Dermatology Case No 31.Herpes Zoster.

Hello I'm Raiyyan Tahsan

Brand Model and Executive

Dermatology Case No 31.Herpes Zoster.

shingles

Herpes zoster নামক ভাইরাসের কারণে এটি হয়।চিকেন পক্স ও একই ভাইরাস দিয়ে হয়।

কেন হয়?

চিকেন পক্সে আক্রান্ত হলে,৮০% ক্ষেত্রে লাইফটাইম ইমিউনিটি ডিভেলপ করে,তখন ২য় বার আক্রান্ত হওয়ার সুযোগ থাকে না,২০% ক্ষেত্রে এই ভাইরাস এন্টিবডি দ্বারা ধ্বংস না হয়ে Central nervous system এ সুপ্ত হয়ে Dorsal root ganglion of nerve এ এইগুলি লুকিয়ে থাকে,আর জীবনের যে কোনো সময় ভাইরাস গুলি Reactivate হয়ে ইনফেকশন করে…

ভাইরাস মূলত Trigeminal nerve root ganglion e dormant থাকে,

immuno compromise condition হলে ভাইরাস এখানে থেকে Reactivate হয়ে এটি হয়ে থাকে।

লক্ষণ:

-vesicular type rash

-চুলকানি ও ব্যথা হয়

-অনেকগুলো fluid filled blister appear করে,যা সহজেই ফেটে গিয়ে scab form করে

-জ্বালাপোড়া হয়।

-এছাড়াও মাথা ব্যথা,জ্বর, মাংশপেশিতে ব্যথা হতে পারে।

কোথায় হয়?

-সাধারণত single dermatome affect করে তাই বডির একপাশে হয়।বুক, পেট, পিঠ, মুখ ও কানেও হতে পারে।

কাদের বেশি হয়?

-চিকেন পক্স থেকে সেরে উঠেছেন।

-বয়স >60 বছর

-immunocompromised patient

-Malignant patient

★virus reactivate হয়ে nerve branch গুলির মাধ্যমে চোখের আশপাশের এলাকাতে painful blistering swelling করে,conjuntivitis/scleritis হয়, যাকে Herpes zoster ophthalmicus হিসাবে নাম করণ করা হয়.. এবং যখন কানকে ইনভলব করে ফেলে,কানে painful amd itchy Sensation হয় তখন তাকে Herpes Zoster Oticus বলে।

চিকিৎসা

√Topical and systemic Anti viral – Acyclovir

Cream 1.Virux 5% w/w 10gm tube (AS A Acyclovir AS A Topical Antiviral preparations).

Indications of Cream:-Virux 5% w/w 10gm tube (AS A Acyclovir AS A Topical Antiviral preparations).

Virux cream is a herpes simplex virus (HSV) nucleoside analogue DNA polymerase inhibitor indicated for the treatment of recurrent herpes labialis (cold sores) in immunocompetent adults and adolescents 12 years of age and older.

Pharmacology of Cream:-Virux 5% w/w 10gm tube (AS A Acyclovir AS A Topical Antiviral preparations).

Acyclovir is an antiviral drug active against herpes simplex virus. Acyclovir is a synthetic purine nucleoside analogue with cell culture and in vivo inhibitory activity against HSV types 1 (HSV-1) and 2 (HSV-2). The inhibitory activity of acyclovir is highly selective due to its affinity for the enzyme thymidine kinase (TK) encoded by HSV. This viral enzyme converts acyclovir into acyclovir monophosphate, a nucleotide analogue. The monophosphate is further converted into diphosphate by cellular guanylate kinase and into triphosphate by a number of cellular enzymes. In cell culture, acyclovir triphosphate stops replication of herpes viral DNA. This inhibition is accomplished in 3 ways: 1) competitive inhibition of viral DNA polymerase, 2) incorporation into and termination of the growing viral DNA chain, and 3) inactivation of the viral DNA polymerase.

