib/ai/coach/workout-evidence-builder";
 import { getScheduledDoseValues } from "@/lib/medications/scheduled-doses";
+import { getMedicationNames } from "@/lib/medications/medication-names";
 import { buildRememberAddendum } from "@/lib/ai/coach/reminders";
 import { buildSuggestActionAddendum } from "@/lib/ai/coach/suggest-action";
 import {
@@ -62,6 +63,8 @@ export interface TurnContext {
   snapshot: CoachSnapshotResult;
   aboutMe: string | null;
   scheduleDoses: Awaited<ReturnType<typeof getScheduledDoseValues>>;
+  /** The schedule's medication names, which the outbound dose screen reads. */
+  medicationNames: string[];
   turnContext: CoachTurnContext;
   workoutEvidence: Record<string, unknown> | null;
   systemPrompt: string;
@@ -129,6 +132,7 @@ export async function assembleTurnContext(args: {
   // continuation exemption. Fail-open: a read failure yields an empty set, which
   // keeps the Guard I phrase-anchored dose behaviour.
   const scheduleDoses = await getScheduledDoseValues(userId).catch(() => []);
+  const medicationNames = await getMedicationNames(userId).catch(() => []);
   // v1.22 (B2/F6) — the canonical system-prompt module is owned elsewhere, so
   // the two memory/action clauses are appended at assembly time here: one
   // teaches the model to emit `---REMEMBER---` (durable "remind me" capture),
@@ -231,6 +235,7 @@ export async function assembleTurnContext(args: {
     snapshot,
     aboutMe,
     scheduleDoses,
+    medicationNames,
     turnContext,
     workoutEvidence,
     systemPrompt,
diff --git a/src/lib/ai/coach/turn/model.ts b/src/lib/ai/coach/turn/model.ts
index c032c45b1..ab7e417b7 100644
--- a/src/lib/ai/coach/turn/model.ts
+++ b/src/lib/ai/coach/turn/model.ts
@@ -307,6 +307,7 @@ export async function runTurnModel(args: {
       figures: () => figures,
       userMessage: args.message,
       scheduleDoses: ctx.scheduleDoses,
+      medicationNames: ctx.medicationNames,
     },
   });
   // A round's digest runs until the next entry opens: the next round's
diff --git a/src/lib/ai/coach/turn/reply-guards.ts b/src/lib/ai/coach/turn/reply-guards.ts
index c7f687b3c..4fd5d0a83 100644
--- a/src/lib/ai/coach/turn/reply-guards.ts
+++ b/src/lib/ai/coach/turn/reply-guards.ts
@@ -201,7 +201,12 @@ export async function guardReply(args: {
   // the system-prompt GLP-1/grounding contracts. On a trip the turn is
   // replaced with a calm, grounded fallback and any reminder suggestion /
   // key-value provenance is dropped — the user never sees the unsafe text.
-  const outbound = screenCoachReply(replyText, locale, ctx.scheduleDoses);
+  const outbound = screenCoachReply(
+    replyText,
+    locale,
+    ctx.scheduleDoses,
+    ctx.medicationNames,
+  );
   if (outbound.block && outbound.reason) {
     replyText = coachOutboundFallback(outbound.reason, locale);
     annotate({
diff --git a/src/lib/ai/safety/__tests__/outbound-screen-named-meds.test.ts b/src/lib/ai/safety/__tests__/outbound-screen-named-meds.test.ts
new file mode 100644
index 000000000..6a0fa23ee
--- /dev/null
+++ b/src/lib/ai/safety/__tests__/outbound-screen-named-meds.test.ts
@@ -0,0 +1,284 @@
+/**
+ * The dose-change class with a named medication.
+ *
+ * The class demanded a medication NOUN ("dose", "tablet", "insulin") next to
+ * every skip / stop / extra imperative, and a bare drug name never counted, so
+ * "skip the amlodipine" and "then take an extra ramipril" passed. Spelled-out
+ * counts ("take two tablets") and the "extra / one more / … mehr" shape were
+ * missing in every locale. The screen now takes the person's own medication
+ * names as medication nouns, knows the generic drug-class words of each
+ * locale (blood thinner, Blutverdünner, anticoagulant, statin, …) and the
+ * common generic-name stems (-pril, -sartan, -olol, -dipine, …), and covers
+ * the extra / spelled-count / stop-a-named-drug shapes.
+ *
+ * The negative corpus pins the false-positive posture: a sentence that merely
+ * names a drug, a description of the schedule, a past change from the log, a
+ * negated warning, a clinician referral without a target, and everyday advice
+ * that shares the verb ("take an extra walk") all pass.
+ */
+import { describe, it, expect } from "vitest";
+
+import {
+  screenModelOutput,
+  CONVERSATIONAL_CONTRACTS,
+} from "@/lib/ai/safety/outbound-screen";
+import { screenCoachReply } from "@/lib/ai/coach/outbound-guard";
+import { locales, type Locale } from "@/lib/i18n/config";
+
+/** The person's schedule, as each locale's user would have typed it. */
+const NAMES: Record<Locale, readonly string[]> = {
+  en: ["Ramipril 5 mg", "Amlodipine", "Eliquis"],
+  de: ["Ramipril 5 mg", "Amlodipin", "Eliquis"],
+  fr: ["Ramipril", "Amlodipine", "Eliquis"],
+  es: ["Ramipril", "Amlodipino", "Eliquis"],
+  it: ["Ramipril", "Amlodipina", "Eliquis"],
+  pl: ["Ramipril", "Amlodypina", "Eliquis"],
+  ko: ["라미프릴", "암로디핀", "엘리퀴스"],
+};
+
+const VIOLATIONS: Record<Locale, readonly string[]> = {
+  en: [
+    "Then take an extra ramipril.",
+    "skip the amlodipine",
+    "take one more tablet of ramipril",
+    "Stop your blood thinner before the run.",
+    "Take two tablets of ramipril tonight.",
+    "Take another amlodipine if your pressure is high.",
+    "Leave out the Eliquis tomorrow.",
+    "Leave your Eliquis out tomorrow.",
+    "Pause your Eliquis for the weekend.",
+    "Take an additional dose of insulin before the run.",
+    "You should stop your Eliquis before the race.",
+    "Consider stopping your ramipril for a week.",
+    "Take half a tablet of amlodipine.",
+  ],
+  de: [
+    "Nimm abends eine Tablette mehr.",
+    "Lass das Ramipril morgen weg.",
+    "Nimm heute eine zusätzliche Tablette Ramipril.",
+    "Nimm noch eine Tablette Amlodipin.",
+    "Nimm zwei Tabletten Ramipril.",
+    "Überspring das Amlodipin morgen.",
+    "Pausiere den Blutverdünner am Wochenende.",
+    "Hör mit dem Ramipril auf.",
+    "Lass den Blutverdünner vor dem Lauf weg.",
+    "Verzichte morgen auf das Eliquis.",
+  ],
+  fr: [
+    "Prenez un comprimé de ramipril en plus.",
+    "Prenez deux comprimés ce soir.",
+    "Sautez l'amlodipine demain.",
+    "Arrêtez votre anticoagulant avant la course.",
+    "Prenez un ramipril supplémentaire.",
+    "Prenez un autre comprimé de ramipril.",
+  ],
+  es: [
+    "Tome una pastilla de más esta noche.",
+    "Tome dos pastillas de ramipril.",
+    "Omita el amlodipino mañana.",
+    "Deje el anticoagulante antes de correr.",
+    "Tome otra pastilla de ramipril.",
+  ],
+  it: [
+    "Prenda una compressa in più stasera.",
+    "Prenda due compresse di ramipril.",
+    "Salti l'amlodipina domani.",
+    "Sospenda l'anticoagulante prima della corsa.",
+    "Prenda un'altra compressa di ramipril.",
+  ],
+  pl: [
+    "Weź dodatkową tabletkę ramiprilu.",
+    "Weź dwie tabletki wieczorem.",
+    "Pomiń amlodypinę jutro.",
+    "Odstaw ramipril przed biegiem.",
+    "Weź jedną tabletkę więcej.",
+  ],
+  ko: [
+    "라미프릴을 한 알 더 드세요.",
+    "암로디핀은 내일 건너뛰세요.",
+    "항응고제를 중단하세요.",
+    "인슐린을 추가로 맞으세요.",
+    "하루 두 알 드세요.",
+  ],
+};
+
+const CLEAN: Record<Locale, readonly string[]> = {
+  en: [
+    "Your ramipril log shows every dose taken.",
+    "Don't skip your ramipril.",
+    "Never take an extra amlodipine to make up for a missed one.",
+    "You took an extra ramipril on Tuesday, according to your log.",
+    "Your log shows you skipped the amlodipine twice last week.",
+    "Your schedule has one tablet of ramipril every morning.",
+    "Your Eliquis was stopped in March, as your log shows.",
+    "Ask your doctor whether to stop your blood thinner before surgery.",
+    "Ask your doctor whether you should stop your Eliquis before surgery.",
+    "Talk to your prescriber before you skip any ramipril.",
+    "Ramipril and amlodipine both lower blood pressure.",
+    "Take an extra walk after dinner.",
+    "Take an extra minute to log your medication.",
+    "Skip the extra coffee today.",
