Neurology Case No 9. Migrain-2

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Neurology Case No 9. Migrain-2

মাইগ্রেন_অ্যাটাক

Acute Rx—-

Tablet1.- Nomi 2.5 mg AS A (zolmitriptan) AS A (5-HT Agonists).

Indications of Tablet:– Nomi 2.5 mg AS A (zolmitriptan) AS A (5-HT Agonists).

Nomi is indicated for the acute treatment of migraines with or without aura in adults.

Pharmacology of Tablet:– Nomi 2.5 mg AS A (zolmitriptan) AS A (5-HT Agonists).

Migraines are likely due to local cranial vasodilatation and/or to the release of sensory neuropeptides through nerve endings in the trigeminal system. The therapeutic activity of Zolmitriptan for the treatment of migraine headache is thought to be due to the agonist effects at the 5-HT_1B/1D receptors on intracranial blood vessels and sensory nerves of the trigeminal system which results in cranial vessel constriction and inhibition of pro-inflammatory neuropeptide release.

Dosage & Administration of Tablet:– Nomi 2.5 mg AS A (zolmitriptan) AS A (5-HT Agonists).

Tablet: The recommended starting dose of Zolmitriptan is 2.5 mg tablet. Maximum recommended single dose is 5 mg. If the migraine has not resolved by 2 hours after taking Zolmitriptan, or returns after a transient improvement, a second dose may be administered at least 2 hours after the first dose. The maximum daily dose is 10 mg in any 24-hours period.

Nasal Spray: Administer one dose of Zolmitriptan Nasal Spray 5 mg for the treatment of acute migraine. If the headache returns the dose may be repeated after 2 hours. The maximum daily dose should not exceed 10 mg in any 24-hour period. In controlled clinical trials, single doses of 5 mg zolmitriptan nasal spray were administered into one nostril and were effective for the treatment of acute migraines in adults. Individuals may vary in response to Zolmitriptan Nasal Spray. The pharmacokinetics of a 5 mg nasal spray dose is similar to the 5 mg oral formulations. Doses lower than 5 mg can only be achieved through the use of an oral formulation. The choice of dose, and route of administration should therefore be made on an individual basis. The effectiveness of a second dose has not been established in placebo-controlled trials. The safety of treating an average of more than four headaches in a 30 day period has not been established.

Contraindications of Tablet:– Nomi 2.5 mg AS A (zolmitriptan) AS A (5-HT Agonists).

Contraindicated in patients with ischemic coronary artery disease, history of stroke, concurrent or recent use of a monoamine oxidase inhibitor and known hypersensitivity to Zolmitriptan.

Side Effects of Tablet:– Nomi 2.5 mg AS A (zolmitriptan) AS A (5-HT Agonists).

Most common adverse reactions were neck/throat/jaw pain or pressure, dizziness, paresthesia, asthenia, somnolence, warm/cold sensation, nausea, heaviness sensation, and dry mouth.

Pregnancy & Lactation of Tablet:– Nomi 2.5 mg AS A (zolmitriptan) AS A (5-HT Agonists).

Pregnancy Category C. Zolmitriptan should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether Zolmitriptan is excreted in human milk. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Precautions & Warnings of Tablet:– Nomi 2.5 mg AS A (zolmitriptan) AS A (5-HT Agonists).

There have been rare reports of serious cardiac adverse reactions, including acute myocardial infarction, occurring within a few hours following administration. Sensations of tightness, pain, and pressure may occur in the chest, throat, neck, and jaw after treatment with Nomi.

Use in Special Populations of Tablet:– Nomi 2.5 mg AS A (zolmitriptan) AS A (5-HT Agonists).

Pediatric Use: Not recommended for use in patients under 18 years of age.

Therapeutic Class of Tablet:– Nomi 2.5 mg AS A (zolmitriptan) AS A (5-HT Agonists).

5-HT Agonists

Tablet2. – Naprosyn 500 mg (AS A (Naproxen Sodium) AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Indications of Tablet: – Naprosyn 500 mg (AS A (Naproxen Sodium) AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Naprosyn is indicated for the relief of sign and symptoms of-

rheumatoid arthritis
osteoarthritis
ankylosing spondylitis
juvenile arthritis
tendonitis
bursitis
acute gout

It is also indicated for the management of primary dysmenorrhea & pain.