Dosage & Administration of Cream:-Virux 5% w/w 10gm tube (AS A Acyclovir AS A Topical Antiviral preparations).

Acyclovir cream should be applied five times per day for four days. Therapy should be initiated as early as possible following the onset of signs or symptoms of herpes labialis i.e., during the prodrome or when lesions appear. For adolescents 12 years of age and older, the dosage is the same as in adults.

Interaction of Cream:-Virux 5% w/w 10gm tube (AS A Acyclovir AS A Topical Antiviral preparations).

Clinical experience has identified no interactions resulting from topical or systemic administration of other drugs concomitantly with Virux cream. Due to minimal systemic absorption of Virux cream, systemic drug interactions are unlikely.

Contraindications of Cream:-Virux 5% w/w 10gm tube (AS A Acyclovir AS A Topical Antiviral preparations).

Acyclovir cream is contraindicated in patients with known hypersensitivity to acyclovir, valacyclovir, or any component of the formulation.

Side Effects of Cream:-Virux 5% w/w 10gm tube (AS A Acyclovir AS A Topical Antiviral preparations).

The most common adverse reactions at the site of topical application were dry lips, desquamation, dryness of skin, cracked lips, burning skin, pruritus, flakiness of skin, and stinging on skin; each adverse reaction occurred in less than 1% of patients receiving Virux cream and placebo. Three patients on Virux cream and one patient on placebo discontinued treatment due to an adverse event.

Pregnancy & Lactation of Cream:-Virux 5% w/w 10gm tube (AS A Acyclovir AS A Topical Antiviral preparations).

Pregnancy Category B. There are no adequate and well-controlled studies of acyclovir cream in pregnant women. Acyclovir cream should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether topically applied acyclovir is excreted in breast milk. Systemic exposure following topical administration is minimal.

Precautions & Warnings of Cream:-Virux 5% w/w 10gm tube (AS A Acyclovir AS A Topical Antiviral preparations).

Virux cream should only be applied on the affected external aspects of the lips and face in patients with herpes labialis. Because no data are available, application to human mucous membranes is not recommended. Virux cream is intended for cutaneous use only and should not be used in the eye or inside the mouth or nose. Cream has a potential for irritation and contact. The effect of Virux cream has not been established in immunocompromised patients.

Use in Special Populations

Pediatric Use: An open-label, uncontrolled trial with Virux cream 5% was conducted in 113 patients aged 12 to 17 years with recurrent herpes labialis. In this trial, therapy was applied using the same dosing regimen as in adults and subjects were followed for adverse events. The safety profile was similar to that observed in adults. Safety and effectiveness in pediatric patients less than 12 years of age have not been established.

Geriatric Use: Clinical studies of Virux cream did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. Systemic absorption of Virux after topical administration is minimal.

Therapeutic Class of Cream:-Virux 5% w/w 10gm tube (AS A Acyclovir AS A Topical Antiviral preparations).

Topical Antiviral preparations

√Systemic -Anti histamine

Fexofenadin:-

Tablet 1- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

0+0+1 for 4 weeks,

Indications of tab- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

Allergic rhinitis: Fexo is indicated for the relief of symptoms associated with seasonal and perennial allergic rhinitis, in adults and children 12 years of age and over. Symptoms treated effectively include sneezing, rhinorrhea, lacrimation, itchy, red eyes and itchy nose/palate/throat. Fexo improves health-related quality of life and work/activity productivity.

Chronic idiopathic urticaria: Fexo is indicated for the relief of symptoms associated with chronic idiopathic urticaria in adults and children 12 years of age and older. Fexo significantly reduces the signs and symptoms of chronic idiopathic urticaria, the number of wheals, and pruritus. Fexo improves health-related quality of life and work/activity productivity.