+    "Stop your run if you feel dizzy.",
+    "Take one more lap around the block.",
+    "Stop worrying about your medication; your log is complete.",
+    "Take your ramipril as prescribed.",
+    "Your April readings were steady.",
+    "Take a reading before your morning amlodipine.",
+    "Take one more reading tonight to confirm the trend.",
+    "Ask your doctor if you should skip the amlodipine before surgery.",
+    "I'd suggest asking your doctor before stopping your ramipril.",
+    "Please don't take an extra ramipril to catch up.",
+    "Two tablets of metformin a day is what your schedule shows.",
+  ],
+  de: [
+    "Dein Ramipril-Protokoll zeigt jede Dosis als genommen.",
+    "Lass das Ramipril nicht weg.",
+    "Nimm keine zusätzliche Tablette, wenn du eine vergessen hast.",
+    "Du hast am Dienstag eine Tablette mehr genommen.",
+    "Laut Plan nimmst du morgens eine Tablette Ramipril.",
+    "Frag deine Ärztin, ob du den Blutverdünner vor der OP absetzen sollst.",
+    "Nimm noch eine Runde um den Block.",
+    "Lass den Zucker im Kaffee weg.",
+    "Ramipril und Amlodipin senken beide den Blutdruck.",
+    "Nimm mehr Wasser zu dir.",
+    "Nimm eine Messung mehr am Abend.",
+    "Lass dir von deiner Ärztin erklären, ob du das Ramipril weglassen kannst.",
+    "Nimm dein Ramipril weiter wie verordnet.",
+  ],
+  fr: [
+    "Votre journal de ramipril montre toutes les prises.",
+    "Ne sautez pas l'amlodipine.",
+    "Ne prenez pas de comprimé en plus.",
+    "Vous avez pris un comprimé de ramipril en plus mardi.",
+    "Faites une marche en plus après le dîner.",
+  ],
+  es: [
+    "Su registro de ramipril muestra todas las tomas.",
+    "No omita el amlodipino.",
+    "No tome una pastilla de más.",
+    "Tome un vaso de agua de más.",
+    "Deje el azúcar por una semana.",
+  ],
+  it: [
+    "Il suo registro di ramipril mostra tutte le dosi.",
+    "Non salti l'amlodipina.",
+    "Non prenda una compressa in più.",
+    "Faccia una passeggiata in più.",
+  ],
+  pl: [
+    "Twój dziennik ramiprilu pokazuje wszystkie dawki.",
+    "Nie pomiń amlodypiny.",
+    "Nie bierz dodatkowej tabletki.",
+    "Zrób dodatkowy spacer po obiedzie.",
+  ],
+  ko: [
+    "라미프릴 기록을 보면 모두 복용하셨어요.",
+    "암로디핀을 건너뛰지 마세요.",
+    "물을 한 잔 더 드세요.",
+    "라미프릴을 한 알 더 드시지 마세요.",
+  ],
+};
+
+describe("screenModelOutput — a named medication in the dose-change class", () => {
+  for (const locale of locales) {
+    it.each(VIOLATIONS[locale])(`blocks in ${locale}: %s`, (text) => {
+      const d = screenModelOutput(text, locale, CONVERSATIONAL_CONTRACTS, {
+        medicationNames: NAMES[locale],
+      });
+      expect(d.block).toBe(true);
+      expect(d.reason).toBe("dose_prescription");
+    });
+
+    it.each(CLEAN[locale])(`passes in ${locale}: %s`, (text) => {
+      const d = screenModelOutput(text, locale, CONVERSATIONAL_CONTRACTS, {
+        medicationNames: NAMES[locale],
+      });
+      expect(d.block).toBe(false);
+      expect(d.reason).toBeNull();
+    });
+  }
+});
+
+describe("screenModelOutput — drug-class words and generic stems without a schedule", () => {
+  // Surfaces that pass no names (nudges, the document chat) still see the
+  // class words and the common generic-name stems.
+  const blocked: Array<[string, Locale]> = [
+    ["Stop your blood thinner before the run.", "en"],
+    ["Skip your statin tonight.", "en"],
+    ["skip the amlodipine", "en"],
+    ["Then take an extra ramipril.", "en"],
+    ["Take an extra insulin shot.", "en"],
+    ["Lass den Blutverdünner morgen weg.", "de"],
+    ["Lass das Ramipril morgen weg.", "de"],
+    ["Arrêtez votre anticoagulant avant la course.", "fr"],
+  ];
+  it.each(blocked)("blocks: %s (%s)", (text, locale) => {
+    expect(
+      screenModelOutput(text, locale, CONVERSATIONAL_CONTRACTS).block,
+    ).toBe(true);
+  });
+
+  const clean: Array<[string, Locale]> = [
+    ["Your April readings were steady.", "en"],
+    ["Skip comparing today with last week.", "en"],
+    ["Your ramipril log shows every dose taken.", "en"],
+  ];
+  it.each(clean)("passes: %s (%s)", (text, locale) => {
+    expect(
+      screenModelOutput(text, locale, CONVERSATIONAL_CONTRACTS).block,
+    ).toBe(false);
+  });
+});
+
+describe("screenModelOutput — a brand name needs the schedule", () => {
+  it("blocks a brand only when it is on the person's schedule", () => {
+    const text = "Skip the Eliquis tomorrow.";
+    expect(screenModelOutput(text, "en", CONVERSATIONAL_CONTRACTS).block).toBe(
+      false,
+    );
+    expect(
+      screenModelOutput(text, "en", CONVERSATIONAL_CONTRACTS, {
+        medicationNames: ["Eliquis 5 mg"],
+      }).block,
+    ).toBe(true);
+  });
+
+  it("ignores names that are too short or carry only a number", () => {
+    const d = screenModelOutput(
+      "Skip the walk tomorrow.",
+      "en",
+      CONVERSATIONAL_CONTRACTS,
+      { medicationNames: ["B", "500", "  "] },
+    );
+    expect(d.block).toBe(false);
+  });
+
+  it("treats regex metacharacters in a name literally", () => {
+    const names = ["Co-Amoxi (875/125)", "Vit. D3+"];
+    expect(
+      screenModelOutput("Skip the walk.", "en", CONVERSATIONAL_CONTRACTS, {
+        medicationNames: names,
+      }).block,
+    ).toBe(false);
+    expect(
+      screenModelOutput(
+        "Stop the co-amoxi tomorrow.",
+        "en",
+        CONVERSATIONAL_CONTRACTS,
+        { medicationNames: names },
+      ).block,
+    ).toBe(true);
+  });
+});
+
+describe("screenCoachReply — passes the schedule's names through", () => {
+  it("blocks a named-drug skip when the names are supplied", () => {
+    expect(
+      screenCoachReply("Skip the Eliquis tomorrow.", "en", [5], ["Eliquis"])
+        .block,
+    ).toBe(true);
+    expect(
+      screenCoachReply("Skip the Eliquis tomorrow.", "en", [5]).block,
+    ).toBe(false);
+  });
+});
diff --git a/src/lib/ai/safety/outbound-screen.ts b/src/lib/ai/safety/outbound-screen.ts
index da8b2a852..d9eec2667 100644
--- a/src/lib/ai/safety/outbound-screen.ts
+++ b/src/lib/ai/safety/outbound-screen.ts
@@ -101,31 +101,64 @@ const UNIT_END = "(?!\\w|\\s*\\/\\s*(?:dl|l|min|mmol)\\b)";
  * dietary noun: "lower your sodium to 1500 mg" and "cut caffeine to 200 mg"
  * are nutrition guidance, not a dose change.
  */
-function objectSlot(stopWords: string): string {
-  return `(?:(?!(?:${stopWords})(?=\\s))[^\\s\\d.?!,;:]+\\s+){0,4}?`;
+function objectSlot(stopWords: string, maxWords = 4): string {
+  return `(?:(?!(?:${stopWords})(?=\\s))[^\\s\\d.?!,;:]+\\s+){0,${maxWords}}?`;
 }
 
-const EN_SLOT = objectSlot(
-  "not|never|and|or|but|if|whether|when|sodium|salt|caffeine|sugars?|fib(?:er|re)|protein|carbs?|carbohydrates?|cholesterol|water|fluids?|coffee|alcohol|steps",
+const EN_STOP =
+  "not|never|and|or|but|if|whether|when|sodium|salt|caffeine|sugars?|fib(?:er|re)|protein|carbs?|carbohydrates?|cholesterol|water|fluids?|coffee|alcohol|steps";
+const DE_STOP =
+  "nicht|nie|niemals|kein\\w*|und|oder|aber|wenn|ob|natrium|salz|koffein|zucker|wasser|eiweiß|protein|ballaststoff\\w*|kalorien";
+const FR_STOP =
+  "pas|jamais|ne|et|ou|mais|si|sodium|sel|caféine|sucres?|eau|protéines?|fibres?";
+const ES_STOP =
+  "no|nunca|y|o|pero|si|sodio|sal|cafeína|azúcar|agua|proteínas?|fibra";
+const IT_STOP =
+  "non|mai|e|o|ma|se|sodio|sale|caffeina|zucchero|acqua|proteine|fibre";
+const PL_STOP =
+  "nie|i|lub|albo|ale|jeśli|czy|sód|sodu|sól|soli|kofein\\S*|cukr\\S*|wod\\S*|białk\\S*|błonnik\\S*";
+
+const EN_SLOT = objectSlot(EN_STOP);
+const DE_SLOT = objectSlot(DE_STOP);
+const FR_SLOT = objectSlot(FR_STOP);
+const ES_SLOT = objectSlot(ES_STOP);
+const IT_SLOT = objectSlot(IT_STOP);
+const PL_SLOT = objectSlot(PL_STOP);
+
+/**
+ * A tighter slot for the shapes that carry no number: an extra / one more /
+ * stop imperative. At most two words, and a preposition ends it, so "take an
+ * extra minute to log your medication" and "stop worrying about your
+ * medication" never reach the medication noun.
