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Clonazepam:

Brand Name: Rivotril(radiant),Rivo(orion)

Epitra(square),Clonatril(healthcare)

Preparation: 0.5/1/2mg tablet

pediatric drop: 2.5mg/ml (cloron)

Adult Dose
Oral
Epilepsy
Adult: Initially, 1 mg given at night for 4 days,
gradually increased over 2-4 wk. Maintenance:
4-8 mg/day. Max: 20 mg/day.
Elderly: Initially, 0.5 mg at night for 4 days.

Panic disorder
Adult: Initially, 0.25 mg bid, increased after 3 days
up to 1 mg/day. Max: 4 mg/day.

Intravenous
Emergency management of status epilepticus
Adult: 1 mg by slow IV inj over at least 2 min or by
infusion, repeated if necessary. Max: 20 mg.

Hepatic impairment: Dosage adjustment may be needed.
Child Dose
Oral
Epilepsy
Child: <10 yr or <30 kg: Initially, 0.01-0.03 mg/kg/day but not to
exceed 0.05 mg/kg/day given in 2 or 3 divided doses. May be
increased by no more than 0.25-0.5 mg every 3rd day until
seizure control is achieved.
Maintenance: 0.1-0.2 mg/kg/day divided 3 times daily.
Max: 0.2 mg/kg/day.

Intravenous
Emergency management of status epilepticus
Child: 500 mcg by slow IV inj or by infusion.
Renal Dose
Administration
May be taken with or without food.
indication
Epilepsy, Anxiety disorders, Panic disorder, Status epilepticus,
Social phobia, Migraines, Parasomnia, Restless legs syndrome,
Rapid eye movement, Behavior disorder, Spasticity, Resistant
depression, Trigeminal neuralgia, Nocturnal myoclonus,
Post traumatic stress disorder, Insomnia and sleep
disturbances, Burning Mouth Syndrome
Contraindication
Hypersensitivity to benzodiazepines, acute pulmonary
insufficiency, acute narrow angle glaucoma.
Side Effects
>10%
Somnolence (37%)

1-10%
Abnormal coordination (5-10%),Ataxia (5-10%),Depression
(5-10%),Dizziness (5-10%),Fatigue (5-10%),Memory impairment
(5-10%),Upper respiratory infection (5-10%),Confusion (1-5%),
Dysarthria (1-5%),Rhinitis (1-5%),Coughing (1-5%),Urinary
frequency (1-5%),Impotence (1-5%),Decreased libido (1-5%)

Frequency Not Defined
Increased salivation,Worsening tonic-clonic seizures

Potentially Fatal: Salivary or bronchial hypersecretion leading
to respiratory problems (children). May produce diminished
reflexes or coma. Rarely, blood dyscrasias.
Theraputic Class
Benzodiazepine hypnotics
Pregnency Category
Category: Not Classified
pregnancy_description
Mode of Action
Clonazepam reduces the nerve transmission in the motor
cortex which suppresses the spike and wave discharge in
absence seizures. Its mechanism is believed to be related to
its ability to enhance the activity of GABA. Clinically, it improves
focal epilepsy and generalised seizures.
Interaction
Additive depressant effect w/ TCAs, MAOIs, sedative and hypnotics,
barbiturates, anxiolytics, antipsychotics, opiate agonists. May
increase serum phenytoin levels.
Pack And Size
Per Unit Price: Tk. 4.5
Package: 100's pack


Bromazepam:

Brand name;Lexotanil(radiant),Bopam(opsonin)

Tanil(ACME),Laxyl(square)

preparation: 3 mg tablet

Adult Dose
Adult: PO Initial: 6-18 mg/day in divided doses.
Higher doses have occasionally been given to
hospitalized patients.
Dose should be reduced at least half in elderly
patients and those with hepatic impairment.
Child Dose
Renal Dose
Renal impairment: No dosage adjustment needed.
Administration
May be taken with or without food.
indication
Anxiety, Panic attacks
Contraindication
Preexisting CNS depression or coma, resp depression,
acute pulmonary insufficiency or sleep apnea; severe
hepatic impairment; not indicated for chronic psychosis,
phobic or obsessional states; may precipitate suicide or
aggressive behavior, not used alone to treat depression o
r anxiety associated with depression; glaucoma.
Side Effects
Drowsiness, sedation, muscle weakness and
ataxia; less frequently vertigo, headache, confusion,
depression, slurred speech, changes in libido, tremor,
visual disturbances, urinary retention, GI disturbances,
changes in salivation and amnesia; rarely, jaundice, blood
disorders and hypersensitivity reactions; pain and
thrombophlebitis; raised liver enzyme values;
paradoxical excitation.
Theraputic Class
Benzodiazepine sedatives
Pregnency Category
Category: Not Classified
pregnancy_description
Mode of Action
Bromazepam is a benzodiazepine with general properties
similar to diazepam. It is used in the treatment of anxiety
occuring alone or associated with insomnia.
Interaction
May enhance the activity w/ CYP450 inhibitor (e.g. azole antifungals,
macrolides, HIV protease inhibitors, Ca channel blockers). Elevated
plasma levels w/ disulfiram or cimetidine. Additive CNS depressant
effects w/ barbiturates, sedatives, anaeasth, anxiolytics, hypnotics,
phenothiazines, other antipsychotics, skeletal muscle relaxants.
May potentiate anticholinergic effects of atropine, antihistamines and
antidepressants. Increased psychic drug dependence w/ narcotic analgesics.
Pack And Size
Per Unit Price: Tk. 7.02
Package: 70's pack


Diazepam:

Brand name: Sedil(square),Easium(opsonin)

Preparation;

Tablet: 5mg

IM/IV Injection: 10mg/2ml

suppository: 10mg

Adult Dose
Anxiety
2-10 mg PO q6-12hr, OR 2-10 mg IV/IM q6-12hr;
no more than 30 mg/8 hours

Alcohol Withdrawal
10 mg PO q6-8hr during first 24hr; reduce to
5 mg PO q6-8hr PRN
Initial: 10 mg IV/IM, may give additional
doses of 5-10 mg IV q6-8hr as needed

Endoscopy
IV: Titrate dose to 10 mg or less immediately
before procedure, not to exceed cumulative
dose of 20 mg; reduce dose of narcotic by one third or omit, OR
IM: 5-10 mg 30 minutes before procedure

Preoperative Sedation
10 mg IM before surgery

Sedation in the ICU
5-10 mg IV 1-2 hours before surgery; 0.03-0.1 mg/kg q30min to 6hr

Muscle Spasm
2-10 mg PO q6-8hr PRN, OR 5-10 mg IV/IM initially;
THEN q3-4hr if necessary

Seizure Disorder
2-10 mg PO q6-12hr as adjunct, OR
0.2 mg/kg PR, repeat after 4-12 hours PRN

Status Epilepticus
5-10 mg IV/IM q5-10min; not to exceed 30 mg, OR
0.5 mg/kg PR (using parenteral solution), THEN 0.25 mg/kg in 10 minutes PRN

Elderly: Should not exceed half the adult dose.
Hepatic impairment: Dose reduction may be required.
Child Dose
Sedative/Muscle Relaxant
Potentially toxic dose in patients <6 years: >0.5 mg/kg
<6 months: Not recommended

>12 years
0.12-0.8 mg/kg/day PO divided q6-8hr, OR
0.04-0.2 mg/kg IV/IM q2-4hr; no more than 0.6 mg/kg within 8 hours

Status Epilepticus
Potentially toxic dose in patients <6 years: >0.5 mg/kg

PR
2-6 years: 0.5 mg/kg; may repeat in 4-12 hours PRN
6-12 years: 0.3 mg/kg; may repeat in 4-12 hours PRN
>12 years: 0.2 mg/kg; may repeat in 4-12 hours PRN

IV
6 months-5 years: 0.2-0.5 mg IV initially, repeat every 2-5 minutes;
do not exceed 5 mg; may repeat 2-4 hours later PRN
>5 years: 1 mg IV given slowly every 2-5 min; not to exceed 10 mg
total dose; may repeat in 2-4 hours if necessary
Renal Dose
Renal impairment: Dose reduction may be required.
Administration
May be taken with or without food.

IV Preparation
Compatibility with D5W, NS, and Ringer's controversial. If infusion is
selected, adding the infusion solution to the diazepam injection
(and not the other way around) may prevent precipitate formation

IV Administration
Administer over 3 min; no more than 5 mg/min
Monitor respiration q5-15min and before each IV dose
Have airway support ready until effects of IV administration are known

Rectal Administration
Place patient on side facing you with upper leg bent forward, lubricate rectal
applicator tip, gently insert syringe tip in rectum and slowly push plunger
indication
Agitation, Anxiety, Anaesthesia, Seizures, Insomnia, Muscle spasms,
Alcohol withdrawal syndrome
Contraindication
Hypersensitivity; myasthenia gravis, preexisting CNS depression or coma,
respiratory depression; acute pulmonary insufficiency or sleep apnoea
syndrome; severe hepatic impairment; acute narrow angle glaucoma;
children <6 mth (oral); pregnancy and lactation.
Side Effects
1-10%
Atax (3%),Euphoria (3%, rectal gel),Incoordination (3%, rectal gel),
Somnolence (>1%),Rash (3%, rectal gel),Diarrhea (4%, rectal gel)

Frequency Not Defined
Common,Hypotension,Fatigue,Muscle weakness,Respiratory depression,
Urinary retention,Depression,Incontinence,Blurred vision,Dysarthria,
Headache,Skin rash,Changes in salivation,Serious,Neutropenia,Jaundice

Local effects: Pain, swelling, thrombophlebitis, carpal tunnel syndrome,
tissue necrosis,Phlebitis if too rapid IV push

Potentially Fatal: Respiratory and CNS depression, coma.
Theraputic Class
Primary anti-epileptic drugs
Pregnency Category
Category: D
pregnancy_description
Mode of Action
Diazepam is a long-acting benzodiazepine w/ anticonvulsant, anxiolytic,
sedative, muscle relaxant and amnestic properties. It increases neuronal
membrane permeability to Cl ions by binding to stereospecific benzodiazepine
receptors on the postsynaptic GABA neuron w/in the CNS and enhancing the
GABA inhibitory effects resulting in hyperpolarisation and stabilisation.
Interaction
May significantly enhance CNS depressant effect w/ antivirals
(e.g. amprenavir, ritonavir). May enhance CNS depressant effect w/
anaesth, narcotic analgesics, antidepressants, antipsychotics, anxiolytics,
antiepileptics, antihistamines, antihypertensives, muscle relaxants
(e.g. tizanidine, baclofen), nabilone. May decrease clearance w/
antibacterials that interfere w/ metabolism by hepatic enzymes
(e.g. isoniazid and erythromycin), OC, cimetidine, omeprazole.
May increase clearance w/ antibacterials which are known inducers
of hepatic enzymes (e.g. rifampicin). May increase serum level w/ disulfiram.
May reduce clearance of digoxin. May reduce therapeutic effect w/ theophylline.
Reversible deterioration of parkinsonism w/ levodopa.
Pack And Size
Per Unit Price: Tk. 3.05
Package: 10 amps pack



Amitriptyline:

Brand name: Tryptin(square),amit(general)

Amilin(opsonin)

Preparation: 10& 25 mg tablet

Adult Dose
Adult: PO Depression Initial:50-75 mg/day; up
to 150 mg/day if needed. Max: 300 mg/day in

severe cases.
Neuropathic pain Initial: 10-25 mg/day at night, up to
75 mg/day if needed.
Migraine prophylaxis Initial: 10 mg/day at night.
Maintenance: 50-75 mg/day at night.

