Gastroenterology Case No11. Bulimia Nervosa

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Gastroenterology Case No11. Bulimia Nervosa

Bulimia nervosa( Eating ডিসঅর্ডার) Only 𝐅𝐥𝐮𝐨𝐱𝐞𝐭𝐢𝐧𝐞 is ড্রাগ অফ চয়েজ

Bulemia nervosa* pt অতিরিক্ত মাত্রায় খাবার খেয়ে ফেলেন, আর পরে সেই খাবারকে শরীর থেকে বের করে দেওয়া সব রকম Try করে…..যখন তাদের মন খারাপ লাগে তখন তারা প্রচুর পরিমানে খাবার খেয়ে ফেলেন, প্রায়ই লুকিয়ে।lতার কিছুক্ষণ পরেই, তাদের অপরাধবোধ হয় আর এত খেয়ে ফেলার জন্য তারা লজ্জিত বোধ করেন; তাই প্রায়শ্চিত্ত করার মনোভাব নিয়ে সেই খাবারকে শরীর থেকে বমি করে বা ব্যায়াম করে বার করে দেওয়ার চেষ্টা করেন।

এই ধরনের অপরাধবোধ নিজেদের শারীরিক গঠন নিয়ে অসন্তোষ আর রোগা হওয়ার চাহিদার থেকে জন্মায়। নিজের শারীরিক গঠন নিয়ে যে ভ্রান্ত ধারণা থাকে তার কারনে আত্মবিশ্বাস কমে যায়। বমি করে বা অন্য ভাবে শরীর থেকে খাবারকে বার করে তারা মনে করেন যে নিজের জীবনের ওপর নিয়ন্ত্রণ রাখতে পারছেন। ওরা মনে করেন যে যদিও জীবনের অন্য বিষয়গুলী তারা নিয়ন্ত্রণ করতে পারছেন না, নিজেদের শরীর আর চেহারাকে তারা এইসব করে নিয়ন্ত্রিত করতে পারছেন।

Fluoxetine:-

Capsule1.Prolert 20mg (AS A Fluoxetine Hydrochloride AS A Phenothiazine related drugs).

Indications of Capsule:-Prolert 20mg (AS A Fluoxetine Hydrochloride AS A Phenothiazine related drugs).

Prolert is indicated for the treatment of-

depressive illness
bulimia nervosa
obsessive compulsive disorder.

Pharmacology of Capsule:-Prolert 20mg (AS A Fluoxetine Hydrochloride AS A Phenothiazine related drugs).

Fluoxetine has been shown to selectively inhibit the reuptake of serotonin at the presynaptic neuronal membrane which causes increased synaptic concentration of serotonin in the CNS. This result in numerous functional changes associated with enhanced serotonergic neurotransmission. Fluoxetine appears to have no effect on the reuptake of norepinephrine and dopamine and does not exhibit anticholinergic, antihistaminic or α1 adrenergic blocking activity at usual therapeutic doses.

Dosage & Administration of Capsule:-Prolert 20mg (AS A Fluoxetine Hydrochloride AS A Phenothiazine related drugs).

Initial treatment: Recent studies suggest that 20 mg/day of Fluoxetine may be sufficient to obtain satisfactory antidepressant response. Consequently, a dose of 20 mg/day administered in the morning is recommended as the initial dose.

A dose increase may be considered after several weeks if no clinical improvement is observed. Dosage above 20 mg/day, should be administered on a bid schedule (i.e. morning and noon) and should not exceed a maximum dose of 80 mg/day. As with other antidepressants, the full antidepressant effect may be delayed until 4 weeks of treatment or longer. As with many other medications, a lower or less frequent dosage should be used in patients with renal and/or hepatic impairment.

A lower or less frequent dosage should also be considered for patients, such as elderly, with concurrent disease or on multiple medication. A recommended maximum dose for elderly patients is 60 mg per day.

Maintenance treatment: It is generally agreed among expert psychopharmacologists that acute episode of depression requires several months or longer sustained pharmacologic therapy. Fluoxetine is also used in dosage of 60 mg daily for the management of bulimia nervosa.

Use in children: The use of Fluoxetine in children is not recommended as safety and efficacy have not been established.

Interaction of Capsule:-Prolert 20mg (AS A Fluoxetine Hydrochloride AS A Phenothiazine related drugs).

MAO inhibitors: Sometimes serious fatal reactions have been reported with concomitant use.
Antidepressants: There have been greater than two fold increases of previously stable plasma levels of other antidepressants.
Lithium: There have been reports of increased or decreased lithium levels when used concomitantly with Prolert.
Antipsychotics: Elevation of blood levels of haloperidol and clozapine has been observed in patients receiving concomitant Prolert.
Anticonvulsants: Patients on stable dose of phenytoin and carbamazepine have developed elevated plasma anticonvulsant concentrations and clinical anticonvulsant toxicity following initiation of concomitant fluoxetine treatment.
CNS active drugs: Caution is advised if concomitant administration of Prolert is required.