+ */
+const EN_SHORT = objectSlot(
+  `${EN_STOP}|to|for|with|at|in|on|of|from|before|after|about|into|than|while|during|like`,
+  2,
 );
-const DE_SLOT = objectSlot(
-  "nicht|nie|niemals|kein\\w*|und|oder|aber|wenn|ob|natrium|salz|koffein|zucker|wasser|eiweiß|protein|ballaststoff\\w*|kalorien",
+const DE_SHORT = objectSlot(
+  `${DE_STOP}|als|zu|mit|für|gegen|statt|ohne|über`,
+  2,
 );
-const FR_SLOT = objectSlot(
-  "pas|jamais|ne|et|ou|mais|si|sodium|sel|caféine|sucres?|eau|protéines?|fibres?",
-);
-const ES_SLOT = objectSlot(
-  "no|nunca|y|o|pero|si|sodio|sal|cafeína|azúcar|agua|proteínas?|fibra",
-);
-const IT_SLOT = objectSlot(
-  "non|mai|e|o|ma|se|sodio|sale|caffeina|zucchero|acqua|proteine|fibre",
-);
-const PL_SLOT = objectSlot(
-  "nie|i|lub|albo|ale|jeśli|czy|sód|sodu|sól|soli|kofein\\S*|cukr\\S*|wod\\S*|białk\\S*|błonnik\\S*",
+const FR_SHORT = objectSlot(
+  `${FR_STOP}|pour|avec|avant|après|sans|à|au|aux`,
+  2,
 );
+const ES_SHORT = objectSlot(`${ES_STOP}|para|con|antes|después|sin|a|al`, 2);
+const IT_SHORT = objectSlot(`${IT_STOP}|per|con|prima|dopo|senza|a|al`, 2);
+const PL_SHORT = objectSlot(`${PL_STOP}|z|ze|do|na|po|przed|bez|dla`, 2);
+
+/**
+ * A count written as a word: "take two tablets", "nimm zwei Tabletten",
+ * "prenez deux comprimés", "weź dwie tabletki". The union of every covered
+ * locale, because a provider mixes languages. Articles ("a", "un", "eine")
+ * are left out on purpose: "take a tablet with food" is an article, not a
+ * count, and the "eine Tablette mehr" shape is its own pattern below.
+ */
+const SPELLED_COUNT =
+  "(?:one|two|three|four|five|six|half\\s+an?|zwei|drei|vier|fünf|sechs|eine?n?\\s+halbe|halbe|deux|trois|quatre|cinq|demi|dos|tres|cuatro|cinco|media|due|tre|quattro|cinque|mezza|dwie|dwa|trzy|cztery|pięć|jedn[ąa]|pół)";
 
 /** A target dose: a number, a drug unit, and an honest unit end. */
-const TARGET = `[\\d.,]+\\s*${DRUG_UNIT}${UNIT_END}`;
+const TARGET = `(?:[\\d.,]+\\s*${DRUG_UNIT}${UNIT_END}|(?<![\\w])${SPELLED_COUNT}\\s+${COUNT_UNIT}${UNIT_END})`;
 
 /**
  * Where an English imperative can start: the sentence head (or a list bullet),
@@ -133,31 +166,153 @@ const TARGET = `[\\d.,]+\\s*${DRUG_UNIT}${UNIT_END}`;
  * ("don't skip your dose") never reaches the verb from any of these.
  */
 const EN_LEAD =
-  "(?:^\\s*(?:[-*•]\\s*|\\d+[.)]\\s*)?|[:;—–]\\s*|\\b(?:please|just|then|now|instead|so|you\\s+(?:should|need\\s+to|must|ought\\s+to)|try\\s+to|go\\s+ahead\\s+and|i'?d|i\\s+would|time\\s+to)\\s+)";
+  "(?:^\\s*(?:[-*•]\\s*|\\d+[.)]\\s*)?|[:;—–]\\s*|(?<!\\b(?:whether|if)\\s)\\b(?:please|just|then|now|instead|so|you\\s+(?:should|need\\s+to|must|ought\\s+to)|try\\s+to|go\\s+ahead\\s+and|i'?d|i\\s+would|time\\s+to)\\s+)";
 
 /** A recommending cue that may sit in front of a gerund / infinitive change. */
 const EN_CUE =
   "\\b(?:consider|try|recommend|suggest|worth|might\\s+want\\s+to|may\\s+want\\s+to|need\\s+to|time\\s+to|i'?d|i\\s+would|should|could)\\b";
 
-const EN_MED =
+/** The letters a drug name is spelled with in the Latin-script locales. */
+const LETTER = "a-zà-ÿąćęłńóśźż";
+
+/**
+ * Medication nouns, per locale: the dosage-form and treatment words.
+ */
+const EN_MED_NOUN =
   "(?:dose|doses|dosage|pill|pills|tablet|tablets|capsule|capsules|medication|medications|medicine|meds|insulin|injection|injections|shot|jab|inhaler)\\b";
-const DE_MED =
+const DE_MED_NOUN =
   "\\S*(?:dosis|tablette\\w*|medikament\\w*|medikation|spritze\\w*|insulin|pille\\w*|kapsel\\w*)";
-const FR_MED =
+const FR_MED_NOUN =
   "(?:doses?|comprimés?|médicaments?|traitement|insuline|injections?|piqûres?|pilules?|gélules?|cachets?)";
-const ES_MED =
+const ES_MED_NOUN =
   "(?:dosis|pastillas?|comprimidos?|medicamentos?|medicaci[óo]n|insulina|inyecci[óo]n|inyecciones|c[áa]psulas?|tratamiento)";
-const IT_MED =
+const IT_MED_NOUN =
   "(?:dos[ei]|compress[ae]|pastigli[ae]|farmac[oi]|medicinal[ei]|insulina|iniezion[ei]|capsul[ae]|terapia)";
-const PL_MED =
+const PL_MED_NOUN =
   "(?:dawk[aęiy]|dawek|tabletk[aęiy]|tabletek|lek|leki|leku|leków|insulin[aęy]|zastrzyk[ia]?|zastrzyków|kapsułk[aęiy]|pigułk[aęiy])(?=[\\s.,;:!?]|$)";
+const KO_MED_NOUN =
+  "(?:약을|약은|약\\s|알약|정제|인슐린|주사|용량|복용량|투약)";
+
+/**
+ * Generic drug-class words, per locale. "Stop your blood thinner" names no
+ * dosage form and no drug, and it is the most dangerous stop of all.
+ */
+const MED_CLASS: Record<Locale, string> = {
+  en: "(?:blood[- ]?thinners?|anti-?coagulants?|anti-?platelets?|statins?|beta[- ]?blockers?|diuretics?|water\\s+pills?|ace\\s+inhibitors?|steroids?|antidepressants?|sleeping\\s+pills?)\\b",
+  de: "\\S*(?:blutverdünner\\w*|gerinnungshemmer\\w*|antikoagul\\w*|statin\\w*|betablocker\\w*|diuretik\\w*|wassertablette\\w*|blutdrucksenker\\w*|antidepressiv\\w*|schlaftablette\\w*)",
+  fr: "(?:anticoagulants?|antiagrégants?|statines?|bêta-?bloquants?|diurétiques?|antidépresseurs?|somnifères?)",
+  es: "(?:anticoagulantes?|antiagregantes?|estatinas?|betabloqueantes?|diuréticos?|antidepresivos?)",
+  it: "(?:anticoagulant[ei]|antiaggregant[ei]|statin[ae]|betabloccant[ei]|diuretic[oi]|antidepressiv[oi])",
+  pl: "(?:lek\\S*\\s+przeciwzakrzepow\\S*|antykoagulant\\S*|statyn\\S*|beta-?bloker\\S*|diuretyk\\S*|lek\\S*\\s+moczopędn\\S*|antydepresant\\S*)",
+  ko: "(?:혈액\\s*희석제|항응고제|항혈소판제|스타틴|베타\\s*차단제|이뇨제|항우울제)",
+};
+
+/**
+ * Common generic-name stems (INN): ramipril, losartan, bisoprolol,
+ * atorvastatin, amlodipine, metformin, semaglutide, apixaban, omeprazole,
+ * furosemide. A surface that passes no schedule (a nudge, the document chat)
+ * still recognises "skip the amlodipine". Two letters must precede the stem,
+ * so "April" is not a drug; the stems are chosen so no everyday word ends in
+ * one ("comparing" is why heparin is spelled out rather than stemmed).
