Petril tablets uses and side effects

Petril ® is a clonazepam (benzodiazepine) brand manufactured in India. It is prescribed in epilepsy, anxiety disorders and in sleep problems. Most commonly reported side effects are drowsiness, dizziness, light headedness and problems in walking (ataxia).

In addition to the side effects mentioned above it has habit forming properties (Needing more dose to get the same effect especially sleep and getting unpleasant withdrawal symptoms when it is stopped) in long term use.

Petril 2mg tablets from MICRO pharma

Uses of Petril ®

This medication is used primarily to treat epilepsy. However, it is used in combination with other types of anti-epileptic medications. In psychiatry practice, it is used to calm down disturbed patients and to treat sleep problems.

In treating sleep problems, it is important to identify the cause for sleep problems and practice sleep hygiene techniques before getting pharmaceutical treatment.

Most common causes for sleep problems are psychiatry and medical problems. Common psychiatry problems are depression and anxiety disorders. Sleep problem settle once the underlying cause is treated.

Sleep hygiene techniques should be tried before taking this medication

Sleep hygiene techniques that could be tried before taking this medication

1. Use the bed only for sleep
2. Do not sleep in the day
3. Do not take alcohol, coffee, coke or chocolate (Caffeine) just before sleep
4. When you are unable to sleep then get up from the bed and do something else for some time
5. Try to make the sleeping environment comfortable, quiet and calm 
6. Overall exercise improves sleep, but try not to do vigorous exercise just before sleep

Dosage and how to take it

Petril ® is prescribed in 0.5mg to 4mg dose range. Most common dose is 1mg and 2mgs. It is taken at night therefore drowsiness would not interfere with day to day activities. Since this medication has long half-life (30 – 40 hrs), it is prescribed once a day.

To minimize side effects do not crush the medication. Take it with a meal and with a full glass of water. Do not exceed the dose prescribed by the doctor. Since it has abuse potential, do not take this without doctor’s prescription.

This medication should be taken long term with close medical supervision. It is because of its habit forming properties and quite severe withdrawal reaction.

Side effects of Petril ®

A list of common side effects

1. Drowsiness
2. Dizziness
3. Unsteady gait (walking)
4. Muscle weakness

It is very important that drowsiness and lightheadedness may persists into next day when you have taken this medication at night. Therefore, it is very important that you need to be very careful when driving or operating machinery.

IMPORTANT ! Operating machinery can become problematic when you are on this medication

IMPORTANT ! You should be careful when driving vehicles while on this medication

Uncommon side effects of Petril ® 

1. Headache
2. Vertigo
3. Slurred speech
4. Low blood pressure or hypotension
5. Tremors of hands and body
6. Urine incontinence and retention: - Common in elderly people
7. Rare side effects 
8. Respiratory depression: - It is important to tell whether you have respiratory problems such as Asthma, before getting the prescription. 
9. Blood disorders
10. Skin reactions
11. Paradoxical excitation: - Can cause disinhibition and increased activity in certain group of people.

What to tell your doctor before getting the prescription?

If you have following problems or medical condition, it is very important that you tell your doctor about them.

1. Liver disease
2. Kidney disease
3. Heart disease
4. Whether you are snoring in the night: - It is an indication that you have obstructive sleep apnea. When this medication is given in obstructive sleep apnea, it can result in dangerous lowering of respiration and blood oxygen levels in sleep that may result in brain damage. People with snoring complaint about poor sleep which make it a dangerous combination. 
5. Your work and occupation
6. Any medications you are on including street drugs
7. Whether you are pregnant or breast feeding

Snoring due to sleep apnea can cause sleep problems and prescribing sleep inducing medications in them can cause serious problems. 

Summary

Petril ® is a benzodiazepine class medication and its generic name is clonazepam. It is prescribed for epilepsy and in sleep problems. Main problems associated with this medication are drowsiness, lightheadedness and habit forming properties. This medication should not be a long term solution for sleep problems.

