Uses and side effect of Zosert tablets

Zosert is a brand of Sertraline manufactured by the Sun Pharmaceuticals, India. It is a SSRI (Selective serotonin reuptake inhibitor) class medication. It is prescribed for major depression, Obsessive compulsive disorder and other anxiety disorders. Most common side effects are nausea, gastric irritation and reduction in sexual desire. In addition, Zosert is one of the safest SSRI medication for patients with com morbid heart disease.

Zosert 50mg tablets

Depression is associated with many physical problems. Recent study has identified prolonged depression can cause heart problems such as heart attacks. 

Depression can cause Heart problems 

Uses of Zosert

This medication is mainly used for depressive disorder. Depression is characterized by more than two weeks period of low energy, low mood and lack of pleasure (unable to get pleasure from previously pleasurable activities). Zosert is given to patients with moderate to severe depressive episodes. A person need to take the medication for at least 7 – 10 days to experience a response.

In addition, Zosert is prescribed for obsessive compulsive disorder, anxiety disorders such as panic disorder, social anxiety disorder and post-traumatic stress disorder.

Depression is one of the  most common indication of Zosert

How Zosert is available and how should it be taken?

Zosert is available as tablets. Usually it is available as 25mg, 50mg and 100mg tablets. Maximum dose is 200mg. Maximum doses are tried for patients with obsessive compulsive disorder.

To minimize side effects, it should be taken fully without crushing after a meal. In addition, a full glass of water should be taken with it.

Another brand of Sertraline common in India

What are the common side effects associated with Zosert tablets?

One of the most common side effect is heart burn and nausea. It can be minimized by taking it after a meal. In addition, some people develop headache especially after several days. Paracetamol (Acetaminophen 1g for an adult) can be taken as a treatment for this side effect.

In addition, sleep disturbances are common with this medication. Some people will experience poor sleep and others may experience drowsiness. Depending on the type patient can adjust the dosage time. E.g if it causes drowsiness take the medication in the evening.

Other more side effect of concern is sexual dysfunction. It can manifest as lack of sexual desire or erectile dysfunction (Impotence).

Summary of common side effects

1.       Nausea

2.       Heartburn

3.       Headache

4.       Sleep problems

5.       Sexual dysfunction

6.       Weight loss and loss of appetite

What are the serious side effects associated with Zosert tablets?

Zosert increases serotonin neurotransmission in the brain. Therefore, it can rarely cause serotonin syndrome. It’s a life-threatening side effect associated with initiation, dose escalation and mixing serotonergic medications. Common symptoms of serotonin syndrome are fever, tremors, muscle rigidity, confusion, delirium, sweating and changes in blood pressure/ pulse rate. Patients with serotonin syndrome should be managed in an Intensive care unit.

In addition, this medication can cause bleeding due to interference with platelet function. It is significant in patients with bleeding disorders, but it is rare.

When Zosert is given to bipolar affective disorder, it can precipitate manic episode. It is a common problem as many patients with bipolar affective disorder presents to doctors in their depressive phase.

In addition, when this medication is given to patients with gastric ulcers, they can be aggravated and sometimes can cause serious bleeding.

There is also concern that SSRI class medications increase suicidal risk when given to teenagers. But the research findings are conflicting.

Summary of serious side effects of Zosert

1.       Serotonin syndrome

2.       Bleeding problems

3.       Aggravation of gastric ulcers

4.       Precipitation of manic symptoms

5.       Increased suicidal risk when given to teenagers

6.       SIADH – Syndrome of inappropriate ADH secretion. This can cause reduced serum Sodium level and it’s a cause for mental confusion.

Summary

Zosert is a SSRI class medication and its generic name is Sertraline. It’s mainly prescribed for major depression anxiety disorders. This is the most cardiac safe drug in SSRI class. Its main side effects are nausea, headache and heartburn. In addition, it can cause serotonin syndrome and can aggrevate gastric ulcers.

Addwize uses and side effects

Addwize is an Indian brand name of Methyl-Phenidate. It is a drug prescribed by doctors for ADHD (Attention Deficit Hyperactive Disorder) in both adults and children. It is classified under central nervous system stimulant. This medication has serious abuse potential, therefore, it is a controlled drug.

What is ADHD?

ADHD or attention deficit hyperactive disorder is characterized by restlessness, inattentiveness and impulsive behavior. Children affected by this disorder are at risk of developing severe learning difficulties, behavioral problems, social problems, substance abuse issues and criminality.

