Is delirium tremens occur during acute alcohol intoxication ?

Delirium tremens is a severe withdrawal reaction to alcohol. Alcohol intoxication is a state that occurs following intake of alcohol. It usually occurs in individuals who is getting rapid increase in blood alcohol concentration.

This was a question asked from me.

Both Delirium tremens and Alcohol intoxication can become life threatening. Alcohol intoxication is life threatening due to large quantities of alcohol in the blood which depresses brain activity. Sometimes such depression of brain activity can result in inhibition of respiratory center. Usually normal people get vomiting before alcohol reach such dangerous levels.

Usually vomiting occurs before alcohol reach dangerous blood level

What happens in delirium tremens

But delirium tremens kills in a very different way. Delirium tremens occur in a person who is alcohol dependent and then stops taking alcohol suddenly. In an alcohol dependent person brain neurochemistry alters so he can tolerate alcohol. Once alcohol is withdrawn from the body, unopposed neurochemical changes become hyperactive and can become life threatening.

Symptoms of delirium tremens is characterized by gross tremors, seeing things that are not real and sudden changes in body temperature and sudden changes in blood pressure. These things can sometimes become so severe, it can kill the person.

It is claimed that people with delirium tremens see small pink elephants!!

It usually does not occur during an usual episode of acute alcohol withdrawal. It occurs only in a dependent alcoholic.

So when an Alcohol dependent person stops taking alcohol, he/she should consult a doctor before doing so. It is very important.

See this article to see medications and how doctors treat delirium tremens.  

Side effects of Zolfresh tablets

Zolfresh is an Indian brand of Zolpidem tartrate prescribed for people with sleep problems. It induces sleep and use to treat insomnia. Its brand name used in US is Ambien. Compared to other medications that induces sleep this medication causes less disruption of sleep architecture.

Zolfresh tablets

What are the side effects of Zolfresh?

This medication causes drowsiness within one hour of taking it. The drowsiness effects usually lasts for around six to eight hours. However, some people may experience persistent drowsiness in next day morning. In addition, some may experience impairment in memory, motor coordination and other cognitive deficits.

Prescribed for sleep problems

Therefore, it is sometimes becomes dangerous to drive vehicles or operate machinery next morning when you take this in the night.

Dangerous to operate machinery next morning

It is advised that you should at least leave eight hours between taking Zolfresh and working on a skilled task.   

In addition to that this medication is known to cause nausea, diarrhea, headache and dizziness. Some people may experience hallucinations and clinical depression with this medication.

During sleep induced by this medication, some may experience nightmares. In addition, there are documented cases of sleepwalking associated with this medication.

Nightmares can occur in sleep

Some may get confused while on this medication. It is especially common among elderly people. Some people may experience motor coordination difficulties, muscle weakness, falls and may get double vision. In addition, some may experience tremors of the hands and body.

Taking this medication with alcohol would exacerbate the effects of alcohol and would cause more severe side effects. 

List of common side effects of Zolfresh

1. Drowsiness and sedation
2. Nausea
3. Diarrhea
4. Memory problems
5. Nightmares and sleepwalking
6. Hallucinations and clinical depression
7. Difficulties in motor coordination, muscle weakness and falls
8. Problems in driving and operating machinery

If you have following problems then you cannot take this medication. Therefore, mention it to your doctor. In addition, you need to mention other medications you are on.

1. Myasthenia gravis
2. Obstructive sleep apnea (people with snoring at night tend to have this problem. It is very dangerous to have sedatives such as Zolfresh when you have this problem as it would cause breathing problems at night. Sometimes it could be fatal)
3. Psychotic illness
4. Severe respiratory distress

Pregnancy and breastfeeding

Pregnant women should be careful when taking this medication

Women who are pregnant should be careful when taking this medication. Taking this medication in late pregnancy can cause problems in the new born. In addition, it is safe not to take this medication in first three months of pregnancy.

This medication was found in significant amounts in breast milk. So it is safe to stop it during breast feeding.