Pictures  Courtesy : Wikimedia

Flutinol tablets uses and side effects

Flutinol is a brand of fluoxetine prescribed for clinical depression and anxiety disorders. It is an SSRI (selective serotonin reuptake inhibitor) class medication manufactured by Sun pharmaceuticals, India. Its main side effects are nausea, insomnia, sexual dysfunction and headache.

Uses of Flutinol

This medication is prescribed for major depression, anxiety disorders, bipolar depression and obsessive compulsive disorders.

Depressive disorder is characterized by persistent low mood, difficulty in doing everyday tasks and work due to lack of energy and unable experience pleasure. In addition, depressed people frequently get suicidal ideas and get ideas of hopelessness and worthlessness.

Flutinol is commonly prescribed for depression

This medication is effective for both major depressive disorder and bipolar depression. Bipolar depression is characterized by having episodes of mania (opposite of depression which is disruptive) interspersed with depressive episodes.

Flutinol is given in combination with Olanzapine (Oleanz) to treat bipolar depression. Otherwise (when given alone) there is risk of shifting to manic phase.

In addition to treating depressive disorders, this medication is effective in treating wide variety of anxiety disorders. These include panic disorder characterized by sudden out of the blue attacks of anxiety. In addition, this medication is used for generalized anxiety disorder characterized by prevailing anxious mood with worrying thoughts.

In addition, this medication is prescribed for obsessive compulsive disorder (OCD). It is usually given in higher doses in OCD.

Other indications are premature ejaculation, premenstrual syndrome and reduce sexual drive in people with abnormal sexual preferences (paraphilia).

Side effects of Flutinol

Commonest side effects are listed here

1. Nausea
2. Vomiting
3. Headache
4. Mania
5. Poor sleep
6. Sexual dysfunction: - Characterized as erectile dysfunction in men and reduced sexual desire in both women and men.  However, since depression can also cause sexual dysfunction net effect may be increased sexual function. 
7. Tremors
8. Gastric irritation and heart burn
9. Increased anxiety at the beginning of the treatment, which usually wanes after some time. 

1. Uncommon side effects
2. Aggrevation of psychosis
3. Bleeding problems
4. Reduction in blood sodium level
5. Serotonin syndrome

How is it prescribed?

Flutinol is available as capsules. Usual dose is 20mg per day. It is given in the morning to prevent interference with sleep. It should be taken fully without crushing the capsule outer coating. In addition, it should be taken with full glass of water and preferably after a meal. Taking it after a meal will reduce the side effects.

For obsession and compulsive disorder, it is prescribed at higher doses sometimes reaching 80mg per day.

Withdrawal symptoms

This medication can cause withdrawal symptoms, if it is stopped suddenly after prolonged use. Common withdrawal symptoms are tiredness, increased lacrimation, rhinorrhea and increased anxiety.

Before you take Flutinol

As with every medication, there are precautions that you might need to take into consideration. Make sure your doctor has your detailed medical history, before starting you on this medication. It is especially important that you should tell your medical problems, other medications you are on and any street drugs you are on to your doctor.

You should inform your doctor, whether you are pregnant, planning to get pregnant or breast feeding. In addition, it is especially important to tell your doctor if you are on following drugs

Other antidepressants (MAOI class of medications, TCA and SSRI class medications)
St Johns wart

Conditions you need to inform your doctor before getting prescription

1. Allergic to SSRI or fluoxetine
2. Gastric bleeding
3. Liver problems
4. Kidney problems
5. Taking alcohol
6. Having a bleeding disorder

Summary

Flutinol is an Indian brand name of fluoxetine prescribed for depression and anxiety disorders. Most common side effects are nausea, headache and gastric discomfort.

Nexito plus uses and side effects

Nexito plus is a combination of escitalopram 5mg and 0.5mg clonazepam in a single tablet. It is effective against anxiety disorders and in depression with poor sleep. This combination is effective against panic disorder, where the patient’s anxiety symptoms usually get worse initially with SSRI (Selective serotonin reuptake inhibitors).

In addition, this medication can be given to people who have sleep problems. It is because escitalopram alone will reduce sleep and clonazepam increases sleep. So the combination can balance out. However, side effects of both compounds occur with this medication.