ADHD

Children with ADHD has inability to concentrate matter at hand

How to diagnose and treat ADHD

Uses of Addwize

This medication can control short term hyperactive behavior and improve attention. This was proven beyond doubt by numerous clinical trials. However, it does not improve ADHD on long term. It should be used when the person need most attention. E.g A child who is studying at school. Once the medication effects are gone, symptoms of ADHD come back. Usually medication effect lasts for about five hours. For children it should be given in the morning just before the child starts school work. Sometimes a afternoon dose may be needed.

What are the problems associated with Addwize?

Addwize is a frequently prescribed medication for people with ADHD.

Most common long term side effect in children that worries the parents is weight loss. This is due to prolonged loss of appetite. In addition, this drug is also known to cause stunting.

Some patients can get nervous with this medication. In addition, some patients may complain lack of sleep. Certain patients may complain muscle tightness, abnormal movements and restlessness.

Other common side effects are nausea, vomiting and stomach pain. Some patients develop skin rashes. Certain patients may complain dry mouth.

What are the serious side effects?

Some people can have dangerously high blood pressure with this medication. So if a patient complains of severe headache, blurred vision, buzzing in ears, chest pain and shortness of breath then you must get the patient to an emergency department.

Medical help should be sought if you notice any abnormal behavior or seizures.

If the patient develops widespread hives, tightening chest pain, edema of the lips and face and shortness of breath, then you must take this patient to a hospital. It can be due to a serious allergic reaction called anaphylactic reaction.

Rarely some patients may experience low blood pressure. Symptoms are faintish ness and lightheadedness.  If a patient falls frequently while on Addwize then you must consult your doctor.

Some patients may get fast, pounding and uneven heartbeats (arrhythmias). Certain patients may complain tremors, restlessness, and motor tics. These side effects must be reported to your consulting doctor.

If a patient complains abnormal perceptions, abnormally elevated mood or any other abnormal behavior then he/she must be seen by a doctor.

What the doctor should know before prescribing Addwize?

Prescribing doctor must know all the drugs patient is currently on including over the counter drugs. If your patient has following problems inform your doctor before he writes the prescription.

1.     Any heart disease

2.     Kidney disease

3.     Epilepsy

4.     Liver disorders

5.     Tic disorder

6.     Tourette's syndrome

What you should know about Addwize?

This drug has some serious abuse potential. So keep this medication in a safe place. Use it only in prescribed dosage. Never share this medication with anybody else.

But it is advisable to take meals before the drug, due to loss of appetite. Take this medication in the morning. Taking this drug in the evening can cause sleep problems. Keep this medication out of reach of children. 

Summary

This is a frequently prescribed medication for ADHD with proven efficacy. But it has some nasty side effects. But your doctor may have prescribed it for a reason, so do not stop it by yourself due to side effects. In addition this drug has a serious abuse potential, so never share it with anyone else.

Different types of medications prescribed for Attention deficit hyperactivity disorder

ADHD or attention deficit hyperactive disorder is characterized by restlessness, inattentiveness and impulsive behavior. Children affected by this disorder are at risk of developing severe learning difficulties, behavioral problems, social problems, substance abuse issues and criminality. However, there are various ways to treat ADHD. Usually several treatment methods can be combined to get a satisfactory outcome. e.g. Drug treatment and behavioral parent therapy.

What are the drugs used for ADHD?

Amphetamines

Amphetamines are types of drugs that cause central nervous system stimulation. However ironically they were found to be quite effective in hyperactive disorders such as Attention Deficit Hyperactive Disorder (ADHD) (1, 2 and 3). In addition it must be noted that common “drugs of abuse” such as Ecstasy are in the Amphetamines group.

Amphetamines are supposed to work by increasing naturally occurring norepinephrine, dopamine and epinephrine neurotransmitter levels in certain areas of the brain. This action stimulates inhibitory areas of the brain, which results in reduction in unnecessary hyperactivity. Therefore it ultimately helps the child to concentrate more and suppress the hyperactive urges. In fact number of clinical trials performed in many different countries has found that ADHD can be effectively treated with Amphetamines.

Addwize is a medication manufactured in India for ADHD

Common Amphetamines used in ADHD are Methylphenidate (Ritalin®, Addwize, Concerta®, Metadate® Methylin®), Lisdexamfetamine (Vyvanse®)   and Dextroamphetamine (Dexedrine®,  DextroStat®,  LiquADD®,   ProCentra®).