Potential for dependence of Zolfresh

This medication is habit forming in some individuals. When this is taken for long duration, some may could not sleep without it. Some may experience calmness, and relief of anxiety therefore tend to abuse it. In addition, this medication should not be used for more than four weeks. If it is taken more than that, it need to be slowly discontinue.

Dependence and abuse of this medication is a problem

Sleep hygiene methods 

It is always better to try sleep hygiene methods before get medications. Common sleep hygiene methods are

1. Use bed only for sleep : - Do not read or watch television on the bed

2. Do not take daytime naps

3. Take a glass of warm milk before bedtime

4. Do not take caffeine containing drinks such as coffee or tea before sleeping

5. Do not take alcohol just before sleep

6. If you are unable to sleep just get up from the bed and do something else such as reading a book.

Following video will illustrate the sleep hygiene methods

If you need to take this medication for more than four weeks then its indicated that there could be a underlying cause for the sleep problem. It need to be found out. Commonest causes for abuse of this medication and continued sleep problems are depression and anxiety disorders.

Venlift OD uses and side effects

Venlift OD ("Once daily") is a medication prescribed for major depression and anxiety disorders. It is an Indian brand name of Venlafaxine manufactured by Torrent pharmaceuticals. This medication is a SNRI or selective serotonin and noradrenalin reuptake inhibitor class medication.

This medication acts by increasing serotonin and noradrenaline in nerve terminals.
Its commonest side effects are dry mouth, reduced sleep and constipation. Venlift OD is the extended release preparation of the Venlift. Venlift OD has to be given less frequently than Venlift.

Sections

1. Side effects of Venlift OD

Uses of Venlift OD

This medication is prescribed for depressive disorder, anxiety disorder such as panic disorder and social phobia.

Venlift OD capsules

Depression is characterized by persistent low mood, difficulty in enjoying pleasure and inability to work due to lack of energy. In addition, patients with severe form of depression get suicidal ideas and can end their lives.

Venlift OD is prescribed for depression

In addition to depression, this medication is useful in treating anxiety disorders such as social phobia and panic disorder. Panic disorder is characterized by sudden onset out of the blue attacks of anxiety associated with fear of death, fear of suffocation or fear of heart attacks. It is common for general medical clinic to get patients with panic disorder.

Social anxiety disorder is characterized by severe disabling anxiety in social situations. They become severely anxious to talk to strangers and participate in social events.

How to take Venlift OD

This medication should be taken with a full glass of water. In addition, it should be taken with food to minimize side effects. Since this medication comes as a capsule, you should not break or remove the cover of the capsule.

Always follow your doctor’s advice and do not stop taking this medication without medical advice.

Usual dose range of this medication is 37.5mg to 375mg per day. Venlift OD preparation can be given once daily but most of the time prescribed twice daily to minimize side effects.

Take this medication with full glass of water to minimize side effects

Taking this medication after a meal would reduce side effects

What are the things you should tell your doctor before getting the prescription?

1. High blood pressure
2. Heart disease
3. Bipolar disease
4. Liver and Kidney failure
5. Myasthenia gravis
6. Hyperthyroidism

It is very important to tell your doctor whether you have hypertension as this medication is known to increase blood pressure.

High blood pressure is a common side effect

How Venlift OD works

Venlift increases serotonin and noradrenaline neurotransmission in the brain counteracting changes that are occurring in depression and other conditions. Compared to SSRI medications, this medication increase both noradrenaline and serotonin levels at higher doses. Which explains its higher efficacy.

What are the common side effects of Venlift OD?

This medication can cause nausea, and sometimes vomiting. In addition, it can cause heart burn and gastric irritation. It can also cause significant sexual dysfunction including lack of desire and erectile dysfunction in men.

At the initial part of the therapy you would experience increase of anxiety symptoms including dry mouth, increased heart rate, sweating and mild tremors. But they will usually goes off as time pass. In addition, you may experience sleep problems with this medication and some will experience poor sleep. In such patients it is advised to take this medication at morning.

