Neurology Case No.6 Migrain-1

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Neurology Case No.6 Migrain-1

মাথা_ব্যাথার_ঔষধ_খেয়ে_মাথা_ব্যাথা_Mx

হাসিনা ৩২ বছর বয়স- ওনার সমস্যা মাথা ব্যাথা– মাসে ২-৩ বার মাথা ব্যাথা উঠে, ব্যাথার সময় বমি বমি ভাব হয়-

তিনি দোকান থেকে এনে একটা Tufnil খান, খেলে ভালো লাগে— রোদে গেলেই ওনার মাথা ব্যাথা শুরু হয়–৷

গ্রামের মহিলা, রোদে কাজ করা লাগে, তাই তিনি ব্যাথার জন্য নিয়মিত একটা করে Tufnil খান, মাঝেমধ্যে Naprosyn খান- এইভাবে প্রতি মাসে উনি ১০-১৫ দিন ব্যাথার ঔষধ খেয়ে ব্যাথা কন্ট্রোল রাখেন– কিন্ত এখন সমস্যা হচ্ছে কোনো ব্যাথার ঔষধে ওনার ব্যাথা যায়না–

আপনি Triptan দিলেন– সেটা দিয়েও ব্যাথা যাচ্ছেনা,।

আপনি হিস্ট্রি নিলেন–

মা, আপনার কখন ব্যাথা হয়?

রোদে গেলে ব্যাথা হয়,

ব্যাথার আগে আপনি বুঝতে পারেন?

হ্যাঁ, বুঝতে পারি, একটু পরে আমার ব্যাথা হবে–

মাথা ব্যাথার সাথে বমি হয়?

জ্বি, প্রায় সময় বমির ভাব হয়, মাঝেমধ্যে বমি হয়েও যায়-

ব্যাথা হলে কি করতে ভালো লাগে?

অন্ধকারে শুয়ে থাকতে ভালো লাগে-

সব শুনে আপনার মনে হলো, এইটা Migraine এর ব্যাথা, পেশেন্ট টা দীর্ঘদিন থেকে migraine এ ভুগতেছে–

এখন কথা হলো,

সে Migraine এর ব্যাথা হিসাবে Tufnil /Naprosyn সব খেয়ে আসছে, আগে এইগুলি দিয়ে ব্যাথা চলে যেতো, এখন এইগুলো দিয়ে ব্যাথা যাচ্ছেনা, এমন কি Migraine এর powerful medicine, Suma triptan দিয়েও তার ব্যাথা যাচ্ছেনা— এখন কি করনীয়?

এই পেশেন্ট এর ডায়াগনোসিস কি হবে?

কিভাবে চিকিৎসা দিবেন?

প্রতি মাসে ১০-১৫ দিন মাথা ব্যাথা থাকলে তো লাইফ হেল হয়ে যাবে—

কিভাবে চিকিৎসার দিকে আগাবেন?

এই পেশেন্ট এর ডায়াগনোসিস প্রথমে যদিও Migraine ছিলো, কারণ তার রোদে গেলে ব্যাথা বাড়ে, ব্যাথার সাথে বমি থাকে, ব্যাথার আগে বুঝতে পারে, অন্ধকার ভালো লাগে, সব মিলিয়ে পেশেন্ট এর ডায়াগনোসিস মাইগ্রেন ছিলো,,,, কিন্ত মাইগ্রেনের চিকিৎসা সে নিজে নিজে করতে গিয়ে irrational use of NSAID ব্যবহার করেছে—

কেনো irrational বললাম?

মাইগ্রেনের চিকিৎসায় NSAID এর রোল আছে তা ঠিক আছে– কিন্ত মাসে যদি ২ বারের বেশি ব্যাথা উঠে, তখন মাইগ্রেনের prophylactic Treatment শুরু করতে হবে,

ধরুণ, কারো যদি মাসে ৬-৭ বার Migraine এর ব্যাথা উঠে, আর সে প্রতি বার ২ দিন করে ব্যাথার ঔষধ খায়, তাহলে প্রথম ২-৩ মাস এইটা খুব ভালো রেসপন্স করলেও একটা সময় এইটা আর রেস্পন্স করবেনা–

মাইগ্রেনের মাথা ব্যাথা হোক, কিংবা tension headache হোক, এইসব ব্যাথায় কেউ যদি অতিরিক্ত NSAID ব্যবহার করে, তাহলে প্রথম কিছুদিন এইসব পেইন কিলার দিয়ে পেইন কমলেও পরে আর পেইন কমবেনা,

অতিরিক্ত ব্যাথার ঔষধ এর কারণে তখন যে কন্ডিশন হয়, তাকে বলে medication overuse headache…

তাহলে হাসিনার ডায়াগনোসিস কি?