Elderly: Initially, 25-50 mg/day as a single dose
(at bedtime) or in divided doses.
Child Dose
PO Depression
Child: Adolescent: Initially, 25-50 mg/day as a single
dose (at bedtime) or in divided doses.

Nocturnal enuresis
Child: 6-10 yr 10-20 mg/day; 11-16 yr 25-50 mg/day.
All doses to be given at bedtime. Max duration: 3 mth.
Renal Dose
Administration
May be taken with or without food.
indication
Migraine headache, Depression, Neuropathic pain,
Post-herpetic neuralgia, Nocturnal enuresis
Contraindication
Hypersensitivity, use of MAO inhibitors within the last 14 days;
acute recovery phase post-MI. Concurrent usage with cisapride.
Side Effects
Postural hypotension, tachycardia, conduction disturbances.
Dry mouth, wt gain, sour or metallic taste, stomatitis,
constipation; blurring of vision, urinary retention, fatigue,
dizziness, weakness, tremors, headache, confusion and
delirium in elderly, sexual disturbances; peripheral neuropathy;
urticaria, angioedema, sweating.

Potentially Fatal: Cardiac arrhythmias.
Theraputic Class
Tricyclic Anti-depressants
Pregnency Category
Category: C
pregnancy_description
Mode of Action
Amitriptyline is a dibenzocycloheptadiene tricyclic antidepressant.
It increases synaptic concentration of serotonin and/or norepinephrine
in the CNS by blocking the neuronal reuptake of
norepinephrine and serotonin.
Interaction
Increased risk of serotonin syndrome w/ SSRIs, TCAs, triptans,
fentanyl, lithium, tramadol. May reduce plasma levels w/ barbiturates,
rifampicin and other anticonvulsants. May increase plasma levels w/
methylphenidate, cimetidine, antipsychotics, Ca channel blockers.
May precipitate cardiac arrhythmias w/ thyroid hormones. May reduce
antihypertensive effects of debrisoquine, guanethidine and clonidine.
May increase pressor effect of epinephrine and norepinephrine. May
increase the risk of ventricular arrhythmias w/ antiarrhythmics
(e.g. amiodarone or quinidine), antihistamines astemizole,
terfenadine, some antipsychotics (pimozide, sertindole, and thioridazine),
sotalol, cisapride and halofantrine. Potentially Fatal: Increased risk of
serotonin syndrome w/ MAOIs, linezolid and methylene blue.
Pack And Size
Per Unit Price: Tk. 0.85
Package: 100's pack


Sodium Valproate (valproic acid):

Brand name: Valex(Incepta),Valoate(square)

Preparation: 

Syrup;200mg/5ml 

Tablet: 200/300/500mg CR 

inj. 500mg/5ml

Adult Dose
Oral
Complex Partial Seizures
Indicated as monotherapy and adjunctive therapy
for complex partial seizures that occur either in
isolation or in association with other types of seizures
PO: 10-15 mg/kg/day initially; increase by 5-10 mg/kg/day
at weekly intervals; may increase dose up to 60 mg/kg/day

Simple & Complex Absence Seizures
Also indicated for use as sole and adjunctive therapy in the
treatment of simple and complex absence seizures, and
adjunctively in patients with multiple seizure types that
include absence seizures
PO: 15 mg/kg/day initially, divided q6-12hr; increase by
5-10 mg/kg/day at weekly intervals; may increase dose
up to 60 mg/kg/day

Migraine
Indicated for prophylaxis of migraine headaches; there is
no evidence of use for acute treatment
250 mg PO q12hr; adjust dose based on clinical response,
not to exceed 1000 mg/day

Bipolar Mania
Indicated for treatment of manic episodes associated
with bipolar disorder
750 mg/day PO in divided doses; adjust dose as rapidly
as possible to desired therapeutic effect;
not to exceed 60 mg/kg/day

Hepatic impairment
Administer lower doses
Contraindicated in severe impairment
Child Dose
<10 years: Safety and efficacy not established

Complex Partial Seizures
Indicated as monotherapy and adjunctive therapy for complex
partial seizures that occur either in isolation or in association
with other types of seizures
PO: 10-15 mg/kg/day initially; increase by 5-10 mg/kg/day at
weekly intervals; may increase dose up to 60 mg/kg/day

Simple & Complex Absence Seizures
Indicated for use as sole and adjunctive therapy in the treatment
of simple and complex absence seizures, and adjunctively in
patients with multiple seizure types that include absence seizures
>10 years
250 mg PO q12hr; adjust dose based on clinical response
up to 1000 mg/day
Renal Dose
Renal impairment
No adjustment necessary
Administration
indication
Epilepsy, e.g. Partial seizures, Absence seizures (petit mal),
Generalized tonic-clonic seizures (grand mal), Myoclonic seizures,
Atonic seizures, Mixed seizures, Anxiety disorder, Posttraumatic stress
disorder, Febrile convulsion, Anorexia nervosa, Panic attack
, Migraine, bipolar disorder.
Contraindication
Preexisting or family history of hepatic dysfunction, active liver disease,
porphyria; mitochondrial and urea cycle disorders.
Hepatic impairment. Pregnancy.
Side Effects
>10%
Nausea (31%),Headache (<31%),Increased bleeding time
(26-30%),Thrombocytopenia (26-30%),Tremor (25%),Alopecia
(<24%),Asthenia (16-20%),Infection (16-20%),Somnolence
(16-20%),Amblyopia (11-15%),Diarrhea (11-15%),Diplopia
(11-15%),Dizziness (11-15%),Dyspepsia (11-15%),Nystagmus
(11-15%),Tinnitus (11-15%),Vomiting (11-15%)

1-10%
Ataxia (<8%),Increased appetite (<6%),Rash (<6%),Abdominal pain
(<5%),Tremor (<5%),Back pain (<5%),Mood changes (<5%),Anxiety
(<5%),Confusion (<5%),Abnormal gait (<5%),Paresthesia (<5%),
Hallucinations (<5%),Catatonia (<5%),Dysarthria (<5%),Tardive
dyskinesia (<5%),Vertigo (<5%),Irregular menses (<5%),Weight gain (4%)

Frequency Not Defined
Anorexia,Acute pancreatitis (may be life-threatening),Hepatic toxicity,
Hyperammonemia,Weight loss,Fractures,Osteoporosis,Osteopenia,
Decreased bone mineral density,Cerebral pseudoatrophy
Theraputic Class
Primary anti-epileptic drugs
Pregnency Category
Category: Not Classified
pregnancy_description
Mode of Action
Valproate is a generic term used to describe valproic acid, its salts and
derivatives. It is available in various forms including the sodium salts
(valproate semisodium and sodium valproate), the amide derivative
(valpromide), or as valproic acid. Valproate is a carboxylic acid
anticonvulsant. It has been suggested that its antiepileptic activity
is related to increased brain levels of ?-aminobutyric acid (GABA).
Interaction
Increased risk of toxicity w/ bupropion. Increased risk of convulsions
w/ mefloquine. Increased risk of carnitine deficiency w/ pivmecillinam
and pivampicillin. Increased risk of hepatotoxicity and carbamazepine
toxicity w/ a decrease in valproic acid levels w/ concurrent carbamazepine.
Decreased valproic acid and increased ethosuximide serum levels w/
ethosuximide. Decreased valproic acid levels w/ carbapenems, rifampicin,
phenytoin, phenobarbital (or primidone) and antineoplastic drug regimens.
Increased valproic acid levels w/ felbamate and aspirin. Increased risk of
hepatotoxicity w/ olanzepine. Concurrent use increased phenobarbital,
nimodipine, nifedipine, lamotrigine, zidovudine, amitriptyline, nortriptyline
and benzodiazepines levels. Concurrent use decreased tigabine and clozapine
levels. Increased risk of absence status w/ clonazepam. Increased risk of
hyperammonaemia w/ topiramate. Increased free valproic acid concentrations
w/ highly protein bound drugs. Potentially Fatal: Concomitant carbapenem is
not recommended as this may decrease valproate levels. Avoid concurrent
salicylates in childn <3 yr due too risk of hepatotoxicity. Increased risk of
hepatotoxicity w/ cosyntropin. Avoid ethanol as this may increase CNS
depression.
Pack And Size
Per Unit Price: Tk. 80
Package: 100ml bot

Pizotifen:

Brand name: Migranil(square),Pizo-A(ACME)

Preparation: 0.5mg,1.5mg

Adult Dose
Oral
Prophylaxis of migraine; Prophylaxis of cluster headache
Adult: Initially, 0.5 mg, increase gradually as necessary.
Maintenance: 1.5 mg daily as a single dose at night
or in 3 divided doses.
Max: 4.5 mg daily (max ?3 mg/dose).

Hepatic impairment: Dose adjustment may be needed.
Child Dose
Oral
Prophylaxis of migraine; Prophylaxis of cluster headache
Child: >2 yr Initially, 0.5 mg. May increase gradually up to
1.5 mg daily in divided doses (max 1 mg/dose).
Renal Dose
Renal impairment: Dose adjustment may be needed.
Administration
May be taken with or without food.
indication
Headache, Migraine
Contraindication
Premature infants or neonates. Postural giddiness.
Side Effects
Increased appetite, nausea, wt gain, drowsiness, dizziness,
dry mouth, fatigue, muscle pain or cramps, heavy or restless
legs, fluid retention, facial flushing, reduced libido, exacerbation
of epilepsy, dreaming, hepatic injury.
Theraputic Class
Other drugs for migraine
Pregnency Category
Category: B
pregnancy_description
Mode of Action
Pizotifen is a sedating antihistamine with strong serotonin
antagonist and weak antimuscarinic properties. It also
antagonises the action of tryptamine.
Interaction
Enhances sedative effects of CNS depressants. Additive
antimuscarinic action with other antimuscarinic drugs. May
mask warning signs of damage caused by ototoxic drugs
eg, aminoglycosides.
Pack And Size
Per Unit Price: Tk. 3
Package: 100's pack



Mirtazapine:

Brand name: Mirtaz(sun pharma),mirapro(square)

Preparation: 7.5/15/30 mg Tablet

Adult Dose
Oral
Depression
Adult: Initially, 15 mg daily; may be increased
gradually depending on clinical response. Change
dose at intervals of at least 1-2 wk. Usual effective
dose: 15-45 mg daily given as single dose, preferably
at bedtime, or in 2 divided doses.