Stimulant medications such as Amphetamines improve academic performance, mathematical skills, word discovery skills and word retrieval. (4, 5, 6, 7 and 8)

Methylphenidate is absorbed readily from the gut and rapidly cross the blood brain barrier. In addition they have short half-life and the effect only lasts around 1 -4 hours. But drug effect will be seen within 30mins. Therefore the drug should be taken frequently. Sustained release preparations are developed to counteract this problem. e.g. Ritalin SR 10mgs. However, these sustained released preparations take around three hours to act.

Usually Amphetamines are considered the first line of treatment for ADHD. However some children with ADHD may not respond to stimulant medications such as Amphetamines.

What are non-stimulant medications prescribed for ADHD?

Tricyclic antidepressants

They are effective for behavioral problems associated with ADHD. However, TCAs are not usually effective for cognitive problems associated with ADHD such as memory impairment, lack of attention and inability to concentrate (9). Therefore they essentially treats only hyperactive component of the disease (This disease has both Attention deficit and hyperactive elements).

Clonidine and Guanfacine

These drugs are categorized as weak alpha 2 noradrenalin stimulators. However, evidence from Randomized double-blind clinical trials are lacking in this regard. Clonidine usually treats behavioural disturbances associated with ADHD. In addition Guanfacine is found to be somewhat effective in treating children with ADHD.

Summary

ADHD or attention deficit hyperactive disorder is usually treated with stimulant drugs, Tricyclic anti-depressants, clonidine and Guanfacine. They are usually given as part of a comprehensive treatment plan.

Sources

1. Spencer, T., Biederman, J., Wilens, T., Harding, M., O'Donnell, D., and Griffin, S. (1996). Pharmacotherapy of attention-deficit hyperactivity disorder across the life cycle Journal of the American Academy of Child and Adolescent Psychiatry, 35, 409–32.

2. Kavale, K. (1982). The efficacy of stimulant drug treatment for hyperactivity: a meta-analysis. Journal of Learning Disabilities, 15, 280–9.

3. Swanson, J.M., McBurnett, K., Wigal, T., et al. (1993). Effects of stimulant medication on children with attention deficit disorder: a ‘review of reviews'. Exceptional Children, 60, 154–62.

4. Douglas, V.I., Barr, R.G., Desilets, J., and Sherman, E. (1995). Do high doses of stimulants impair flexible thinking in attention-deficit hyperactivity disorder? Journal of the American Academy of Child and Adolescent Psychiatry, 34, 877–85.

5. Milich, R., Licht, B.G., Murphy, D.A., and Pelham, W.E. (1989). Attention-deficit hyperactivity disordered boys' evaluations of and attributions for task performance on medication versus placebo. Journal of Abnormal Psychology, 98, 280–4.

6. Milich, R., Carlson, C.L., Pelham, W.E., Jr, and Licht, B.G. (1991). Effects of methylphenidate on the persistence of ADHD boys following failure experiences. Journal of Abnormal Child Psychology, 19, 519–36.

7. Rapport, M.D., Denney, C., DuPaul, G.J., and Gardner, M.J. (1994). Attention deficit disorder and methylphenidate: normalization rates, clinical effectiveness, and response prediction in 76 children. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 882–93.

8. Douglas, V.I., Barr, R.G., O'Neill, M.E., and Britton, B.G. (1986). Short term effects of methylphenidate on the cognitive, learning and academic performance of children with attention deficit disorder in the laboratory and the classroom. Journal of Child Psychology and Psychiatry and Allied Disciplines, 27, 191–211.

9. Popper, C.W. (1997). Antidepressants in the treatment of attention-deficit/hyperactivity disorder. Journal of Clinical Psychiatry, 58, 14–31.

New oxford textbook of Psychiatry

Use of Anxizide for alcohol withdrawal and its side effects

Anxizide is a brand of Chlodiazepoxide manufactured in India.
It is a long acting drug of the benzodiazepine family. It is a prescription only medication used in anxiety disorders and alcohol withdrawal. Main side effects are lightheadedness and drowsiness.

How Anxizide acts?

It increases the action of GABA type A receptors. This increases the inhibitory neurotransmission in the brain and it relieves anxiety and induces side effects such as drowsiness.

It works in alcohol withdrawal as it will counter balances the effects caused by alcohol withdrawal. In alcohol dependence there are certain changes happening in the brain which will become unopposed when the alcohol is suddenly discontinued. Alcohol withdrawal can become very dangerous (lethal) if not treated adequately.

