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.

Effects of lithum on developing fetus

Lithium is a drug that is used in Bipolar affective disorder and resistant depression. However, it is a rather toxic molecule to the human body. But it is safe within certain dose range.

There are several documented cases of birth defects caused by Lithium in humans. They include Epstein anomaly. It is a heart anomaly that can become a severe problem in later life.

In addition, high doses of lithium can cause several abnormalities in the rat fetus. They include high incidence of cleft palate, growth retardation, brain liquification and pulpy brain, hepatomegaly and digital abnormalities. However, incidence in humans are not available because of the obvious reasons.

But stopping lithium during pregnancy can cause severe relapse of bipolar disorder. Which can result in more damages to the fetus and the mother. So doctors weigh risks and benefits of continuing lithium during pregnancy. Sometimes your doctor may decide to continue lithium with the aforementioned risks. In addition, there are very few safer bipolar maintenance therapy options available to the doctors. Some doctors may change the drug regimen to anti-psychotic medications with mood stabilizing properties such as seroquel/zyprexa.

Sources

Teratogenic effects of lithium and ethanol in the developing fetus.

Effects of Lithium toxicity

Lithium is a medication prescribed for bipolar affective disorder and resistant depression. It has one of the simplest structure (in ionized form an atom), but has quite complex mechanism of action. In addition, it is also a toxic metal to the human body. But toxicity occurs when the blood lithium levels reach a critical level.
Usually Lithium should be taken in higher dose for some time to get lithium toxicity. It is unlikely to get lithium toxicity when single large dose of lithium is taken.

However, critical level that is needed to produce toxicity and the level that is needed to achieve symptom control is within a narrow margin. Therefore, it is important to take the drug as prescribed, take adequate amounts of water and do regular lithium levels in the blood (at least every six months). In addition, it is important to know the early features of lithium toxicity and get medical attention before full blown toxicity sets in.

What are the important lithium levels?
Lithium levels should be monitored after 12 hours of last dose. If the patient is on twice daily dosing then blood should be taken just before the morning dose of the day (Lithium is usually prescribed once or twice a day). Blood should be collected to a plain bottle and carried to the laboratory.

Lithium normal therapeutic range
0.6 - 1.2 mmol/l

Early toxicity
> 1.5mmol/l

Life threatening toxicity
>2.0 mmol/l

How to prevent lithium toxicity?

Lithium levels should be tested at least every six monthly in a patient with stabilized regimen. In addition, patients should not take NSAID pain killers, ACE inhibitors, and Diuretics without expert advice. It is important to note that they should not take over the counter NSAID pain killers such as Aspirin and Motrin.

Effects of lithium on organs


1. Kidney failure – 1% of patients develop irreversible kidney damage on long term use (after 10 years of treatment).
a. Around 10% develop structural kidney changes
2. Hypothyroidism: Around 5 -35% develops reversible thyroid gland failure. But treatment with thyroxin can alleviate the symptoms.
3. Effects on the developing baby: Lithium is known to cause heart anomalies in the newborn, if taken during pregnancy. There is 400 fold rises in the incidence of Ebstein anomaly of the heart.


What are the symptoms of Lithium Toxicity?


Early signs

1. Marked tremors,
2. Anorexia, Nausea/Vomiting,
3. Diarrhea, and lethargy


Late signs

1. Restlessness
2. Muscle fasciculation’s/jerks
3. Abnormal movements
4. Severe drowsiness
5. Confusion
6. Reduced blood pressure
7. Heart rhythm abnormalities
8. Fits


What are side effects of Lithium therapy?

Side effects are different from toxic effects. It is because side effects can occur within lithium normal dosage range. They are not usually dangerous.

Warning and disclaimer
This articles is for the information only. You should not take or discontinue lithium without your doctors advice.


Sources
New Oxford textbook psychiatry

Use and side effects of Zaleplon(Sonata, Zalep, Zalpilo, Zanlop, Zaplon, Zaso)

Sonata is a prescription only medication used for short term relief of insomnia. Its generic name is Zaleplon. This drug is quite useful for initiation of sleep. However, it is not helpful in maintaining sleep and it usually does not prevent frequent nighttime awakenings.


 Similar to benzodiazepines, Sonata Modulate GABA Type A receptors in the brain and increase their action. This action increases the inhibitory neuro transmission and it ultimately relieves insomnia.


 What the doctor should know before prescribing Sonata?
 If the patient has kidney disease, liver disease, breathing disorder, clinical depression, ataxia (poor control of body movements), or myasthenia gravis then he/she should discuss that with the doctor before taking Sonata. In addition, the doctor should know what the over the counter medications patient is on.


  The doctor may not prescribe this medication to pregnant and nursing mothers. Problematic effects to the new born are reported in regular use, especially in the last three months of the pregnancy.


In addition, this drug increases adverse effects of alcohol and other recreational drugs. Therefore the doctor should know the patients sober habits, before prescribing Sonata.


What should the patient know before taking Sonata?


This medication is available as tablets. Tablets should be taken with full glass of water without crushing, to minimize side effects. It can be taken with or without meals. This is a very short acting drug. Therefore patients should take this medication immediately before sleep.


What are the common side effects?


 If taken in the night drowsiness is usually not continued to the next day. However, operating machinery and driving motor vehicles are not recommended in the following day. 


 Other common side effects are numbness in extremities and menstrual pain. Reduced muscle strength and co-ordination problems of movements are side effects as well. In addition, people can get poor mental concentration, restlessness, confusion and memory loss with this drug.


In addition, one of the main problems associated with Sonata is dependence and withdrawal symptoms like rebound insomnia and fits. Dependence and withdrawal means getting adverse effects when the drug is stopped. However, unlike other hypnotics, tolerance is not reported with regular use. In addition, tolerance means requiring increased amount of the drug to achieve the same benefit.