Contraindications of Capsule:-Prolert 20mg (AS A Fluoxetine Hydrochloride AS A Phenothiazine related drugs).

Fluoxetine Hydrochloride is contraindicated in patients known to be hypersensitive to it.

Monoamine oxidase inhibitors: There have been reports of serious, sometimes fatal reactions (including hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs and changes of mental status that include extreme agitation progressing to delirium and coma) in patients receiving Fluoxetine in combination with monoamine oxidase inhibitors (MAOIs), and in patients who have recently discontinued Fluoxetine and are then started on MAOIs. Some cases presented with features resembling neuroleptic malignant syndrome. Therefore, Fluoxetine should not be used in combination with MAOI, or within 14 days of discontinuing therapy with MAOI. Since Fluoxetine and its major metabolites have very long elimination half-lives, at least 5 weeks should be allowed after stopping Fluoxetine and before starting MAOI.

Side Effects of Capsule:-Prolert 20mg (AS A Fluoxetine Hydrochloride AS A Phenothiazine related drugs).

Gastrointestinal: Nausea, vomiting, dyspepsia, dry mouth, and diarrhoea.

Neurological: Anxiety, nervousness, insomnia/ drowsiness and fatigue.

Others: Excessive sweating, pruritus, skin rashes associated with liver, kidney and lung involvement. It has therefore been advised that Prolert therapy should be discontinued in any patient who develops a skin rash.

Pregnancy & Lactation

In animal studies, no teratogenicity or harmful effect was found. Because animal reproductive studies are not always predictive of human responses, Fluoxetine should be used in pregnancy only if clearly needed. As Fluoxetine is excreted in human milk, caution should be exercised when Fluoxetine is administered to nursing women.

Precautions & Warnings of Capsule:-Prolert 20mg (AS A Fluoxetine Hydrochloride AS A Phenothiazine related drugs).

As Prolert undergoes hepatic metabolism and renal excretion, it should be used with caution and in reduced doses in patients with impaired hepatic or renal function. Because of its epileptogenic effect, it should be used with caution in patients with epilepsy or a history of such disorders. Prolert may alter glycaemic control and therefore caution is also warranted in diabetic subjects. Depressed patients with suicidal tendencies should be carefully supervised during treatment. Prolert is not usually considered a suitable form of therapy for the depressive component of bipolar (manic depressive) illness as mania may be precipitated.

Therapeutic Class of Capsule:-Prolert 20mg (AS A Fluoxetine Hydrochloride AS A Phenothiazine related drugs).

Phenothiazine related drugs

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𝐅𝐢𝐛𝐫𝐨𝐦𝐲𝐚𝐥𝐠𝐢𝐚 Duloxetine,Venlafaxine,TCA& SSRI…

𝐅𝐢𝐛𝐫𝐨𝐦𝐲𝐚𝐥𝐠𝐢𝐚 হলো এমন রোগ যার কারণে সমস্ত শরীরের পেশী এবং Soft tissue ব্যথা হতে পারে। ফাইব্রোমায়ালজিয়ায় আক্রান্ত ব্যক্তিদের শরীরের অনেক জায়গা থাকে, যেগুলো স্পর্শ করলে অনেক ব্যথা হয়…..এর প্রকৃত কারণ এখনও অজানা…

Duloxetine:-

Tablet 1.Duloxen 60mg AS A Duloxetine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI).

Indications of Tablet:-Duloxen 60mg AS A Duloxetine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI).

Duloxen is a serotonin and norepinephrine reuptake inhibitor (SNRI) indicated for-

Major Depressive Disorder (MDD)
Generalized Anxiety Disorder (GAD)
Diabetic Peripheral Neuropathic Pain (DPNP)
Fibromyalgia and
Chronic Musculoskeletal Pain.

Pharmacology of Tablet:-Duloxen 60mg AS A Duloxetine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI).

Duloxetine Hydrochloride is a selective serotonin and norepinephrine reuptake inhibitor (SSNRI) for oral administration. Duloxetine is a less potent inhibitor of dopamine reuptake. Duloxetine has no significant affinity for dopaminergic, adrenergic, cholinergic, histaminergic, opioid, glutamate, and GABA receptors in vitro. Duloxetine does not inhibit monoamine oxidase (MAO). Orally administered Duloxetine hydrochloride is well absorbed. Elimination of Duloxetine is mainly through hepatic metabolism.