Elderly
Depression
7.5 mg/day PO qHS; increase by 7.5-15 mg/day no
more frequently than q1-2Weeks; not to exceed 45 mg/day

Alzheimer Dementia-related Depression
7.5 mg/day PO qHS; increase by 7.5-15 mg/day no
more frequently than q1-2Weeks; not to exceed 60 mg/day

Hepatic impairment: Clearance is reduced; monitor closely
Child Dose
Safety and efficacy not established
Renal Dose
Renal impairment (CrCl <39 mL/min): Clearance is reduced;
monitor closely
Administration
May be taken with or without food.
indication
Depression, Major depressive disorder
Contraindication
Mirtazapine Tablets are contraindicated in patients with a known
hypersensitivity to mirtazapine or to any of the excipients.
Side Effects
>10%
Somnolence (54%),Weight gain (>7% increase in <49% of pediatric
patients),Xerostomia (25%),Increased appetite (17%),Constipation (13%)

1-10%
Asthenia (8%),lWeakness (8%),Weight gain (>7% increase in 8% of adults)
,Dizziness (7%),Serum TGs increased (6%),Dream disorder (4%),
Disturbance in thinking (3%),ALT increased (2%),Peripheral edema
(2%),Myalgia (2%),Confusion (2%),Urinary frequency (2%),Tremor
(2%),Back pain (2%),Dyspnea (1%)

<1%
Mania (0.2%),Grand mal seizure (less than 0.1%)

Frequency Not Defined
Depression exacerbation,Status epilepticus,Suicidal thoughts,
suicide (rare),Agranulocytosis,Neutropenia
Theraputic Class
Atypical anti-depressant drugs
Pregnency Category
Category: Not Classified
pregnancy_description
Mode of Action
Mirtazapine, a piperazinoazepine tetracyclic antidepressant, enhances
noradrenergic and serotonergic activity through blockade of central
presynaptic adrenergic alpha 2-receptors.
Interaction
Potentiation of sedative effects with alcohol or benzodiazepines.
Increased plasma levels with potent CYP3A4 inhibitors
(e.g. HIV-protease inhibitors, azole antifungals including
ketoconazole, erythromycin, nefazodone). Reduced plasma
levels with carbamazepine and other inducers of CYP3A4.
Increased bioavailability with cimetidine. Potentially Fatal: Do
not use with or within 2 wk of stopping an MAOI; at least 1 wk
should elapse between discontinuing mirtazapine and initiating
any drug which may provoke a serious reaction (e.g. phenelzine).
Pack And Size
Per Unit Price: Tk. 8.07
Package: 50's pack


Amitriptyline + Chlordiazepoxide:

Brand name: Limbix(ACME),Reelife(SKF)

Adult Dose
Depression with Anxiety
1 tablet (5-10 mg chlordiazepoxide/12.5-25 mg amitriptyline)
PO three/four times daily; may increase to 6 tablets
if necessary; 2 tablets reported to be effective in
some patients.

Elderly: Avoid; strong anticholinergic and sedative
effects; may cause orthostatic hypotension
(Beers criteria)

Consider alternatives; if must use, initiate with
lower initial dose; long-acting active metabolites

1 tablet (5 mg/12.5 mg) PO three times daily
Child Dose
Renal Dose
Administration
indication
Depression with Anxiety, agitation or tension.
Contraindication
Hypersensitivity.

Severe cardiovascular disorders, Angle clossure glaucoma,
Within 14 days of MAOIs, Any drugs or conditions
that prolong QT interval, Acute recovery post-MI.
Side Effects
Drowsiness, Dry mouth, Constipation, Blurred vision,
Dizziness, Bloating, Vivid dreams, Impotence, Tremor,
Confusion, Nasal congestion, Edema, Syncope, Ataxia,
EEG abnormalities, Menstrual irregularities, Blood
dyscrasias (agranulocytosis), Hepatic dysfunction (jaundice).
Theraputic Class
Combined anxiolytics & anti-depressant drugs
Pregnency Category
Category: D
pregnancy_description
Mode of Action
Chlordiazepoxide: Antianxiety agent; depresses all levels of CNS,
including limbic and reticular formation, possibly by increasing
gamma-aminobutyric acid (GABA) activity, a major inhibitory
neurotransmitter. Amitriptyline: Antidepressant; neurotransmitter
(especially norepinephrine and serotonin) reuptake inhibitor;
elicits anticholinergic effects.
Interaction
Pack And Size
Per Unit Price: Tk. 7
Package: 50's packs

Flupenthixol + Melitracen:

Brand name: Frenxit(beximco),Renxit(Renata)

Adult Dose
Adults: Usually 2 tablets daily; morning and noon.
In severe cases the morning dose may be increased to 2 tablets.
Elderly: 1 tablet in the morning.
Maintenance dose: Usually 1 tablet in the morning. In cases
of insomnia or severe restlessness additional treatment with
a sedative in the acute phase is recommended.
Child Dose
Renal Dose
Administration
indication
Depression, Anxiety, Apathy, Dysphoria
Contraindication
The immediate recovery phase after myocardial infarction
, Defects in bundle-branch conduction, Untreated narrow angle
glaucoma, Acute alcohol, barbiturate and opiate intoxications,
Flupentixol-Melitracen should not be given to patients who have
received a MAO-inhibitor within two weeks. Not recommended for
excitable or overactive patients since its activating effect may lead
to exaggeration of these characteristics.
Side Effects
In the recommended doses side effects are rare. These could be
transient restlessness and insomnia.
Theraputic Class
Combined anxiolytics & anti-depressant drugs
Pregnency Category
Category: C
pregnancy_description
Mode of Action
Flupentixol is a thioxanthene antipsychotic that inhibits
dopamine-mediated effects by blocking postsynaptic
dopamine receptors in the CNS. Melitracen is a TCA
with anxiolytic properties.
Interaction
May potentiate the adverse effects of drugs with antimuscarinic
effects e.g. TCAs. Reduced efficacy of levodopa. Increases
adverse extrapyramidal symptoms with dopamine antagonists
(metoclopramide and prochlorperazine). Potentially Fatal: Potentiates
CNS effects of alcohol, general anaesthetics, hypnotics, anxiolytics
and opioids. Blocks antihypertensive effect of guanethidine. Additive
toxicity with antimuscarinics, CNS depressants. Response to TCA may
be accelerated with thyroid hormones; pressor effects of sympathomimetics
may be enhanced; risk of serotonin syndrome when taken with other
antidepressants. Antidiabetic dosage may need to be adjusted.
Pack And Size
Per Unit Price: Tk. 5
Package:


Escitalopram:

Brand name: Essita(healthcare),Nexcital(Unimed)
Oxapro(square),Losita(skf)

Preparation: 5mg/10mg tablet

Adult Dose
Oral
Anxiety; Depression; Obsessive compulsive disorder
Adult: 10 mg once daily, increased after at least a
wk if needed. Max: 20 mg once daily.

Panic disorder with or without agoraphobia
Adult: Initially, 5 mg once daily, increased after a
wk to 10 mg once daily. Max: 20 mg daily.
Elderly: Half the adult dose.

Hepatic impairment: Mild to moderate: Initially,
5 mg daily, increased to 10 mg daily after 2 wk
if needed. Severe: More careful dose titration needed.
Child Dose
Major Depressive Disorder
<12 years: Safety and efficacy not established

>12 years: 10 mg PO qDay; may increase dose after
at least 3 weeks; not to exceed 20 mg/day
Renal Dose
Administration
May be taken with or without food.
indication
Major depressive disorder, Depression, Panic disorder,
Obsessive compulsive disorder, Anxiety disorder
Contraindication
Concomitant use with or within 2 wk of MAOI withdrawal.
Side Effects
>10%
Headache (24%),Nausea (18%),Ejaculation disorder (9-14%),
Somnolence (4-13%),Insomnia (7-12%)

1-10%
Xerostomia (4-9%),Constipation (3-6%),Fatigue (2-8%),Libido
decrease (3-7%),Anorgasmia (2-6%),Flatulence (2%),Toothache
(2%),Weight gain (1%),Menstrual disorder (2%),Neck/shoulder
pain (3%),Rhinitis (5%),Flu-like syndrome (5%),Ejaculation
disorder (9-14%)

<1%
Arthralgia,Abdominal pain,Abnormal bleeding,Abnormal dreams,
Allergy,Blurred vision,Bronchitis,Chest pain,Constipation,
Decreased appetite,Decreased concentration,Disrupts
platelets/hemostasis,Dizziness,Dyspepsia,Fever,Heartburn
,Hot flashes,Impotence,Irritability,Jaw stiffness,Lethargy
,Lightheadedness,Menstrual disorder,Hypertension,Palpitations
,Migraine,Myalgia,Paresthesia,Rash,Sweating,Tinnitus,Tremor,
Urinary frequency,Urinary tract infection,Vertigo,Vomiting,Yawning
Theraputic Class
SSRIs & related anti-depressant drugs
Pregnency Category
Category: Not Classified
pregnancy_description
Mode of Action
Escitalopram selectively inhibits CNS neuronal re-uptake of
serotonin (5-HT) and potentiates serotonergic activity. It has
minimal effects on norepinephrine and dopamine
neuronal re-uptake.
Interaction
Increased risk of bleeding when used with aspirin, NSAIDs or
drugs that affect coagulation. Serum levels may be reduced by
CYP2C19 inducers (e.g. carbamazepine, rifampin, phenytoin) or
CYP3A4 inducers (e.g. nafcillin, nevirapine). Serum levels may
also be increased by CYP2C19 inhibitors (e.g. fluconazole,
fluvoxamine, omeprazole) or CYP3A4 inhibitors (e.g. azole
antifungals, clarithromycin). May increase serum levels of
desipramine or metoprolol. Increased risk of serotonin syndrome
when used with linezolid or sibutramine. Escitalopram may
enhance the sedative effects of alcohol. Potentially Fatal:
Concomitant administration with MAOIs may lead to serious
or fatal reactions; should not be started until at least 2 wk after
stopping escitalopram or vice versa. Moclobemide may increase
the risk of serotonin syndrome.
Pack And Size
Per Unit Price: Tk. 12
Package: 20's pack

Sertraline Hydrochloride:

Brand name: Setra(general),Seronex(Renata)

Andep(healthcare)

Preparation: 25/50/100mg

Adult Dose
Oral
Major Depressive Disorder;
Obsessive compulsive disorder
Adult: Initially, 50 mg daily, may
increase in increments of 50 mg at wkly
intervals. Max: 200 mg daily.