Problems with Nexito plus

Since this medication has fixed combination, it is impossible to change a single medication. Therefore, during early treatment phase, this medication is not recommended. It is better to have both types of medications given as single tablets, so they can be changed individually.

In addition, some mental health professionals do not agree about continuing benzodiazepines for long time. It is due to habit forming potential of benzodiazepines (clonazepam in Nexito plus).
Escitalopram alone is usually prescribed for long duration. Therefore, this medication is not recommended for longer duration. In such patients pure Nexito will be the choice.

Advantages of Nexito plus

This medication has the advantage of having less SSRI side effects such as insomnia, tremors and agitation. It is especially useful for patients who are sensitive for such side effects. In addition, this combination simplifies medication schedule so people will have less tablets to swallow.

You can see the comprehensive account on Nexito (Pure escitalopram) here.

Anxit is medication prescribed for sudden anxiety attacks

Side effects of Nexito plus

Side effects are combination of both escitalopram and clonazepam. Compared to pure Nexito, Nexito plus causes less tremors, less sleep disturbances and less agitation.

1. Nausea
2. Vomiting
3. Headache
4. Weight loss
5. Loss of appetite
6. Sexual dysfunction
7. Sleep disturbances

Sexual dysfunction is common side effect of SSRI class medications

In addition to above side effects, this medication can have following side effects.

1. Increased risk of mania in patients with bipolar affective disorders. 
2. Reduced blood sodium level
3. Serotonin syndrome
4. Increased bleeding
5. Yawning
6. Impaired concentration

Due to the presence of clonazepam, this medication can cause drowsiness, dizziness, loss of memory and unsteady walking. In addition, there is danger in working next day after this medication is taken in the night. It is safe not to engage in driving or operate machinery in the next day until you know how this medication affects you.

Operating machinery can be dangerous when you are on this medication

It is also advisable not to take alcoholic beverages as this medication can increase intoxication and side effects of alcohol.

Due to the presence of clonazepam, this medication can become habit forming. In addition, if you suddenly discontinued this medication, then you may experience more withdrawal symptoms (agitation, poor sleep, increased anxiety).

Summary

Nexito plus is a mixture of escitalopram and clonazepam. It is useful in patients who are sensitive to side effects of SSRI medications. Side effects are nausea, dizziness and sexual dysfunction.

Uses and side effects of Lamosyn

Lamosyn is an Indian brand name of generic anti-epileptic lamotrigine. In addition to epilepsy, it is also prescribed for mental health problems such as bipolar affective disorder. Skin rash is the most significant side effect. In addition, this medication can cause nausea, dry mouth and unsteady walking.

Lamosyn 25mg tablets

Uses of Lamosyn

This medication is classified as an anti-epileptic. But it was found that this medication is also effective in psychiatric disorders such as Bipolar affective disorder. It is prescribed to prevent bipolar depressive episodes in patients who are in predominantly depressive phase.

25mg and 50mg tablets

Use in neurology

This medication is used in most types of epilepsies. It is used in focal and generalized seizures. In addition, it is used in Lennox – Gastaut syndrome. It is also used in typical absence seizures in children.

Use in psychiatry

 Bipolar depression is depressive phase in patients with bipolar affective disorders. Bipolar affective disorder is characterized by different phases of mood and activity. In manic phase patients have extremely elevated mood, increased energy and disruption in social function. In depressive phase, patients get exact opposite of manic phase. They get low mood, suicidal ideation, low energy and feeling of worthlessness.

Compared to major depressive disorder, depression associated with bipolar disease is challenging to treat. It is because most antidepressants do not work in bipolar depression.

Lamosyn is one of the medications that is proven to be effective in preventing depressive episodes in bipolar illness.

What are the common side effects?

Commonest side effects of this medication are nausea and vomiting. To minimize these side effects, you need to take it with a full glass of water without crushing the medication. In addition, taking this medication after a meal will reduce the stomach side effects.

Other common side effects list

1. Dry mouth
2. Dizziness
3. Tremors
4. Poor sleep
5. Vision problems
6. Rash

Skin rash is the most problematic common side effect. It can occur in 1% of individuals who take this medication. If you develop any skin problem while on Lamosyn, then stop the medication immediately and consult your doctor. Skin reactions can go into life threatening conditions. This is one reason doctors start this medication very slowly.