Dosage & Administration of Tablet:-Duloxen 60mg AS A Duloxetine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI).

Major Depressive Disorder (MDD)-

Starting Dose: 40 mg/day to 60 mg/day
Target Dose: Acute: 40 mg/day (20 mg twice daily) to 60 mg/day (once daily or as 30 mg twice daily); Maintenance: 60 mg/day
Maximum Dose: 120 mg/day

Generalized Anxiety Disorder (GAD)-

Starting Dose: 60 mg/day
Target Dose: 60 mg/day (once daily)
Maximum Dose: 120 mg/day

Diabetic Peripheral Neuropathic Pain (DPNP)-

Starting Dose: 60 mg/day
Target Dose: 60 mg/day (once daily)
Maximum Dose: 60 mg/day

Fibromyalgia-

Starting Dose: 30 mg/day
Target Dose: 60 mg/day (once daily)
Maximum Dose: 60 mg/day

Chronic Musculoskeletal Pain-

Starting Dose: 30 mg/day
Target Dose: 60 mg/day (once daily)
Maximum Dose: 60 mg/day

Some patients may benefit from starting at 30 mg once daily. There is no evidence that doses greater than 60 mg/day confers an additional benefit, while some adverse reactions were observed to be dose-dependent. A gradual dose reduction is recommended to avoid discontinuation symptoms.

Interaction of Tablet:-Duloxen 60mg AS A Duloxetine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI).

Both CYP1A2 and CYP2D6 isozymes are responsible for Duloxen metabolism. When Duloxen was co-administered with fluvoxamine, a potent CYP1A2 inhibitor, the AUC, Cmax and t of Duloxen was increased. Other drugs that inhibit CYP1A2 metabolism include cimetidine and quinolone antimicrobials such as ciprofloxacin and enoxacin would be expected to have similar effects and these combinations should be avoided. Because CYP2D6 is involved in Duloxen metabolism, concomitant use of Duloxen with potent inhibitors of CYP2D6 may result in higher concentrations of Duloxen.

Side Effects of Tablet:-Duloxen 60mg AS A Duloxetine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI).

The most commonly observed adverse events in Duloxen treated patients were nausea, dizziness, dry mouth, constipation, decreased appetite, fatigue, somnolence, increased sweating, hyperhidrosis and asthenia. It may slightly increase blood pressure. No clinically significant differences were observed for QT, PR, and QRS intervals between Duloxen-treated and placebo-treated patients.

Pregnancy & Lactation of Tablet:-Duloxen 60mg AS A Duloxetine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI).

Pregnancy: Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women; therefore, Duloxetine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Labor and Delivery: The effect of Duloxetine on labor and delivery in humans is unknown. Duloxetine should be used during labor and delivery only if the potential benefit justifies the potential risk to the fetus.

Lactation: It is unknown whether or not Duloxetine and/or it’s metabolites are excreted into human milk, but nursing while on Duloxetine is not recommended

Therapeutic Class of Tablet:-Duloxen 60mg AS A Duloxetine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI).

Serotonin-norepinephrine reuptake inhibitor (SNRI)

Venlafaxine:-

Tablet 2.Venlax 75mg (AS A Venlafaxine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI)).

Indications of Tablet:-Venlax 75mg (AS A Venlafaxine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI)).

Venlax tablets is indicated for the treatment of major depressive disorder.

The efficacy of venlafaxine tablets, in the treatment of major depressive disorder was established in 6 week controlled trials of adult outpatients whose diagnoses corresponded most closely to the DSM-III or DSM-III-R category of major depression and in a 4 week controlled trial of inpatients meeting diagnostic criteria for major depression with melancholia

A major depressive episode implies a prominent and relatively persistent depressed or dysphoric mood that usually interferes with daily functioning (nearly every day for at least 2 weeks); it should include at least 4 of the following 8 symptoms: change in appetite, change in sleep, psychomotor agitation or retardation, loss of interest in usual activities or decrease in sexual drive, increased fatigue, feelings of guilt or worthlessness, slowed thinking or impaired concentration, and a suicide attempt or suicidal ideation.

The efficacy of Venlax extended-release capsules in maintaining an antidepressant response for up to 26 weeks following 8 weeks of acute treatment was demonstrated in a placebocontrolled trial. The efficacy of venlafaxine tablets in maintaining an antidepressant response in patients with recurrent depression who had responded and continued to be improved during an initial 26 weeks of treatment and were then followed for a period of up to 52 weeks was demonstrated in a second placebo-controlled trial (see Clinical Trials). Nevertheless, the physician who elects to use venlafaxine tablets / extended-release capsules for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient.

Pharmacology of Tablet:-Venlax 75mg (AS A Venlafaxine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI)).