Pharmacology of Tablet: – Naprosyn 500 mg (AS A (Naproxen Sodium) AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

As with other non-selective NSAIDs, naproxen exerts it’s clinical effects by blocking COX-1 and COX-2 enzymes leading to decreased prostaglandin synthesis. Although both enzymes contribute to prostaglandin production, they have unique functional differences. The COX-1 enzymes is constitutively active and can be found in normal tissues such as the stomach lining, while the COX-2 enzyme is inducible and produces prostaglandins that mediate pain, fever and inflammation. The COX-2 enzyme mediates the desired antipyretic, analgesic and anti-inflammatory properties offered by Naproxen, while undesired adverse effects such as gastrointestinal upset and renal toxicities are linked to the COX-1 enzyme.

Dosage & Administration of Tablet: – Naprosyn 500 mg (AS A (Naproxen Sodium) AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Naproxen oral preparations should be taken with water preferably after meals.

Naproxen Enteric Coated Tablet: Adult:

For rheumatoid arthritis/ osteoarthritis/ ankylosing spondylitis: For adults 500-1000 mg per day taken in two devided doses at 12- hour intervals. The maintenance dose is usually 500 mg per day taken in two devided doses at 12 – hour intervals. The total daily dose of Naproxen should not exceed 1000 mg maintaining 12-hour intervals.
For acute gout: 750 mg should be given initially, then 250 mg every 8 hours until the attack has passed. Children under 16 years are not recommended.
For dysmenorrhoea: For adults 500 mg should be given initially, followed by 250 mg at 6-8 hour intervals for upto 5 days, if necessary.
For other indications like analgesia and acute musculoskeletal disorders: 500 mg should be given initially, followed by 250 mg at 6-8 hour intervals, if necessary.

Naproxen Enteric Coated Tablet: Children: Children under 16 years are not recommended.

Naproxen Suspension: Children:

For juvenile rheumatoid arthritis: The usual dose for children over 2 years is 10 mg/kg/day given as two divided doses at 12-hour intervals. Therapy in children under 2 years of age is not recommended. The following may be used as a guide for dosage of suspension:

13 kg (29 lb) 2.5 mL b.i.d.
25 kg (55 lb) 5 mL b.i.d.
38 kg (84 lb) 7.5 mL b.i.d.

Naproxen Gel: Is to be applied 2-6 times a day as required and is not recommended for use in children.’

Interaction

ACE inhibitors: diminish the antihypertensive effect of ACE inhibitors.
Antacids & Sucralfate: delay the absorption of Naprosyn.
Aspirin: increase adverse effects.
Diuretics: reduce the natriuretic effect of Furosemide and Thiazides.
Methotrexate: enhance the toxicity of Methotrexate.
Warfarin: increase the risk of GI bleeding.
Selective Serotonin Reuptake Inhibitors (SSRI): increase the risk of GI bleeding.

Contraindications of Tablet: – Naprosyn 500 mg (AS A (Naproxen Sodium) AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Naproxen is contraindicated in patients with known hypersensitivity to Naproxen. It should not be given to patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. It is contraindicated for the treatment of perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.

Side Effects of Tablet: – Naprosyn 500 mg (AS A (Naproxen Sodium) AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Most frequently reported side effects include following:

Gastrointestinal: Heartburn, abdominal pain, nausea, diarrhea, dyspepsia.
Central Nervous System: Headache, vertigo, drowsiness.
Dermatological: Pruritus (itching), purpura.
Cardiovascular: Edema, palpitation.
Others: Visual disturbances, hearing disturbances.

Pregnancy & Lactation of Tablet: – Naprosyn 500 mg (AS A (Naproxen Sodium) AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Most non-steroidal anti-inflammatory drugs may have an adverse effect on the fetus through their pharmacological properties. Naproxen causes a delay in parturition in animals and has been associated with premature closure of the ductus arteriosus and severe pulmonary hypertension in infants born to mothers taking Naproxen. The use of Naproxen in the first and third trimesters requires careful balancing of the benefits to the mother against the possible risks to the fetus. Naproxen is excreted in small amounts in the breast milk for nursing mothers. The amount of Naproxen distributed into breast milk is considered by some authorities to be too small to be harmful to a breast-fed infant although some manufacturers recommend that breast feeding should be avoided during Naproxen therapy.

Precautions & Warnings

Renal effects: As with other non-steroidal anti- inflammatory drugs, long-term administration of naproxen to animal has resulted in renal papillary necrosis and other abnormal renal pathology. In humans, there have been reports of acute interstitial nephritis, hematuria, proteinuria and occasionally nephrotic syndrome associated with Naprosyn-containing products and others NSAIDs since they have been marketed. Naprosyn and its metabolites are eliminated primarily by the kidneys; therefore, the drug should be used with caution in patients with significantly impaired renal function, and the monitoring of serum creatinine and/or creatinine clearance is advised in these patients. Caution should be used if the drug is given to the patients with creatinine clearance of less than 20ml/min because accumulation of naproxen metabolites has been seen in such patients.

Hepatic effects: There have been a few reports of moderate to severe jaundice attributed to Naprosyn.

Therapeutic Class of Tablet: – Naprosyn 500 mg (AS A (Naproxen Sodium) AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Tablet3.- motigut 10 mg (AS A (Domperidone Maleate ) (AS A Motility Stimulants, Motility stimulants/Dopamine antagonist, Prokinetic drugs).

Indications of Tablet:-Motigut 10 mg (AS A Domperidone Maleate AS A Motility Stimulants, Motility stimulants/Dopamine antagonist, Prokinetic drugs).

Motigut is indicated in-

Dyspeptic symptom complex, often associated with delayed gastric emptying, gastroesophageal reflux and esophagitis:

Epigastric sense of fullness, feeling of abdominal distension, upper abdominal pain
Eructation, flatulence, early satiety
Nausea and vomiting
Heartburn with or without regurgitations of gastric contents in the mouth
Non-ulcer dyspepsia

Acute nausea and vomiting of the functional, organic, infectious, dietetic origin or induced by radiotherapy or drug therapy or induced in migraine.

Parkinson’s disease: In dopamine-agonist induced nausea and vomiting.

Radiological studies: Speeding barium transit in follow-through radiological studies.

Pharmacology of Tablet:-Motigut 10 mg (AS A Domperidone Maleate AS A Motility Stimulants, Motility stimulants/Dopamine antagonist, Prokinetic drugs).

Domperidone is a dopamine antagonist that principally blocks the dopamine receptors located in the ChemoreceptorTrigger Zone (CTZ) and stomach. Its gastroprokinetic action is based on its blocking effect of dopamine receptors that have an influence on the motility of the gastrointestinal tract. Due to its weak penetration across the blood-brain barrier, Domperidone has almost no effect on the dopaminergic receptors in the brain, therefore, excluding psychotropic and neurologic side effects. Domperidone restores normal motility and tone of the upper gastrointestinal tract, facilitates gastric emptying, enhances antral and duodenal peristalsis and regulates contraction of the pylorus. Domperidone also increases esophageal peristalsis and lower esophageal sphincter pressure, and thus prevents regurgitation of gastric content.

Dosage & Administration of Tablet:-Motigut 10 mg (AS A Domperidone Maleate AS A Motility Stimulants, Motility stimulants/Dopamine antagonist, Prokinetic drugs).

Domperidone should be taken 15-30 minutes before meals and, if necessary, before retiring.

The usual recommended oral dose of Domperidone is as follows:

Adults: 10-20 mg (1-2 tablet or 10-20 ml suspension), every 6-8 hours daily. The maximum dose of Domperidone is 80 mg daily.
Children: 2-4 ml suspension/10 kg body weight or 0.4-0.8 ml paediatric drops/10 kg body weight, every 6-8 hours daily.

In dyspeptic symptom:

Adults: 10-20 mg (1-2 tablet or 10-20 ml suspension), every 6-8 hours daily.
Children: 0.2-0.4 mg/kg (2-4 ml suspension/10 kg or 0.4-0.8 ml paediatric drops/10 kg) body weight, every 6-8 hours daily.

In acute and sub-acute conditions (mainly in acute nausea and vomiting):

Adults: 20 mg (2 tablets or 20 ml suspension), every 6-8 hours daily
Children: 0.2-0.4 mg/kg (2-4 ml suspension/10 kg or 0.4-0.8 ml paediatric drops/10 kg) body weight, every 6-8 hours daily. (In acute nausea and vomiting maximum period of treatment is 12 weeks).

By rectum in suppositories:

Adults (including elderly): 30-60 mg every 4-8 hours.
Children: The maximum daily dose rectally in children’s is 30 mg for those weighting 10 to 25 kg. The dose may be divided throughout day if necessary.
The maximum period of treatment is 12 weeks.’

Interaction of Tablet:-Motigut 10 mg (AS A Domperidone Maleate AS A Motility Stimulants, Motility stimulants/Dopamine antagonist, Prokinetic drugs).

Concomitant administration of anticholinergic drugs may antagonise the antidyspeptic effect of domperidone: Antacids and antisecretory drugs should not be given simultaneously with domperidone as they lower its oral bioavailability. The main metabolic pathway of domperidone is through CYP3A4. In vitro data suggest that the concomitant use of drugs that significantly inhibit this enzyme may result in increased plasma levels of domperidone. Examples of CYP3A4 inhibitors include: azole antifungals, macrolide antibiotics. HIV protease inhibitors, nefazodone, etc. Theoretically, since domperidone has gastro-kinetic effects it could influence the absorption of concomitantly orally administered drugs, particularly those with sustained release or enteric coated formulations. However, in patients already stabilised on digoxin or paracetamol, concomitant administration of domperidone did not influence the blood levels of these drugs.

neuroleptics, the action of which it does not potentiate,
dopaminergic agonists (bromocriptine, L-dopa), whose unwanted peripheral effects such as digestive disorders, nausea and vomiting it suppresses without counteracting their central properties.

Contraindications

Domperidone is contraindicated to patients having known hypersensitivity to this drug and in the case of neonates. Domperidone should not be used whenever gastrointestinal stimulation might be dangerous i.e., gastrointestinal hemorrhage, mechanical obstruction or perforation. Also contraindicated in patients with prolactin releasing pituitary tumor (prolactinoma).

Side Effects of Tablet:-Motigut 10 mg (AS A Domperidone Maleate AS A Motility Stimulants, Motility stimulants/Dopamine antagonist, Prokinetic drugs).

Side-effects are rare; exceptionally some transient intestinal cramps have been reported. Extrapyramidal phenomena are rare in young children and exceptional in adults: they reverse spontaneously and completely as soon as the treatment is stopped. As the pituitary gland is located outside the blood-brain barrier, domperidone may induce an increase in the plasma prolactin level. In rare case this hyperprolactinaemia may give rise to neuroendocrinological phenomena such as galactorrhoea and gynaecomastia. When the blood-brain barrier is immature (as in infants) or impaired, the possible occurrence of neurological side-effects cannot be totally excluded. Rare allergic reactions, such as rash and urticaria, have also been reported.

Pregnancy & Lactation of Tablet:-Motigut 10 mg (AS A Domperidone Maleate AS A Motility Stimulants, Motility stimulants/Dopamine antagonist, Prokinetic drugs).

Domperidone given to animals at doses up to 160 mg/kg/day did not produce teratogenic effects. However, as most medicines, domperidone should only be used during the first trimester of pregnancy if this is justified by the anticipated therapeutic benefit. Up to now, there has been no evidence of any increase in the risk of malformations in humans. The drug is excreted in breast milk of lactating rats. In women, domperidone concentrations in breast milk is 4 times lower than corresponding plasma concentrations. It is not known whether this is harmful to the newborn. Therefore nursing is not recommended for mothers who are taking domperidone, unless the expected benefits outweigh any potential risk. Effects on ability to drive and use machines: Domperidone does not affect the mental alertness.

Precautions & Warnings of Tablet:-Motigut 10 mg (AS A Domperidone Maleate AS A Motility Stimulants, Motility stimulants/Dopamine antagonist, Prokinetic drugs).

Motigut should be used with absolute caution in the case of children because there may be an increased risk of extra-pyramidal reactions in young children because of an incompletely developed blood-brain barrier. Since domperidone is highly metabolized in liver, it should be used with caution in patient with hepatic impairment.

Use in Special Populations of Tablet:-Motigut 10 mg (AS A Domperidone Maleate AS A Motility Stimulants, Motility stimulants/Dopamine antagonist, Prokinetic drugs).

Use in infants: Because the metabolic and blood-brain barrier functions are not fully developed during the first months of life, any drug should only be given to infants with great caution and under close medical supervision. Since the typical absence of neurological side effects with domperidone is mainly due to its poor penetration through the blood-brain barrier, the possible occurrence of such effects cannot be totally excluded in infants under 1 year of age. Use in liver disorders: Since domperidone is highly metabolised in the liver, domperidone should be used with caution in patients with hepatic impairment. Use in kidney disorders: In patients with severe renal insufficiency (serum creatinine >6 mg/100ml, i.e. >O.6 mmol/I) the elimination half-life of domperidone as increased from 7.4 to 20.8 hours, but plasma drug levels were lower than in healthy volunteers. Since very little unchanged drug is excreted via the kidneys, it is unlikely that the dose of a single acute administration needs to be adjusted in patients with renal insufficiency. However, on repeated administration, the dosing frequency should be reduced to once or twice daily, depending on the severity of the impairment, and the dose may need to be reduced. Generally, patients on prolonged therapy should be reviewed regularly.

Overdose Effects

Symptoms of overdosage may include drowsiness, disorientation and extrapyramidal reactions, especially in children. In case of overdosage, the administration of activated charcoal, and close observation of the patients are recommended. Anticholinergic, antiparkinson drugs or antihistamines with anticholinergic properties may be helpful in controlling the extrapyramidal reactions.

Therapeutic Class of Tablet:-Motigut 10 mg (AS A Domperidone Maleate AS A Motility Stimulants, Motility stimulants/Dopamine antagonist, Prokinetic drugs).

Motility Stimulants, Motility stimulants/Dopamine antagonist, Prokinetic drugs

Tablet4.- Rabe 20 mg AS A Rabeprazole AS A PPI.

যখন ব্যাথা উঠবে– এইগুলি সব থেকে একটা করে খেয়ে নিবেন – Acute attack যদি মাসে একবার হয়, তাহলে আর কোনো Prophylaxis লাগবেনা— উপরের ৪ পদের ঔষধ এক পাতা করে কিনে বাসায় রেখে দিতে বলবেন, যখন ব্যাথা উঠবে, তখন ৪ পদ থেকে ৪ টা খেয়ে নিবে.

এক মাসে যদি ২ বারের বেশি ব্যাথা উঠে- তাহলে prophylaxis নিবেন- Prophylaxis একটা মেডিসিন দিয়ে শুরু করলে সেটা হবে Propanol 20 mg BD.

What is in Prophylaxis simple terms?

Answer is:-prophylaxis. noun. pro·phy·lax·is -ˈlak-səs. plural prophylaxes -ˈlak-ˌsēz. : measures designed to preserve health and prevent the spread of disease : protective or preventive treatment.

What is the goal of prophylaxis?

Answer is:-

Prophylaxis describes medical care aimed at preventing disease or stopping it from getting worse, while other types of care are aimed at curing or managing an existing disease.

মাইগ্রেন প্রফিল্যাক্সিস কি?

গুরুতর এবং/অথবা ঘন ঘন মাইগ্রেনের রোগীদের দীর্ঘমেয়াদী প্রতিরোধমূলক থেরাপি প্রয়োজন। প্রফিল্যাক্সিসের জন্য সম্ভাব্য প্রতিকূল ঘটনা বা প্রতিকূলতা সহ অ্যান্টি-মাইগ্রেন যৌগগুলির দৈনিক প্রশাসনের প্রয়োজন হয় এবং অন্যান্য সমসাময়িক অবস্থা এবং চিকিত্সার সাথেও হস্তক্ষেপ করতে পারে ..