Skin rash that occur in 1% of patients. Courtesy : http://www.newhealthguide.org

Rare side effects of Lamosyn

1. Inflammation of eye
2. Liver failure
3. Unsteadiness in walking
4. Confusion
5. Hallucinations
6. Blood problems

Dose and administration

This medication starts with 25mg once daily for 14 days then 50mg daily for another two weeks usually up to maximum dose of 600mg per day with two weekly dose increments. Very slow increase of dose is required to prevent the rash from developing.

Pregnancy

This medication can harm the unborn child. But the discontinuation of medication in pregnancy can result in aggravation of epilepsy or bipolar depression (which may have more risk of harm to mother as well as to the baby). Therefore, continuation or discontinuation of this medication should be done by an experienced clinician.

Breast feeding

Lamosyn occur in breast milk. Again the decision to stop medication should be done by an experienced clinician.

It is very important that you should consult your doctor before planning to get pregnant and you need to use contraception to prevent unexpected pregnancies.

Summary

Lamosyn is prescribed for epilepsy and bipolar depression. Most troublesome side effect is the skin rash. In addition, it should be cautiously used in pregnancy and breast feeding under super vision of an experienced clinician.

Zolax tablets uses and side effects

Zolax is a brand of sustained release Alprazolam manufactured in India. It is primarily prescribed for anxiety disorders and to induce sleep in insomnia. Side effects are drowsiness, fatigue and lightheadedness next day. This medication should not be used more than three to four weeks at a stretch due to its long term habit forming properties.

Zolax SR tablets

Uses of Zolax 

This medication is primarily prescribed for anxiety related mental health problems. Most common indications are short term use in social anxiety disorder, simple phobia and panic disorder. In addition to the use in anxiety disorders, this medication can be used to prevent seizures. However, it is rarely prescribed for this.

This medication can also prescribe in short term relief of sleep problems. However, before taking this medication, a cause for sleep problems should be found. Commonest cause for sleep problems is lack of sleep hygiene.


Anxit is another brand of Alprazolam

What is sleep hygiene

      Sleep hygiene is habits and practices that will promote quality sleep. Good sleep hygiene promotes quality sleep and it will help to reduce unnecessary medication use.

Following list is a simple guide for good sleep hygiene

1. Avoid napping or sleeping during the day
2. Avoid stimulants such as coffee, or tea before sleep
3. Avoid alcohol or smoking before sleep
4. Use bed only for sleep. Do not use bed for watching TV, reading books or any other task.
5. Regular exercises promote quality sleep
6. Avoid emotionally upsetting events before bed

This medication should not be discontinued suddenly after prolonged use. It should be gradually discontinued.

What is the dosage range for Zolax ?

This medication is usually prescribed within 0.5mg - 1.5mg per day. It should be taken with a full glass of water and it should not be crushed before use as it will increase the side effects.

Sustained released preparation is usually available as 0.5 mg, 1mg and 1.5mg tablets.

What are the most common side effects of Zolax ?

1.       Sedation and drowsiness: - Can goes to the next day

2.       Problems in operating machinery and driving even in the next day morning

3.       Lack of quality sleep

4.       Confusion

5.       Loss of memory

6.       Muscle weakness

7.       Abuse and dependency risk

This medication is habit forming and has dependency risk.

Operating machinery can be dangerous while on this medication

Driving under influence of this medication can cause problems

What you should inform before getting the prescription of this medication?

1.       Liver problems

2.       Kidney problems

3.       Heart problems

4.       Obstructive sleep apnea

5.       Respiratory disease

6.       Muscle problems including myasthenia gravis

7.       History of drug and alcohol abuse

If your sleep problem is due to Obstructive sleep apnea, it can cause serious complications. Obstructive sleep apnea occurs in obese individuals. In addition, snoring is a symptom of obstructive sleep apnea.  

What are the rare side effects of Zolax ?