Panic disorder with or without agoraphobia;
Posttraumatic stress disorder; Social anxiety disorder
Adult: Initially, 25 mg daily, increased to 50 mg daily
after a wk. May increase in increments of 50 mg at
wkly intervals. Max: 200 mg daily.

Premenstrual dysphoric disorder
Adult: Initially, 50 mg daily, either throughout the
menstrual cycle or during the luteal phase only. May
increase in increments of 50 mg per menstrual cycle.
Max: 150 mg daily (for continuous dosing) or 100 mg daily
(during luteal phase).
Patient who require 100 mg daily during luteal phase-only:
Initially, 50 mg daily for the first 3 days of each
luteal phase period.

Hepatic impairment: Reduce dose.
Child Dose
Oral
Obsessive compulsive disorder
Child: 6-12 yr Initially, 25 mg once daily;
13-17 yr Initially, 50 mg once daily. May increase
at intervals of at least 1 wk.
Max: 200 mg daily.
Renal Dose
Renal impairment: Dose adjustment not necessary
Administration
May be taken with or without food.
indication
Major Depressive illness, Panic disorder, Premenstrual
dysphoric disorder, Post-traumatic stress disorder,
Obsessive-compulsive disorder, Social anxiety disorder
Contraindication
Sertraline is contraindicated in patients with a known
hypersensitivity to Sertraline or any of the excipients of drug.
Concurrent use or w/in 14 days of discontinuation of MAOIs
(e.g. linezolid or IV methylene blue). Concomitant use w/ pimozide.
Side Effects
>10%
Diarrhea (13-24%),Nausea (13-30%),Headache (20-25%),Insomnia
(12-28%),Ejaculation disorder (7-19%),Dizziness (6-17%),Dry mouth
(6-16%),Fatigue (10-16%),Drowsiness (2-15%)

1-10%
Agitation (1-6%),Anorexia (5-10%),Anxiety (4%),Constipation (5-8%)
,Paresthesia (2%),Impotence (5-10%),Sweating (< 1%),Malaise (7-9%),
Vomiting (4%),Pain (3-6%)

Frequency Not Defined
Asthenia,Back pain,Chest pain,Hypoesthesia,Increased appetite,Myalgia
,Palpitations,Rhinitis,Tinnitus,Weight gain,Yawning
Theraputic Class
SSRIs & related anti-depressant drugs
Pregnency Category
Category: C
pregnancy_description
Mode of Action
Sertraline has a potent and selective inhibitory action on CNS neuronal
reuptake of 5-HT resulting in increased 5-HT concentrations at the
synaptic clefts, leading to sustained activity at the postsynaptic
receptor sites and improvement of depression. Reduction of
serotonin turnover (in brain) also contributes to its action. Its
long half-life allows once daily admin.
Interaction
May increase risk of delirium when used with antimuscarinics.
Increased risk of extrapyramidal symptoms and neuroleptic
malignant syndrome when used with aripiprazole. Serum levels
may be reduced by carbamazepine. Concurrent use with
dihydroergotamine or linezolid may lead to serotonin syndrome.
May increase serum levels of lamotrigine and risk of toxicity. May
increase serum levels of olanzapine, pimozide, risperidone, methadone
, clozapine and amiodarone. Plasma levels may be increased by
cimetidine and ritonavir. May increase the anticoagulant activity of
warfarin and acenocoumarol. Potentially Fatal: Concomitant admin
with MAOIs can result in serious serotonin syndrome.
Pack And Size
Per Unit Price: Tk. 10.07
Package: 30's pack


Paroxetine:

Brand name:Oxat(square),Parotin(ACI)

Preparation: 10/20mg

Adult Dose
Oral
Depression, Anxiety, Posttraumatic stress disorder
Adult: 20 mg daily, increase gradually, if necessary,
by 10-mg increments wkly; max: 50 mg/day.

Obsessive compulsive disorder, Social anxiety disorder
Adult: Initially, 20 mg daily, increase wkly in 10-mg increments.
Maintenance: 40-60 mg daily.

Panic disorder with or without agoraphobia
Adult: Initially, 10 mg daily, increase wkly in 10-mg
increments according to clinical response.
Maintenance: 40-60 mg daily.

Elderly: Initially, 10 mg daily, increase if needed
by 10 mg/day at 1 wk intervals; max: 40 mg daily.

Hepatic impairment: Severe: 10 mg daily,
increase to a max of 40 mg daily as necessary.
Child Dose
Safety and efficacy not established
Renal Dose
Renal impairment: Severe: 10 mg daily, increase
to a max of 40 mg daily as necessary.
Administration
May be taken with or without food. May be taken
w/ meals to minimise GI upset.
indication
Depression, Anxiety, Panic disorder, Obsessive-compulsive
disorder, Posttraumatic stress disorder, Social anxiety disorder,
Premenstrual dysmorphic disorder
Contraindication
Use with or within 14 days of MAOIs; concurrent use with
thioridazine or pimozide.
Side Effects
>10% (Based on 40 mg Dose)
Nausea (15-24%),Insomnia (11-24%),Dry mouth (9-18%),Headache
(17%),Asthenia (10-15%),Constipation (10-15%),Diarrhea (9-12%),
Dizziness (6-14%),Ejaculation disorder (10-15%),Tremor (4-11%),

1-10% (Based on 40 mg Dose)
Anxiety (5-10%),Blurred vision (5-10%),Decreased appetite (5-10%),
Impotence (2-9%),Nervousness (2-5%),Paresthesia (2-5%),
Hypomania (0.3 to 2.2%)

Frequency Not Defined (Based on 40 mg Dose)
Hypertension,Tachycardia,Emotional lability,Pruritus,Weight gain,
Arthralgia,Tinnitus.Vertigo.Angle clossure glaucoma

Serious
Depression exacerbation,Mania (rare),Serotonin syndrome,
Suicidal thoughts (rare),Suicide (rare),Seizure (rare),Toxic epidermal
necrolysis,Hyponatremia (rare),Bleeding, abnormal (rare).Acute
hepatitis (rare).Stevens-Johnson Syndrome
Theraputic Class
SSRIs & related anti-depressant drugs
Pregnency Category
Category: Not Classified
pregnancy_description
Mode of Action
Paroxetine selectively inhibits the reuptake of serotonin. It has limited
direct action at other neurotransmitter sites including muscarinic receptors.
Interaction
Levels/effects inhibited by cyproheptadine, phenytoin. Levels/effects
increased by carbamazepine, cimetidine, CYP2D6 inhibitors
(e.g. chlorpromazine, delavirdine, fluoxetine, miconazole, pergolide
, quinidine, quinine, ritonavir, ropinirole). Increases levels/effects of
atomoxetine, carvedilol, clozapine, CYP2B6 substrates
(e.g. bupropion, promethazine, propofol, selegiline, sertraline), CYP2D6
substrates (e.g. amphetamines, selected beta-blockers, dextromethorphan,
fluoxetine, lidocaine, mirtazapine, nefazodone, risperidone, ritonavir,
thioridazine, TCAs, venlafaxine), duloxetine, galantamine, mexilitine,
pimozide, procyclidine, propafenone. Decreases levels/effects of CYP2D6
prodrug substrates (e.g. codeine, hydrocodone, oxycodone, tramadol).
Inhibits the metabolism of dextromethorphan, haloperidol, thioridazine.
Enhances bradycardic effect of beta-blockers. Enhances toxic effects of
other CNS depressants. Increased risk of serotonin syndrome with
amphetamines, SSRIs, meperidine, nefazodone, trazodone, serotonin
agonists, sibutramine, sympathomimetics, tramadol, venlafaxine.
Increases risk of bleeding with NSAIDs, aspirin, warfarin, or other
drugs affecting coagulation. Increases sensitivity to amphetamines.
Neurotoxicity with lithium. Additive hyponatraemia with loop diuretics.
Mania or hypertension with selegiline. Potentially Fatal: Fatal reactions
with nonselective MAOI.
Pack And Size
Per Unit Price: Tk. 12.03
Package: 30's pack


Flupenthixol (flupentixol):

Brand name: Sentix(SKF)(0.5mg)

Adult Dose
Oral
Psychoses
Adult: Initially, 3-9 mg bid, adjusted
according to response. Max: 18 mg daily.
Elderly: Initial dose: ¼ or ½ of the usual initial dose.

Oral
Depression with or without anxiety
Adult: Initially, 1 mg daily increased after 1 wk to 2 mg
daily and then to a max of 3 mg daily, last dose should
be given not later than 4 p.m.
Doses >2 mg should be given in 2 divided doses.
Discontinue treatment if there is no improvement within
1 wk of using the max dose.
Elderly: Initially, 0.5 mg daily increased after 1 wk to 1 mg
daily with the last dose given not later than 4 p.m.
Max: 2 mg daily in 2 divided doses.

Intramuscular
Psychoses
Adult: As decanoate: Initially, 20 mg is given as test dose.
After at least 7 days and depending on the response,
subsequent doses of 20-40 mg may be given at
intervals of 2-4 wk.
Usual maintenance dose: 50 mg every 4 wk to 300 mg
every 2 wk. Up to 400 mg wkly may be used in severe
or resistant cases.
Elderly: Initial dose: ¼ or ½ of the usual initial dose.
Child Dose
Renal Dose
Administration
May be taken with or without food.
indication
Depression, Schizophrenia, Psychoses
Contraindication
Hypersensitivity. Extremely excitable and overactive patients;
mania; porphyria; coma; preexisting CNS depression; bone-marrow
supression; phaeochromocytoma. Lactation.
Side Effects
Rigidity, tremors, restlessness, tardive dyskinesia, insomnia, dryness
of mouth, wt gain, sexual dysfunction, galactorrhoea and
menstrual disturbances.