The exact mechanism of action of venlafaxine is unknown, but appears to be associated with the its potentiation of neurotransmitter activity in the CNS. Venlafaxine and its active metabolite, O-desmethylvenlafaxine (ODV), inhibit the reuptake of both serotonin and norepinephrine with a potency greater for the 5-HT than for the NE reuptake process. Both venlafaxine and the ODV metabolite have weak inhibitory effects on the reuptake of dopamine but, unlike the tricyclics and similar to SSRIs, they are not active at histaminergic, muscarinic, or alpha(1)-adrenergic receptors.

Dosage & Administration of Tablet:-Venlax 75mg (AS A Venlafaxine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI)).

Initial Treatment: The recommended starting dose for venlafaxine tablets is 75 mg/day, administered in two or three divided doses, taken with food. Depending on tolerability and the need for further clinical effect, the dose may be increased to 150 mg/day. If needed, the dose should be further increased up to 225 mg/day. When increasing the dose, increments of up to 75 mg/day should be made at intervals of no less than 4 days. In outpatient settings there was no evidence of usefulness of doses greater than 225 mg/day for moderately depressed patients, but more severely depressed inpatients responded to a mean dose of 350 mg/day. Certain patients, including more severely depressed patients, may therefore respond more to higher doses, up to a maximum of 375 mg/day, generally in three divided doses

Dosage For Elderly Patients: No dose adjustment is recommended for elderly patients on the basis of age. As with any antidepressant, however, caution should be exercised in treating the elderly. When individualizing the dosage, extra care should be taken when increasing the dose.

Maintenance Treatment: It is generally agreed that acute episodes of major depressive disorder require several months or longer of sustained pharmacological therapy beyond response to the acute episode. In one study, in which patients responding during 8 weeks of acute treatment with venlafaxine hydrochloride extendedrelease capsules were assigned randomly to placebo or to the same dose of venlafaxine hydrochloride extended-release capsules (75, 150, or 225 mg/day, qAM) during 26 weeks of maintenance treatment as they had received during the acute stabilization phase, longer-term efficacy was demonstrated. A second longer-term study has demonstrated the efficacy of venlafaxine tablets in maintaining an antidepressant response in patients with recurrent depression who had responded and continued to be improved during an initial 26 weeks of treatment and were then randomly assigned to placebo or venlafaxine tablets for periods of up to 52 weeks on the same dose (100 to 200 mg/day, on a b.i.d. schedule) (see Clinical Trials). Based on these limited data, it is not known whether or not the dose of venlafaxine tablets / extended-release capsules needed for maintenance treatment is identical to the dose needed to achieve an initial response. Patients should be periodically reassessed to determine the need for maintenance treatment and the appropriate dose for such treatment.

Discontinuing Venlafaxine Tablet: Symptoms associated with discontinuation of venlafaxine tablets, other SNRIs, and SSRIs, have been reported. Patients should be monitored for these symptoms when discontinuing treatment. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate.

Interaction of Tablet:-Venlax 75mg (AS A Venlafaxine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI)).

Increased risk of serotonin syndrome with TCA, SSRI, SNRI, lithium, sibutramine, tramadol. May increase serum levels with CYP3A4 inhibitors (e.g. ketoconazole, atazanavir, clarithromycin). May increase serum levels of haloperidol. May decrease serum levels of indinavir. May increase bleeding risk with aspirin, NSAIDs, warfarin and other anticoagulants.

Contraindications of Tablet:-Venlax 75mg (AS A Venlafaxine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI)).

Concomitant use with MAOIs or within 14 days of discontinuing the MAOI. Use with linezolid or IV methylene blue.

Side Effects of Tablet:-Venlax 75mg (AS A Venlafaxine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI)).

Changes in behaviour, suicidal ideation, agitation, tremor, nervousness, anxiety, insomnia, confusions, abnormal dreams, HTN, nausea, headache, asthenia, somnolence, dizziness, dry mouth, vomiting, constipation, diarrhoea, dyspepsia, abdominal pain, anorexia, sexual dysfunction, urinary frequency, visual disturbances, mydriasis, vasodilatation, paraesthesia, hypertonia, chills or fever, palpitations, wt gain or loss, arthralgia, myalgia, tinnitus, pruritus, dyspnoea, yawning, rashes, sweating, increased serum cholesterol, may impair platelet aggregation.

Pregnancy & Lactation of Tablet:-Venlax 75mg (AS A Venlafaxine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI)).

Treatment Of Pregnant Women During The Third Trimester
Neonates exposed to venlafaxine tablets, USP, other SNRIs, or SSRIs, late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. When treating pregnant women with venlafaxine tablets during the third trimester, the physician should carefully consider the potential risks and benefits of treatment.