+ */
+const INN_STEM = `(?<![${LETTER}])[${LETTER}]{2,}(?:pril|sartan|olol|statin|dipin|dypin|formin|glutid|gliflozin|gliptin|xaban|ksaban|prazol|semid)[${LETTER}]{0,4}(?![${LETTER}])|(?<![${LETTER}])(?:enoxa|dalte)?heparin[${LETTER}]{0,4}`;
+
+/**
+ * Words a schedule entry's first token may not stand for on its own: a name
+ * like "Morning blend" must not make every "skip the morning …" a dose stop.
+ */
+const NAME_ALIAS_DENY = new Set([
+  "morning",
+  "evening",
+  "night",
+  "daily",
+  "blood",
+  "extra",
+  "water",
+  "sleep",
+  "salt",
+  "slow",
+  "high",
+  "low",
+]);
+
+function escapeRegExp(text: string): string {
+  return text.replace(/[.*+?^${}()|[\]\\]/g, "\\$&");
+}
+
+/**
+ * The person's medication names as one alternation, or null. Each schedule
+ * entry contributes its name up to the first digit or bracket ("Ramipril 5 mg"
+ * → "ramipril") and its first word when that word is long enough to be a drug
+ * on its own ("Metformin retard" → "metformin"). A final vowel is dropped from
+ * a long name so an inflected form still matches (Polish "amlodypinę",
+ * Italian "amlodipina"), and up to four letters of ending or a Korean particle
+ * may follow ("ramiprilu", "라미프릴을").
+ */
+function medicationNameAlternation(
+  names: readonly string[] | undefined,
+): string | null {
+  if (!names || names.length === 0) return null;
+  const stems = new Set<string>();
+  for (const raw of names.slice(0, 64)) {
+    const base = (raw ?? "")
+      .toLowerCase()
+      .split(/[\d([{/,;+]/)[0]
+      .replace(/[.\s]+$/, "")
+      .replace(/\s+/g, " ")
+      .trim();
+    const first = base.split(" ")[0];
+    const candidates = [base];
+    if (first !== base && first.length >= 4 && !NAME_ALIAS_DENY.has(first)) {
+      candidates.push(first);
+    }
+    for (const candidate of candidates) {
+      if ([...candidate].length < 3 || NAME_ALIAS_DENY.has(candidate)) continue;
+      const stem =
+        candidate.length >= 6 ? candidate.replace(/[aeiouyę]$/, "") : candidate;
+      stems.add(stem);
+    }
+  }
+  if (stems.size === 0) return null;
+  const alternation = [...stems]
+    .sort((x, y) => y.length - x.length)
+    .map((stem) => escapeRegExp(stem).replace(/ /g, "\\s+"))
+    .join("|");
+  return `(?<![${LETTER}])(?:${alternation})[^\\s.,;:!?]{0,4}(?=[\\s.,;:!?'’")]|$)`;
+}
+
+/** The medication-noun alternation each locale's patterns use. */
+type MedVocabulary = Record<Locale, string>;
+
+/**
+ * Build each locale's medication noun from the dosage-form words, the class
+ * words, the generic stems and the person's own names. An elided article
+ * ("l'amlodipine", "dell'insulina") may sit in front of a French or Italian
+ * noun.
+ */
+function medVocabulary(names: string | null): MedVocabulary {
+  const extra = (locale: Locale) =>
+    [MED_CLASS[locale], locale === "ko" ? null : INN_STEM, names]
+      .filter((part): part is string => part !== null)
+      .join("|");
+  const elided = "(?:[a-z]{1,4}['’])?";
+  return {
+    en: `(?:${EN_MED_NOUN}|${extra("en")})`,
+    de: `(?:${DE_MED_NOUN}|${extra("de")})`,
+    fr: `${elided}(?:${FR_MED_NOUN}|${extra("fr")})`,
+    es: `(?:${ES_MED_NOUN}|${extra("es")})`,
+    it: `${elided}(?:${IT_MED_NOUN}|${extra("it")})`,
+    pl: `(?:${PL_MED_NOUN}|${extra("pl")})`,
+    ko: `(?:${KO_MED_NOUN}|(?:${extra("ko")})\\S{0,3})`,
+  };
+}
 
 /**
  * Korean dosage-form counters. They attach to the digit with no space ("2정",
  * "10단위"); `정` is guarded against "정상" (normal) and `알` against "알레르기".
  */
 const KO_COUNT = "(?:단위|유닛|캡슐|정(?!상|도|확|말)|알(?!레))";
-const KO_TARGET = `[\\d.,]+(?:\\s*${DRUG_UNIT}${UNIT_END}|${KO_COUNT})`;
+const KO_TARGET = `(?:[\\d.,]+(?:\\s*${DRUG_UNIT}${UNIT_END}|${KO_COUNT})|(?:한|두|세|네|반)\\s*(?:알(?!레)|정(?!상|도|확|말)|캡슐))`;
 
 /**
  * A Korean imperative or recommendation that closes a dose clause. The stem
@@ -166,7 +321,6 @@ const KO_TARGET = `[\\d.,]+(?:\\s*${DRUG_UNIT}${UNIT_END}|${KO_COUNT})`;
  */
 const KO_IMPERATIVE =
   "(?:(?:늘리|올리|높이|줄이|내리|낮추|증량하|감량하|중단하|끊으|건너뛰|멈추|복용하|드시|드|투여하|맞으|주사하|바꾸|변경하)(?:세요|십시오|시기\\s*바랍니다|셔야|는\\s*(?:것이|게)\\s*좋)|(?:늘려|올려|높여|줄여|내려|낮춰|끊어|멈춰|바꿔|드셔|복용해|투여해|증량해|감량해|중단해)\\s*(?:보세요|주세요|보십시오|야\\s*(?:해요|합니다)))";
-const KO_MED = "(?:약을|약은|약\\s|알약|정제|인슐린|주사|용량|복용량|투약)";
 
 /**
  * Dose-prescription banks. Each entry requires a CHANGE verb plus a target
@@ -187,6 +341,9 @@ const KO_MED = "(?:약을|약은|약\\s|알약|정제|인슐린|주사|용량|
 const DE_DOSE_OBJECT =
   "(?:\\s+(?:(?:deine|die|ihre|eure|seine)\\s+)?(?:dosis|dosierung|medikation|wochendosis|tagesdosis))?";
 
+/** A German count in front of a medication noun ("eine Tablette mehr"). */
+const DE_COUNT = "ein(?:e|en)?|zwei|drei|vier|halbe|\\d+(?:[.,]\\d+)?";
+
 /**
  * The dose-change class, per locale. The banks below this one were written
  * one reported sentence at a time and each fixed the exact shape it was handed,
@@ -204,7 +361,17 @@ const DE_DOSE_OBJECT =
  *   3. an imperative to halve, double, skip, pause or stop a medication, which
  *      needs no number at all — "skip your evening dose", "stop taking
  *      metformin". A medication noun is required except for the explicit
- *      "stop taking X" form, so "skip your walk" and "double your steps" pass.
+ *      "stop taking X" form, so "skip your walk" and "double your steps" pass;
+ *   4. an imperative to take an extra, another or one more of a medication —
+ *      "take an extra ramipril", "nimm abends eine Tablette mehr", "prenez un
+ *      comprimé en plus", "weź dodatkową tabletkę".
+ *
+ * A medication noun is a dosage-form word, a drug-class word ("blood
+ * thinner", "Blutverdünner", "anticoagulante"), a common generic-name stem
+ * ("-pril", "-dipine"), or one of the person's own medication names when the
+ * caller passes them. A count may be spelled out ("two tablets", "zwei
+ * Tabletten"). The number-free shapes use a two-word slot that a preposition
+ * ends, because they have no unit to anchor them.
  *
  * Verb forms are imperative or infinitive on purpose: the past forms a log
  * restatement uses ("your dose was increased to 2000 mg", "du nimmst 1000 mg")
@@ -214,152 +381,249 @@ const DE_DOSE_OBJECT =
  * passes; one that names a target ("… whether to increase to 2000 mg") stays
  * blocked, the same accepted fail-safe residual as "discussing the 2.4 mg step".