1.       Headache
2.       Vertigo
3.       Dizziness
4.       Slurred speech
5.       Low blood pressure
6.       Difficulty in speech
7.       Tremors of the hands
8.       Increased breast size or gynecomastia
9.       Reduced breathing can occur, especially it is given intravenously

This medication is generally well tolerated for most of the time. However, elderly people will get more confused with this medication. Sometimes, certain people can become more aggressive and disinhibited while on this medication.

Summary

Zolax is a sustained released brand of Alprazolam manufactured in India. It is prescribed for anxiety disorders and sleep problems. Most common side effect is sedation and drowsiness. 

Clofranil use and side effects

Clofranil is a brand of Clomipramine. It is prescribed for obsessive compulsive disorder and depressive disorder. Main side effects are drowsiness, feeling faintish, dry mouth and constipation. This is a TCA class antidepressant with more serotonergic actions than other TCA antidepressants. More serotonergic action makes this medication more similar to SSRI (Selective serotonin reuptake inhibitors) class medication and it is more effective in OCD (Obsessive compulsive disorder).

Clofranil 50mg tablets

Uses of Clofranil

This medication is an antidepressant. It is primarily used for mental health problems such as depression and obsessive compulsive disorder. Compared to other antidepressants in this class, this medication is more effective in OCD or obsessive compulsive disorder.

This medication is useful in treating OCD (Obsessive compulsive disorder)

Obsessive compulsive disorder is a mental health problem associated with repeated thoughts or actions that are resisted.  A common example is excessive hand washing in a patient with repetitive belief that his/her hands are contaminated by germs. Usually excessive means around more than 10 times of washing hands per session. Usually the compulsion or act starts once the patient gets the thought that his hands are dirty.  

In fact, in current psychiatry practice it is used as a medication for OCD than depression. Most doctors use it as a second line treatment option for OCD, due to its unfavorable side effects profile. But according to this author's experience this medication helps patients who are resistant to SSRI medications.

What are the common side effects of Clofranil?

1. Drowsiness
2. Dry mouth
3. Constipation
4. Increased heart rate
5. Feeling faintish
6. Confusion
7. Nausea
8. Headache
9. Yawning
10. Blurred vision
11. Sexual dysfunction

Since this is a TCA (Tricyclic antidepressant) class medication, drowsiness and dry mouth is common. Usually SSRI medications do not cause such side effects.

Due to side effect of drowsiness, it will affect driving and ability to operate machinery.

Sexual dysfunction includes erectile dysfunction in males and reduced sexual desire in females.

What are the dangerous side effects?

1. Urine retention
2. Glaucoma or increased eye pressure
3. Heart block
4. Mania

Since this medication can cause serious heart problems (heart block) it is toxic when taken overdose. Therefore, it is prescribed carefully for highly suicidal patients. This medication can cause manic shift in patients with bipolar affective disorder. Urine retention can be a troublesome side effect in elderly patients.

What are rare but documented side effects of Clofranil?

1. Breast enlargement
2. Increased appetite with increased body weight
3. Getting low sodium in the blood (Hyponatremia)
4. Hallucinations
5. Epileptic Seizures
6. Flushing
7. Impaired memory
8. Muscle weakness

Things you need to discuss with your doctor?

Before getting the prescription, you need to inform your doctor if you have following medical/psychiatric conditions.

1. Any heart disease or Hypertension
2. Liver disease
3. Kidney disease
4. Bipolar affective disorder
5. Diabetes mellitus
6. Schizophrenia
7. Eye problems
8. Prostate problems in males (History of urinary retention)
9. Long standing constipation
10. History of all the medications you are on including street drugs

Compared to newer anti-depressants this medication is safe in pregnancy and breast feeding. It is due to availability of large amount of safety information.

How Clofranil is taken?

This medication is available as 50mg and 25mg tablets. Usual dose range is 50mg per day to 250mg per day. It should be taken with a full glass of water and should not be crushed before ingesting.

Summary

Clofranil is a TCA class antidepressant medication usually prescribed for OCD (Obsessive compulsive disorder) and depression. Common side effects are drowsiness and dry mouth.

