Tuesday, November 4, 2014

Uses and side effects of Nitrest

Nitrest is an Indian brand of generic medication called Zolpidem Tartrate. It’s common brand name is Ambien. It is classified as a non-benzodiazepine hypnotic. It is a prescription only medication used to induce sleep or as a temporary treatment for insomnia. However, it has addictive and abuse potential.

Nitrest10mg tablets

Uses of Nitrest

Nitrest helps to induce sleep. You will usually get sleepy usually within 15 minutes of taking Nitrest. Its effects usually lasts for six to seven hours. But some people can get hangovers in the next day.

In addition, it does not change the sleep architecture (Amount of REM and NREM sleep). Therefore, unlike benzodiazepine hypnotics (Valium) you will feel refreshed after the sleep. Due to its sleep inducing properties some people abuse it. In fact Zolpidem (Nitrest) abuse is a recognized phenomenon. 

Another brand of Zolpidem is Zolfresh.
Nitrest is used to help sleep

What are other side effects associated with Nitrest?

This medication can cause diarrhea, nausea, dizziness, headache, hallucinations, agitation, memory problems, nightmares, depression, confusion and problems in walking such as unsteady gait.
Sleep walking is also reported rarely.

However, above side effects are not common and most people tolerate this medication quite well.

Problems associated with Nitrest

This medication should be used only for short term relief of insomnia. It is not recommended to use it for long term. It is not recommended to use it for more than four weeks. It is because long term insomnia would be due to underlying medical or psychiatric condition that need treatment. In addition, due to addictive potential long term use can cause problems.

Nitrest should be used cautiously in depression, psychosis and in patients with history of alcohol and other substance use.

This medication should not be used by patients with myasthenia gravis.

Sometimes drowsiness may persist into next day. This will cause problems with driving and operating machinery.

Inform your doctor whether you have following conditions,

1. Clinical depression or Bipolar disorder
2. Liver and kidney problems
3. Myasthenia gravis
4. Breathing difficulties

Driving can be dangerous if you took Nitrest last night

Nitrest should not be used by people with obstructive sleep apnea. It is common among people who snores at night. Snoring is caused by obstruction in respiratory tract that occurs in deep sleep. Due to this obstruction frequent nighttime awakenings occur and it can be misidentified as insomnia. In addition, taking this class of medications (hypnotics) by such people can cause severe obstruction and in some occasions brain damage.

In addition, this medications should not be used in patients with end stage renal and hepatic disease.
Use in pregnancy can cause problems in muscle tone, delayed crying and reduced body temperature in newborn baby.


Nitrest is a medication prescribed for short term relief of insomnia. It acts quickly and effects goes off quickly as well. However, it have addictive potential and can cause problems with driving and operating machinery. 

Wednesday, July 9, 2014

What are Topirol uses and side effects?

Topirol is a medication manufactured by Sun pharmaceutical company, India. Its Generic Name is Topiramate.

Topirol is a medication prescribed for epilepsy and prevention of migraine. This drug is also used as a mood stabilizer in certain hospitals. One of the main problems with this drug is increased risk of suicide and angle closure gluocoma (increased pressure in the eye).
Topirol 50mg Tablets

 Topirol blocks voltage dependant sodium channels, increase the activity of GABA, blocks NMDA receptors and inhibits the enzyme carbonic anhydrase. These effects decreases nerve impulse transmission and prevent seizures.

 This medication is available as tablets. Tablets should be taken as a whole without crushing and should be taken with a full glass of water to minimize side effects. Patients should drink enough water during the therapy as well. Otherwise this medication is known to cause kidney stones. Topirol should be taken exactly as directed by the doctor. Abrupt withdrawal of this drug can have problems. Patient should not take alcoholic beverages during therapy.

 Use in epilepsy

This medication is prescribed for partial and generalized epilepsies. In partial epilepsy patient gets a seizure in a part of the body. In generalized epilepsy, patients whole body is involved in the seizure. This medication can be combined with other seizure medications like sodium valproate. It is used in adults as well in children.

 Use in migraine

This medication is prescribed for long term prevention of migraine attacks. Several studies have demonstrated its effectiveness in this condition. But Topirol cannot be used to treat a migraine attack.
 Some psychiatrists use this drug in bipolar affective disorder to stabilize the patients mood. But no proper clinical trials have been conducted so far, in this regard.