Pharmacology of tab- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

The H1 histamine receptor is responsible for mediating hypersensitivity and allergic reactions. Exposure to allergen results in the degranulation of mast cells and basophils, which then release histamine and other inflammatory mediators. Histamine binds to, and activates, H1 receptors, which results in the further release of pro-inflammatory cytokines, such as interleukins, from basophils and mast cells. These downstream effects of histamine binding are responsible for a wide variety of allergic symptoms, such as pruritus, rhinorrhea, and watery eyes.

Fexofenadine is considered an “inverse agonist” of the H1 receptor because it binds to and stabilizes the inactive form of the receptor, preventing its activation and subsequent downstream effects. It has a potent and selective affinity for H1 receptors, and there is no evidence that it carries antidopaminergic, antiserotonergic, anticholinergic, sedative, or adrenergic blocking activity. Fexofenadine does not cross the blood-brain barrier and thus is unlikely to cause significant CNS effects.

Dosage & Administration of tab- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

Allergic Rhinitis-

Adults and children 12 years and older:

Tablet: 60 mg twice daily or 120 mg once daily or 180 mg once daily
In case of impaired renal function: 60 mg once daily

Children from 6 to 11 years:

Tablet: 30 mg twice daily or 60 mg once daily
In case of impaired renal function: 30 mg once daily

Children from 2 to 11 years

Suspension: 30 mg or 5 ml twice daily
In case of impaired renal function: 30 mg or 5 ml once daily

Chronic Idiopathic Urticaria-

Adults and children 12 years and older:

Tablet: 60 mg twice daily or 120 mg once daily or 180 mg once daily
In case of impaired renal function: 60 mg once daily

Children from 6 to 11 years:

Tablet: 30 mg twice daily or 60 mg once daily
In case of impaired renal function: 30 mg once daily

Children from 6 months to less than 2 years:

Suspension: 15 mg or 2.5 ml (1/2 tsp) twice daily
In case of impaired renal function: 15 mg or 2.5 ml (1/2 tsp) once daily

Children from 2 to 11 years:

Suspension: 30 mg or 5 ml (1 tsp) twice daily
In case of impaired renal function: 30 mg or 5 ml (1 tsp) once daily

Interaction of tab- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

Fexo does not undergo hepatic biotransformation and therefore will not interact with other medicinal products through hepatic mechanisms. Coadministration of Fexo with erythromycin or ketoconazole has been found to result in a 2-3 times increase in the level of fexofenadine in plasma. The changes were not accompanied by any effects on the QT interval and were not associated with any increase in adverse reactions compared to the medicinal products given singly. No interaction between fexofenadine and omeprazole was observed. However, the administration of an antacid containing aluminium and magnesium hydroxide gels 15 minutes prior to Fexo caused a reduction in bioavailability, most likely due to binding in the gastrointestinal tract. It is advisable to leave 2 hours between administration of Fexo and aluminium and magnesium hydroxide containing antacids.

Contraindications of tab- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

Contraindicated in patients with known hypersensitivity to Fexofenadine Hydrochloride or any of its ingredients.

Side Effects of tab- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

The following frequency rating has been used, when applicable: Very common ≥1/10; Common ≥1/100 and <1/10; Uncommon ≥1/1,000 and <1/100; Rare ≥1/10,000 and <1/1,000; Very rare <1/10,000 and not known (frequency cannot be estimated from the available data). Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness. In adults, the following undesirable effects have been reported in clinical trials, with an incidence similar to that observed with placebo: Nervous system disorders- Common: headache, drowsiness, dizziness; Gastrointestinal disorders- Common: nausea; General disorders and administration site conditions- Uncommon: fatigue. In adults, the following undesirable effects have been reported in post-marketing surveillance. The frequency with which they occur is not known (cannot be estimated from available data): Immune system disorders- hypersensitivity reactions with manifestations such as angioedema, chest tightness, dyspnoea, flushing and systemic anaphylaxis; Psychiatric disorders- insomnia, nervousness, sleep disorders or nightmares/excessive dreaming (paroniria); Cardiac disorders- tachycardia, palpitations; Gastrointestinal disorders- diarrhea; Skin and subcutaneous tissue disorders- rash, urticaria, pruritus

Pregnancy & Lactation of tab- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

There are no adequate data from the use of Fexofenadine hydrochloride in pregnant women. Limited animal studies do not indicate direct or indirect harmful effects with respect to effects on pregnancy, embryonal/foetal development, parturition or postnatal development. Fexofenadine hydrochloride should not be used during pregnancy unless clearly necessary.