Potentially Fatal: Neuroleptic malignant syndrome
(hyperthermia, hypertonicity of skeletal muscles,
unconsciousness and autonomic nervous system instability).
Theraputic Class
SSRIs & related anti-depressant drugs
Pregnency Category
Category: C
pregnancy_description
Mode of Action
Flupentixol is a thioxanthene antipsychotic that inhibits dopamine-mediated
effects by blocking postsynaptic dopamine receptors in the CNS.
Interaction
May potentiate the adverse effects of drugs with antimuscarinic effects
e.g. TCAs. Reduced efficacy of levodopa. Increases adverse extrapyramidal
symptoms with dopamine antagonists (metoclopramide and prochlorperazine).
Potentially Fatal: Potentiates CNS effects of alcohol, general anaesthetics,
hypnotics, anxiolytics and opioids. Blocks antihypertensive effect of guanethidine.
Pack And Size
Per Unit Price: Tk. 3.5
Package: 50's pack



Clomipramine Hydrochloride;

Brand name : Timex(25mg)(orion)


Adult Dose
Oral
Adjunct for cataplexy associated with narcolepsy
Adult: Initially, 10 mg daily gradually increased
to 10-75 mg daily.
Elderly: Dose reduction may be needed.

Obsessive compulsive disorder; Panic disorder;
Phobias
Adult: Initially, 25 mg daily, gradually increased
to 100-150 mg daily over 2 wk. Max: 250 mg daily.
Elderly: Initially, 10 mg daily.

Depression
Adult: Initially, 10 mg daily; may increase gradually
to 30-150 mg daily if needed. Up to 250 mg daily or
more may be required in more severe cases.
Elderly: Initially, 10 mg daily; may increase gradually
over 10 days to 30-75 mg daily.
Max Dosage: 100-150 mg daily.
Child Dose
Obsessive-Compulsive Disorder
<10 years: Safety and efficacy not established

>10 years: 25 mg PO qDay initially

Gradually increase to maximum 3 mg/kg/day or
100 mg/day, whichever is less

May further increase to maximum 3 mg/kg/day
or 200 mg/day, whichever is less; may give as
single dose qHS once tolerated
Renal Dose
Administration
Should be taken with food.
indication
Depression, Panic disorder, Obsessive compulsive
disorder, Cataplexy, Narcolepsy, Phobias, Premature
ejaculation, Enuresis, Trichotillomania
Contraindication
Hypersensitivity. Concomitant use of MAOIs; recovery
phase following MI, heartblock or other arrhythmias;
mania; childn.
Side Effects
>10%
Xerostomia (84%),Headache (50-55%),Constipation
(47%),Ejaculation failure (42%),Fatigue (35-40%),
Nausea (30-35%),Impotence (20-25%),Weight gain (18%)

1-10%
Weight loss (5%),Hepatotoxicity (1-3%)

Frequency Not Defined
Common, Dizziness, mainia, somnolence, tremor, Dyspepsia,
Blurred vision, Urinary retention, Orgasm incapacity, libido change

Potentially Fatal: Death, rare (except in patients with preexisting
significant heart block and patients on MAOI therapy). Induction
of mania in individuals with underlying manic-depressive illness
or worsening of psychoses in already psychotic individuals.
Theraputic Class
Tricyclic & related anti-depressant drugs
Pregnency Category
Category: C
pregnancy_description
Mode of Action
Clomipramine is a potent inhibitor of serotonin re-uptake in the brain.
Significant antagonism at cholinergic and ?1-receptors. Weak
antagonism at dopamine receptors. It has also antidepressant,
sedative and anticholinergic effects.
Interaction
Barbiturates increase metabolism of tricyclic antidepressants;
conversely cimetidine, guanethidine, haloperidol and phenothiazines
block the tricyclic metabolism. CNS effects of alcohol enhanced.
Potentially Fatal: If clomipramine is to be substituted for MAOIs,
at least 3 wk should elapse after discontinuing MAOIs. Risk of
hypertension and arrhythmias if co-administered with adrenaline
and noradrenaline.
Pack And Size
Per Unit Price: Tk. 5
Package: 30's pack

Doxepin:

Brand name: Slipaid (3/6 mg)(Slipaid)

Adult Dose
Oral
Depression/Anxiety
Adult: Initiate at low dose (25 mg/day); gradually
titrate upward every 5-7 days
Dosage range: 25-300 mg/day PO, up to 150 mg/day
as single dose

If dose exceeds 150 mg/day, divide q12hr
Hepatic impairment: Use lower dose and adjust
gradually for depression;

Insomnia (Silenor)
Sleep maintenance
3-6 mg PO within 30 minutes before bedtime; not
to exceed 6 mg/day

Hepatic impairment/debilitated patients: 3 mg PO
within 30 minutes before bedtime

Elderly
Insomnia
Sleep maintenance
Starting dose: 3 mg PO within 30 minutes before bedtime
May increase to 6 mg PO HS if clinically indicated

Depression/Anxiety
Lower initial dose (ie, 10 mg/day) and adjust gradually;
10-25 mg PO qHS
May increase by 10-25 mg increments q3Day for inpatients
and weekly for outpatients if tolerated
Child Dose
<12 years old: Not recommended
Renal Dose
Administration
May be taken with or without food.
indication
Anxiety disorders, Depression, Insomnia
Contraindication
Hypersensitivity; mania, glaucoma, neonates (topical); lactation.
Side Effects
Sedation, fatigue, weakness, lethargy,Dry mouth,Constipation,
Blurred vision,Headache,Agitation,Insomnia,Anxiety,Nausea,
vomiting,Sweating,Confusion, extrapyramidal symptoms (EPS),
dizziness, paresthesia,Orthostatic hypotension, ECG changes,
tachycardia,Increased LFTs,Tinnitus,Sexual dysfunction,Rash,
Seizure,Agranulocytosis,Thrombocytopenia,Eosinophilia,
Leukopenia,SIADH
Theraputic Class
Tricyclic & related anti-depressant drugs
Pregnency Category
Category: Not Classified
pregnancy_description
Mode of Action
Doxepin inhibits serotonin and norepinephrine re-uptake by the
presynaptic neuronal membrane increasing its synaptic conc
in the CNS.
Interaction
Methylphenidate may increase plasma doxepin levels. Potentially
Fatal: Potentiates hypertensive action of sympathomimetics.
Increased anticholinergic effects with MAOIs. Additive CNS
effects with anticholinergics, CNS depressants and alcohol.
Pack And Size
Per Unit Price: Tk. 10
Package: 30's Pack


Imipramine:

Brand name: Pramin(drug int),Depram(square)

Dose: 25 mg

Adult Dose
Oral
Depression
Adult: Initially, 75 mg in divided doses, may gradually
increase to 150-200 mg daily as necessary.
Max: 300 mg/day. May give in divided doses or single dose HS
Maintenance dose: 50-100 mg PO qDay
Elderly: 10 mg daily, may gradually increase to 30-50 mg daily.

Hepatic impairment: Severe: Contraindicated.
Child Dose
Oral
Nocturnal enuresis
Child: 6-7 yr 20-25 kg: 25 mg;
8-11 yr 25-35 kg: 25-50 mg;
>11yr 35-54 kg: 50-75 mg.
Doses are given just before bedtime. Max treatment
duration: 3 mth.
Renal Dose
Administration
May be taken with or without food.
indication
Depression, Nocturnal enuresis
Contraindication
Any degree of heart block or cardiac arrhythmias,
recent MI, porphyria, narrow-angle glaucoma, urine
retention, mania. Severe hepatic impairment.
Childn <6 yr. Concomitant use w/ MAOIs.
Side Effects
Orthostatic hypotension, HTN, tachycardia, palpitation,
MI, arrhythmias, heart block, ECG changes, precipitation
of CHF, stroke; confusional states (esp in elderly) w/
hallucinations, disorientation, delusions; anxiety, restlessness,
agitation, insomnia and nightmares, hypomania, exacerbation
of psychosis; numbness, tingling, paraesthesias of extremities;
incoordination, ataxia, tremors, peripheral neuropathy, extrapyramidal
symptoms, seizures, altered EEG patterns, tinnitus; dry mouth; rarely,
associated SL adenitis; blurred vision, accommodation disturbances,
mydriasis, constipation, paralytic ileus, urinary retention, delayed
micturition, dilated urinary tract; skin rash, petechiae, urticaria,
itching, photosensitization, oedema, drug fever; bone marrow
depression, agranulocytosis; eosinophilia, purpura, thrombocytopenia;
nausea and vomiting, anorexia, epigastric distress, diarrhoea, peculiar taste
stomatitis, abdominal cramps, black tongue; gynaecomastia (male),
breast enlargement and galactorrhea (female), increased/decreased
libido, impotence, testicular swelling, increased/decreased blood sugar
levels, inappropriate antidiuretic hormone secretion syndrome; jaundice,
altered liver function, wt gain/loss, perspiration, flushing, urinary frequency,
drowsiness, dizziness, weakness and fatigue, headache, parotid swelling,
alopecia, proneness to falling.
Theraputic Class
Tricyclic & related anti-depressant drugs
Pregnency Category
Category: D
pregnancy_description
Mode of Action
Imipramine is believed to increase the synaptic concentration of serotonin
and/or norepinephrine in the CNS by inhibition of their reuptake by the
presynaptic neuronal membrane. However, additional receptor effects
have been found including desensitisation of adenyl cyclase, down
regulation of β-adrenergic receptors, and down regulation of
serotonin receptors.
Interaction
Increased plasma levels and effects with quinidine, cimetidine,
SSRIs, propafenone, flecainide. Reduced plasma levels with
barbiturates, phenytoin. May increase effects of anticholinergic
drugs. Severe orthostatic hypotension with altretamine. Causes
drowsiness and impaired performance in combination with alcohol.
Potentially Fatal: Severe hypertension with adrenaline, noradrenaline
and methylphenidate. Reduces hypotensive effects of guanethidine,
bethanidine, debrisoquine, bretylium, methyldopa and clonidine.
Possible serotonin syndrome with MAOIs, separate admin by 3 wk.
Pack And Size
Per Unit Price: Tk. 2
Package: 50's pack


Nortriptyline:

brand name:Nortin(Navana),Moodnor(IBNSINA)

Preparation; 10mg,25 mg

Adult Dose
Oral
Depression
Adult: 75-100 mg/day in 3 or 4 divided doses.
Max: 150 mg/day in severe depression.

Elderly: 30-50 mg/day in divided doses.

Hepatic impairment: Administer lower dose
and titrate at a slower rate
Child Dose
Oral
Depression
Child: Adolescent: 30-50 mg/day in divided
doses.

Nocturnal enuresis
Child: 6-7 yr (20-25 kg): 10 mg;
8-11 yr (25-35kg): 10-20 mg;
>11 yr (35-54 kg): 25-35 mg.
All doses are given 30 minutes before bedtime
and treatment should continue for not >3 mth.
Renal Dose
Administration
May be taken with or without food.
indication
Depression, Nocturnal enuresis
Contraindication
Mania, recent MI, arrhythmias (particularly heart
block); severe liver disease; children <6 yr.
Side Effects
Hypotension, HTN, tachycardia, palpitation, MI,
arrhythmias, heart block, stroke; confusional
states w/ hallucinations, disorientation, delusions;
anxiety, restlessness, agitation; insomnia, panic,
nightmares; hypomania; exacerbation of psychosis;
suicidal ideation and behaviours; numbness, tingling,
paraesthesia; incoordination, ataxia, tremors; peripheral
neuropathy; extrapyramidal symptoms; seizures; tinnitus,
dry mouth, blurred vision, accommodation disturbances,
mydriasis; constipation, paralytic ileus; urinary retention,
delayed micturition, dilation of the urinary tract.