  */
-const DOSE_CHANGE_CLASS: Record<Locale, readonly RegExp[]> = {
-  en: [
-    new RegExp(
-      `\\b(?:increase|raise|up|bump|boost|titrate|step|move|go|ramp|push|switch|change|adjust|lower|reduce|cut|drop|decrease|taper|halve|double|trim|bring)\\s+${EN_SLOT}(?:from\\s+${TARGET}\\s+)?(?:up\\s+|down\\s+|back\\s+)?(?:to|by)\\s+${TARGET}`,
-      "i",
-    ),
-    new RegExp(
-      `${EN_CUE}[^.?!]{0,20}?\\b(?:increas(?:e|ing)|rais(?:e|ing)|bump(?:ing)?|boost(?:ing)?|titrat(?:e|ing)|lower(?:ing)?|reduc(?:e|ing)|cut(?:ting)?|drop(?:ping)?|decreas(?:e|ing)|taper(?:ing)?|halv(?:e|ing)|doubl(?:e|ing)|switch(?:ing)?|adjust(?:ing)?|go(?:ing)?\\s+up|step(?:ping)?\\s+up)\\s+${EN_SLOT}(?:from\\s+${TARGET}\\s+)?(?:up\\s+|down\\s+)?(?:to|by)\\s+${TARGET}`,
-      "i",
-    ),
-    new RegExp(
-      `${EN_LEAD}(?:take|start\\s+(?:taking|on|with|at)|begin\\s+(?:taking|with|at)|inject|use|give\\s+yourself)\\s+${EN_SLOT}${TARGET}`,
-      "im",
-    ),
-    new RegExp(
-      `${EN_LEAD}(?:halve|double|skip|pause|hold|drop|miss|split|cut)\\s+${EN_SLOT}${EN_MED}`,
-      "im",
-    ),
-    new RegExp(
-      `${EN_LEAD}(?:(?:(?:stop|quit)\\s+(?:taking|injecting)|discontinue)\\s+\\S|(?:come|wean\\s+(?:yourself\\s+)?)\\s*off\\s+${EN_SLOT}${EN_MED})`,
-      "im",
-    ),
-    new RegExp(
-      `${EN_CUE}[^.?!]{0,20}?\\b(?:(?:halv|doubl|skipp|paus|hold|dropp|miss|splitt|cutt)ing\\s+${EN_SLOT}${EN_MED}|(?:stopping|quitting)\\s+(?:taking|injecting)\\s+\\S|discontinuing\\s+\\S|coming\\s+off\\s+${EN_SLOT}${EN_MED})`,
-      "i",
-    ),
-  ],
-  de: [
-    new RegExp(
-      `\\b(?:erhöh(?:e|en)?|steiger(?:e|n)?|reduzier(?:e|en)?|senk(?:e|en)?|verringer(?:e|n)?|halbier(?:e|en)?|verdopp(?:e?le|eln)|stell(?:e|en)?|geh(?:e)?|setz(?:e|en)?|bring(?:e|en)?)(?:\\s+sie)?\\s+${DE_SLOT}(?:(?:hoch|rauf|runter|herunter)\\s+)?(?:auf|um)\\s+${TARGET}`,
-      "i",
-    ),
-    new RegExp(
-      `\\b(?:nimm|nehmen\\s+sie|spritz|spritzen\\s+sie|injizier(?:e)?|injizieren\\s+sie|beginn(?:e)?\\s+mit|beginnen\\s+sie\\s+mit|starte\\s+mit)\\s+${DE_SLOT}${TARGET}`,
-      "i",
-    ),
-    new RegExp(
-      `\\b(?:halbier(?:e|en)?|verdopp(?:e?le|eln)|pausier(?:e|en)?|überspring(?:e|en)?)(?:\\s+sie)?\\s+${DE_SLOT}${DE_MED}`,
-      "i",
-    ),
-    new RegExp(
-      `\\b(?:setz(?:e|en)?)(?:\\s+sie)?(?:\\s+(?!(?:nicht|nie|niemals|kein\\w*)(?=\\s))[^\\s.?!,;:]+){1,4}?\\s+ab(?=\\s*(?:[.?!,;:]|$|und\\s|oder\\s))`,
-      "i",
-    ),
-    new RegExp(
-      `\\b(?:lass|lassen\\s+sie)\\s+${DE_SLOT}${DE_MED}(?:(?!\\b(?:nicht|nie|niemals)\\b)[^.?!]){0,20}?\\b(?:aus|weg)\\b`,
-      "i",
-    ),
-    new RegExp(
-      `\\bh(?:ör(?:e)?|ören\\s+sie)\\s+(?:mit\\s+\\S+\\s+)?auf\\b[^.?!]{0,40}?\\b(?:zu\\s+nehmen|einzunehmen|zu\\s+spritzen)`,
-      "i",
-    ),
-    new RegExp(
-      `\\b(?:solltest|sollten\\s+sie|empfehle|rate\\s+(?:dir|ihnen)|würde\\s+ich)\\b(?:(?!\\b(?:nicht|nie|niemals|kein\\w*)\\b)[^.?!]){0,40}?\\b(?:absetzen|abzusetzen|halbieren|zu\\s+halbieren|verdoppeln|zu\\s+verdoppeln|auslassen|auszulassen|weglassen|wegzulassen|pausieren|zu\\s+pausieren)\\b`,
-      "i",
-    ),
-  ],
-  fr: [
-    new RegExp(
-      `(?<!\\b(?:vous|nous|je|tu|il|elle|on)\\s)(?<!n['’])\\b(?:(?:augment|mont|pass|port|major|diminu|baiss|abaiss|doubl|ramen)(?:ez|e|er)|r[ée]dui(?:sez|s|re))\\s+${FR_SLOT}(?:de\\s+${TARGET}\\s+)?(?:[àa]|de|jusqu'[àa])\\s+${TARGET}`,
-      "i",
-    ),
-    new RegExp(
-      `(?<!\\b(?:vous|nous|je|tu|il|elle|on)\\s)\\b(?:prenez|prends|injectez|injecte|commencez\\s+(?:par|à|avec))\\s+${FR_SLOT}${TARGET}`,
-      "i",
-    ),
-    new RegExp(
-      `(?<!\\b(?:vous|nous|je|tu|il|elle|on)\\s)(?<!n['’])\\b(?:divisez|doublez|sautez|suspendez|interrompez|oubliez|arrêtez|stoppez|supprimez)\\s+${FR_SLOT}${FR_MED}`,
-      "i",
-    ),
-    new RegExp(
-      `(?<!n['’])\\b(?:arrêtez|cessez|stoppez)\\s+de\\s+(?:prendre|vous\\s+injecter)\\b`,
-      "i",
-    ),
-    new RegExp(
-      `\\b(?:vous\\s+devriez|je\\s+recommande\\s+de|je\\s+sugg[èe]re\\s+de|envisagez\\s+de|essayez\\s+de)\\s+(?:sauter|suspendre|arrêter|interrompre|diviser|doubler)\\s+${FR_SLOT}(?:de\\s+prendre\\s+\\S|${FR_MED})`,
-      "i",
-    ),
-  ],
-  es: [
-    new RegExp(
-      `(?<!\\b(?:no|nunca)\\s)\\b(?:aumente|aumenta|aumentar|suba|sube|subir|pase|pasar|incremente|incrementar|reduzca|reduce|reducir|baje|bajar|disminuya|disminuir|duplique|duplicar|lleve|llevar|ajuste|ajustar)\\s+${ES_SLOT}(?:de\\s+${TARGET}\\s+)?(?:a|en|hasta)\\s+${TARGET}`,
-      "i",
-    ),
-    new RegExp(
-      `(?<!\\b(?:no|nunca)\\s)\\b(?:tome|tómese|inyecte|inyéctese|administre|empiece\\s+con|comience\\s+con)\\s+${ES_SLOT}${TARGET}`,
-      "i",
-    ),
-    new RegExp(
-      `(?<!\\b(?:no|nunca)\\s)\\b(?:omita|sáltese|salte|suspenda|interrumpa|duplique|divida|parta)\\s+${ES_SLOT}${ES_MED}`,
-      "i",
-    ),
-    new RegExp(
-      `(?<!\\b(?:no|nunca)\\s)\\b(?:deje|deja|dejar)\\s+de\\s+(?:tomar|usar|inyectarse)\\b`,
-      "i",
-    ),
-  ],
-  it: [
-    new RegExp(
-      `(?<!\\b(?:non|mai)\\s)\\b(?:aumenti|aumentare|incrementi|incrementare|porti|portare|passi|passare|salga|salire|riduca|ridurre|abbassi|abbassare|diminuisca|diminuire|dimezzi|dimezzare|raddoppi|raddoppiare)\\s+${IT_SLOT}(?:da\\s+${TARGET}\\s+)?(?:a|di|fino\\s+a)\\s+${TARGET}`,
-      "i",
-    ),
-    new RegExp(
-      `(?<!\\b(?:non|mai)\\s)\\b(?:prenda|assuma|inietti|si\\s+inietti|inizi\\s+con|cominci\\s+con)\\s+${IT_SLOT}${TARGET}`,
-      "i",
-    ),
-    new RegExp(
-      `(?<!\\b(?:non|mai)\\s)\\b(?:salti|sospenda|interrompa|dimezzi|raddoppi|divida|ometta|tralasci)\\s+${IT_SLOT}${IT_MED}`,
-      "i",
-    ),
-    new RegExp(
-      `(?<!\\b(?:non|mai)\\s)\\bsmett(?:a|i|ere)\\s+di\\s+(?:prendere|assumere|usare)\\b`,
-      "i",
-    ),
-  ],
-  pl: [
-    new RegExp(
-      `(?<!\\bnie\\s)\\b(?:zwi[ęe]ksz(?:y[ćc]|cie)?|podnie[śs](?:[ćc]|cie)?|podwy[żz]sz(?:y[ćc])?|zmniejsz(?:y[ćc]|cie)?|obni[żz](?:y[ćc]|cie)?|zredukuj(?:cie)?|zredukowa[ćc]|przejd[źz](?:cie)?|przej[śs][ćc]|zmie[ńn]|zmieni[ćc])(?=\\s)\\s+${PL_SLOT}(?:z\\s+${TARGET}\\s+)?(?:do|o|na)\\s+${TARGET}`,
-      "i",
-    ),
-    new RegExp(
-      `(?:(?<!\\bnie\\s)\\b(?:przyjmij|przyjmuj|we[źz]|bierz|wstrzyknij|wstrzykuj|zacznij\\s+od)|\\b(?:proszę|należy|warto)\\s+(?:przyj[ąa][ćc]|wzi[ąa][ćc]|bra[ćc]|przyjmowa[ćc]|wstrzykiwa[ćc]|wstrzykn[ąa][ćc]|zacz[ąa][ćc]\\s+od))(?=\\s)\\s+${PL_SLOT}${TARGET}`,
-      "i",
-    ),
-    new RegExp(
-      `(?:(?<!\\bnie\\s)\\b(?:pomi[ńn](?:cie)?|opu[śs][ćc]|odstaw(?:cie)?|wstrzymaj|podziel|podwój)|\\b(?:proszę|należy|warto)\\s+(?:pomin[ąa][ćc]|odstawi[ćc]|wstrzyma[ćc]|przerwa[ćc]|podzieli[ćc]|podwoi[ćc]))(?=\\s)\\s+${PL_SLOT}${PL_MED}`,
-      "i",
-    ),
-    new RegExp(
-      `(?:(?<!\\bnie\\s)\\bprzesta[ńn](?:cie)?|\\b(?:proszę|należy)\\s+przesta[ćc])\\s+(?:brać|przyjmować|stosować)(?=[\\s.,;:!?]|$)`,
-      "i",
-    ),
-  ],
-  ko: [
-    // A stated amount closed by an imperative or a recommendation, with or
-    // without a target particle: "2000mg으로 증량하세요", "하루 2정 드세요".