Paxidep CR tablets uses and side effects

Paxidep CR is an Indian brand of SSRI (Selective serotonin reuptake inhibitor) antidepressant. Its generic name is paroxetine. It is prescribed for depression, panic disorder and other anxiety disorders. It is especially prescribed for breastfeeding mothers due to low concentration of the medication in breast milk. CR is shortened name for controlled release. It means once the medication is ingested, tablet will release the active drug into the blood  slowly. Therefore it will cause less side effects. 

However, this medication is having side effects common to SSRI class medications such as nausea, heartburn and headache. In addition, compared to other SSRI medications, it can cause more fetal malformations. Therefore, this medication should be discontinued in pregnancy.

Paxidep controlled release tablets can  be used less frequently and at low doses to minimize side effects

Pregnant women should not take this medication due to risk to the baby

Uses of Paxidep CR

This medication is prescribed for major depression, panic disorder and other anxiety disorders. Clinical depression is characterized by persistent low mood, low energy, and lack of enjoyment of previously enjoyable activities lasting for more than two weeks. In addition, depression can cause suicidal ideation.

Depression is a common indication for this medication

Panic and other anxiety disorders are characterized by inappropriate anxiety (“a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.”) that can cause severe functional impairment in the affected individual.

Panic disorder can be treated with Paxidep

In addition, Paxidep CR is effective in obsessive compulsive disorders (OCD). Obsessive compulsive disorder is characterized by inappropriately repetitive behavior which is senseless and resisted by the individual. E.g Repetitive hand washing to wash away germs.

This medication is preferred antidepressant in breastfeeding due to minimal drug concentration in breast milk. However, it should not be used by pregnant women. Therefore, breast feeding women should take adequate contraception during treatment.

What are the common side effects of Paxidep CR?

1. Nausea
2. Heartburn
3. Headache
4. Loss of appetite
5. Sexual dysfunction
6. Yawning
7. Abnormal dreams
8. Sleep problems
9. Increased blood cholesterol

What are the rare side effects of this medication?

1. Heart problems
2. Documented harm to the baby when the mother takes this medication.
3. Initial increase of anxiety when prescribed for anxiety disorders. Due to this risk many doctors prescribe low doses at the initial period of illness. But this effect usually wanes after that.
4. Hives and allergic reaction
5. Risk of mania (Opposite of depression with excessive energy, elevated self-esteem that can cause severe social malfunction)
6. Reduced salt levels in blood
7. Increased risk of bleeding
8. Serotonin syndrome

Most of the side effects go off after some time. But most troublesome side effects such as sexual dysfunction, may persist. It is characterized by erectile dysfunction in men and reduced sexual desire in females. In addition, this medication can cause delayed ejaculation which can be used in the treatment of premature ejaculation.

Since depression can also cause sexual dysfunction, some will experience elevated sexual activity due to reduced depression. So it is a balance of effects of depression and medication.

In anxiety disorders, at the initial period of treatment, this medication can cause elevated anxiety. This usually wanes over time.  

How Paxidep CR is prescribed?

This medication is available as tablets. Usual dose range is between 12.5 to 37.5mg per day. Elderly patients will get maximum daily dose of 25mg. Usually the medication is prescribed in morning due to the disturbance of sleep associated with this medication.

This medication should be taken with meals to minimize side effects. It should be taken with a full glass of water and the tablet should not be crushed/broken.

What the doctor should know before prescribing this medication

1. Bipolar affective disorder
2. Liver problems
3. Kidney problems
4. Pregnancy status (should not be given in first trimester of pregnancy)
5. Bleeding problems
6. Long standing gastritis

"If you are a woman in reproductive age then this medication should be taken with adequate contraception to prevent exposure to baby. "

Oxat is another paroxetine brand that is popular in India. 

Summary

Paxidep CR is a controlled release SSRI class medication prescribed for depression and anxiety disorders. Main side effects are nausea, heart burn and sexual dysfunction. This medication should not be prescribed for pregnant women who are in their first trimester. 

Sizopin uses and side effects

Sizopin is an Indian brand name of the generic medication clozapine. It is prescribed specifically in resistant schizophrenia. However, this medication has several dangerous side effects such as reduced blood counts (agranulocytosis) and inflammation of heart muscles.