Rash, itching, urticaria, photosensitisation; oedema
(general or of face and tongue); bone-marrow
depression including agranulocytosis, aplastic anaemia,
eosinophilia, thrombocytopenia. Nausea, vomiting, anorexia,
epigastric distress, diarrhoea, peculiar taste, stomatitis,
abdominal cramps, malaise, jaundice, hepatitis and
liver necrosis. Sweating, flushing, urinary frequency,
nocturia, drowsiness, dizziness, weakness, fatigue,
headache, parotid swelling, alopecia.

Gynaecomastia, breast enlargement and galactorrhoea;
increased or decreased libido, impotence, testicular swelling;
elevation or reduction of blood sugar levels; inappropriate
secretion of antidiuretic hormone syndrome. Wt gain or loss,
altered liver function. Rarely, associated sublingual adenitis
or gingivitis.

Potentially Fatal: Rare, blood dyscrasias.
Theraputic Class
Tricyclic Anti-depressants
Pregnency Category
Category: C
pregnancy_description
Mode of Action
Nortriptyline, a dibenzocycloheptadiene tricyclic antidepressant,
is the primary active metabolite of amitriptyline. It increases synaptic
concentration of serotonin and/or norepinephrine in the CNS by
blocking the neuronal reuptake of norepinephrine and serotonin.
Interaction
Increased risk of serotonin syndrome w/ SSRIs, SNRIs, TCAs,
triptans, fentanyl, lithium, tramadol, tryptophan, buspirone. May
reduce antihypertensive effect of bethanidine, guanethidine,
debrisoquine, clonidine. May increase metabolism w/ barbiturates.
Increased risk of arrhythmias and hypotension w/ anaesth.
Increased plasma level w/ fluoxetine. Potentially Fatal:
Increased risk of serotonin syndrome w/ MAOIs, linezolid
and methylene blue.
Pack And Size
Per Unit Price: Tk. 1.51
Package: 100's pack


Phenobarbitone:

Brand name: Barbit(incepta),Berdinal(Gacopharma)

Preparation: 30/60mg ,200mg/1ml inj,20mg/5ml  

Adult Dose
Parenteral
Status epilepticus ; Emergency management
of acute seizures
Adult: As phenobarbital Na: 200-600 mg.
OR 15-18 mg/kg IV loading dose infused a
t 25-60 mg/min; prepare to support ventilation;
may repeat in 20-minute intervals PRN; not to exceed 30 mg/kg

As a hypnotic
Adult: 100-320 mg. Do not admin for >2 wk for the treatment of insomnia.

Intramuscular
Preoperative sedation
Adult: As phenobarbital Na: 100-200 mg 60-90 min pre-op.


Hepatic impairment: Reduce dose. Severe: Contraindicated.
Child Dose
Parenteral
Status epilepticus ; Emergency management of acute seizures
Child: As phenobarbital Na: 100-400 mg. OR
Infants and children: 15-20 mg/kg IV infused at a rate not to
exceed 2 mg/kg/min;
not to exceed 1000 mg/dose
<60 kg: IV rate at <30 mg/min
May repeat with 5-10 mg/kg bolus dose after 15-30 min PRN;
not to exceed cumulative dose of 40 mg/kg

Seizures
Neonates (<28 days): 3-5 mg/kg/day IV/PO in 1-2 divided doses
Infants: 5-6 mg/kg/day in 1-2 divided doses
1-5 years: 6-8 mg/kg/day in 1-2 divided doses
6-12 years: 4-6 mg/kg/day in 1-2 divided doses
>12 years: 1-3 mg/kg/day in 1-2 divided doses, OR 50-100 mg BID/TID

Intramuscular
Preoperative sedation
Child: As phenobarbital Na: 16-100 mg 60-90 min pre-op.

Intravenous
Preoperative sedation
Child: 1-3 mg/kg pre-op.
Renal Dose
Renal impairment: Reduce dose. Severe: Contraindicated.
Administration
Reconstitution:
Dilute w/ most IV infusion soln (e.g. NaCl 0.45% or 0.9%, lactated
Ringer's, dextrose 5%, Ringer's).

IV Administration
Slow injection at <60 mg/min
May be given IM into large muscle
indication
Status epilepticus, Partial seizures, Sedation, Generalised
tonic-clonic seizures, Hypnotic, Preoperative sedation
Contraindication
Severe renal and hepatic disorders. Severe respiratory depression
, dyspnoea or airway obstruction; porphyria. Pregnancy.
Side Effects
Common
Ataxia,Dizziness,Drowsiness,Dysarthria,Fatigue,Headache,
Irritability,Nystagmus,Paresthesia restlessness,Vertigo
Geriatric patients: Excitement, confusion, depression
Pediatric patients: Paradoxical excitement/hyperactivity

Less Common
Mental dullness,Constipation,Diarrhea,Nausea,Vomiting,
Megaloblastic (folate-deficiency) anemia

Uncommon
Rash,Hypocalcemia,Hepatotoxicity

Rare
Stevens-Johnson syndrome,Rickets,Osteomalacia

Potentially Fatal: Stevens-Johnson syndrome.
Theraputic Class
Barbiturates
Pregnency Category
Category: D
pregnancy_description
Mode of Action
Phenobarbitone is a short-acting barbiturate. It depresses
the sensory cortex, reduces motor activity, changes cerebellar
function, and produces drowsiness, sedation and hypnosis.
Its anticonvulsant property is exhibited at high doses.
Interaction
May enhance the hepatotoxic potential of paracetemaol overdoses.
May decrease levels/effects of various CYP isoenzyme substrates
e.g. teniposide, methotrexate, antipsychotics, beta-blockers,
calcium-channel blockers, other anticonvulsants, chloramphenicol,
cimetidine, corticosteroids, ciclosporin, doxycycline, oestrogens,
felbamate, griseofulvin, tacrolimus, furosemide, methadone, oral
contraceptives, theophylline, TCAs, warfarin. May reduce effects of
guanfacine. Reduced metabolism and or increased toxicity with
chloramphenicol, felbamate, MAOIs, valproic acid. May enhance
the nephrotoxic effects of methoxyflurane. Potentially Fatal: Additive
sedation and/or respiratory depression with ethanol, sedatives,
antidepressants, opioid analgesics, benzodiazepines and other
CNS depressants. May decrease levels/effects of antiarrhythmi
drugs e.g. disopyramide, propafenone, quinidine.
Pack And Size
Per Unit Price: Tk. 16
Package: 5 amps pack

Topiramate: 

Brand name; Topirva(incepta),Etopira(Unimed)

Preparation: 25/50 mg tablet,100mg XR capsule

Adult Dose
Oral
Partial-Onset or Primary Generalized Tonic-Clonic Seizures
Monotherapy
Adult: 25 mg PO q12hr initially; may increase by 50 mg/day at
weekly intervals to 200 mg PO q12hr.

Adjunctive therapy
25-50 mg/day PO initially; increase by 25-50 mg/day at weekly
intervals to 100-200 mg q12hr for partial onset seizures
and 200 mg q12hr.

Lennox-Gastaut Syndrome
Indicated as adjunctive therapy for seizures associated
with Lennox-Gastaut syndrome (LGS)
25-50 mg/day PO initially; increase by 25-50 mg/day
at weekly intervals to 100-200 mg q12hr

Migraine Headache
Indicated for prophylaxis of migraine headache
Titrate over 4 wk to achieve a dose of 50 mg PO BID

Week 1: 25 mg PO at night
Week 2: 25 mg PO BID
Week 3: 25 mg PO in the morning and 50 mg at night
Week 4: 50 mg PO BID

Hepatic impairment: Dosage adjustment may be needed.
Child Dose
Oral
Partial-Onset or Primary Generalized Tonic-Clonic Seizures
Monotherapy
<2 years: Safety and efficacy not established

2 to <10 years: 25 mg PO at night for 1 week; titrate dose over
5-7 weeks to target daily maintenance dose (weight based)
and divide into q12hr dosing schedule

Weight-based dosing
Up to 11 kg: 150 mg/day minimum; 250 mg/day maximum
12-22 kg: 200 mg/day minimum; 300 mg/day maximum
23-31 kg: 200 mg/day minimum; 350 mg/day maximum
32-38 kg: 250 mg/day minimum; 350 mg/day maximum
>38 kg: 250 mg/day minimum; 400 mg/day maximum

>10 years
25 mg PO q12hr initially
Titrate by increments of 50 mg/week up to 200 mg q12hr

Adjunctive therapy
<2 years: Safety and efficacy not established
2-16 years: 25 mg PO qHS(once at night) initially for first
week (based on 1-3 mg/kg/day); increase dose by 1-3 mg/kg/day
PO divided q12hr at 1-2 week intervals to 5-9 mg/kg/day divided q12hr
>17 years: 25-50 mg/day PO initially; increase by 25-50 mg/day
at weekly intervals to 100-200 mg q12hr for partial onset seizures
and 200 mg q12hr for generalized tonic/clonic seizures

Lennox-Gastaut Syndrome
Adjunctive therapy
<2 years: Safety and efficacy not established
2-16 years: 25 mg PO qHS initially for first week (based on 1-3 mg/kg/day); i
ncrease dose by 1-3 mg/kg/day PO divided q12hr at 1-2 week
intervals to 5-9 mg/kg/day divided q12hr
>17 years: 25-50 mg/day PO initially; increase by 25-50 mg/day
at weekly intervals to 100-200 mg q12hr for partial onset seizures
and 200 mg q12hr for generalized tonic/clonic seizures

Migraine Headache
Indicated for prophylaxis of migraine headache

<12 years: Safety and efficacy not established

Guide dose/titration rate by clinical outcome; if needed,
use longer intervals between dose adjustments