Anxizide is also called Librium

Use in Alcohol withdrawal

 Anxizide mainly used as a detoxification agent in the acute alcohol withdrawal. Usually doctors start from very high doses in alcohol withdrawal and gradually tailing it off over period of time (Usually within five to six days). Also it is prescribed in the management of anxiety disorders and for short term relief of anxiety.

Alcohol withdrawal is the main indication of Anxizide

Usual starting dose would be 30mg thrice daily for one day. Then it is gradually tailed off depending on the response.

What the doctor should know before prescribing?

If you have any medical problems such as kidney disease, liver disease, breathing disorders or myasthenia gravis, discuss with your doctor before taking Anxizide. If you are pregnant, your doctor may not prescribe this medication, especially in last three months of the pregnancy.

General advice to avoid/minimize side effects

This medication is available as capsules. It should be taken as whole with a full glass of water. This medication must be taken according to the advice given by the doctor. You should avoid alcoholic beverages during the drug therapy. Operating machinery and driving is not recommended while on this medication. If the drowsiness is severely affecting patient’s day to day activities, it is recommended to discuss about the dosing schedule with the doctor.

Side effects of Anxizide

Most common side effects are light headedness and drowsiness which can continue to the next day. If the patient is taking Chlordiazepoxide for alcohol withdrawal, chances are high that he is taking high doses of the drug. This makes the side effects severe in patients who are taking the drug for alcohol withdrawal. Rarely excitation and aggression can occur (paradoxical excitation).

Confusion and ataxia (loss of full control of bodily movements) is also common. This usually manifest as a tremor when patient tries to move. Confusion and ataxia is common in elderly patients. It can also cause recent memory loss. Muscle weakness is also common.

If the patient continues to take the drug for a longer period, then patient can become dependant on the drug. That means having withdrawal symptoms after stopping the drug.

Occasionally patients complain of a headache. This can be controlled by taking over the counter pain killers such as paracetamol. Vertigo is another symptom that can occur occasionally.

Sometimes faintishness can occur due to low blood pressure (Hypotension) due to Anxizide. Some patients will have gastro intestinal disturbances like nausea, vomiting and diarrhea.

Some patients will have visual hallucinations, illusions and various other visual disturbances but they are very uncommon. Rarely patients can develop urinary incontinence and urinary retention. Also there are harmful interactions with other central nervous system depressants like opiates.


Summary
Anxizide is a medication in Benzodiazepine drug class. It is used primarily in alcohol detoxification. Main side effects are nausea, drowsiness and light headedness.

Sources
British National Formulary

Uses and side effects of Encorate chrono tablets

Encorate is a brand of Sodium Valproate manufactured by Sun pharmaceuticals India. Encorate chrono is long acting preparation that can be given once daily. It is prescribed for epilepsy, migraine and bipolar disorder. Main side effects are nausea, weight gain and hair loss with curly regrowth.

What are the uses of Encorate ?

Primary use of this medication is for epilepsy. In addition, recently it has been licensed in bipolar affective disorder. In addition, it is used for people with migraine to prevent further attacks.

Encorate is prescribed for all major forms of epilepsy. In fact it is one of the most prescribed anti-epileptic.

Encorate 200mg tablets

Use in Bipolar disorder

In addition to epilepsy, Encorate is prescribed for people with bipolar disorder. Bipolar disorder is characterized by episodes of depression and mania. These patients at times get depressed and at times they get manic. In the manic phase patients experience extreme elevation of mood, increased energy, and reduced need to sleep. In mild form of the disorder, they tend to work more, get more sexual desire and spend more money. Most of the time spending excessive money and sexual disinhibitions can cause serious social harm. When the manic phase is serious, the patients would become irritable, violent and start getting psychotic experiences. They become destructive and need to be treated in a secure psychiatric facility.

Bipolar disorder - Mania and depression in same person 

At the other extreme, same patient can develop depressive episodes. Depressive episode is characterized by Low mood, lack of energy, and getting lack of pleasure from previously enjoyable activities.

Encorate is used to prevent severity of episodes, therefore classified as a mood stabilizer. It is prescribed for patients with serious or frequent episodes (more than two within five years).

Side effects of Encorate

Most common side effects

Nausea, vomiting and diarrhea are the most common side effects. In addition, hair loss with curly regrowth can occur. Ankle edema and obesity can be troublesome side effects. In addition, some patients may experience tremors of limbs.