Sleep problems are common side effect

Common side effects

1. Nausea
2. Gastric irritation
3. Headache
4. Sexual dysfunction
5. High blood pressure
6. Sleep problems
7. Dry mouth
8. Sweating
9. Increased anxiety

Sexual side effects can be annoying - But successful treatment of depression would improve sexual function

What are the more serious side effects associated with Venlift OD

This medication can cause manic shift in patients with bipolar disorder. It is characterized by increased energy, increased wellbeing and increased activity followed by more disinhibited behavior which is out of character.

In addition, certain group of people would develop serious complication called serotonin syndrome. It is characterized by high fever, sweating, course tremors and confusion. It usually occurs when you were changed from one medication to another or in case of rapid increase in dose.

List of serious side effects associated with Venlift OD

1. Serotonin syndrome
2. Bipolar mania
3. Increased bleeding
4. Increased gastric ulceration
5. Dangerous increase in blood pressure (Usually in over dose)

This medication can become toxic in overdose and therefore doctors prescribe Venlift carefully to patients with high suicidal risk.

Summary

Venlift OD is a SNRI class medication. Its generic name is Venlafaxine. It is prescribed for major depression and anxiety disorders. Its main side effects are nausea, gastric irritation, increased blood pressure, sexual dysfunction and sleep problems.

Serdep uses and side effects

Serdep is a brand of prescription only, SSRI class Anti-depressant manufactured by Cipla pharmaceuticals, India. Its generic name is Sertraline. It is prescribed for major depression, and anxiety disorders such as panic disorder. Most common side effects reported by patients are nausea, gastric irritation, and reduced desire for sex. However, this medication is one of the safest antidepressants for patients with heart disease.

Serdep tablets

Uses of Serdep

This medication is primarily used for depressive disorder. It is effective in both moderate and severe depressive disorder. Depressive episodes are characterized by prolonged period of low mood, inability to feel pleasure and having low energy to do day to day tasks. Depression is usually diagnosed when above symptoms are present for more than two weeks.

In addition, this medication is prescribed for anxiety disorders such as panic disorder, social anxiety disorder and obsessive compulsive disorder. It is also prescribed for Post-traumatic stress disorder.

Panic disorder is characterized by sudden out of the blue attacks of anxiety. It can occur without any precipitant cause. Usually you are diagnosed as having panic disorder when you have more than 4 attacks per month. These anxiety attacks are characterized by having increased heart rate, palpable heart rate, fear of dying, sweating, fear of going mad and chest pain.

OCD or obsessive compulsive disorder is characterized by repetitive, senseless, own thoughts or actions that are not pleasurable. e.g. repeated hand washing to remove "germs". 

This medication is commonly prescribed in depression

How Serdep is taken

It is usually available as tablet form and is available as 50mg and 100mg tablets. Doses can go up to maximum of 200mg per day. Doctors usually start at the dose of 50mg and then gradually increase the dose.

To minimize side effects, one should take this medication with full glass of water and should be taken without crushing the tablets. When it is taken after a meal, side effects are minimal.

This medication should be taken with a Glass of Water

Side effects

What are the common side effects ?

Most common side effect is nausea and heartburn. In addition, this can cause headache and sleep disturbances. Another annoying side effect is sexual dysfunction. However, conditions that are prescribed this medication also cause sexual dysfunction (depression cause lack of desire for sex). Since this medication treats depression, it can improve sexual function in certain people with depression.

In addition, patients with anxiety disorders may notice that their anxiety becomes aggravated at the start of treatment. However, it usually wanes after one to two weeks. Usually some doctors prescribe benzodiazepine medication such as Lonazep to cover the initial period of increased anxiety. 