What is the best prophylaxis for migraine?

Answer is:- Propanol is the most common and one of the most effective first-line medications used for migraine prophylaxis. [11] The starting dose is 40 mg and can go up to 320 mg daily.

অনেক সময় দেখা যায়, একটা দিয়ে Migraine

attack এর ফ্রিকুয়েন্সি কমেনা, তখন এইটার সাথে combination এ অন্য মেডিসিন দেওয়া হয়- TCA / Flunarizine

Tab- indever 40 mg

1/2+0+1/2 =৬ মাস

propranolol:-

Tablet 7. Indever 40 mg Propranolol Hydrochloride (AS A Beta-adrenoceptor blocking drugs, Beta-blockers). For used AS a Migraine prophylaxis

Indications of Tablet:-Indever 40 mg Propranolol Hydrochloride (AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Indever is indicated in:

Essential hypertension
Angina pectoris
Cardiac arrhythmia
Thyrotoxicosis
Anxiety
Prophylaxis of migraine, etc.

Pharmacology of Tablet:-Indever 40 mg Propranolol Hydrochloride (AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Propranolol Hydrochloride is a B-adrenergic receptor blocking drug which is widely used in hypertension and angina pectoris. Propranolol antagonizes catecholamines at B-adrenergic receptors, thus prevents excess rate and force of contraction of the heart and decreases the excess consumption of oxygen by the heart.

Propranolol is almost completely absorbed from the gastrointestinal tract, but a portion is immediately metabolized by the liver when passing through the portal circulation. Peak plasma concentration occurs in 1 to 1.5 hours after oral administration. The plasma half-life of propranolol is from 3 to 6 hours. The metabolites of propranolol are excreted through the urine.

Dosage & Administration of Tablet:-Indever 40 mg Propranolol Hydrochloride (AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Adult (above 18 years):

Hypertension: Initially 80 mg twice daily, may be increased at weekly intervals and then maintenance dose of 160-320 mg daily is recommended.
Angina pectoris: Initially 40 mg 2-3 times daily and then maintenance dose of 120-240 mg daily is given.
Thyrotoxicosis: 10-40 mg, 3-4 times daily is given.
Anxiety: 40 mg once daily, may be increased to three times daily.
Prophylaxis of migraine: Initially 40 mg 2-3 times daily; then maintenance dose of 80-160 mg daily is recommended.

Child (From day 1 to 18 years): Hypertension:

Neonate: 0.25-0.5 mg/kg 3 times daily, adjusted according to response.
Child 1 month: 12 years: 0.25-1 mg/kg 3 times daily, maximum dose 5 mg/kg daily in divided dose.
Child 12-18 years: initially 80 mg twice daily, maintain 160-320 mg daily.

Interaction of Tablet:-Indever 40 mg Propranolol Hydrochloride (AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Patients receiving verapamil, salbutamol, Levosalbutamol, ergot alkaloids, lidocain, phenobarbital drugs should be closely observed during therapy.

Contraindications of Tablet:-Indever 40 mg Propranolol Hydrochloride (AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Bronchospasm, cardiogenic shock, second or third degree heart block, diabetes mellitus etc.

Side Effects of Tablet:-Indever 40 mg Propranolol Hydrochloride (AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Cold extremities, lassitude, nausea, dizziness, insomnia, paresthesia etc.

Pregnancy & Lactation of Tablet:-Indever 40 mg Propranolol Hydrochloride (AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Pregnancy category C, should not be used in pregnant women. Propranolol is excreted in human milk. Caution should be taken when propranolol is administered to a nursing mother.

Therapeutic Class of Tablet:-Indever 40 mg Propranolol Hydrochloride (AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Beta-adrenoceptor blocking drugs, Beta-blockers

tab- Amilin 10 mg অথবা Norium 10 mg

0+0+1 (৬ মাস)

Amitryptiline:-

Tablet 5.Amilin 10 mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

0+0+1 (6 month)

Indications of Tablet:-Amilin 10 mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

Amilin is indicated in-

Depressive Illness: particularly where sedation is required.
Nocturnal Enuresis in children.
Prophylaxis of Migraine.
Tension Headache.
Chronic Pain.

