Uses and side effects of Deprex tablets

What is Deprex?

Deprex is a brand of olanzapine manufactured by Square Pharmaceuticals, India. It is a drug prescribed for psychosis and bipolar disorder.

When administered as an injection, it quite useful for treating acutely disturbed patients who are unable take oral medications. Its principal side effects are drowsiness, weight gain, and problems with blood sugar patients predisposed to diabetes.

Uses of Deprex

Deprex can be used in a wide variety of mental disorders

·         Schizophrenia—Deprex is effective in managing the symptoms Schizophrenia including delusions, hallucinations, disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions.

·         Bipolar disorder—This exhibits itself as an extreme and often persistent mood swings that can disrupt a person’s day to day functioning. Mania and depression can be sometimes accompanied by psychotic symptoms such as auditory hallucinations and grandiose delusions. Deprex is found to be effective in treating both the manic and depressive phases of the illness and it stabilizes the mood of the patients.

·         Depression—Current evidence suggest that in combination with Prodep (Fluoxetine), Deprex is quite effective in treating depression resulting in bipolar disorder.

·         Controlling disturbed patients—Deprex have a sedative and calming profile and patients with acutely disturbed behavior, especially psychotic patients. Deprex is available as both intramuscular injection and rapid ingestion tablets that dissolves quickly inside the mouth.

How to Take Deprex

Deprex comes as a pill in an Aluminium wrapping or as orally disintegrating tablet (tablet that dissolves quickly in the mouth). Usual dosage is once a day.

You need to follow the prescription carefully, and need to ask your doctor or your if you do not understand what it says. You need to take the medication as exactly as directed by the psychiatrist. You should not take more or less of the medication.

Orally dissolving tablets will quickly dissolve in the mouth and do not have an unpleasant aftertaste.

Usually, your doctor start you on a low dose of Deprex then gradually increase the dose.

It is very important to understand that this medication would control your symptoms, but will not cure your underlying condition. In addition, it may take around several weeks or may be longer before you feel the full benefit of the treatment. It is also very important to continue to take the medication even though you feel well.

Do not stop the medication without explicit advice from your doctor.

Picture of bipolar illness depicting both mania and depression

Warnings and Precautions Before You Take Deprex

·         Tell your doctor or pharmacist if you are allergic to olanzapine or any other medications and food stuffs

·         Tell your doctor or pharmacist the prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you take or plan to take because this could affect your treatment.

·         Tell your doctor if you have or have ever had a stroke, a mini-stroke, heart disease or a heart attack, an irregular heartbeat, fits, breast cancer,

·         Any condition that makes it difficult for you to swallow,

·         High or low blood pressure,

·         a high level of fats (cholesterol and triglycerides) in your blood,

·         a low number of white blood cells,

·         liver or prostate disease, Stomach problems, glaucoma (an eye condition),

·         High blood sugar, or if you or anyone in your family has or has ever had diabetes.

·         Tell your doctor if you have severe vomiting or diarrhea

·         Tell your doctor if you are pregnant, especially if you are in the last few months of your pregnancy, or whether you plan to become pregnant or are breast-feeding.

·         If you become pregnant while taking olanzapine, call your doctor immediately.

• Olanzapine may cause problems in newborns after delivery

·         It is very important You should know that Deprex may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.

·         You should know that alcohol can add to the drowsiness

·         Cigarette smoking may decrease the level of blood levels of this medication.

You should not smoke as it will reduce blood level of this medication causing less effect

Important Warning Before Taking Deprex

Newer Studies have shown that patients with dementia (a brain disorder that affects the ability to remember, think clearly, communicate, and perform daily activities and that may cause changes in mood and personality) who take medication similar to deprex

Senior citizens with dementia may also have a greater chance of having a stroke or mini-stroke during treatment with deprex.

Side Effects of Deprex

·         Drowsiness

·         Dizziness

·         Restlessness

·         Unusual behavior

·         Sleep difficulties

·         Weakness

·         Difficulty in walking

·         Constipation

·         Weight gain is common

·         Dry mouth

·         Pain in various body parts

·         Breast enlargement 

·         Late or missed periods

·         Decreased sexual potency

Some can be serious, call your doctor immediately. If you experience any of the following symptoms,

·         Seizures (Fits)

·         Visual disturbances

·         Swelling of the arms, hands, feet, ankles, or lower legs

·         Sore throat, fever, chills with rigors, and other signs of infection

·         Very stiff muscles

·         Excess sweating

·         Fast or irregular heartbeat

·         Rash

·         Hives

·         Difficulty breathing or swallowing

Overdose Symptoms

Symptoms of overdose may include:

·         Excessive Drowsiness

·         Slurred speech

·         Fast heartbeat

·         Sudden movements that you cannot control or extrapyramidal side effects

·         Coma (loss of consciousness for a period of time)

If any of this symptoms are experienced, call the doctor immediately.