 The doctor needs patient’s complete medical history including over the counter medications he/she is taking, before prescribing Topiramate. If the patient is having kidney problems or liver problems it is very important to discuss that with the doctor, before taking Topiramate. If the patient is pregnant or planning to get pregnant, then the patient should discuss that with the doctor as well. The doctor should know whether the patient is having any psychiatric illnesses including depression. This medication can increase the risk of suicide in susceptible individuals.

In addition, Topirol is used in treatment of alcohol dependence as an anti craving medication.

 Common side effects
One of the main side effect of Topirol is cognitive impairment. It can cause learning disability in children.
Nausea, gastric irritation, diarrhea and dry mouth are the commonest side effects. Some patients can get taste disturbance, weight loss and loss of appetite. This medication does not cause weight gain, unlike other antiepileptic drugs. This medication also causes headache and numbness.This medication also causes drowsiness, fatigue, sleep disturbances, impaired memory and concentration.

 Very rarely this medication can cause reduced sweating in children. This medication secretes into the breast milk. So this drug should not be taken in breast feeding.


British National Formulary
AHFS Drug information

Friday, June 6, 2014

What is Acrophobia and how to treat it?

Acrophobia is an extreme irrational fear and anxiety of heights. According to the DSM IV diagnostic guidelines Acrophobia is categorized as a specific phobia.

What are the clinical features?

Acrophobia is characterized by extreme anxiety in heights. People with acrophobia get panic attacks in a heights and wants to quickly go down.  In addition they fear, that they will fall from the height. However they behave perfectly normally when not on heights.  In addition they may have features of anxiety. Anxiety symptoms are classified as physical and psychological.

Psychological symptoms

People with acrophobia can get fearful anticipation or extreme anxiety, when they go to a height. Some people may get the anxiety even for the idea of going to a height.
During an episode they can get increased sensitivity to noise, irritability, restlessness and get poor concentration.

Physical symptoms

People who are afraid of heights may get dry mouth, difficulty in swallowing, felling of constriction of their chest and difficulty in inhaling. In addition they may get cardiovascular symptoms such as palpitations (subjective feeling of their own heart beat) and awareness of missed beats. Other than that they may get tremors, headache especially when they stay too long and muscle aching. Sometimes people with acrophobia may develop hyperventilation and get dizziness, tingling sensation in fingers /toes and subjective feeling of breathlessness.

These anxiety symptoms cause the patient to avoid such situations and it maintains the problem. Therapy is targeted to expose the person into the anxiety provoking situation and desensitize him/her.

How to treat Acrophobia?

Acrophobia is treated mainly with psychological methods. In addition some people may need specific medications such as benzodiazepines. Psychological methods include cognitive behavioral therapy. Cognitive behavioral therapy method used in Acrophobia includes systemized desensitization, relaxation training and graded exposure.

Systemized desensitization

Here patient need to construct, a list made of situations that provoke increased degrees of anxiety. If the patient has minimal anxiety, when seeing a photo of a height, then he/she may write it down at the top. Then the patient is asked to write down next anxiety provoking situation. E.g. seeing a video of a height. The list should continue until the patient write down the most anxiety provoking situation. E.g. Standing on one foot in a unstable bridge.

Relaxation training

Once the list is formulated, patient is taught how to control anxiety by way of relaxation therapy. In relaxation therapy patient is trained to relax, first individual muscles then the whole body. This method should be practiced regularly during sessions.

Graded exposure

Here patient is entered into least anxiety provoking situation. E.g. If the least anxiety provokimg situation is seeing an photo of a height, he/she may be asked to look at it and imagine that he/she is in a height. This is done until the anxiety is diminished. Then the patient is entered into the next scenario. Like that, it is carried out until the patient is not anxious to the previously most anxiety provoking situation. Here a patient can send to a bridge that is unstable but safe, and ask him/her to stand on one foot.

During the therapy the patient is asked to practice relaxations methods to relieve anxiety. Sometimes drugs may be needed to relax patients.


Acrophobia is a specific phobic disorder that can be troublesome for the sufferer. But it can be treated with various psychotherapies.

