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.

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.

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.