Please note that this author does not have any affiliation to Square Pharma, India or Deprex. The only purpose for this article is to highlight the uses and side effects of this medication. Always see a doctor before starting any treatment.

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. 

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 Arip MT

Arip MT is an Indian brand of Antipsychotic Aripiprazole. It is an atypical antipsychotic medication prescribed in schizophrenia, psychoses and bipolar mania.

Other common brand name is Abilify. Most common side effects are nausea, vomiting and constipation. This drug reduces weight in some patients, unlike other common antipsychotics such as Olanzapine. It is a plus point in some patients who are obese. Compared to some other antipsychotics this medication is relatively safe for heart.

In addition, this medication is prescribed to patients who develop certain side effects such as increased body weight, increased blood sugar levels and increased blood lipid levels due to other antipsychotic medications.

Arip MT Tablets

Common dosage for this medication are 7.5mg, 15mg and 30mg. This medication is usually prescribed once daily. Compared to other antipsychotics this medication cause less drowsiness.

However, it can cause type of movement side effect called Akathisia. In akathisia, patient experience restlessness in their legs causing urgency to move. It can become a serious side effect to note as patients sometimes tend to commit suicide due to Akathisia. It can sometimes be missed by less experienced doctors as they may interpret the side effect as something to do with the illness. 

For resistant variety of Schizophrenia Sizopin is prescribed.


Another antipsychotic that is commonly prescribed

Uses and side effects of Sizodon

How it acts?

Schizophrenia and other psychoses are caused by problems in brain chemistry. Arip MT alters and corrects the brain chemistry so patient’s psychotic features disappear.

What the doctor should know before prescribing?

If the patient has depression, dementia, seizure disorder, liver disease, kidney disease, stroke and diabetes mellitus, then he/she must discuss with the doctor before taking this medication. The doctor should know whether the patient is pregnant or breast feeding.

What are the general advices?

This medication can be taken without regard to meals. This medication should not be shared with other people. Taking alcoholic beverages can increase certain side effects.

Do not change medication dose or stop taking medication on your own. If you get side effects or problems with this medication then consult your doctor. He/She will change the medication and dose.

What are the common side effects?

Gastrointestinal disturbances like nausea and vomiting are the most common. Increased heart rate is another side effect. Some patients may get sleep disturbances with this medication. Akathesia (inability to keep the feet in one place) can occur with Arip MT. Some patients can get tremors. Headache is another side effect. Blurred vision is also common.

Less commonly patients can get depressed with this medication. This medication can increase the suicidal risk of susceptible individuals.

What are the rare side effects?

Very rarely patients can get loss of appetite, difficulty in swallowing, hepatitis, yellowish discoloration of the body, edema, increased blood pressure and chest pain. Some patients may get agitated with this medication. Few patients may have anxiety, seizures, and reduced sodium levels in the blood and muscle pains. Certain patients may get urinary retention, incontinence, and sweating and hair loss. Very rarely some patients may report increased salivation, pancreatitis, laryngospasm and thromboembolism.

Summary

Arip MT is a medication prescribed for psychotic disorders such as Schizophrenia. Main side effects are nausea, akathisia and weigh loss. 

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.

Glumet for the use of weight gain and menstrual problems due to anti psychotics

Glumet is a popular anti diabetic medication. It’s generic name is called Metformin. It is defined as the most popular insulin sensitizer. Use of Glumet is associated with reduction in overall cardiovascular complications in diabetes. In addition, it is used in poly cystic ovarian syndrome (PCOD). In PCOD, it restores menstruation.

Anti-psychotics medications are notorious for their metabolic and endocrine side effects. Especially, second generation anti psychotics such as Olanzapine and Clozapine are known to cause significant weight gain. In addition, Risperidone is notorious for causing menstrual problems such as complete stopping of menstruation. These side effects are common cause for non-adherence of anti-psychotic medications.