Uses of Sizopin

This is the only medication that has proven efficacy in resistant forms of Schizophrenia. It is usually prescribed when the symptoms of schizophrenia does not respond to two or more anti-psychotic medications. It is used as a third line medication, because of its potentially dangerous side effects and cumbersome monthly blood tests that has to be done in a patient on Sizopin.   

Sizopin 100mg tablets

Because of life threatening agranulocytosis (reduction of type of white cells called granulocytes in blood) it had been withdrawn from the market. But it was reintroduced due to its effectiveness in treating resistant schizophrenia, so frequent white cell counts should be done in patients who take Sizopin. Patients on Sizopin must be registered with a central monitoring agency.

Following video will explain the importance of treating treatment resistant schizophrenia by an expert in the field.

In addition, to the use in resistant schizophrenia some psychiatrists use it in patients with resistant mania, and psychosis associated with Parkinson disease/ Lewy body dementia.

Schizophrenia : Artists depiction

How Sizopin is prescribed?

This medication is prescribed usually when the patient is in a hospital. Before starting medication doctors do various blood tests including, full blood count, liver function test, electro cardiogram and a 2D echocardiogram to exclude any medical problems. It is usually started with a small dose of 12.5mg at night then it is gradually increased up to desired level. While the dose is increasing, doctors monitor patients’ blood pressure, heart rate, and emergence of side effects.

Increased heart rate is common at the initial period of therapy

Due to increased risk of fits with higher doses, doctors give this medication with anti epileptic medication such as Sodium Valproate.

At the initial period, a patient should undergo blood tests every week upto six months then two weekly up to one year and after that monthly for the rest.

It is very important not to discontinue the medication for more than 48 hours as it need to be restarted from 12.5mg after that. If you have problems with the medication then contact your doctor and do as he/she says.

Monthly blood tests should be done when you take Sizopin

Common side effects of Sizopin

Sedation (excessive sleepiness)

Sedation can be alleviated by altering the dosing schedule, so patient can take small dose at the morning and a bigger dose in the evening.

Constipation

It is a common side effect. This can be controlled by taking high fibre diet (diet with lots of fruits and vegetables) and adequate fluid intake.

Increased heart rate

Increased heart rate is a common side effect at the initial period of therapy. If it is persisting a doctor will look for heart problems.

Fever

Patient should seek medical advice. It can be due to agranulocytosis. If not, can be treated with over the counter antipyretics like acetaminophen.

Hypersalivation (Increased saliva secretion.)

This is usually a troublesome side effect. Patients sometimes discover that their pillow is soaked with saliva after getting out from sleep. Doctors can give drugs like buscopan to control salivation.

Hypertension (increased blood pressure)

It is another side effect that has to be monitored. If it is persistent doctors can start anti hypertensives. This usually occur after sometime.

Hypotension (decreased blood pressure)

Hypotension can occur at the initial treatment phase. If they have this problem, they should not get up quickly after sleep, then should be monitored closely by a doctor.

Nausea

It is a common side effect. Doctors can start anti emetics if it becomes troublesome.

Passing urine during sleep (Nocturnal Enuresis).

It is another troublesome side effect. Patients can avoid fluids in evening. When complained, doctor can alter dosing schedule. Sometimes drugs may be necessary to control enuresis.

Serious side effects

Blood problems

Sizopin is known to cause serious drop in white blood cell counts known as agranulocytosis. It is a very serious medical complication that need urgent attention. You need to contact your doctor immediately if you have developed infections, fever, and sore throat at the initial part of the therapy. It usually occur more at the initial part of the treatment. However, it affects only 0.8% of patients who takes this medication and therefore is not a common side effect.

Seizures (fits)

If patient had a seizure, drug should be withheld for at least 24 hours. Then doctor will restart with lowest possible dose. Sometimes doctors may prescribe anti epileptic drugs.

Heart problems

This medication is known to cause heart disease known as myocarditis or inflammation of the heart muscle. It occurs in early part of the illness and usually diagnosed by a doctor with electrocardiography and 2D echo.