>12 years
Titrate over 4 wk to achieve a dose of 50 mg PO BID
Week 1: 25 mg PO qHS(once at night)
Week 2: 25 mg PO BID
Week 3: 25 mg PO in the morning and 50 mg HS
Week 4: 50 mg PO BID
Renal Dose
Renal impairment: Moderate to severe: Doses should be halved.
Haemodialysis: supplemental dose equal to about ½ of the daily dose
should be given in divided doses (at the start and finish of haemodialysis).
Administration
May be taken with or without food.
indication
Epilepsy, Migraine prophylaxis, Seizures associated w/
Lennox-gastaut syndrome
Contraindication
Contraindicated in persons showing hypersensitivity to any
component of this preparation.
Side Effects
>10%
Decrease in serum bicarbonate (7-67%),Dizziness (4-29%),
Fatigue (9-16%),Ataxia (6-16%),Nervousness (9-18%),
Paresthesia (1-11%),Psychomotor slowing (3-13%),Abnormal
vision (2-13%),Anorexia (4-24%),Confusion (4-11%),Decreased
memory (2-12%),Nausea (6-10%),Speech disorder (2-13%),Injury (14%)

1-10%
Abdominal pain (6-10%),Weight loss (4-9%),Diplopia (1-10%),
Mood problems (<6%),Pharyngitis (6%),Tremor (3-9%),Abnormal
gait (3-8%),Apathy (1%),Asthenia (1-5%),Dry mouth (2%),
Menorrhagia (1-2%),Skin disorder (2-3%),Taste change (2%)
,Edema (2%),Hypertension (1-2%),Syncope (1%),
Bradycardia (1%),Pallor (1%)

<1%
Angina,Erythema,Hepatic failure,Hyperthermia
,Hypokalemia,Neuropathy,Toxic epidermal necrolysis
Theraputic Class
Others
Pregnency Category
Category: Not Classified
pregnancy_description
Mode of Action
Topiramate is a sulfamate-substituted monosaccharide with
precise mechanism of action unknown. It may be due to
various mechanisms e.g. blocking of voltage-dependent sodium
channels; augmenting the activity of ?-aminobutyric acid (GABA)
at GABA-A receptor; antagonising AMPA/kainate glutamate receptors;
inhibiting carbonic anhydrase.
Interaction
Coadmin with antiepileptic drugs e.g. phenytoin, carbamazepine,
phenobarbital decreases plasma concentration of topiramate.
Possible increase in phenytoin levels. Increased risk of renal stone
formation with carbonic anhydrase inhibitors e.g. acetazolamide.
Increased risk of CNS depression with CNS depressants and alcohol.
Increased risk of hyperammonaemia and encephalopathy with valproic
acid. Increased risk of contraceptive failure in women taking combined
oral contraceptives.
Pack And Size
Per Unit Price: Tk. 5
Package: 30's pack



Pregabalin:

Brand name:Pregaba(opsonin),Neurolin(square)

Lyric(healthcare),PG(SKF)

Preparation: 25/50/75 mg capsule ,82.5mg CR TABLET

Adult Dose
Oral
Neuropathic pain, Postherpetic Neuralgia
Adult: Initially, 150 mg/day, may increase to 300 mg/day
after 3-7 days. Max: 600 mg/day after a 7-day interval.
All doses to be given in 2 or 3 divided doses.

Diabetic Peripheral Neuropathic Pain
Initial: 50 mg PO q8hr
Maintenance: May increase to 100 mg PO q8hr within
1 week, as needed; not to exceed 300 mg/day

Adjunct in partial seizures
Adult: Initially, 150 mg/day, may increase to 300 mg/day
after a wk. Max: 600 mg/day. All doses to be given
in 2 or 3 divided doses.

Fibromyalgia
Adult: Initially, 150 mg/day, may increase to 300 mg/day
after a wk. Max: 450 mg/day, if needed. All doses to be
given in 2 or 3 divided doses.
Child Dose
Safety and efficacy not established
Renal Dose
Renal impairment: Haemodialysis: 25-100 mg immediately
after each 4-hr haemodialysis session.
CrCl (ml/min) Dosage Recommendation
30 to <60 75 mg/day. Max: 300 mg/day. All doses to
be given in 2 or 3 divided doses.
15 to <30 Initially, 25-50 mg/day. Max: 150 mg/day.
All doses to be given as a single dose or in 2 divided doses.
<15 Initially, 25 mg/day. Max: 75 mg/day. All doses to
be given as a single dose.
Administration
May be taken with or without food.
indication
Anxiety, Fibromyalgia, Post herpetic Neuralgia, Partial seizures,
Pain from diabetic neuropathy, Neuropathic pain associated with
spinal cord injury
Contraindication
Hypersensitivity. Pregnancy, lactation. Driving or working with
machines, or do other dangerous activities.
Side Effects
>10%
Dizziness (8-45%),Somnolence (4-36%),Peripheral edema
(16%),Ataxia (1-20%),Fatigue (5-11%),Xerostomia (1-15%),
Weight gain (16%),Tremor (11%),Blurred vision (1-12%),
Diplopia (12%)

1-10%
Asthenia (5%),Edema (8%),Facial edema (<3%),Hypotension
(2%),Neuropathy (2-9%),Pain (5%),Disorientation (<2%),
Constipation (5%),Weight gain (4%),Accidental injury (4%),
Abnormal thinking (2%),Confusion (<7%),Amnesia (<6%),
Vertigo (1-4%),Hypoesthesia (2-3%),Euphoria (2%),Decreased
libido (>1%),Incoordination (2%),Vomiting (1-3%),Balance disorder
(2-9%),Myoclonus (4%),Nasopharyngitis pain (1-3%),Flu-like
syndrome (1-2%)

<1%
Addiction,Anemia,Diarrhea,Gynecomastia and breast
enlargement,Epididymitis,Esophagitis,Dysmenorrhea,
Dystonia,Heart failure,Hirsutism,Uveitis

<0.1%
Neutropenia, first degree heart block, hypotension,
hypertension, pancreatitis, dysphagia, oliguria,
rhabdomyolysis, suicidal thoughts or behavior
Theraputic Class
Adjunct anti-epileptic drugs
Pregnency Category
Category: Not Classified
pregnancy_description
Mode of Action
Pregabalin is an analog of the neurotransmitter GABA.
It binds potently to the alpha2-delta subunit resulting in
modulation of Ca channels and reduction in the release
of several neurotransmitters, including glutamate,
norepinephrine, serotonin, dopamine, calcitonin
gene-related peptide and substance P.
Interaction
May potentiate the effects of lorazepam. Additive CNS
depressant effects w/ opiates and benzodiazepines. May
increase risk of angioedema w/ ACE inhibitors. May increase
risk of wt gain and peripheral oedema w/ thiazolidinediones.
Pack And Size
Per Unit Price: Tk. 22
Package: 30's pack


Piracetam:

Brand name: Neurolep(square),Memopil(ACI)

Preparation: 800mg tablet, 500mg/5 ml syrup

Adult Dose
Oral
Adjunct in cortical myoclonus
Adult: 7.2 g daily in 2-3 divided doses,
increased by 4.8 g/day every 3-4 days.
Max dose: 20 g daily.

As a cognitive enhancer in cerebrocortical
insufficiency
Adult: 2.4 g daily, given as 2-3 divided doses.
Up to 4.8 g daily may be used in severe cases.
Child Dose
<16 years old: not recommended

> 16 yeras
The daily dosage depends on the weight,
50 mg/kg of body weight in 3 divided doses.
Once the desired results has been obtained,
reduce the initial dose by half.
Renal Dose
Renal impairment:
CrCl (ml/min) Dosage Recommendation
50-79 2/3 usual dose
30-49 1/3 usual dose
20-29 1/6 usual dose
<20 Contra-indicated
Administration
Oral soln: May be taken with or without food.
Take w/ a glass of water or soft drink to mask

bitter taste.
indication
Cortical myoclonus, Cognitive enhancer
Contraindication
Hepatic and severe renal impairment. Cerebral
haemorrhage. Pregnancy and lactation.
Side Effects
Hyperkinesia, nervousness, depression, diarrhoea,
rashes. CNS stimulation, sleep disturbances,
dizziness, excitement, insomnia, somnolence, wt gain.
Theraputic Class
Drugs used in tremor, tics & related disorders
Pregnency Category
Category: Not Classified
pregnancy_description
Mode of Action
Piracetam protects the cerebral cortex against hypoxia.
It also inhibits platelet aggregation and reduces blood viscosity.
Interaction
May increase prothrombin time in patients who are on warfarin.
Pack And Size
Per Unit Price: Tk. 150.57
Package: 100 ml bot

Phenytoin Sodium:

Brand name : Fosfen(popular),D-Toin(Drug int)

Diphedan(Ambee) 

Preparation; 100mg tablet,150mg/2 ml injection,30mg/5ml syrup

Adult Dose
Status epilepticus
Load 10-15 mg/kg or 15-20 mg/kg at 25-50 mg/min,
THEN
Maintenance: 100 mg IV q6-8hr PRN
Administer IV slowly; not to exceed 50 mg/min
Child Dose
Status Epilepticus
15-20 mg/kg IV in single or divided dose; if necessary
may administer additional dose of 5-10 mg/kg 10 min
after loading dose
Maintenance: 4-8 mg/kg/day IV divided twice daily
Renal Dose
Administration
IV Preparation
Load IV in 250 mL NS; monitor BP

IV/IM Administration
Administer slowly; no more than 50 mg/min in adults and
no more than 1-3 mg/kg/min in pediatric patients
indication
Epilepsy, Tonic-clonic status epilepticus
Contraindication
Pregnancy. IV admin in sinus bradycardia, heart block, or
Stokes-Adams syndrome.
Side Effects
Hypersensitivity, lack of appetite, headache, dizziness,
tremor, transient nervousness, insomnia, GI disturbances
(e.g. nausea, vomiting, constipation), tenderness and hyperplasia
of the gums, acne, hirsutism, coarsening of the facial features,
rashes, osteomalacia. Phenytoin toxicity as manifested as a
syndrome of cerebellar, vestibular, ocular effects, notably
nystagmus, diplopia, slurred speech, and ataxia; also with
mental confusion, dyskinesias, exacerbations of seizure
frequency, hyperglycaemia. Solutions for inj may cause
local irritation or phlebitis. Prolonged use may produce
subtle effects on mental function and cognition,
especially in children.