Glumet can be used in to treat weight gain associated with Antipsychotics 

Recently concluded randomized double blind placebo controlled clinical trial conducted in china shows evidence for using Glumet in Anti-psychotic induced amenorrhea and weight gain. They compared two groups of women who experienced amenorrhea after antipsychotic treatment. One group was given Glumet 1g per day and other group was given a placebo (dummy medication similar to Glumet in external appearance).

They followed up them for six months. Menstruation was restored in 66% of women (28 women) after six months in Glumet group. Only two women experienced restoration of menstruation placebo group. This is the first study that detected restoration of menstruation after Glumet therapy in patients with antipsychotic induced amenorrhea.

Common Antipsychotics side effects including weight gain : Courtesy  Dr. Stephen M. Stahl. 

In addition, there is significant reduction in body weight and body mass index in Glumet arm of the study.

Most studies that were conducted prior to this also confirm the positive effect of Glumet in anti-psychotic induced weight gain. However, most studies suffer from small sample size. Therefore, studies with larger sample size are needed to conclude Glumet can be used in weight gain associated with anti-psychotic treatment.

Metformin for Treatment of Antipsychotic-Induced Amenorrhea and Weight Gain in Women With First-Episode Schizophrenia: A Double-Blind, Randomized, Placebo-Controlled Study

Fighting weight gain associated with antipsychotics. WEBMD article

Treatment of negative schizophrenic symptoms with antidepressants

Due to similarity and association of depression with negative symptoms of schizophrenia, many doctors prescribe anti-depressants to patients with negative schizophrenic symptoms. 

According to meta-analysis published in British Journal of Psychiatry (Efficacy of anti-depressants in treating the negative symptoms of chronic schizophrenia: Meta-analysis by Surendra p. Singh, Vidhi Sinh, Nilamadhab Kar and Kelvin Chan) there is a good reason to believe that above practice has good evidence base.

 

Above meta-analysis went through 22 randomized placebo controlled clinical trials. It found that there is a statistically significant symptom relief when anti-depressants were co - prescribed with antipsychotics for negative schizophrenic symptoms. 

What are the common negative schizophrenic symptoms?

• Social withdrawal

• Underactivity

• Lack of speech

• Slowness

• Depression

• Lack of drive

• Apathy

Above symptoms are the most common symptoms seen in negative schizophrenia. They are very difficult to treat. Co prescribing Antidepressants are found to be effective in treating negative schizophrenia.  

Individual antidepressants that are found to be effective in treating negative symptoms

It seems Ritanserin and Trazadone is more effective in treating negative schizophrenic symptoms. Ritanserin > Trazadone > Fluoxetine

Ritanserin is the generic name of Tisterton. Trazadone is generic name of Desyrel. Fluoxetine is the generic of Prozac. Fluoxetine had minimal effects in treating negative schizophrenia. 

Limitations of above meta-analysis

• Numbers of trials are relatively small. 

• Number of trials are not adequate in interpreting individual anti-depressant effects.

• Three studies with very large effect size shift whole study to that direction

• No RCTs available for tricyclics, venlafaxine, and mono amine oxidase inhibitors. 

Sources

1. Efficacy of anti-depressants in treating the negative symptoms of chronic schizophrenia: Meta-analysis by Surendra p. Singh, Vidhi Sinh, Nilamadhab Kar and Kelvin Chan

Complications of Newer Antipsychotic drugs

Newer anti-psychotics gave hope for the psychiatry patients due to their low side effects profile. Commonly used newer antipsychotic drugs are Zyprexa, Clozaril, Risperdal and Abilify. They cause fewer extra-pyramidal side effects compared to older typical anti-psychotics. In addition, serious complications such as neuroleptic malignant syndrome and tardive dyskinesia are rare in newer anti psychotics (compared to older anti psychotics).

But recent evidence suggest that newer anti psychotics have different very dangerous complications. Newer atypical anti psychotics are known to cause serious blood lipid elevation in certain patients. It can complicate ischemic heart disease treatment in such patients. In addition, atypical/newer anti psychotics increase body weight. Common drugs that are responsible for body weight increase are Zyprexa, Clozaril and Seroquel. Risperdal and Abilify cause less weight gain. In fact Abilify seems to cause weight reduction in certain individuals.

Newer atypical antipsychotics such as Zyprexa, Clozaril and Risperdal (less) can also cause diabetes mellitus by way of increasing blood glucose level.

Therefore, long term overall benefit of newer anti psychotics remain questionable.