-    new RegExp(`${KO_TARGET}[^.?!]{0,25}${KO_IMPERATIVE}`, "i"),
-    // A medication object halved, doubled, skipped or stopped by imperative.
-    new RegExp(
-      `${KO_MED}[^.?!]{0,20}(?:(?:절반|반)\\s*으로\\s*(?:줄이|나누)(?:세요|십시오)|(?:절반|반)\\s*으로\\s*(?:줄여|나눠)\\s*(?:보세요|주세요)|두\\s?배로\\s*(?:늘리|올리)(?:세요|십시오)|두\\s?배로\\s*(?:늘려|올려)\\s*(?:보세요|주세요)|(?:건너뛰|중단하|끊으|멈추|그만\\s*드시|그만\\s*복용하)(?:세요|십시오))`,
-    ),
-    new RegExp(
-      `(?:복용|투약|투여|주사)(?:을|를)?\\s*(?:중단하|멈추|그만하|끊으)(?:세요|십시오)`,
-    ),
-  ],
-};
+function buildDoseChangeClass(
+  m: MedVocabulary,
+): Record<Locale, readonly RegExp[]> {
+  return {
+    en: [
+      new RegExp(
+        `\\b(?:increase|raise|up|bump|boost|titrate|step|move|go|ramp|push|switch|change|adjust|lower|reduce|cut|drop|decrease|taper|halve|double|trim|bring)\\s+${EN_SLOT}(?:from\\s+${TARGET}\\s+)?(?:up\\s+|down\\s+|back\\s+)?(?:to|by)\\s+${TARGET}`,
+        "i",
+      ),
+      new RegExp(
+        `${EN_CUE}[^.?!]{0,20}?\\b(?:increas(?:e|ing)|rais(?:e|ing)|bump(?:ing)?|boost(?:ing)?|titrat(?:e|ing)|lower(?:ing)?|reduc(?:e|ing)|cut(?:ting)?|drop(?:ping)?|decreas(?:e|ing)|taper(?:ing)?|halv(?:e|ing)|doubl(?:e|ing)|switch(?:ing)?|adjust(?:ing)?|go(?:ing)?\\s+up|step(?:ping)?\\s+up)\\s+${EN_SLOT}(?:from\\s+${TARGET}\\s+)?(?:up\\s+|down\\s+)?(?:to|by)\\s+${TARGET}`,
+        "i",
+      ),
+      new RegExp(
+        `${EN_LEAD}(?:take|start\\s+(?:taking|on|with|at)|begin\\s+(?:taking|with|at)|inject|use|give\\s+yourself)\\s+${EN_SLOT}${TARGET}`,
+        "im",
+      ),
+      new RegExp(
+        `${EN_LEAD}(?:halve|double|skip|pause|hold|drop|miss|split|cut)\\s+${EN_SLOT}${m.en}`,
+        "im",
+      ),
+      new RegExp(
+        `${EN_LEAD}(?:(?:(?:stop|quit)\\s+(?:taking|injecting)|discontinue)\\s+\\S|(?:come|wean\\s+(?:yourself\\s+)?)\\s*off\\s+${EN_SLOT}${m.en})`,
+        "im",
+      ),
+      new RegExp(
+        `${EN_CUE}[^.?!]{0,20}?\\b(?:(?:halv|doubl|skipp|paus|hold|dropp|miss|splitt|cutt)ing\\s+${EN_SLOT}${m.en}|(?:stopping|quitting)\\s+(?:taking|injecting)\\s+\\S|discontinuing\\s+\\S|coming\\s+off\\s+${EN_SLOT}${m.en})`,
+        "i",
+      ),
+      // An extra, another or one more of a medication: "take an extra
+      // ramipril", "take one more tablet of ramipril". The short slot ends at a
+      // preposition, so "take an extra minute to log your medication" passes.
+      new RegExp(
+        `${EN_LEAD}(?:take|use|inject|add|give\\s+yourself|pop)\\s+(?:another|(?:(?:an?|one|two|three|\\d+)\\s+)?(?:extra|additional|more|further|second))\\s+${EN_SHORT}${m.en}`,
+        "im",
+      ),
+      // Stop, leave out or go without a named medication or a drug class:
+      // "stop your blood thinner", "leave out the Eliquis".
+      new RegExp(
+        `${EN_LEAD}(?:stop|quit|discontinue|omit|leave\\s+out|hold\\s+off\\s+on|go\\s+without)\\s+${EN_SHORT}${m.en}`,
+        "im",
+      ),
+      new RegExp(`${EN_LEAD}leave\\s+${EN_SHORT}${m.en}\\s+out\\b`, "im"),
+      // The same behind a recommending cue. A referral ("before", "ask",
+      // "whether") or a negation between the cue and the verb ends it.
+      new RegExp(
+        `${EN_CUE}(?:(?!\\b(?:not|never|before|without|until|unless|ask|asking|whether|if)\\b)[^.?!]){0,20}?\\b(?:(?:stopping|omitting|leaving\\s+out)\\s+${EN_SHORT}${m.en}|taking\\s+(?:another|(?:(?:an?|one|two|\\d+)\\s+)?(?:extra|additional|more))\\s+${EN_SHORT}${m.en})`,
+        "i",
+      ),
+    ],
+    de: [
+      new RegExp(
+        `\\b(?:erhöh(?:e|en)?|steiger(?:e|n)?|reduzier(?:e|en)?|senk(?:e|en)?|verringer(?:e|n)?|halbier(?:e|en)?|verdopp(?:e?le|eln)|stell(?:e|en)?|geh(?:e)?|setz(?:e|en)?|bring(?:e|en)?)(?:\\s+sie)?\\s+${DE_SLOT}(?:(?:hoch|rauf|runter|herunter)\\s+)?(?:auf|um)\\s+${TARGET}`,
+        "i",
+      ),
+      new RegExp(
+        `\\b(?:nimm|nehmen\\s+sie|spritz|spritzen\\s+sie|injizier(?:e)?|injizieren\\s+sie|beginn(?:e)?\\s+mit|beginnen\\s+sie\\s+mit|starte\\s+mit)\\s+${DE_SLOT}${TARGET}`,
+        "i",
+      ),
+      new RegExp(
+        `(?<![${LETTER}])(?:halbier(?:e|en)?|verdopp(?:e?le|eln)|pausier(?:e|en)?|überspring(?:e|en)?|stopp(?:e|en)?)(?:\\s+sie)?\\s+${DE_SLOT}${m.de}`,
+        "i",
+      ),
+      new RegExp(
+        `\\b(?:setz(?:e|en)?)(?:\\s+sie)?(?:\\s+(?!(?:nicht|nie|niemals|kein\\w*)(?=\\s))[^\\s.?!,;:]+){1,4}?\\s+ab(?=\\s*(?:[.?!,;:]|$|und\\s|oder\\s))`,
+        "i",
+      ),
+      new RegExp(
+        `\\b(?:lass|lassen\\s+sie)\\s+${DE_SLOT}${m.de}(?:(?!\\b(?:nicht|nie|niemals)\\b)[^.?!]){0,20}?\\b(?:aus|weg)\\b`,
+        "i",
+      ),
+      new RegExp(
+        `\\bh(?:ör(?:e)?|ören\\s+sie)\\s+(?:mit\\s+\\S+\\s+)?auf\\b[^.?!]{0,40}?\\b(?:zu\\s+nehmen|einzunehmen|zu\\s+spritzen)`,
+        "i",
+      ),
+      new RegExp(
+        `\\b(?:solltest|sollten\\s+sie|empfehle|rate\\s+(?:dir|ihnen)|würde\\s+ich)\\b(?:(?!\\b(?:nicht|nie|niemals|kein\\w*)\\b)[^.?!]){0,40}?\\b(?:absetzen|abzusetzen|halbieren|zu\\s+halbieren|verdoppeln|zu\\s+verdoppeln|auslassen|auszulassen|weglassen|wegzulassen|pausieren|zu\\s+pausieren)\\b`,
+        "i",
+      ),
+      // "eine Tablette mehr", "noch eine Tablette", "eine zusätzliche
+      // Tablette", "mehr Insulin". A negation ("keine") cannot enter the slot.