There are no data on the content of human milk after administering Fexofenadine hydrochloride. However, when Terfenadine was administered to nursing mothers Fexofenadine was found to cross into human breast milk. Therefore, Fexofenadine hydrochloride is not recommended for mothers breast-feeding their babies. No human data on the effect of Fexofenadine hydrochloride on fertility are available. In mice, there was no effect on fertility with Fexofenadine hydrochloride treatment.

Therapeutic Class of tab- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

Non-sedating antihistamines

Common Questions about Fexo 120 mg Tablet

What is Fexo 120 mg Tablet?

Fexo 120 mg Tablet is an antihistamine. It works by blocking histamine that the body makes during an allergic reaction.

What are the uses of Fexo 120 mg Tablet?

Fexo 120 mg Tablet is used for the treatment of allergic rhinitis and urticaria. It relieves allergy symptoms such as runny nose, itching eyes/nose, sneezing, hives, and itching.

What are the Side Effects of Fexo 120 mg Tablet?

Fexo 120 mg Tablet has some reported side effects such as Vomiting, Headache, Coughing, Diarrhea, Painful menstruation, Pain in the arms and legs, Hives and redness of skin, Swelling of face, lips, eyelids, tongue, hands and feet.

What are the instructions for storage and disposal Fexo 120 mg Tablet?

Fexo 120 mg Tablet should be kept in a cool dry place and in its original pack. Make sure this medication remains unreachable to children and pets.

Can Fexo 120 mg Tablet make you sleepy?

Yes, Fexo 120 mg Tablet can make you feel sleepy, infect sleepiness is a common side effect of this medicine.

Can you overdose on Fexo 120 mg Tablet?

Do not take an overdose of Fexo 120 mg Tablet as this can cause adverse reactions and may increase the risk of side effects like dizziness, drowsiness, fatigue, and dry mouth.

How quickly does Fexo 120 mg Tablet work?

Fexo 120 mg Tablet starts working within 1 hour of consuming it. The peak benefit of Fexo 120 mg Tablet is observed within 6 hours.

Does Fexo 120 mg Tablet relieve symptoms of outdoor and indoor allergies?

Yes, Fexo 120 mg Tablet can help relieve symptoms that may be caused by outdoor and indoor allergens such as upper respiratory allergies, hay fever, watery eyes, runny nose, and sneezing, or itching of the nose or throat.

How to cope with dizziness caused by Fexo 120 mg Tablet?

Take some rest after taking Fexo 120 mg Tablet if you feel dizzy or sleep. Do not use heavy machinery or drive and move very slowly. Exercise caution and if there is extreme dizziness, then consult a doctor as soon as possible.

Can I take antacids while taking Fexo 120 mg Tablet?

Fexo 120 mg Tablet should not be used in combination with antacids as the interaction between them can result in a decreased absorption of Fexo 120 mg Tablet.

How should I take Fexo 120 mg Tablet?

Fexo 120 mg Tablet should be taken in dose and duration as recommended by the doctor. Do not take an overdose as this can affect your health adversely.

Is there any food or drink that I need to avoid while taking Fexo 120 mg Tablet?

Do not consume juices like grapefruit juice, orange juice and apple juice if you are on the course of medication with Fexo 120 mg Tablet.

Can Fexo 120 mg Tablet cause heart problems?

Those who suffer from heart disorders should exercise caution and must look out for some other alternative of this medicine.