Medication overused headache.

হাসিনার চিকিৎসা কি হবে?

প্রথমত হাসিনার সকল ঔষধ বন্ধ করতে হবে–

এতে করে প্রথম ৫-৭ দিন হাসিনার প্রচন্ড মাথা ব্যাথা হবে— এই সময় ধৈর্য্য ধরবে, বরফ লাগাতে পারে, কিংবা রেস্ট নিবে–

এর পর Migraine Dx হলে Migraine prophylaxis শুরু করবে– propranolol /sodium valproate/Topiramete /Amitryptiline /Flunarizine

propranolol:-

Tablet 1. Indever 10 mg Propranolol Hydrochloride (AS A Beta-adrenoceptor blocking drugs, Beta-blockers). For used AS a Migraine prophylaxis

Indications of Tablet:-Indever 10 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 10 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 10 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 10 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 10 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 10 mg Propranolol Hydrochloride (AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

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

Pregnancy & Lactation of Tablet:-Indever 10 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 10 mg Propranolol Hydrochloride (AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Beta-adrenoceptor blocking drugs, Beta-blockers

Amitryptiline

Tablet 2.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 3:-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

Topiramete:-

Tablet 4.Topirva 25mg (AS A Topiramete AS A Adjunct anti-epileptic drugs).

Indications of Tablet:-Topirva 25mg (AS A Topiramete AS A Adjunct anti-epileptic drugs).

Epilepsy: Topirva is indicated as monotherapy in adults and children aged 6 years and above with newly diagnosed epilepsy who have generalised tonic-clonic seizures or partial seizures with or without secondarily generalised seizures. Topirva is indicated as adjunctive therapy for adults and children over 2 years of age who are inadequately controlled on conventional first line antiepileptic drugs for partial seizures with or without secondarily generalised seizures; seizures associated with Lennox Gastaut Syndrome and primary generalised tonic-clonic seizures.

Migraine: Topirva is indicated in adults for the prophylaxis of migraine headache. Prophylactic treatment of migraine may be considered in situations such as: adults experiencing three or more migraine attacks per month; frequent migraine attacks that significantly interfere with the patient’s daily routine. Continuing therapy should be reviewed every six months.

Pharmacology of Tablet:-Topirva 25mg (AS A Topiramete AS A Adjunct anti-epileptic drugs).

A seizure is an abnormal and unregulated electrical discharge occurring in the brain. This leads to a transient interruption in brain function, manifested by reduced alertness, abnormal sensations, and focal involuntary movements or convulsions. Several types of seizures exist, with common types including tonic-clonic seizures and partial onset seizures.

The exact mechanisms by which topiramate exerts pharmacological actions on seizures and migraines are currently not fully characterized. Several properties of this drug, however, are likely to contribute to its therapeutic effects. Topiramate has been observed to exert actions on voltage-dependent sodium channels, GABA receptors, and glutamate receptors.

Topiramate stimulates GABA-A receptor activity at brain non-benzodiazepine receptor sites and reduces glutamate activity at both AMPA and kainate receptors. Normally, GABA-A receptors are inhibitory and glutaminergic receptors are stimulatory for neuronal activity. By increasing GABA activity and inhibiting glutamate activity, topiramate blocks neuronal excitability, preventing seizures and migraines. Additionally, it blocks the voltage-dependent sodium channels, further blocking seizure activity. Topiramate has been shown to inhibit various carbonic anhydrase isozymes, but the clinical significance of this is unknown at this time.

Dosage & Administration of Tablet:-Topirva 25mg (AS A Topiramete AS A Adjunct anti-epileptic drugs).

Epilepsy: Monotherapy:

Adults and children over 16 years: Titration should begin at 25 mg nightly for 1 week. The dosage should then be increased at 1- or 2-week intervals by increments of 25 or 59 mg/day, administered in two divided doses. The recommended initial target dose for topiramate monotherapy in adults with newly diagnosed epilepsy is 100 mg/day and the maximum recommended daily dose is 400 mg.
Children aged 6-16 years: Treatment of children aged 6 years and above should begin at 0.5 to 1 mg/kg nightly for the first week. The dosage should then be increased at 1- or 2-week intervals by increments of 0.5 to 1 mg/kg/day, administered in two divided doses. The recommended initial target dose range for topiramate monotherapy in children with newly diagnosed epilepsy aged 6 years and above is 3 to 6 mg/kg/day. Higher doses have been tolerated and rarely doses up to 16 mg/kg/day have been given.