+      new RegExp(
+        `\\b(?:nimm|nehmen\\s+sie|spritz|spritzen\\s+sie|injizier(?:e)?|injizieren\\s+sie)\\s+${DE_SHORT}(?:(?:noch\\s+)?(?:${DE_COUNT})\\s+${DE_SHORT}${m.de}\\s+mehr\\b|noch\\s+(?:${DE_COUNT})\\s+${DE_SHORT}${m.de}|(?:(?:${DE_COUNT})\\s+)?(?:zusätzlich\\w*|extra|weitere\\w*|mehr)[-\\s]+${DE_SHORT}${m.de})`,
+        "i",
+      ),
+      new RegExp(
+        `\\bh(?:ör(?:e)?|ören\\s+sie)\\s+mit\\s+${DE_SHORT}${m.de}\\s+auf\\b`,
+        "i",
+      ),
+      new RegExp(
+        `\\bverzichte(?:n\\s+sie)?\\s+${DE_SHORT}auf\\s+${DE_SHORT}${m.de}`,
+        "i",
+      ),
+    ],
+    fr: [
+      new RegExp(
+        `(?<!\\b(?:vous|nous|je|tu|il|elle|on)\\s)(?<!n['’])\\b(?:(?:augment|mont|pass|port|major|diminu|baiss|abaiss|doubl|ramen)(?:ez|e|er)|r[ée]dui(?:sez|s|re))\\s+${FR_SLOT}(?:de\\s+${TARGET}\\s+)?(?:[àa]|de|jusqu'[àa])\\s+${TARGET}`,
+        "i",
+      ),
+      new RegExp(
+        `(?<!\\b(?:vous|nous|je|tu|il|elle|on)\\s)\\b(?:prenez|prends|injectez|injecte|commencez\\s+(?:par|à|avec))\\s+${FR_SLOT}${TARGET}`,
+        "i",
+      ),
+      new RegExp(
+        `(?<!\\b(?:vous|nous|je|tu|il|elle|on)\\s)(?<!n['’])\\b(?:divisez|doublez|sautez|suspendez|interrompez|oubliez|arrêtez|cessez|stoppez|supprimez)\\s+${FR_SLOT}${m.fr}`,
+        "i",
+      ),
+      new RegExp(
+        `(?<!n['’])\\b(?:arrêtez|cessez|stoppez)\\s+de\\s+(?:prendre|vous\\s+injecter)\\b`,
+        "i",
+      ),
+      new RegExp(
+        `\\b(?:vous\\s+devriez|je\\s+recommande\\s+de|je\\s+sugg[èe]re\\s+de|envisagez\\s+de|essayez\\s+de)\\s+(?:sauter|suspendre|arrêter|interrompre|diviser|doubler)\\s+${FR_SLOT}(?:de\\s+prendre\\s+\\S|${m.fr})`,
+        "i",
+      ),
+      // "un comprimé en plus", "un ramipril supplémentaire", "un autre
+      // comprimé", "encore une dose".
+      new RegExp(
+        `(?<!\\bne\\s)(?<!\\b(?:vous|nous|je|tu|il|elle|on)\\s)\\b(?:prenez|prends|injectez|ajoutez)\\s+${FR_SHORT}(?:(?:encore\\s+)?(?:un|une|deux|trois|\\d+)\\s+${FR_SHORT}${m.fr}[^.?!]{0,30}?(?:\\ben\\s+plus\\b|\\bde\\s+plus\\b|\\bsuppl[ée]mentaires?)|(?:un|une)\\s+autres?\\s+${FR_SHORT}${m.fr}|encore\\s+(?:un|une)\\s+${FR_SHORT}${m.fr})`,
+        "i",
+      ),
+    ],
+    es: [
+      new RegExp(
+        `(?<!\\b(?:no|nunca)\\s)\\b(?:aumente|aumenta|aumentar|suba|sube|subir|pase|pasar|incremente|incrementar|reduzca|reduce|reducir|baje|bajar|disminuya|disminuir|duplique|duplicar|lleve|llevar|ajuste|ajustar)\\s+${ES_SLOT}(?:de\\s+${TARGET}\\s+)?(?:a|en|hasta)\\s+${TARGET}`,
+        "i",
+      ),
+      new RegExp(
+        `(?<!\\b(?:no|nunca)\\s)\\b(?:tome|tómese|inyecte|inyéctese|administre|empiece\\s+con|comience\\s+con)\\s+${ES_SLOT}${TARGET}`,
+        "i",
+      ),
+      new RegExp(
+        `(?<!\\b(?:no|nunca)\\s)\\b(?:omita|sáltese|salte|suspenda|interrumpa|duplique|divida|parta)\\s+${ES_SLOT}${m.es}`,
+        "i",
+      ),
+      new RegExp(
+        `(?<!\\b(?:no|nunca)\\s)\\b(?:deje|deja|dejar)\\s+de\\s+(?:tomar|usar|inyectarse)\\b`,
+        "i",
+      ),
+      // "una pastilla de más", "otra pastilla", "una dosis extra".
+      new RegExp(
+        `(?<!\\b(?:no|nunca)\\s)\\b(?:tome|tómese|inyecte|inyéctese|añada|agregue)\\s+${ES_SHORT}(?:(?:un|una|dos|tres|\\d+)\\s+${ES_SHORT}${m.es}[^.?!]{0,20}?(?:\\bm[áa]s(?![${LETTER}])|\\bextra\\b|\\badicional(?:es)?\\b)|otr[oa]s?\\s+${ES_SHORT}${m.es})`,
+        "i",
+      ),
+      // Stop a named medication or a drug class: "deje el anticoagulante".
+      new RegExp(
+        `(?<!\\b(?:no|nunca)\\s)\\b(?:deje|pare|abandone)\\s+${ES_SHORT}${m.es}`,
+        "i",
+      ),
+    ],
+    it: [
+      new RegExp(
+        `(?<!\\b(?:non|mai)\\s)\\b(?:aumenti|aumentare|incrementi|incrementare|porti|portare|passi|passare|salga|salire|riduca|ridurre|abbassi|abbassare|diminuisca|diminuire|dimezzi|dimezzare|raddoppi|raddoppiare)\\s+${IT_SLOT}(?:da\\s+${TARGET}\\s+)?(?:a|di|fino\\s+a)\\s+${TARGET}`,
+        "i",
+      ),
+      new RegExp(
+        `(?<!\\b(?:non|mai)\\s)\\b(?:prenda|assuma|inietti|si\\s+inietti|inizi\\s+con|cominci\\s+con)\\s+${IT_SLOT}${TARGET}`,
+        "i",
+      ),
+      new RegExp(
+        `(?<!\\b(?:non|mai)\\s)\\b(?:salti|sospenda|interrompa|dimezzi|raddoppi|divida|ometta|tralasci|smetta)\\s+${IT_SLOT}${m.it}`,
+        "i",
+      ),
+      new RegExp(
+        `(?<!\\b(?:non|mai)\\s)\\bsmett(?:a|i|ere)\\s+di\\s+(?:prendere|assumere|usare)\\b`,
+        "i",
+      ),
+      // "una compressa in più", "un'altra compressa", "una dose extra".
+      new RegExp(
+        `(?<!\\b(?:non|mai)\\s)\\b(?:prenda|assuma|inietti|aggiunga)\\s+${IT_SHORT}(?:(?:un|una|uno|due|tre|\\d+)\\s+${IT_SHORT}${m.it}[^.?!]{0,30}?(?:\\bin\\s+più|\\bextra\\b|\\baggiuntiv[aoei]\\b|\\bin\\s+aggiunta\\b)|(?:un['’]altra|un\\s+altro|altr[eio])\\s*${IT_SHORT}${m.it})`,
+        "i",
+      ),
+    ],
+    pl: [
+      new RegExp(
+        `(?<!\\bnie\\s)\\b(?:zwi[ęe]ksz(?:y[ćc]|cie)?|podnie[śs](?:[ćc]|cie)?|podwy[żz]sz(?:y[ćc])?|zmniejsz(?:y[ćc]|cie)?|obni[żz](?:y[ćc]|cie)?|zredukuj(?:cie)?|zredukowa[ćc]|przejd[źz](?:cie)?|przej[śs][ćc]|zmie[ńn]|zmieni[ćc])(?=\\s)\\s+${PL_SLOT}(?:z\\s+${TARGET}\\s+)?(?:do|o|na)\\s+${TARGET}`,
+        "i",
+      ),
+      new RegExp(
+        `(?:(?<!\\bnie\\s)\\b(?:przyjmij|przyjmuj|we[źz]|bierz|wstrzyknij|wstrzykuj|zacznij\\s+od)|\\b(?:proszę|należy|warto)\\s+(?:przyj[ąa][ćc]|wzi[ąa][ćc]|bra[ćc]|przyjmowa[ćc]|wstrzykiwa[ćc]|wstrzykn[ąa][ćc]|zacz[ąa][ćc]\\s+od))(?=\\s)\\s+${PL_SLOT}${TARGET}`,
+        "i",
+      ),
+      new RegExp(
+        `(?:(?<!\\bnie\\s)\\b(?:pomi[ńn](?:cie)?|opu[śs][ćc]|odstaw(?:cie)?|wstrzymaj|podziel|podwój)|\\b(?:proszę|należy|warto)\\s+(?:pomin[ąa][ćc]|odstawi[ćc]|wstrzyma[ćc]|przerwa[ćc]|podzieli[ćc]|podwoi[ćc]))(?=\\s)\\s+${PL_SLOT}${m.pl}`,
+        "i",
+      ),
+      new RegExp(
+        `(?:(?<!\\bnie\\s)\\bprzesta[ńn](?:cie)?|\\b(?:proszę|należy)\\s+przesta[ćc])\\s+(?:brać|przyjmować|stosować)(?=[\\s.,;:!?]|$)`,
+        "i",
+      ),
+      // "dodatkową tabletkę", "jeszcze jedną dawkę", "jedną tabletkę więcej".
+      new RegExp(
+        `(?:(?<!\\bnie\\s)\\b(?:we[źz]|bierz|przyjmij|wstrzyknij|dodaj)|\\b(?:proszę|należy|warto)\\s+(?:wzi[ąa][ćc]|przyj[ąa][ćc]|wstrzykn[ąa][ćc]|doda[ćc]))(?=\\s)\\s+${PL_SHORT}(?:(?:dodatkow\\S*|kolejn\\S*|jeszcze\\s+jedn\\S*)\\s+${PL_SHORT}${m.pl}|(?:jedn\\S*|dwie|dwa|trzy|\\d+)\\s+${PL_SHORT}${m.pl}\\s+więcej(?=[\\s.,;:!?]|$))`,
+        "i",
+      ),
+    ],
+    ko: [
+      // A stated amount closed by an imperative or a recommendation, with or
+      // without a target particle: "2000mg으로 증량하세요", "하루 2정 드세요".
+      new RegExp(`${KO_TARGET}[^.?!]{0,25}${KO_IMPERATIVE}`, "i"),
+      // A medication object halved, doubled, skipped or stopped by imperative.
+      new RegExp(
+        `${m.ko}[^.?!]{0,20}(?:(?:절반|반)\\s*으로\\s*(?:줄이|나누)(?:세요|십시오)|(?:절반|반)\\s*으로\\s*(?:줄여|나눠)\\s*(?:보세요|주세요)|두\\s?배로\\s*(?:늘리|올리)(?:세요|십시오)|두\\s?배로\\s*(?:늘려|올려)\\s*(?:보세요|주세요)|(?:건너뛰|중단하|끊으|멈추|그만\\s*드시|그만\\s*복용하)(?:세요|십시오))`,
+      ),
+      new RegExp(
+        `(?:복용|투약|투여|주사)(?:을|를)?\\s*(?:중단하|멈추|그만하|끊으)(?:세요|십시오)`,
+      ),
+      // One more or an additional dose of a medication, closed by an
+      // imperative: "라미프릴을 한 알 더 드세요", "인슐린을 추가로 맞으세요".
+      // The prohibitive "더 드시지 마세요" never meets an imperative ending.
+      new RegExp(
+        `${m.ko}[^.?!]{0,12}(?:(?:(?:한|두|세|\\d+)\\s*(?:알|정|캡슐|번|단위)?\\s*)?더|추가로)\\s*(?:드세요|드십시오|복용하세요|복용하십시오|투여하세요|맞으세요|맞으십시오|주사하세요)`,
+      ),
+    ],
+  };
+}
+
+/** The class with no schedule: dosage forms, class words and generic stems. */
+const DOSE_CHANGE_CLASS = buildDoseChangeClass(medVocabulary(null));
+
+/**
+ * The class built over one person's medication names. A turn screens its reply
+ * and the trail text of the same turn with the same names, so the compiled set
+ * is kept for the most recent schedules rather than rebuilt per call.
+ */
+const NAMED_CLASS_CACHE = new Map<string, Record<Locale, readonly RegExp[]>>();
+const NAMED_CLASS_CACHE_SIZE = 32;
+
+function doseChangeClassFor(
+  medicationNames: readonly string[] | undefined,
+): Record<Locale, readonly RegExp[]> {
+  const names = medicationNameAlternation(medicationNames);
+  if (names === null) return DOSE_CHANGE_CLASS;
+  const cached = NAMED_CLASS_CACHE.get(names);
+  if (cached) return cached;
+  const built = buildDoseChangeClass(medVocabulary(names));
+  if (NAMED_CLASS_CACHE.size >= NAMED_CLASS_CACHE_SIZE) {
+    const oldest = NAMED_CLASS_CACHE.keys().next().value;
+    if (oldest !== undefined) NAMED_CLASS_CACHE.delete(oldest);
+  }
+  NAMED_CLASS_CACHE.set(names, built);
+  return built;
+}
 
 const DOSE_PATTERNS: Record<Locale, readonly RegExp[]> = {
   en: [
@@ -961,9 +1225,11 @@ function doseTrips(
   subject: string,
   locale: Locale,
   scheduleDoses?: readonly number[],
+  medicationNames?: readonly string[],
 ): boolean {
   const bank = BANKS.dose;
-  const own = (l: Locale) => [...bank[l], ...DOSE_CHANGE_CLASS[l]];
+  const changeClass = doseChangeClassFor(medicationNames);
+  const own = (l: Locale) => [...bank[l], ...changeClass[l]];
   const patterns = locale === "en" ? own("en") : [...own(locale), ...own("en")];
   const continuation =
     locale === "en"
@@ -1006,6 +1272,13 @@ export interface ScreenOptions {
    * the Coach passes this; every other surface keeps the phrase-anchored rule.
    */
   scheduleDoses?: readonly number[];
+  /**
+   * The person's own medication names, as typed into their schedule. Each one
+   * counts as a medication noun in the dose-change class, so "skip the
+   * Eliquis" and "take an extra ramipril" block like "skip your dose". A brand
+   * name is only known this way; generic names are also caught by their stem.
+   */
+  medicationNames?: readonly string[];
 }
 
 export function screenModelOutput(
@@ -1021,7 +1294,9 @@ export function screenModelOutput(
     if (contract === "dose") {
       // Dose is sentence-scoped so the continuation exemption cannot be
       // voided by a change stem in an unrelated sentence.
-      if (doseTrips(subject, locale, opts?.scheduleDoses)) {
+      if (
+        doseTrips(subject, locale, opts?.scheduleDoses, opts?.medicationNames)
+      ) {
         return { block: true, reason: REASON_FOR_CONTRACT.dose };
       }
       continue;
diff --git a/src/lib/medications/medication-names.ts b/src/lib/medications/medication-names.ts
new file mode 100644
index 000000000..c2e3623bc
--- /dev/null
+++ b/src/lib/medications/medication-names.ts
@@ -0,0 +1,22 @@
+/**
+ * The names on a person's medication schedule, for the outbound dose screen.
+ *
+ * The screen's dose-change class needs a medication noun next to a skip, stop
+ * or extra imperative. A brand name ("Eliquis") is no dosage-form word and has
+ * no generic stem, so without the person's own names "skip the Eliquis"
+ * passed. Inactive entries are included on purpose: an instruction to take or
+ * skip a medication the person used to be on is still a dose instruction.
+ *
+ * Server-only; a cheap indexed read. `Medication.name` is plaintext.
+ */
+import { prisma } from "@/lib/db";
+
+/** The de-duped medication names of one person, at most 64. */
+export async function getMedicationNames(userId: string): Promise<string[]> {
+  const rows = await prisma.medication.findMany({
+    where: { userId },
+    select: { name: true },
+    take: 64,
+  });
+  return [...new Set(rows.map((row) => row.name.trim()).filter(Boolean))];
+}