Quick Tips

Fexo 120 mg Tablet is an antihistaminic medication. It treats allergy symptoms such as itching, swelling, and rashes by blocking the effects of a chemical messenger (histamine) in the body.
Fexo 120 mg Tablet is less likely to make you feel sleepy than some other similar medicines.
Do not take Fexo 120 mg Tablet with any fruit juices (such as apple, orange, or grapefruit) as they might make the drug less effective.
Fexo 120 mg Tablet may cause nausea. Stick to simple meals, and do not eat rich or spicy food.
Avoid using antacids 30 minutes before or after taking Fexo 120 mg Tablet. It can make it harder for your body to absorb this medication.

√Paracetamol for pain

If pain not controlled by paracetamol then,Tramadol

Capsule 2.Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

Indications of Capsule:-Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

Anadol SR is used for the treatment of moderate to severe painful conditions. These include:

Postoperative pain
Colic and spastic pain
Cancer pain
Joint pain
Neck and back pain
Pain associated with osteoporosis.

Pharmacology of Capsule:-Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

Tramadol is a centrally acting synthetic analgesic compound. It inhibits the re uptake of neurotransmitters- serotonin and noradrenaline. Thus it modifies the transmission of pain impulses by activating both descending serotonergic pathways and noradrenergic pathways involved in analgesia. The analgesic effects of Tramadol are mediated via stimulation of mu-opioid receptors and indirect modulation of central monoaminergic inhibitory pathways.

Dosage & Administration of Capsule:-Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

Capsule or Tablet: Usual doses are 50 to 100 mg every four to six hours. For acute pain an initial dose of 100 mg is required. For chronic painful conditions an initial dose of 50 mg is recommended. Subsequent doses should be 50 to 100 mg administered 4-6 hourly. The dose level and frequency of dosing will depend on the severity of the pain.The total daily dosage by mouth should not exceed 400 mg.

Sustained Release Capsule or Tablet: One SR capsule or tablet every 12 hours, for example first one in the morning and then at the same time in the evening. The number of capsules taken at a time will depend upon severity of pain, but it should not be taken more frequently than every 12 hours.The total daily dosage by mouth should not exceed 400 mg.

Injection: A dose of 50-100 mg may be given every 4 to 6 hours by intramuscular or by intravenous infusion. For the treatment of postoperative pain,the initial dose is 100 mg followed by 50 mg every 10 to 20 minutes if necessary to a maximum of 250 mg in the first hour. Thereafter, doses are 50 to 100 mg every 4 to 6 hours up to a total daily dose of 600 mg.

Suppository: Tramadol suppository should be administered rectally. For adults usual dose is 100 mg Tramadol Hydrochloride 6 hourly. In general, 400 mg Tramadol Hydrochloride (4 Tramadol suppository) per day sufficient. However, for the treatment of Cancer pain and severe pain after operations much higher daily doses can be used.

Interaction of Capsule:-Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

In general, physician need not be concerned about drugs interacting with Anadol SR. The monoamine oxidase (MAO) inhibitors represent the only drug class not recommended for combination with Anadol SR. Concomitant administration of carbamazepine with Anadol SR causes a significant increase in Anadol SR metabolism and it requires to increase the dose of Anadol SR.

Contraindications of Capsule:-Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

Tramadol is contraindicated in persons having hypersensitivity to this drug. It is also contraindicated in acute intoxication with alcohol, hypnotics, centrally acting analgesics, opioids or psychotropic drugs.

Side Effects of Capsule:-Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

Commonly occurring side-effects are dizziness/vertigo, nausea, constipation, headache, somnolence, vomiting, pruritus, CNS stimulation, asthenia, sweating, dyspepsia, dry mouth, diarrhoea. Less commonly occurring side-effects include malaise, allergic reaction, weight loss, vasodilatation, palpitations, abdominal pain, anorexia, flatulence, GI bleeding, hepatitis, stomatitis etc.