Precautions & Warnings of Tablet:-Venlax 75mg (AS A Venlafaxine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI)).

History of MI or unstable cardiac disease, seizure; hypomania or mania, increased intraocular pressure or at risk of acute narrow-angle galaucoma, at risk of bleeding. Renal and hepatic impairment. Gradual dose reduction is recommended rather than abrupt withdrawal. Pregnancy and lactation. Patient Counselling May impair ability to drive or operate machinery.

Use in Special Populations

Dosage For Patients With Hepatic Impairment: Given the decrease in clearance and increase in elimination half-life for both venlafaxine and ODV that is observed in patients with hepatic cirrhosis and mild and moderate hepatic impairment compared to normal subjects, it is recommended that the total daily dose be reduced by 50% in patients with mild to moderate hepatic impairment. Since there was much individual variability in clearance between subjects with cirrhosis, it may be necessary to reduce the dose even more than 50%, and individualization of dosing may be desirable in some patients.

Dosage For Patients With Renal Impairment: Given the decrease in clearance for venlafaxine and the increase in elimination half-life for both venlafaxine and ODV that is observed in patients with renal impairment (GFR = 10 to 70 mL/min) compared to normals, it is recommended that the total daily dose be reduced by 25% in patients with mild to moderate renal impairment. It is recommended that the total daily dose be reduced by 50% in patients undergoing hemodialysis. Since there was much individual variability in clearance between patients with renal impairment, individualization of dosing may be desirable in some patients.

Overdose Effects of Tablet:-Venlax 75mg (AS A Venlafaxine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI)).

Symptoms: Sweating, dizziness, somnolence, mydriasis, convulsions, vomiting, ECG changes, cardiac arrhythmias and seizures.

Management: Symptomatic and supportive treatment. Ensure adequate airway, oxygenation and ventilation. Initiate gastric lavage immediately after ingestion. Admin activated charcoal to reduce absorption. Monitor cardiac rhythm and vital signs.

Therapeutic Class of Tablet:-Venlax 75mg (AS A Venlafaxine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI)).

Serotonin-norepinephrine reuptake inhibitor (SNRI)

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𝐎𝐛𝐞𝐬𝐢𝐭𝐲 তে Sibutramin( Tab Obenil)

-Simaglutide

এটি (Semaglutide) Dm er Medicine **+ Jader Dm নেই তারাও ওজন কমাতে পারবে..

এটি GLP1RA (Semaglutide)

বেশ ভালোই ওজন কমানো যায়!! এক সার বলছিলেন প্রায় ১০ কেজি ও কমানো যায়..

Side effect o kom..

তবে এইটাCostly + injected form..

চামড়ার নিচে 1টা করে per week..long time dite hoy..

Price 1500 tk may b!

তবে অনেকেই বলে ২/৩ কেজি কমে পরে আর কমে না নাকি

Best Diet , Exercise!!!

Injection 3.Semazic SC Injection (0.25mg/0.188ml AS A Semaglutide GLP-1 receptor agonists).

Indications of Injection:-Semazic SC Injection (0.25mg/0.188ml AS A Semaglutide GLP-1 receptor agonists).

For Diabetes: Semazic is indicated in-

An adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus
To reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus and established cardiovascular disease

For Obesity: An adjunct to a reduced calorie diet and increased physical activity for chronic weight management in adult patients with an initial body mass index (BMI) of:

30 kg/m² or greater (Obesity) or
27 kg/m² or greater (Overweight) in the presence of at least one weight-related comorbid condition (e.g. hypertension, type 2 diabetes mellitus or dyslipidemia).

Pharmacology of Injection:-Semazic SC Injection (0.25mg/0.188ml AS A Semaglutide GLP-1 receptor agonists).

Semaglutide is a GLP-1 analogue with 94% sequence as same as to human GLP-1. Semaglutide acts as a GLP-1 receptor agonist that selectively binds to and activates the GLP-1 receptor. Semaglutide reduces blood glucose in a glucose dependent manner by stimulating insulin secretion and lowering glucagon secretion when blood glucose is high. The mechanism of blood glucose lowering also involves a minor delay in gastric emptying. During hypoglycemia, Semaglutide diminishes insulin secretion and does not impair glucagon secretion. Semaglutide reduces body weight and body fat mass by an overall reduced appetite.

Dosage & Administration of Injection:-Semazic SC Injection (0.25mg/0.188ml AS A Semaglutide GLP-1 receptor agonists).

For Diabetes:

Semaglutide Tablet: Take Semaglutide at least 30 minutes before the first food, beverage, or other oral medications of the day with no more than 4 ounces (118 ml) of plain water only.