Weight gain is another problematic side effect. It can be controlled by following proper dietary advice. This can also cause diabetes mellitus and blood lipid problems. You should inform your doctor if you have diabetes, hypertension, liver and kidney problems, heart problem or epilepsy before getting prescription of this medication.

Risk and benefit of this medication

Patients with resistant schizophrenia has serious problems in functioning and this medication can change it and around one third of patients with resistant schizophrenia can live normally with this medication. Therefore, in patients with resistant schizophrenia benefit greatly outweighs risk of taking Sizopin.

Summary

Sizopin is a medication prescribed for resistant schizophrenia. It can cause serious and annoying side effects, but for patients with resistant schizophrenia there seems to be no better alternative. 

Nodict tablets uses and side effects

Nodict is a brand of generic Naltrexone manufactured by Sun Rise Pharmaceuticals, India. It is prescribed for Alcohol and Opioid (Heroin and Morphine) dependence. This medication is one of modern treatment methods used by doctors to treat substance dependence.

How Nodict is used?

This medication is used as a relapse prevention method in Alcohol dependence. Once alcohol withdrawal is treated by a specialist, it is important to prevent any potential reverting back to drinking behavior.

Nodict Tablets

When Nodict is taken, person would not get the same enjoyment as before. Therefore, motivation to continue abstinence increases. In addition, it prevents the person from going back to alcohol taking behavior when he sees related stimuli e.g. Sight of a bar, meeting friends who are used to drinking with him/her.

Nodict can be used to treat Heroin use

However, it cannot prevent an unmotivated person from drinking alcohol. It just helps to prevent alcohol taking behavior in a well-motivated individual. So motivation is the key to achieve abstinence.

Same principals apply to person with opioid dependence. A person who tries to take Opioids while on Nodict would need higher doses to achieve same effects and it could result in serious over dose (could be fatal) of Opioids (Heroin or Morphine).

Courtesy : Pixabay

It is important to note that this medication is successful in people who are already motivated to stop the substance, but could not do it due to long term changes in their brains. In addition, to be successful this medication should be taken as a part of comprehensive treatment plan including psychological and social problem management.

How Nodict is taken

It is available as 25mg and 50mg oral tablets. Usually in the first day 25mg is taken then the dose is increased to 50mg. It should be stopped once the person relapsed (started taking alcohol despite on Nodict) or the person is able to completely get rid of alcohol taking behavior (which should be determined by a professional).

To minimize side effects it should be taken orally with a full glass of water without crushing the tablet. It should be stopped, once the individual starts taking the intended substance while taking this medication.

For people who take heroin and opioids, this medication should be taken only when the substance is completely got off from their body. Otherwise they will experience exaggerated withdrawal reaction.

It should be taken at least six months after achieving abstinence. After six months medication can be stopped. 

How this medication acts?

This medication blocks the opioid receptors in the brain including opioids produced by our own body (endorphins). Opioids produced by our own brain plays a part in alcohol dependence, while heroin and morphine abuse directly causes pleasure and dependence. This medication helps to attain abstinence by way of stopping these substance from acting on the brain.

People with following problems would not able to take this medication

1.       Severe liver damage

2.       Severe kidney damage

3.       People who do not motivated to stop substance and already on them.

4.       Breast feeding women

5.       Pregnant women

Side effects of Nodict

Following side effects are most common. They are Nausea, vomiting, abdominal pain, diarrhea, reduced appetite, increased thirst and sleep problems. Some people may complain headache, increased anxiety, mood swings, delayed ejaculation and increased tears and increased sweating.

Most common side effects in a list

1.       Nausea

2.       Abdominal pain

3.       Diarrhea

4.       Loss of appetite

5.       Sleep problems

6.       Headache

7.       Increased anxiety

8.       Mood swings

9.       Delayed ejaculation

10.   Tearfulness

11.   Increased sweating

Summary

Nodict is a brand of Naltrexone that is used in Opioids and alcohol dependence. It should be prescribed by a professional as part of comprehensive treatment plan. Main side effects are nausea loss appetite, and headache.

Evidence

1. Naltrexone (Nodict) in the Treatment of Alcohol Dependence