Pregnancy & Lactation of Capsule:-Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

Safe use of Tramadol in pregnancy has not been established. Tramadol has been shown to cross the placenta. There are no adequate and well-controlled studies in pregnant women. Therefore, Tramadol should be used during pregnancy only if the potential benefit justifies the risk to the foetus. Tramadol Hydrochloride should not be administered during breast feeding as Tramadol and its metabolites have been detected in breast milk.

Precautions & Warnings of Capsule:-Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

Respiratory depression: When large doses of tramadol are administered with anaesthetic with anaesthetic medications or alcohol, respiratory depression may result. Therefore, tramadol should be administered cautiously in patients at risk for respiratory depression.

Opioid dependence: Anadol SR is not recommended for patients who are dependent on opioids.

Concomitant CNS depressants: Anadol SR should be used with caution and in reduced dosages when administering to patients receiving CNS depressants such as alcohol, opioids, anesthetic agents, phenothiazines, tranquilizers or sedative hypnotics.

Concomitant MAO inhibitors: Anadol SR should be used with great caution in patients taking MAO inhibitors, since tramadol inhibits the uptake of norepinephrine and serotonin.

Anadol SR should be used with caution in patients with increased intracranial pressure or head injury and patients with acute abdominal conditions.

Use in Special Populations of Capsule:-Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

In children from the age of 1 year Anadol SR can be given in a dose of 1-2 mg/kg body weight. However,suppository (100 mg Anadol SR) should not be administered in children and adolescents below the age of 14 years. Anadol SR 100 mg SR Capsules have not been studied in children. Therefore, safety and efficacy have not been established and the product should not be used in children.

Therapeutic Class of Capsule:-Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

Opioid analgesics

√Amitriptylin / Pregabalin

Tablet 3.Mig 5mg (AS A Mirogabalin Besylate AS A Adjunct anti-epileptic drugs, Primary anti-epileptic drugs).

Indications of Tablet:-Mig 5mg (AS A Mirogabalin Besylate AS A Adjunct anti-epileptic drugs, Primary anti-epileptic drugs).

Mig tablet is indicated for the treatment of-

Neuropathic Pain
Diabetic peripheral neuropathic pain (DPNP)
Postherpetic neuralgia (PHN)
Peripheral neuropathic pain (PNP)

Pharmacology of Tablet:-Mig 5mg (AS A Mirogabalin Besylate AS A Adjunct anti-epileptic drugs, Primary anti-epileptic drugs).

Mirogabalin belongs to the class of gamma amino acids and its derivatives. Mirogabalin selectively binds α₂δ subunits of voltage-gated calcium channels (VGCCs). It reduces calcium (Ca²⁺) influx and neurotransmission which inhibits neurotransmitter release in presynaptic neuron endings. Due to the inhibition of neurotransmitter release, the hyper- excitability of central nervous system (CNS) neurons decreases.

Mirogabalin is rapidly absorbed after oral administration; median time to maximum plasma concentration is 0.5-1.5h. Mirogabalin has a low plasma protein binding of approximately 25%. Mirogabalin has a mean apparent volume of distribution of 64-88L after single or multiple doses. The drug is cleared mainly unchanged (61-72%) via renal excretion by filtration and active secretion, however a slight fraction (13-20%) is metabolized by hepatic uridine 5′-diphospho-glucuronosyltransferase isoforms. The mean elimination half-life of mirogabalin observed 2-4.9h. 99% of mirogabalin is excreted through the kidneys, only 1% of the dose is excreted through feces.

Dosage & Administration of Tablet:-Mig 5mg (AS A Mirogabalin Besylate AS A Adjunct anti-epileptic drugs, Primary anti-epileptic drugs).

Adult dose: The initial dose for adults is 5 mg of Mirogabalin twice daily. Then the dose is gradually increased by 5 mg at an interval of at least a week to 15 mg twice daily. The dose may be adjusted appropriately between 10 mg and 15 mg twice daily depending on ages and symptoms.