Starter Dose: Start Semaglutide with 3 mg once daily for 30 days
Maintenance Dose: After 30 days on the 3 mg dose, increase the dose to 7 mg once daily
For Additional Glycemic Control: If additional glycemic control is needed after at least 30 days on the 7 mg dose, the dose can be increased to 14 mg once daily

Semaglutide injection: The starting dose is 0.25 mg Semaglutide once weekly. After 4 weeks the dose should be increased to 0.5 mg once weekly. After at least 4 weeks with a dose of 0.5 mg once weekly, the dose can be increased to 1 mg once weekly to further improve glycemic control. Weekly doses higher than 1 mg are not recommended. Semaglutide is to be administered once weekly at any time of the day with or without meals. Semaglutide is to be injected subcutaneously in the abdomen, thigh or in upper arm. The injection site can be changed without dose adjustment. Semaglutide should not be administered intravenously or intramuscularly. The day of weekly administration can be changed if necessary as long as the time between two doses is at least 3 days (>72 hours). After selecting a new dosing day, once weekly dosing should be continued.

Switching patients between Semaglutide injection and Semaglutide tablet-

Patients treated with once weekly Semaglutide injection 0.5 mg subcutaneous injection can be transitioned to Semaglutide 7 mg or 14 mg tablet. Patients can start Semaglutide tablet up to 7 days after their last injection of Semaglutide injection. There is no equivalent dose of Semaglutide tablet for Semaglutide injection 1 mg
Patients treated with Semaglutide 14 mg tablet daily can be transitioned to Semaglutide subcutaneous injection 0.5 mg once weekly. Patients can start Semaglutide injection the day after their last dose of Semaglutide tablet.

For Obesity: The starting dose is 0.25 mg Semaglutide once weekly for 4 weeks subcutaneously. If patients do not tolerate a dose during dose escalation, consider delaying dose escalation for 4 weeks. If patients do not tolerate the maintenance dose 2.4 mg, the dose can be temporarily decreased to 1.7 mg once weekly for maximum 4 weeks. After 4 weeks increase the dose to 2.4 mg. Weekly doses higher than 2.4 mg is not recommended. Semaglutide is to be administered once weekly at any time of the day with or without meals. Semaglutide is to be injected subcutaneously in the abdomen, thigh or in upper arm. The injection site can be changed without dose adjustment. Semaglutide should not be administered intravenously or intramuscularly. The day of weekly administration can be changed if necessary as long as the time between two doses is at least 2 days (>48 hours). After selecting a new dosing day, once weekly dosing should be continued.

Interaction of Injection:-Semazic SC Injection (0.25mg/0.188ml AS A Semaglutide GLP-1 receptor agonists).

With medicine: Semazic delays gastric emptying which may influence the absorption of other oral medications. Trials were conducted to study the potential effect of Semazic on the absorption of oral medicinal products taken with Semazic administered orally at steady state exposure.

With food & others: Concomitant intake of food reduces the exposure of Semazic.

Contraindications of Injection:-Semazic SC Injection (0.25mg/0.188ml AS A Semaglutide GLP-1 receptor agonists).

Semaxen is contraindicated in patients who are hypersensitive to Semaxen or to any ingredient in the formulation, including any non-medicinal ingredient, or component of the container.
Semaxen is contraindicated in patients who have a personal or family history of Medullary Thyroid Carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
Semaxen s hould not be used during pregnancy or breastfeeding.

Side Effects of Injection:-Semazic SC Injection (0.25mg/0.188ml AS A Semaglutide GLP-1 receptor agonists).

Common side effects: Vomiting, stomach upset or indigestion inflamed stomach, reflux or heartburn or GERD, stomach pain, bloating of the stomach, constipation, change in the way food or drink tastes, tiredness, less appetite, gas (flatulence), increase of pancreatic enzymes (such as lipase and amylase).

Rare side effects: Serious allergic reactions (anaphylactic reactions). You should seek immediate medical help and inform your doctor straight away if you get symptoms such as breathing problems, swelling of face and throat, wheezing, fast heartbeat, pale and cold skin, feeling dizzy or weak.

Pregnancy & Lactation of Injection:-Semazic SC Injection (0.25mg/0.188ml AS A Semaglutide GLP-1 receptor agonists).

Pregnancy: The extent of exposure in pregnancy during clinical trials was very limited and there are no adequate and well controlled studies of Semaglutide in pregnant women. Therefore, Semaxen should not be used during pregnancy. If a patient wishes to become pregnant, or pregnancy occurs, Semaxen should be discontinued. Semaxen should be discontinued at least 2 months before a planned pregnancy due to the long half-life of Semaglutide.