Description of Tablet:-Amilin 10 mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

Amilin is a tricyclic antidepressant. It has marked anticholinergic and sedative properties. It prevents the reuptake of noradrenaline and serotonin at the nerve ending. Amilin is rapidly absorbed from the Gl tract. Peak plasma concentrations occur within 2-12 hours. Amilin is excreted in the urine, mainly in the form of its metabolites.

Pharmacology of Tablet:-Amilin 10 mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

The mechanism of action of this drug is not fully elucidated. It is suggested that amitriptyline inhibits the membrane pump mechanism responsible for the re-uptake of transmitter amines, such as norepinephrine and serotonin, thereby increasing their concentration at the synaptic clefts of the brain. These amines are important in regulating mood. The monoamine hypothesis in depression, one of the oldest hypotheses, postulates that deficiencies of serotonin (5-HT) and/or norepinephrine (NE) neurotransmission in the brain lead to depressive effects. This drug counteracts these mechanisms, and this may be the mechanism of amitriptyline in improving depressive symptoms. Whether its analgesic effects are related to its mood-altering activities or attributable to a different, less obvious pharmacological action (or a combination of both) is unknown.

Dosage & Administration of Tablet:-Amilin 10 mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

Depression: Initially 75 mg (Elderly and Adolescents 30-75 mg) daily in divided doses or as a single dose at bedtime increased gradually as necessary to 150-200 mg; Child under 16 years not recommended for depression.

Nocturnal Enuresis: Child 7-10 years: 10-20 mg, 11-16 years: 25-50 mg at night; max. period of treatment (including gradual withdrawal) 3 months-full physical examination before the further course.

Prophylaxis of Migraine: 100 mg daily.

Tension Headache: 10-25 mg three times daily.

Interaction of Tablet:-Amilin 10 mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

TCA enhances the sedative effect of alcohol and opioid analgesics. When TCA is used with Moxifloxacin or Terfenadine, it increases the risk of ventricular arrhythmias. Disulfirum and Cimetidine inhibit the metabolism of Amilin. When TCA is used with diuretics, it enhances the risk of postural hypotension.

Contraindications of Tablet:-Amilin 10 mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

Amitriptyline is contraindicated in myocardial infarction, arrythmias, particularly heart block of any degree, mania and severe liver disease. Initially, sedation may affect the ability to drive or operate machinery.

Side Effects of Tablet:-Amilin 10 mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

Anticholinergic: Excessive perspiration, dry mouth, blurred vision, hyperpyrexia, urinary retention and urinary tract dilatation.
Cardiovascular reactions: Hypotension, syncope, postural hypotension, hypertension, tachycardia, palpitations, myocardial infarction, etc.
CNS and Neuromuscular: Confusional states, disturbed concentration, disorientation, delusions, etc.
Allergic: Skin rash, urticaria, photosensitization, etc.
Haematological: Bone-marrow depression.
Gastrointestinal: Nausea, epigastric distress, vomiting, anorexia, stomatitis, unpleasant taste, weight loss, diarrhoea, constipation, etc.
Endocrine: Testicular swelling, gynaecomastia, breast enlargement, galactorrhoea, etc.

Pregnancy & Lactation of Tablet:-Amilin 10 mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

Pregnancy Category C. Amitriptyline has been shown to cross the placenta. Amitriptyline should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus. Amitriptyline is excreted into breast milk. Because of the potential for serious adverse reactions in nursing infants from Amitriptyline, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Therapeutic Class of Tablet:-Amilin 10 mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

Tricyclic Anti-depressant

Flunarizine:-

Tablet 6:-Norium 10 mg (AS A Flunarizine AS A Miscellaneous prophylactic migraine preparations).

Indications of Tablet :-Norium 10 mg (AS A Flunarizine AS A Miscellaneous prophylactic migraine preparations).

Norium is indicated for

Prophylaxis of classic (with aura) or common (without aura) migraine
Symptomatic treatment of vestibular vertigo (due to a diagnosed functional disorder of the vestibular system).
Peripheral Vascular Disease (PVD)
Motion sickness
Refractory epilepsy resistant to conventional antiepileptic therapy.

Pharmacology of Tablet :-Norium 10 mg (AS A Flunarizine AS A Miscellaneous prophylactic migraine preparations).

Flunarizine is the difluorinated derivative of cinnarizine. It is a selective calcium channel antagonist. By reducing excessive transmembrane influx of calcium Flunarizine prevents cellular calcium overload. It does not interfere with normal cellular calcium homeostasis. Flunarizine also has some antihistaminic and sedative properties. It binds at an affinity of 99% to plasma protein.

Dosage & Administration of Tablet :-Norium 10 mg (AS A Flunarizine AS A Miscellaneous prophylactic migraine preparations).

Migraine Prophylaxis:

Starting Dose: 10 mg at night in patients less than 65 years of age and 5 mg daily in patients older than 65 years. If, during this treatment depressive, extrapyramidal or other unacceptable symptoms occur, administration should be discontinued. If, after 2 months of this initial treatment, no significant improvement is observed, the patient should be considered a non-responder and administration should be discontinued.
Maintenance Treatment: If a patient is responding satisfactorily and if a maintenance treatment is needed, the dose should be decreased to 5 days treatment at the same daily dose with two successive medicine free days every week. Even if the prophylactic maintenance treatment is successful and well tolerated, it should be interrupted after 6 months and it should be re-initiated only if the patient relapses.

Peripheral Vascular disease: 10 mg twice daily, up to 30 mg per day if required.

Vertigo & motion sickness: 10-20 mg daily for adults and 5 mg daily for children (> 40 kg).

Epileptic seizure: 15-20 mg daily in adults and 5 to 10 mg daily for children as an add-on therapy

Interaction of Tablet :-Norium 10 mg (AS A Flunarizine AS A Miscellaneous prophylactic migraine preparations).

Galactorrhoea has been reported in few women on oral contraceptives within the first two months of Norium treatment. Hepatic enzyme inducers such as Carbamazepine and Phenytoin may interact with Norium by increasing its metabolism. So an increase in dosage of Norium may be required.

Contraindications of Tablet :-Norium 10 mg (AS A Flunarizine AS A Miscellaneous prophylactic migraine preparations).

Hypersensitivity to Flunarizine. Flunarizine is contra-indicated in patients with a history of depressive illness, or with pre-existing symptoms of Parkinson’s disease or other extrapyramidal disorders.

Side Effects of Tablet :-Norium 10 mg (AS A Flunarizine AS A Miscellaneous prophylactic migraine preparations).

Drowsiness and/or fatigue, as well as weight gain and/or increased appetite may occur. The following adverse experiences have been reported during chronic treatment with Norium: depression, of which female patients with a history of depressive illness may be particularly at risk; extrapyramidal symptoms (such as bradykinesia, rigidity, akathisia, orofacial dyskinesia, tremor), of which elderly patients seem particularly at risk. Infrequently reported adverse reaction are: heartburn; nausea; gastralgia; insomnia; anxiety; galactorrhoea; dry mouth; muscle ache; skin rash.

Pregnancy & Lactation of Tablet :-Norium 10 mg (AS A Flunarizine AS A Miscellaneous prophylactic migraine preparations).

Safety in pregnancy and lactation has not been established.

Therapeutic Class of Tablet :-Norium 10 mg (AS A Flunarizine AS A Miscellaneous prophylactic migraine preparations).

Miscellaneous prophylactic migraine preparations

Migraine এর চিকিৎসার সাথে সাথে সকল Triggering factor ও Avoid করবে—

রোদে যাওয়া, চা, কফি, চকলেট, অতি উচ্চ শব্দ এইসব মাইগ্রেন ট্রিগার করে-

Raiyyan Tahsan Date:31-01-2025 Friday Time:7-23-45 Pm

Raiyyan Tahsan

Raiyyan Tahsan