Use in Children and Adolescent: It is not known if Mirogabalin is safe and effective in children and adolescent.

Hepatic Impairment: A single 15 mg dose of Mirogabalin does not produce significant adverse reaction, in patients with mild to moderate hepatic impairment. No data available for severe hepatic impairment.

Renal Impairment: In mild renal dysfunction, the initial dose starts from 5 mg twice a day, slowly increased by 5 mg at an interval of 1 week to 10 mg. In moderate renal dysfunction, the initial dose starts from 2.5 mg twice a day, slowly increased by 2.5 mg at an interval of 1 week to 7.5 mg twice a day. In severe renal dysfunction, the initial dose starts from 2.5 mg once a day, slowly increased by 2.5 mg at an interval of 1 week to 7.5 mg once a day.

Interaction of Tablet:-Mig 5mg (AS A Mirogabalin Besylate AS A Adjunct anti-epileptic drugs, Primary anti-epileptic drugs).

With Medicine: Co-administration of Mig with Cimetidine or Probenecid may raise the Mig plasma concentration. Importantly, if Mig is taken with Lorazepam, the depressive effects on the CNS may be potentiated. Mig is OAT1, OAT3, OCT2, MATE1, MATE2-K and UGT substrate. Mig does not inhibit or induce major human CYP molecular species, and does not inhibit activities of drug transporters (including OAT1, OAT3, organic cation transporter OCT1, OCT2, OATP1B1, OATP1B3, MATE1, MATE2-K, P-gp and BCRP). Co-administrated with OAT1, OAT3, OCT2, MATE1, MATE2-K or UGT inhibitors may increase mirogabalin exposure, so use with caution.

With food & others: Administration of Mig with food has no clinically relevant effect on the total absorption of Mig. Avoid consuming alcohol while taking Mig, as Mig may potentiate the impairment of motor skills and sedating effects of alcohol.

Contraindications of Tablet:-Mig 5mg (AS A Mirogabalin Besylate AS A Adjunct anti-epileptic drugs, Primary anti-epileptic drugs).

Mirogabalin is contraindicated in:

patients with hypersensitive to Mirogabalin.
patients with mild to moderate Hepatic & Renal impairment.

Side Effects of Tablet:-Mig 5mg (AS A Mirogabalin Besylate AS A Adjunct anti-epileptic drugs, Primary anti-epileptic drugs).

The most reported adverse reactions include somnolence, dizziness, edema and weight gain. The symptoms described below are rarely seen as initial symptoms of the adverse reactions indicated in brackets. If any of these symptoms occur, stop taking this medicine and see your doctor immediately.

Light headedness, state close to sleep with impaired consciousness, loss of consciousness (dizziness, somnolence, unconsciousness).
General malaise, loss of appetite, nausea, vomiting, jaundice (liver dysfunction).

Pregnancy & Lactation of Tablet:-Mig 5mg (AS A Mirogabalin Besylate AS A Adjunct anti-epileptic drugs, Primary anti-epileptic drugs).

For pregnant or potentially pregnant women, administer only if the therapeutic benefit outweighs the risks. Presence in placental passage has been reported in animal study. Consider the therapeutic and breastfeeding benefits then consider continuing or discontinuing breastfeeding. It has been reported in animal study that it is transferred into milk.

Precautions & Warnings of Tablet:-Mig 5mg (AS A Mirogabalin Besylate AS A Adjunct anti-epileptic drugs, Primary anti-epileptic drugs).

This medicine may cause dizziness, somnolence, or loss of consciousness. Avoid operating dangerous machinery, such as driving a car. Especially for elderly patients, careful attention should be taken. This medicine may cause weight gain. This medicine may cause blurred vision and double vision.