Lactation: There are no data on the presence of Semaglutide in human milk, the effects on the breastfed infant, or the effects on milk production. Because of the unknown potential for serious adverse reactions in the breastfed infant due to the possible accumulation of salcaprozate sodium (SNAC), an absorption enhancer in Semaxen, from breastfeeding and because there are alternative formulations of Semaglutide that can be used during lactation, advise patients that breastfeeding is not recommended during treatment with Semaxen. Discontinue Semaxen in women at least 2 months before a planned pregnancy due to the long washout period for Semaglutide.

Precautions & Warnings of Injection:-Semazic SC Injection (0.25mg/0.188ml AS A Semaglutide GLP-1 receptor agonists).

Should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. Patients should be advised to take precautions to avoid hypoglycemia while driving and using machines. Semazic causes an increase in heart rate. Caution should be observed in patients who have cardiac conditions that might be worsened by an increase in heart rate, such as tachyarrhythmias. Patients treated with Semazic in combination with an insulin secretagogue (e.g., sulfonylureas) or insulin may have an increased risk of hypoglycemia. The risk of hypoglycemia may be lowered by reducing the dose of the secretagogue or insulin when initiating treatment with Semaxen.

Use in Special Populations

Pediatric population: The safety and efficacy of Semazic in children and adolescents below 18 years have not yet been established. No data are available.

Elderly: No dose adjustment is required based on age.

Renal impairment: No dose adjustment is required for patients with mild moderate or severe renal impairment. Semazic is not recommended for use in patients with end-stage renal disease.

Hepatic impairment: No dose adjustment is required for patients with hepatic impairment. Caution should be exercised when treating these patients with Semazic.

Overdose Effects of Injection:-Semazic SC Injection (0.25mg/0.188ml AS A Semaglutide GLP-1 receptor agonists).

Overdose: Overdose of up to 4 mg in a single dose and up to 4 mg in a week have been reported in clinical trials. The most commonly reported adverse reaction was nausea. There is no specific antidote for overdose with Semazic. In the event of overdose appropriate supportive treatment should be initiated according to the patients clinical sign and symptoms.

Dose adjustment: When Semazic is added to existing metformin and/or thiazolidinedione therapy, the current dose of metformin and/or thiazolidinedione can be continued unchanged. When Semazic is added to existing therapy of sulfonylurea or insulin, a reduction in the dose of sulfonylurea or insulin should be considered to reduce the risk of hypoglycemia. Self-monitoring in blood glucose is not needed in order to adjust the dose of Semazic. Blood glucose self-monitoring is necessary to adjust the dose of sulfonylurea and insulin particularly when Semazic is started and insulin is reduced.

Missed dose: If a dose is missed, it should be administered as soon as possible and within 5 days after the missed dose. If more than 5 days have passed, the missed dose should be skipped and the next dose should be administered on the regular scheduled day. In each case, patients can then resume their regular once weekly dosing schedule.

Therapeutic Class of Injection:-Semazic SC Injection (0.25mg/0.188ml AS A Semaglutide GLP-1 receptor agonists).

GLP-1 receptor agonists

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𝐒𝐦𝐨𝐤𝐢𝐧𝐠 𝐜𝐞𝐬𝐚𝐚𝐭𝐢𝐨𝐧 এ Buproprion

___________

Urological এর ক্ষেত্রে Premature Ejaculation, Irritable bladder Syndrome Nocturnal Enuresis এ ড্রাগ অফ চয়েজ -–�

I𝐦𝐢𝐩𝐫𝐚𝐦𝐢𝐧𝐞:-

Tablet 4:-Depram 25mg (AS A Imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

Indications of Tablet :-Depram 25mg (AS A Imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

Depram is indicated in-

Depressive illness
Nocturnal enuresis in children.

Description of Tablet :-Depram 25mg (AS A Imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

Depram is an original tricyclic antidepressant, a member of the dibenzazepine group of compounds. The mechanism of action of Depram is not definitely known. However, it does not act primarily by stimulation of the central nervous system. The clinical effect is hypothesized as being due to the potentiation of adrenergic synapses by blocking uptake of norepinephrine at nerve endings. The mode of action of the drug in controlling childhood enuresis is thought to be apart from its antidepressant effect.

Pharmacology of Tablet :-Depram 25mg (AS A Imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

Imipramine works by inhibiting the neuronal reuptake of the neurotransmitters norepinephrine and serotonin. It binds the sodium-dependent serotonin transporter and sodium-dependent norepinephrine transporter reducing the reuptake of norepinephrine and serotonin by neurons. Depression has been linked to a lack of stimulation of the post-synaptic neuron by norepinephrine and serotonin. Slowing the reuptake of these neurotransmitters increases their concentration in the synaptic cleft, producing knock-on effects in protein kinase signaling which is thought to contribute to changes in neurotransmission and brain physiology which relieves symptoms of depression.

Dosage & Administration of Tablet :-Depram 25mg (AS A Imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

Depression:

Initially up to 75 mg daily in divided doses increased gradually to 150-200 mg (up to 300 mg in hospital patients)
Up to 150 mg may be given as a single dose at bedtime
Elderly initially 10 mg daily, increased gradually to 30-50 mg daily
Child not recommended for depression

Nocturnal enuresis:

Child 7-8 years: 25 mg
8-11 years: 25-50 mg
Over 11 years: 50-75 mg at bedtime; max

Period of treatment (including gradual withdrawal): 3 months-full physical examinations before the further course.

Interaction of Tablet :-Depram 25mg (AS A Imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

Methylphenidate may increase the effects of imipramine. This is usually avoided by reducing the dosage of imipramine. Depram may increase the depressant action of alcohol. Dangerously high blood pressure has resulted from the combination of imipramine, and members of monoamine oxidase (MAO) inhibitors. Because of this, imipramine should never be taken in combination with MAO inhibitors. Patients taking any MAO inhibitors, for example phenelzine sulfate or tranylcypromine sulfate, should stop the MAO inhibitor then wait at least 14 days before starting imipramine or any other tricyclic antidepressant. The same holds true when discontinuing imipramine and starting an MAO inhibitor. The anticholinergic (drying out) effects of imipramine are additive with other anticholinergic drugs such as benztropine, biperiden, trihexyphenidyl, and antihistamines.

Contraindications

Imipramine should not be given in conjunction with, or within 14 days of treatment with a MAO inhibitor. The combined therapy of this type could lead to the appearance of serious interactions such as hypertensive crises, hyperactivity, hyperpyrexia, spasticity, severe convulsions or coma and death may occur. Imipramine is contraindicated in patients with existing severe hepatic or renal damage, and those with a history of blood dyscrasias. Imipramine is contraindicated in patients who have shown hypersensitivity to the drug or hypersensitivity to tricyclic antidepressants belonging to the dibenzazepine group. Imipramine is contraindicated for use during the acute recovery phase following myocardial infarction. It should not be used in patients with convulsive disorders or glaucoma.

Side Effects of Tablet :-Depram 25mg (AS A Imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

The most frequent of side effects are dry mouth, constipation, urinary retention, increased heart rate, sedation, irritability, dizziness, and decreased coordination. Dry mouth, if severe to the point of causing difficulty speaking or swallowing, may be managed by dosage reduction or temporary discontinuation of the drug. Depram usage has been linked to both increases and decreases in blood pressure and heart rate. Heart attacks, congestive heart failure, and strokes have been reported. Confusion, disorientation, delusions, insomnia, and anxiety have also been reported as side effects in a small percentage of people taking imipramine. Problems associated with the skin (loss of sensation, numbness and tingling, rashes, spots, itching and puffiness), seizures, and ringing in the ears have also been reported. Nausea, vomiting, loss of appetite, diarrhea, and abdominal cramping are all side effects associated with imipramine usage in a small number of people.

Pregnancy & Lactation of Tablet :-Depram 25mg (AS A Imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

Pregnancy category D. Limited data suggest that imipramine is likely to be excreted in human breast milk. Known risk of damage to fetus.

Precautions & Warnings of Tablet :-Depram 25mg (AS A Imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

Depram should be used cautiously and with close physician supervision in people, especially the elderly, who have benign prostatic hypertrophy, urinary retention, and glaucoma, especially angle-closure glaucoma. The sedative effect is increased when imipramine is taken with other central nervous system depressants, such as alcoholic beverages, sleeping medications, other sedatives, or antihistamines. Depram may increase heart rate and stress on the heart. It may be dangerous for people with cardiovascular disease, especially those who have recently had a heart attack, to take Depram or other antidepressants in the same pharmacological class. Older people and persons with a history of heart disease may develop heart arrhythmias, heart conduction abnormalities, congestive heart failure, heart attack, abnormally rapid heart rates and strokes. Until a therapeutic dosage has been determined, people starting imipramine should be closely watched for signs of suicide. The risk of suicide is increased when imipramine is taken in overdose or combined with alcohol. Manic episodes and the emergence of symptoms of pre-existing psychotic states have been reported when imipramine therapy is started.

Overdose Effects of Tablet :-Depram 25mg (AS A Imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

Children have been reported to be more sensitive than adults to an acute overdosage of imipramine. An acute overdose in infants or young children must be considered serious and potentially fatal.

Therapeutic Class of Tablet :-Depram 25mg (AS A Imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant

Raiyyan Tahsan Date:27-01-2025 Monday Time:10-37-45 PM

Raiyyan Tahsan

Raiyyan Tahsan