                                  

Serious side effects that can rarely occur with Encorate

1.    Liver dysfunction

2.    Increased ammonia in the blood

3.    Blood disorders

4.    Pancreatitis

5.    Allergic reactions

Encorate should not be given to pregnant women(Especially at the early pregnancy). It is documented to cause harm to the unborn baby. Therefore, always tell the last menstrual period to the doctor and whether you are pregnant to the doctor.

Should avoid in Early pregnancy

If you are on Encorate, then make sure you use adequate contraception and plan the pregnancies after discussing with your doctor.

In addition, if you have liver disease, you should inform that  to the doctor before he/she prescribe this medication.

Different formulations of Encorate

Encorate is available as tablets, syrups and long acting preparation. Generally it is prescribed twice or thrice per day. 

What is Encorate Chrono ?

Encorate chrono is a long acting preparation of Sodium Valproate. Unlike normal preparation, it causes fewer short term side effects such as Nausea. In addition, it can be prescribed once daily, compared to twice or thrice daily prescription of its normal sibling. However, it is more expensive than the normal preparation.

Encorate chrono - Long acting preparation

When you are taking this medication, make sure you do not crush or break tablets. It will reduce the effectiveness and cause more side effects. In addition, take this medication with meals and with a full glass of water.

Summary

Encorate is a anti epileptic medication that is also used in bipolar disorder and migraine prophylaxis. It can cause liver failure and should not be taken by pregnant mothers.

Uses and side effects of Citopam tablets

Citopam is an Indian brand name of Citalopram. It is a SSRI (Selective serotonin reuptake inhibitor) class medication. Citopam is commonly prescribed for major depression, anxiety disorders and panic disorders.

Uses of Citopam

This is primarily prescribed for major depression. In addition, it is prescribed for anxiety disorders. Depression is characterized by persistent (more than two weeks) low mood, lack of energy, and inability to feel happiness. Citopam is given in moderate to severe forms of depression, but it is generally not recommended for mild depressive disorder. In addition, it is also not recommended in normal bereavement and grief.

Citopam 10mg tablets

Citopam is effective in treating anxiety disorders such as obsessive compulsive disorder and social phobia. It is specifically indicated for panic disorder. Panic disorder is characterized by episodes of sudden out of the blue severe anxiety. In social phobia the person is overwhelmed by anxiety in social situations.

Depression can be treated with Citopam

Common Side effects of Citopam

This medication is a SSRI class medication. Therefore all side effects of medications in this class apply to this medication. These are the common side effects of SSRI medications.

1.       Nausea

2.       Heartburn

3.       Poor sleep

4.       Loose stools

5.       Headache

6.       Weight loss

7.       Loss of appetite

8.       Sexual dysfunction

Sexual dysfunction is one of the troublesome side effect of Citopam

Rare side effects of Citopam

1.       Allergic reactions : Hives, edema of the lips and anaphylaxis

2.       Increased anxiety at the initial period of treatment, which usually settles after sometime.

3.       Mania: Other extreme of depression. Therefore, it is given carefully to patients with Bipolar  affective disorder

4.       Can cause occasional reduction of blood sodium level

5.       Serotonin syndrome: A very rare serious side effect associated with SSRI treatment. It is characterized by fever, muscle rigidity and tremors.

6.       Increased risk of bleeding.

In addition to the above side effects, Citopam specifically causes following side effects.

1.       Reduced heart rate and heart problems

2.       Yawning

3.       Impaired concentration

For most of the people above side effects settles with time.

However, one of the annoying side effect is Sexual dysfunction. It makes people to discontinue medication without seeing their doctor. They are erectile dysfunction in men and lack of sexual desire in women. Since depression can also cause sexual side effects, net effect of the sexual function may be favorable for patients with depression.

Most people tolerate above side effects.  

How Citopam is prescribed

Citopam is available as tablets. Usual dose range is 10mg to 40mg. It should be taken as a whole tablet without crushing as it will increase side effects. It should be taken immediately after a meal to minimize stomach side effects.

When it is prescribed your doctor should know whether you have,

1.       Bipolar affective disorder

2.       Liver problems

3.       Kidney problems

4.       Heart problems

5.       Bleeding problems

6.       Chronic gastritis

Summary

Citopam is a SSRI class medication prescribed for depression, panic and other anxiety disorders. Its most common side effect are heartburn, nausea and headache. However, compared to other antidepressants, this medication is well tolerated among patients.