Potentially Fatal: Toxic epidermal necrolysis,
Stevens-Johnson syndrome.
Theraputic Class
Sodium Channel Agents
Pregnency Category
Category: Not Classified
pregnancy_description
Mode of Action
Phenytoin acts as an anticonvulsant by increasing efflux or decreasing
influx of sodium ions across cell membranes in the motor cortex during
generation of nerve impulses; thus stabilising neuronal membranes
and decreasing seizure activity. It acts as an antiarrhythmic by extending
the effective refractory period and suppressing ventricular pacemaker
automaticity, shortening action potential in the heart.
Interaction
Effects with other sedative drugs or ethanol may be potentiated.
Enhances toxic effects of paracetamol, lithium. Increased risk of
osteomalacia with acetazolamide. Decreased serum levels/effects
with acyclovir, antineoplastics, benzodiazeines, ciprofloxacin,
CYP2C9 inducers (e.g. carbamazepine), CYP2C19 inducers (e.g. rifampin),
folic acid, vigabatrin. Increased serum concentrations with allopurinol,
capecitabine, cimetidine, CYP2C9 inhibitors (e.g. fluconazole),
CYP2C19 inhibitors (e.g. delavirdine), disulfiram, methylphenidate,
metronidazole, omeprazole, SSRI, trazodone, trimethoprim. Increases
metabolism of antiarrhythmics, anticonvulsants, antipsychotics, beta-blockers,
calcium channel blockers, chloramphenicol, corticosteroids, doxycycline, oestrogens
, HMG-CoA reductase inhibitors, methadone, theophylline, TCAs. Decreases
levels/effects of clozapine, ciclosporin, tacrolimus, CYP2B6 substrates
(e.g. bupropion, selegiline), CYP2C8 substrates (e.g. amiodarone),
CYP2C9 substrates (e.g. celecoxib), CYP2C19 substrates (e.g. citalopram),
CYP3A4 substrates (e.g. benzodiazepines), digoxin, itraconazole, levodopa,
neuromuscular-blocking agents, thyroid hormones, topiramate. Increases
levels/effect of dopamine, ticlopidine. Valproic acid may displace phenytoin
from binding sites; and affect phenytoin serum concentrations. Transiently
increases the hypothrombinaemia response to warfarin initially, followed by
an inhibition of the response. Potentially Fatal: Enhances the hypotensive
properties of dopamine and the cardiac depressant properties of lidocaine.
Pack And Size
Per Unit Price: Tk. 70.26
Package: 5's pack



Carbamazepine:

Brand name: Tegretol(Novartis),Anleptic(Square)

Preparation: 200mg tablet,200 mg CR tablet,100mg/5ml suspention

Adult Dose
Oral
Epilepsy
Adults - Initial: Either 200 mg b.i.d. for tablets and XR tablets,
or 1 teaspoon q.i.d. for suspension (400 mg/day).
Increase at weekly intervals by adding up to 200 mg/day using
a b.i.d or a t.i.d. or q.i.d. regimen of the either formulations
until the optimal response is obtained.
Doses up to 1600 mg daily have been used in adults in
rare instances.
Maintenance: usually 800-1200 mg daily.

Trigeminal neuralgia
Adult: Initially, 100-200 mg bid, increased gradually as needed.
Maintenance: 400-800 mg daily in divided doses. Max: 1.2 g daily.

Prophylaxis of bipolar disorder
Adult: Initially, 400 mg daily in divided doses, increased gradually as
necessary. Maintenance: 400-600 mg daily in divided doses.
Max: 1.6 g daily.
Child Dose
Epilepsy
<6 Years
Initial (oral suspension): 10-20 mg/kg/day PO q6hr
Initial (tablet): 10-20 mg/kg/day PO q8-12hr
Maintenance: For tablets or suspension may divide frequency
into 3-4 times daily not to exceed 35 mg/kg/day

6-12 Years
Initial (oral suspension): 50 mg PO q6hr
Initial (tablet, immediate- or extended-release): 100 mg PO q12hr;
may increase qWeek by 100 mg/day
Maintenance: 400-800 mg/day PO q6-8hr (immediate-release);
q12hr (extended-release)
Not to exceed 1000 mg/day

>12 Years
Initial (oral suspension): 10 mL (200 mg) PO q6hr
Initial (tablet, immediate- or extended-release): 200 mg PO q12hr
May increase by up to 200 mg/day qWeek; q12hr (extended-release
tablet); q6-8hr (other formulations)

12-15 years: Dose not to exceed 1000 mg/day
>15 years: Dose not to exceed 1200 mg/day
Renal Dose
Administration
Should be taken with food. Avoid grapefruit juice.
indication
Epilepsy, Schizophrenia, Bipolar disorder, Trigeminal neuralgia
Contraindication
Hypersensitivity; bone marrow depression; porphyria, pregnancy.
Side Effects
>10%
Ataxia (15%),Dizziness (44%),Drowsiness (32%),Nausea (29%),
Vomiting (18%)

1-10%
Dry mouth (8%)

Rare
MI,Stevens-Johnson syndrome

Hepatic failure,Punctate cortical lens opacities,Syndrome of
inappropriate antidiuretic hormone secretion (SIADH)

Frequency Not Defined
Hemopoietic system: Aplastic anemia, agranulocytosis, pancytopenia,
bone marrow depression, thrombocytopenia, leukopenia, leukocytosis,
eosinophilia, anemia, acute intermittent porphyria, variegate porphyria,
porphyria cutanea tarda

Skin: Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome
(SJS) (see Black Box Warnings), pruritic and erythematous rashes, urticaria,
photosensitivity reactions, alterations in skin pigmentation, exfoliative
dermatitis, erythema multiforme and nodosum, purpura, aggravation of
disseminated lupus erythematosus, alopecia, diaphoresis, and
onychomadesis

Cardiovascular system: Congestive heart failure, edema, aggravation
of hypertension, hypotension, syncope and collapse, aggravation of
coronary artery disease, arrhythmias and AV block, thrombophlebitis,
thromboembolism, and adenopathy or lymphadenopathy

Liver: Abnormalities in liver function tests, cholestatic and hepatocellular
jaundice, hepatitis; very rare cases of hepatic failure

Pancreatic: Pancreatitis

Respiratory System: Pulmonary hypersensitivity characterized by fever,
dyspnea, pneumonitis, or pneumonia

Genitourinary System: Urinary frequency, acute urinary retention, oliguria
with elevated blood pressure, azotemia, renal failure, and impotence (rare
reports of impaired male fertility and/or abnormal spermatogenesis)

Laboratory: Albuminuria, glycosuria, elevated BUN, decreased plasma
calcium, and microscopic deposits in the urine

Nervous system: Dizziness, drowsiness, disturbances of coordination,
confusion, headache, fatigue, blurred vision, visual hallucinations,
transient diplopia, oculomotor disturbances, nystagmus, speech
disturbances, abnormal involuntary movements, peripheral neuritis
and paresthesias, depression with agitation, talkativeness, tinnitus,
hyperacusis, neuroleptic malignant syndrome; isolated cases of
neuroleptic malignant syndrome

Digestive system: Nausea, vomiting, gastric distress and abdominal
pain, diarrhea, constipation, anorexia, and dryness of the mouth and
pharynx, including glossitis, and stomatitis

Eyes: Scattered punctate cortical lens opacities, increased intraocular
pressure as well as conjunctivitis

Musculoskeletal system: Aching joints and muscles, and leg cramps

Metabolism: Fever and chills; SIADH; cases of frank water intoxication,
with decreased serum sodium (hyponatremia) and confusion; decreased
levels of plasma calcium leading to osteoporosis

Potentially Fatal: Agranulocytosis, aplastic anaemia, hepatic failure, severe
exfoliative dermatitis and Stevens-Johnson syndrome.
Theraputic Class
Primary anti-epileptic drugs
Pregnency Category
Category: D
pregnancy_description
Mode of Action
Carbamazepine reduces polysynaptic responses and blocks post-tetanic
potentiation. It is effective in partial and generalised convulsions as well as
in mixed types but not in petit mal seizures. It reduces or abolishes pain in
trigeminal and glossopharyngeal neuralgia.
Interaction
Increased plasma levels w/ CYP3A4 inhibitors (e.g. cimetidine). Decreased
plasma levels w/ CYP3A4 inducers (e.g. cisplatin). Increased risk of neurotoxic
side effects w/ lithium. May decrease the effect of hormonal contraceptives.
Increased plasma levels of active metabolite carbamazepine-10, 11-epoxide
w/ loxapine, quetiapine, primidone, progabide, valproic acid and valpromide.
May increase cyclophosphamide levels. May reduce exposure of aripiprazole.
May reduce plasma levels of tacrolimus, temsirolimus and lapatinib. May increas
e risk of isoniazid-induced hepatotoxicity. Risk of symptomatic hyponatraemia w/
diuretics (e.g. hydrochlorothiazide, furosemide). Potentially Fatal: May decrease
serum concentrations of nefazodone and its active metabolites. Toxic reactions
may develop when taken concurrently w/ MAOIs.
Pack And Size
Per Unit Price: Tk. 9.03
Package: 60's pack


Ethosuximide: 

Brand name: Serontin(ACI- 250mg/5ml)

Adult Dose
Oral
Absence seizures
Adult: Initially, 500 mg daily, may increase in
steps of 250 mg at intervals of 4-7 days.
Usual dose: 1-1.5 g daily.
Optimum plasma concentration: 40-100 mg/L
(300-700 micromol/L).
Max: Up to 2 g in some patients. Strict supervision
is recommended if dose >1.5 g daily.

Hepatic Impairment
Monitor closely
Child Dose
Child: <6 yr: Initially, 250 mg daily, may increase
gradually to usual dose of 20 mg/kg daily.
>6 yr: Initially, 500 mg daily, may increase in steps of
250 mg at intervals of 4-7 days.
Usual dose: 1-1.5 g daily. Max: <6 yr: Up to 1 g/day
and ?6 yr: 2 g/day .
Renal Dose
Renal Impairment
Monitor closely
Administration
May be taken with or without food.
indication
Absence seizures
Contraindication
Hypersensitivity. Pregnancy and lactation.
Side Effects
Common
Dizziness,Headache,Somnolence,Anorexia,Diarrhea
,GI upset,Nausea,Vomiting

Less Common
Ataxia, confusion, drowsiness, sleep disturbance,Gum
hypertrophy, hiccoughs, swelling of tongue,Blood dyscrasias
including aplastic anemia,Allergic reaction,Urticaria,Pruritic
erythematous rashes,Blurred vision, myopia

Rare
Psychosis,Seizure,Suicidal thoughts and behavior,
Stevens-Johnson syndrome,Systemic lupus
erythematosus,Hirsutism
Theraputic Class
Primary anti-epileptic drugs
Pregnency Category
Category: C
pregnancy_description
Mode of Action
Ethosuximide is used mainly in the management of absence
(petite mal) seizures. It is usually ineffective in the management
of partial seizures with complex symptomatology or tonic-clonic
seizures.
Interaction
Isoniazid may increase the serum concentration of ethosuximide,
leading to toxicity. Antipsychotics, antidepressants, MAOIs, and
mefloquine may antagonise anticonvulsant effects of ethosuximide.
Plasma conc of ethosuximide may be reduced by carbamazepine,
phenobarbital, phenytoin, and primidone; and affected by valproate.
Chloroquine or hydroxychloroquine may increase risk of convulsions.
Isoniazid.
Pack And Size
Per Unit Price: Tk. 130.39
Package: