Use and side effects of Clonotril

Clonotril ® is a brand of clonazepam available in Indian sub-continent. It is a benzodiazepine class medication prescribed for epilepsy, anxiety disorders and for sleep disorders. Most common side effects reported by patients are drowsiness, dizziness, light headedness and walking difficulties (ataxia).

Long term side effects of Clonotril 

In addition to the common short term side effects mentioned above this medication has habit forming properties (Where the person need increasingly higher dosage to get the same effect esp. Sleep and reduction in anxiety) in long term use.

Clonotril 2mg tablets

What are the Uses of Clonotril ®

Epilepsy is the primary use of this medication. It decreases seizure frequency in epileptic patients. But it is commonly used in combination with other anti-epileptic medications. In psychiatry, it can be used to calm down severely disturbed patients and it is also used to treat sleep problems.

However, when it is used for sleep problems, it is very important to identify the underlying cause for the sleep problem. It is important to practice sleep hygiene techniques before getting treatment from sleep medications.

There are many causes for sleep problems that can be treated without sleep inducing medications. Depression and anxiety disorders are common causes for sleep disturbances. These problems settle once underlying cause is treated. In addition, there can be numerous medical problems associated with sleep difficulties.

Clonotril is prescribed in sleep problems, but sleep hygiene techniques should be tried first

Following sleep hygiene methods should be tried before taking medications

1. It is important to use the bed only for sleep

2. Do not take daytime naps or minimize them

3. It is very important not to take alcohol, coffee, coke or chocolate (Caffeine) just before sleep. Alcohol causes serious sleep disturbances. 

4. When you are having difficult time falling asleep then you need to get up from the bed and do something else without staying on the bed.

5. It is also important to make the sleeping environment comfortable, quiet and calm. Make your bed sheets clean and tidy.  

6. Exercise in day time, but not in night before sleep. 

Dose of Clonotril and how to use it

Dosage range is between 0.5mg to 4mg. However, most doctors prescribe between is 1mg and 2mgs. It is usually taken in the night to make sure drowsiness would not interfere with day to day activities. In addition, this medication has long action (30 – 40 hrs), so it is usually prescribed once a day.

Crushing this medication would increase side effects. E.g. Taking half a tablet would increase blood levels rapidly and cause more side effects so take the dose similar to ½ tablet as whole. In addition, take this medication with meal and with a full glass of water. 

It is very important not to exceed the dose prescribed by the doctor. If you feel you need more medication, then discuss with your prescribing doctor. This medication is having habit forming properties, therefore do not take it for long term without explicit advice from your doctor. If you discontinue it suddenly after prolonged use then there is possibility that it will cause severe withdrawal symptoms. 

What are the side effects of Clonotril

Following are a list of common side effects

1. Drowsiness

2. Dizziness

3. Unsteady gait (walking)

4. Muscle weakness

Drowsiness is a very significant side effect. It can affect driving and machinery operation. Sometimes it can persist into the morning even after night dose. Therefore, it is very important that you to see how you feel before driving or operating machinery. 

Operating machinery and driving can be dangerous when you are on this medication

What are the less common side effects of this medication? 

1. Headache and pain

2. Vertigo or unbalanceness 

3. Slurred speech

4. Low blood pressure 

5. Tremors of hands and body

6. Urine problems: - Common in elderly people

7. Respiratory depression: - It is important to tell whether you have respiratory problems such as Asthma, before getting the prescription. 

8. Blood disorders

9. Skin reactions

10. Paradoxical excitation: - Can cause disinhibition and increased activity in certain group of people.

What you should to tell your doctor, before getting the prescription?

If you are known to have following problems or medical condition, it is important that you tell that to your family doctor.

1. Liver problems

2. Kidney problems

3. Heart problems

4. Snoring in the night: - It is an indication of a condition called obstructive sleep apnea. In such people, it can cause dangerous lowering of breathing which causes the blood oxygen levels to drop during sleep. It may result in brain damage. Due to poor sleep at night, people with snoring complaints daytime drowsiness. 

5. Any medications or drugs you are taking, including street drugs

6. If you are a woman, then it is important to mention whether you are pregnant. 

You need to tell whether you are pregnant before getting prescription

Summary

Clonotril ® is a benzodiazepine class medication prescribed for epilepsy, calm down disturbed patients and for sleep problems. Common problems associated with this medication are drowsiness, lightheadedness and it can be habit forming in long term use.

Pictures  Courtesy : Wikimedia

Uses and side effects of Sizodon

Sizodon is a brand of Risperidone manufactured by the Sun Pharma, India. It is an atypical antipsychotic medication prescribed primarily for Schizophrenia, Delusional disorder and Bipolar disorder. Main notable side effects of Sizodon are movement problem called acute dystonia and drug induced Parkinsonism.

Uses of Sizodon

Sizodon is prescribed primarily for psychotic disorders such as schizophrenia, bipolar mania and delusional disorder. In addition, it is prescribed for acute and transient psychotic disorders. It is available as tablets and usual dose range is 0.5mg to 16mg. But it is usually prescribed in the range 2mg – 8mg.

Sizodon 1mg tablets

Sizodon 2mg tablets

Schizophrenia is a psychiatry disorder characterized by delusions and hallucinations. Delusions are strongly held beliefs that are culturally unacceptable and not amenable to logical arguments. Hallucinations are perceptions (sounds, visions and sensations) without a stimulus (e.g hearing voices when nobody is talking). It is found scientifically, that patients with schizophrenia experience above symptoms due to abnormalities in their brain chemistry.

Artists Depiction of Schizophrenia

Bipolar disorder is a mood disorder where the patients experience extreme mood swings. They sometime become severely depressed with ideas of worthlessness, having inability to experience pleasure, and hopelessness. Some patients commit suicide when the depression overwhelms them. In addition, at other times they have normal mood and sometimes get very high elevation of mood. At the time of elevation of mood they can become destructive, over spend their money and have sexual misadventures.

Having both happy and sad moods in Bipolar disorder

Sizodon is especially effective in the mood elevated phase or the manic phase. In addition, it has some mood stabilizing properties. Therefore, some doctors prescribe it after their manic phase.

This medication is also prescribed in Delusional disorder. It is a disorder characterized by persisting delusions. Common example of Delusional disorder is morbid jealousy. Here the person suspects his/her sexual partner fidelity without any adequate evidence.

Side effects of Sizodon

Sizodon is an antipsychotic medication and it shares side effects of other anti psychotics. Most common side effects are nausea, gastric upset and drowsiness. They are common to most of western medications.

Most notable side effects are movement problems named acute dystonia and drug induced Parkinsonism. Acute dystonia occurs within hours of taking the medication and Parkinsonism occur within days of taking it. These side effects are common in higher doses of the medication (Usually more than 4mg).

It can cause restlessness in legs and the person gets a feeling that he need to continue to move. It is very distressing symptom and if you get this symptom, you need to meet your doctor.

These movement related side effects are described in the following post.

Causes, symptoms and treatment of extrapyramidal side effects

In addition, Sizodon is known to aggravate glaucoma, cause acute urine retention, cause constipation and male erectile dysfunction. It is also causes menstrual problems in women. Some people experience severe drowsiness and sedation.

Sexual dysfunction is a common cause for discontinuation of medication. It can be addressed by doctors. 

Some people would experience weight gain, increased blood sugar and increased blood lipid levels with this medication. It is called metabolic syndrome.

A list of common side effects

1. Anxiety
2. Changes in vision, including blurred vision
3. Difficulty concentrating
4. Difficulty speaking or swallowing
5. Inability to move the eyes
6. Loss of balance and control
7. Mask like face
8. Memory problems
9. Muscle spasms of face, neck, and back
10. Problems with urination
11. Need to keep moving the legs
12. Shuffling walk
13. Skin rash or itching
14. Stiffness or weakness of the arms or legs
15. Tic-like or twitching movements
16. Trembling & shaking of the fingers/hands
17. Trouble sleeping
18. Twisting like body movements

How to minimize side effects

You should take the dose recommended by your doctor. You should also take the medication with a full glass of water. Take the medication after a meal. In addition, never crush the medication before taking it. If you experience abnormal movements, inability to keep still (constantly in need of moving the legs) or drooling of saliva or severe constipation then you need to meet your doctor again.

Sometimes your doctor would prescribe medications that would alleviate or prevent you from getting side effects. Common such medication is Benzhexol (or Trihexyphenidyl).

What are the rare but dangerous side effects?

Most significant dangerous side effect would be neuroleptic malignant syndrome. It is characterized by fever, muscle rigidity, confusion and can cause multi organ failure. It is a serious complication of all the antipsychotic medications including Sizodon.

Symptoms of Neuroleptic malignant syndrome  

Summary

Sizodon is an antipsychotic medication called risperidone. It is prescribed for schizophrenia and other psychotic disorders. Main side effects are movement abnormalities called acute dystonic reaction and drug induced parkinsonism.

Uses and side effects of Lonazep tablets

Lonazep is a brand of clonazepam manufactured by Sun pharmaceuticals, India. It is a benzodiazepine class medication prescribed for epilepsy, calm down disturbed patients, and induce sleep and to treat anxiety. Its main side effects are drowsiness, dizziness and unsteadiness or ataxia.

What are the uses of Lonazep?

Lonazep is mainly prescribed to treat epilepsy. It is effective in most types of epilepsies and it is usually prescribed in combination with other anti epileptic medications. It is also prescribed immediately to prevent further seizures when a seizure attack occurs.

In addition, it is prescribed for short term relief of insomnia (poor sleep). However, it should not be used for more than three weeks for the purpose of insomnia, as it is known to cause dependence (habit forming).

It is also used to treat alcohol dependence. In addition, it is helpful for people with poor sleep following discontinuation of alcohol. Medications like Zolfresh would also help people with sleep problems. 

Another brand of clonazepam that is commonly prescribed is Anxit. 

Summary of uses

1.       To induce sleep

2.       To calm down disturbed patients

3.       Epilepsy

4.       To relieve Alcohol withdrawal symptoms

Who should not use this medication?

Lonazep should be used carefully in patients with breathing difficulties. It is known to cause breathing difficulties, especially in higher doses. It should not be used in patients with myasthenia gravis.

In addition, it should not be used in patients with sleep apnea. Therefore, if you have poor sleep associated with snoring at night then you need to inform that to your doctor.

Lonazep should be used cautiously in patients with severe liver and kidney problems.

You should be cautious when you have following problems and inform them to the prescribing doctor.

1.       Breathing difficulties

2.       Snoring at night with poor sleep

3.       Kidney and liver problems

Lonazep 2mg tablets pack.

What are the common side effects of Lonazep?

Drowsiness and light headedness can go on to next day when it is taken in the night. In addition, it can cause unsteadiness or ataxia. It is also dangerous to operate machinery or drive vehicles when its effects are present.

Operating machinery can be dangerous when taking Lonazep tablets

In addition, some patients who were given Lonazep can become more agitated and it is called paradoxical excitation.

In addition, this medication is habit forming in long term use. People can become addicted to this medication and they may find that sleeping is becoming dependent on medication. It is common when this medication is taken more than three weeks.

Summary of common side effects

1.       Drowsiness

2.       Light headed ness

3.       Ataxia

4.       Danger of operating machinery and driving even in next day

5.       Habit forming

6.       Paradoxical excitation

How do you take Lonazep?

This medication is taken as oral tablet. It should be taken without crushing or breaking. It should be taken with a full glass of water. Also it should be taken as prescribed by the doctor. Never adjust dose for yourself or use it for poor sleep for more than three weeks.

This medication is available as 1 - 2mg tablets.

Lonazep mouth dissolving tablets

Mouth dissolving tablets are useful when the patient is violent and refusing medications. In such situations putting the tablets into the mouth causes rapid disintegration and patient cannot spit out the medication.

In addition,  they can be given in covert medication administration. Here the tablets are dissolved into a drink without patient’s knowledge. However, it has associated legal and ethical problems.

Lonazep mouth dissolving tablets

Summary

Lonazep is a benzodiazepine class medication prescribed for epilepsy, poor sleep and to calm down agitated patients. Its main side effect is drowsiness and difficulty in operating machinery and driving. In addition, this medication has abuse potential and can be habit forming.

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.

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.