Oxford short textbook of Psychiatry

Sunday, May 18, 2014

Side effects of Electroconvulsive therapy (ECT)

ECT or electroconvulsive therapy is a procedure performed by the doctors to induce an artificial seizure (fit). It is because, seizures are found to reduce psychiatric symptoms. This effect was observed in people who have both psychosis and epilepsy. Doctors treating these patients observed that psychotic symptoms were reduced immediately after they experienced a seizure. Later when they induce seizures to people who have psychosis, same effect was observed.
Earlier days, doctors used to induce seizures by way of injecting large doses of insulin. This causes severe hypoglycemia which induces the fit (It was depicted in the popular film “beautiful mind”). However, it was found to be quite dangerous and caused unacceptable side effects.
After that doctors start to induce seizures by way of passing an electric current through the brain. It is called Electroconvulsive therapy.
Common uses of ECT (Electroconvulsive therapy)
ECT is useful in patients with severe depression and severe mania with aggressiveness and exhaustion. In addition, ECT is indicated in psychiatric patients with poor oral food and water intake. ECT is also given to mothers with psychotic symptoms, immediately after delivery. In addition, ECT is also given to patients with significant suicidal and homicidal ideas with plans. However, ECT is not indicated in uncomplicated schizophrenia.Basically ECT is indicated when a rapid symptom relief is needed such as in a case with a mother with a small infant. It is because drugs usually take around two to three weeks to show any action.
How to prepare for ECT
Preparation is similar to any procedure that is performed under general anesthesia. Salient features are
1.Fasting for solid foods for eight hours. Four hours for water.
2.Bowels and bladder should be emptied before the procedure
3.May need to undertake several blood tests and electrocardiographic tests before the procedure.
Some procedures may vary from institution to institution.

Side effects and problems of ECT

1.Problems of general anesthesia: - ECT or Electroconvulsive therapy is given under general anesthesia. Problems of general anesthesia includes allergic reactions, difficulty in getting up from anesthesia, muscle pain and stuff in the stomach going into the lungs (aspiration).
2.Memory loss: - ECT or Electroconvulsive is associated with loss of memory for certain events. This loss is usually irreversible. In addition, level of memory loss is directly proportionate to the amount of electric current given (dose).
3.Possibility of aggravating intra-cranial (inside the head) problems: - If the patient has a defect in blood vessels inside the brain then there is a possibility intracranial hemorrhage that can be lethal.
4.Possibility of getting uncontrollable fits (status epilepticus): - If the patient has a history of epilepsy then there is a limited chance of getting a seizure that is prolonged.

Sunday, January 19, 2014

Why Lithosun (Lithium carbonate) be toxic?

Lithosun is a brand of Lithium carbonate manufactured by Sun Pharma India.
Lithium  is an essential medication in treating Bipolar Affective disorder. It is especially effective in Manic phase of the illness. Numerous studies have shown its effectiveness and no one doubts its effectiveness. However, it is a toxic metallic ion that can be fatal if taken overdose.

Its toxic effects are thought to be mediated via Lithosun ‘s ability to interfere with Sodium potassium channels in neurons. In a normal neuronal cell, there is an electrical gradient between outer and inner cell membranes. This electrical gradient is essential for neuronal transmission. Problem with Lithium is Human body mistakenly thinks Lithium is sodium and incorporate it instead of Sodium in the ion channels. This disrupts cell membrane electrical gradient and disrupt neuronal transmission. However, this effect is marked only in over dose.

Normally Lithosun is toxic when the plasma levels go beyond 1.2 mmol/l. Problem is that lithium need to be given dose above 0.6 mmol/l to be effective. Therefore, Lithosun level should be maintained within a very narrow spectrum. Therefore, patients who are on lithium should follow strict guidelines on how to maintain lithium levels at optimal level.

Generally following advices should be followed to avoid Lithosun toxicity,

1.       Take adequate water.
2.       When going to a doctor for any other illness, patients need to tell him/her that they are taking lithium as some medications can cause dangerous interactions with Lithium
3.       In addition, they should know toxic side effects of Lithium such as Gross tremors of limbs, severe vomiting, diarrhea, and confusion.
4.       Check blood lithium levels at least three monthly intervals. However, in some centers Blood lithium level test can be an expensive one.

 Another interesting finding is before 1951 Lithium is included in popular soft drink 7Up. It was introduced to improve mood. After that it was discontinued due to reports of toxicity. 

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