Epilepsy: Adjunctive therapy:

Adults and children over 16 years: The minimal effective dose as adjunctive therapy is 200 mg per day. The usual total daily dose is 200 mg to 400 mg in two divided doses. Some patients may require doses up to 800 mg per day, which is the maximum recommended dose.
Children aged 2-16 years: The recommended total daily dose of Topiramate as adjunctive therapy is approximately 5 to 9 mg/kg/day in two divided doses. Titration should begin at 25 mg nightly for the first week. The dosage should then be increased at 1- or 2-week intervals by increments of 1 to 3 mg/kg/day (administered in two divided doses), to achieve optimal clinical response. Dose titration should be guided by clinical outcome. Daily doses up to 30 mg/kg/day have been studied and were generally well tolerated.

Migraine:

Adults and children over 16 years: Titration should begin at 25 mg nightly for 1-week. The dosage should then be increased in increments of 25 mg/day administered at 1-week intervals. The recommended total daily dose of topiramate as treatment for the prophylaxis of migraine headache is 100 mg/day administered in two divided doses. Some patients may experience a benefit at a total daily dose of 50 mg/day.
Children: Topiramate in migraine prophylaxis has not been studied in children under 16 years.

Contraindications of Tablet:-Topirva 25mg (AS A Topiramete AS A Adjunct anti-epileptic drugs).

Hypersensitivity to any component of this product.

Side Effects of Tablet:-Topirva 25mg (AS A Topiramete AS A Adjunct anti-epileptic drugs).

Nausea, abdominal pain, dyspepsia, diarrhoea, dry mouth, taste disturbance, weight loss, anorexia, paraesthesia, hypoaesthesia, headache, fatigue, dizziness, speech disorder, drowsiness, insomnia, impaired memory & concentration, anxiety, depression, visual disturbance, lesscommonly: sucidal ideation, rarely: reduced sweetening mainly children, metabolic acidosis and alopecia, very rarely: Leucopenia, thrombocytopenia and serious skin reaction.

Pregnancy & Lactation of Tablet:-Topirva 25mg (AS A Topiramete AS A Adjunct anti-epileptic drugs).

Topiramate should not be used during pregnancy unless, in the opinion of the physician, the potential benefit outweighs the potential risk to the foetus. Topiramate should not be used during breastfeeding.

Therapeutic Class of Tablet:-Topirva 25mg (AS A Topiramete AS A Adjunct anti-epileptic drugs).

Adjunct anti-epileptic drugs

Sodium valproate:-

Tablet 5:-Valex 200 mg (AS A Sodium valproate AS A Primary anti-epileptic drugs).

Indications of Tablet :-Valex 200 mg (AS A Sodium valproate AS A Primary anti-epileptic drugs).

Valex is indicated for the treatment of all types of epilepsy, e.g.

Partial seizures
Absence seizures (petit mal)
Generalized tonic-clonic seizures (grand mal)
Myoclonic seizures
Atonic seizures
Mixed seizures that include absence attack
Prophylaxis of febrile convulsion
Prophylaxis of post-traumatic epilepsy.

Valex is also indicated in the treatment of bipolar disorder & prophylaxis of migraine.

Composition of Tablet :-Valex 200 mg (AS A Sodium valproate AS A Primary anti-epileptic drugs).

Sodium Valproate tablet: Each enteric-coated tablet contains Sodium Valproate BP 200 mg.
Sodium Valproate syrup: Each 5 ml syrup contains Sodium Valproate BP 200 mg.
Sodium Valproate controlled release 200 tablet: Each enteric-coated controlled release tablet contains Sodium Valproate 200 mg as Sodium Valproate BP 133.2 mg & Valproic acid BP 58 mg.
Sodium Valproate controlled release 300 tablet: Each enteric-coated controlled release tablet contains Sodium Valproate 300 mg as Sodium Valproate BP 199.8 mg & Valproic acid BP 87 mg.
Sodium Valproate controlled release 500 tablet: Each enteric-coated controlled release tablet contains Sodium Valproate 500 mg as Sodium Valproate BP 333 mg & Valproic acid BP 145 mg.
Sodium Valproate injection: Each 5 ml injectable solution contains Sodium Valproate BP eqv. to Valproic Acid 500 mg.

Pharmacology of Tablet :-Valex 200 mg (AS A Sodium valproate AS A Primary anti-epileptic drugs).