Summary of common side effects

1. Nausea
2. Heartburn
3. Initial increased anxiety
4. Sexual dysfunction
5. Headache
6. Weight loss and appetite loss
7. Sleep difficulties

If you have following problems then you should mention them to your doctor before getting the prescription

1. Bipolar disorder
2. Stomach ulcers
3. Previous history of serious adverse effects to anti-depressants
4. Bleeding disorders
5. Liver and kidney problems
6. Heart problems

             People with bipolar disorder have chance of getting a manic episode with this medication. Therefore, when you are giving a history to the doctor, it is better you mentioned whether you had previous episodes of increased energy or increased well being that is out of character for you.

In addition, your doctor would get a full medical history from you. You need to tell him the medications you are on including street drugs and recreational substances.

What are the serious side effects of Serdep?

Serdep can cause increased serotonin neurotransmission in the brain. It can result in serious adverse effect called serotonin syndrome. It can become life threatening in certain people. Common symptoms that can be used to diagnose this syndrome is fever, tremors, muscle rigidity, confusion and excessive sweating.

This medication can also cause interference of platelet function leading to increased risk of bleeding. 

However, it is a rare side effect.

Another side effect worth mentioning is increased suicidal risk in teenagers. Therefore, it is risky to prescribe this medication for teenagers.

Summary of possible life threatening side effects?

1. Serotonin syndrome
2. Stomach bleeding
3. Bleeding problems
4. Causing mania in patients with bipolar disorder.
5. Increased suicidal risk in teenagers

Summary

Serdep is a SSRI class medication. It is prescribed for major depression and anxiety disorders. Even though it is safest SSRI in heart disease, it can cause serious side effects. Common side effects are nausea and heart burn.  

Problems associated with Lithosun (Lithium carbonate) therapy

Lithosun is a brand name of Lithium carbonate. It is a medication prescribed for bipolar disorder and resistant depression. However it can cause various toxic effects and side effects. Since it is a toxic chemical there are many problems associated with it.

Problems related to medications can be classified as relative and absolute. In absolute, the treatment should not be commenced for reason. But in relative, the treatment can be commenced after weighing the risks and benefits by an expert in the field. Most of the problems in Lithosun therapy are in the relative type.

What are the conditions, Lithosun is prescribed?

Lithosun is considered as a mood stabilizer, where it prevents mood swings (mania to depression and vice versa) of the bipolar disorder.

In addition Lithosun is prescribed in resistant depression. It is used to augment the effects of anti-depressant medications. Some psychiatrists use this medication to treat resistant schizophrenia as well.

Lithosun acts by a complex mechanism, which is not fully understood. It is thought that Lithosun acts by changing various complex neurotransmitters.

What are the Problems associated?

Severe hypothyroidism

Lithosun is known to reduce the thyroid gland function. So doctors will not usually prescribe Lithosun to severe hypothyroidism patients. However it can be prescribed to people with mild to moderate hypothyroidism. Here thyroxin hormone is co prescribed with Lithosun. In addition patients should monitor there thyroid function levels during the therapy.

Courtesy : Wikipedia

Severe renal failure

Lithosun is excreted from the kidneys. So in renal (kidney) failure, Lithosun accumulates inside the body. So it can lead to Lithosun toxicity. However Lithosun can be given very cautiously in mild to moderate renal impairment. In addition Lithosun can itself cause renal impairment, so renal functions should be checked during Lithosun treatment.

Courtesy : www.kidneytreatment.space

Heart disease

Lithosun can cause several electrocardiogram changes that may cause confusion with existing cardiac problems. In addition Lithosun is usually not given to patients with severe heart failure.
In addition Lithosun is also used very cautiously in sodium metabolism problems such as Addison’s and Conn's disease.

Courtesy : www.materheartfailureservice.ie

Pregnancy

Lithosun is known to cause cardiac problems in an unborn child. There are documented cases of cardiac anomalies (Epstein anomaly), so most doctors will change this medication to something else during pregnancy. So if you happened to get pregnant while on Lithosun then you must inform your doctor immediately.

Lactation

Lithosun should not be used in breast feeding. So patients are usually advised to bottle feed there babies.

Courtesy : Wikipedia

Conclusion

Lithosun is an essential drug in bipolar disorder treatment. However, due to the toxicity it is not used in many co existing conditions.