Sodium Valproate, the active ingredient of this preparation is endowed with anti-epileptic activity against a variety of seizures. The mechanism by which Sodium Valproate exerts its anti-epileptic effects has not been established. However, it has been suggested that its activity is related to increase brain levels of gamma-aminobutyric acid (GABA).

Dosage & Administration of Tablet :-Valex 200 mg (AS A Sodium valproate AS A Primary anti-epileptic drugs).

Oral: Sodium Valproate tablets may be given once or twice daily and syrup should be given in divided doses.

Epilepsy:

Adult: Initially, 600 mg daily is given in 2 divided doses, preferably after food, increasing by 200 mg/day at 3-day intervals to a maximum of 2.5 g daily in divided doses until control of seizure is achieved. Usual maintenance dose is 1-2 g daily (20-30 mg/kg daily).
Children (over 20 kg)– Initially 400 mg daily in divided doses increased until control (usually in the range of 20-30 mg/kg daily); Maximum 35 mg/kg daily.
Children (up to 20 kg)– Initially 20 mg/kg daily in divided doses.

Febrile convulsion: 20-30 mg/kg/day in 3 divided doses.

Bipolar disorder: Initially 600 mg daily (20-30 mg/kg/day) in 2-3 divided doses. The maintenance dosage is 1000-2000 mg daily.

Prophylaxis of migraine: 400-600 mg daily, although some may require 1000-1500 mg daily.

Injection:

Adults– May be given a slow intravenous injection over 3-5 minutes, usually 400-800 mg depending on body weight (up to 10 mg/kg) followed by continuous or repeated infusion up to a maximum of 2500 mg/day.
For children– Initial: 20-30 mg/kg/day, Maximum: 40 mg/kg/day. It may be given by direct slow intravenous injection or by infusion using compatible diluents e.g. 0.9% Sodium Chloride injection, 5% Dextrose injection.

Interaction of Tablet :-Valex 200 mg (AS A Sodium valproate AS A Primary anti-epileptic drugs).

Valex Vaiproate appears to act as a non specific inhibitor of drug metabolism. Drugs to which it interacts most significantly are Phenobarbital, Phenytoin, Warfarin, Aspirin etc.

Contraindications of Tablet :-Valex 200 mg (AS A Sodium valproate AS A Primary anti-epileptic drugs).

Sodium Valproate is contraindicated to patients who have known hypersensitivity to the drug and liver dysfunction. Use of Sodium Valproate is restricted during pregnancy and in women of childbearing potential.

Side Effects of Tablet :-Valex 200 mg (AS A Sodium valproate AS A Primary anti-epileptic drugs).

The most common side effects are anorexia, nausea and vomiting. However, these side effects are minimized with the use of enteric coated tablets. Effects on the CNS include sedation, ataxia and tremor. These symptoms occur infrequently and usually respond to a decrease in doses. Rash, alopecia and stimulation of appetite have been observed occasionally. Valex Vaiproate has several effects on hepatic function of which elevation of liver enzymes in plasma is observed in up to 40% of patients and often occurs asymptomatically during the first few months of therapy. Rarely a fulminate hepatitis that may be fatal may develop. Children below 2 years of age with other medical conditions and those being treated with multiple antiepileptic agents are specially prone to suffer from hepatic injury, acute pancreatitis and hyperammonemia have also been frequently associated with the use of Valex.

Pregnancy & Lactation of Tablet :-Valex 200 mg (AS A Sodium valproate AS A Primary anti-epileptic drugs).

Sodium Vaiproate crosses the placenta and in humans, exposure to valproate in the first trimester has been associated with neural tube defects such as anencephaly and spina bifida in newborn. Pregnant women treated with Sodium Vaiproate should be offered to estimate serum a-fetoprotein. Sodium Valproate is excreted in breast miik. However, breast-feeding by a mother taking Sodium Valproate probably causes no risk to the child.

Tension headache হলেও একই চিকিৎসা, প্রথম ১-২ সপ্তাহ dull headache থাকতে পারে, পরে ঠিক হয়ে যাবে-

GENERAL QUERIES NO.1দেড় থেকে দুই বছর ধরে Amitriptyline 10 খেয়ে যাচ্ছে তার পরেও মাসে ২/১ বার এটাক দেয়।

এখন কি অন্য কোনোটা শুরু করবে?

Answer is:-মাসে ১-২ Attack মানে আপনার migraine controll এ আছে–Norium 10 mg add করতে পারেn.

Raiyyan Tahsan. Date:21-01-2025 Tuesday Time:8-21-45 PM

Raiyyan Tahsan

Raiyyan Tahsan