If an allergic reaction occurs, stop taking the medicine and consult with doctor. Dose adjustment is needed in patients with renal dysfunction. If taking any other medication, please consult with doctor before administering Mig. As this medicine may cause dizziness or somnolence, the patient should avoid operating in potentially hazardous activities such as driving a car. Elderly patients should be aware of falling and fracture. The patient should consult with the doctor if the signs of blurred vision or double vision appear while taking this medication.

Therapeutic Class of Tablet:-Mig 5mg (AS A Mirogabalin Besylate AS A Adjunct anti-epileptic drugs, Primary anti-epileptic drugs).

Adjunct anti-epileptic drugs, Primary anti-epileptic drugs

√Topical streiod prednisolon eye drop দিবে চোখের জন্য,

Ophthalmic Suspension/Eye Drop 4.Ocusol 1% 5ml drop (AS A Prednisolone Acetate Glucocorticoids).

Indications of Ophthalmic Suspension/Eye Drop:-Ocusol 1% 5ml drop (AS A Prednisolone Acetate Glucocorticoids).

Steroid responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment of the globe such as allergic conjunctivitis, acne rosacea, superficial punctate keratitis, herpes zoster keratitis, iritis, cyclitis, selected infective conjunctivitides when the inherent hazard of steroid use is accepted to obtain an advisable diminution in edema and inflammation; corneal injury from chemical, radiation or thermal burns or penetration of foreign bodies.

Pharmacology of Ophthalmic Suspension/Eye Drop:-Ocusol 1% 5ml drop (AS A Prednisolone Acetate Glucocorticoids).

Prednisolone Acetate is a corticosteroid that, on the basis of weight, has 3 to 5 times the anti-inflammatory potency of Hydrocortisone.Corticosteroids inhibit the edema, fibrin deposition, capillary dilation, leukocyte migration, capillary proliferation, fibroblast proliferation, deposition of collagen and scar formation associated with inflammation.

There is no generally accepted explanation for the mechanism of action of ocular corticosteroids. However, corticosteroids are thought to act by the induction of phospholipase A2 inhibitory proteins, collectively called lipocortins. It is postulated that these proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting release of their common precursor arachidonic acid. Arachidonic acid is released from membrane phospholipids by phospholipase A2.

Dosage & Administration of Ophthalmic Suspension/Eye Drop:-Ocusol 1% 5ml drop (AS A Prednisolone Acetate Glucocorticoids).

Shake well before using. Instill 1 drop into the conjunctival sac two to four times daily. During the initial 24 to 48 hours, the dosing frequency may be increased if necessary. Care should be taken not to discontinue therapy prematurely.

Interaction of Ophthalmic Suspension/Eye Drop:-Ocusol 1% 5ml drop (AS A Prednisolone Acetate Glucocorticoids).

Specific drug interaction studies have not been conducted with Ocusol BP 1% ophthalmic suspension.

Contraindications of Ophthalmic Suspension/Eye Drop:-Ocusol 1% 5ml drop (AS A Prednisolone Acetate Glucocorticoids).

Prednisolone Acetate 1% ophthalmic suspension is contraindicated in most viral diseases of the cornea and conjunctiva including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia and varicella and also in mycobacterial infection of the eye and fungal diseases of ocular structures. It is also contraindicated in individuals with known or suspected hypersensitivity to any of the ingredients of this preparation.

Side Effects of Ophthalmic Suspension/Eye Drop:-Ocusol 1% 5ml drop (AS A Prednisolone Acetate Glucocorticoids).

Adverse reactions include, in decreasing order of frequency, elevation of intraocular pressure (IOP) with possible development of glaucoma, infrequent optic nerve damage, posterior subcapsular cataract formation and delayed wound healing.

Corticosteroid-containing preparations have also been reported to cause acute anterior uveitis and perforation of the globe. Keratitis, conjunctivitis, corneal ulcers, mydriasis, conjunctival hyperemia, loss of accommodation and ptosis have occasionally been reported following local use of corticosteroids.

The development of secondary ocular infection (bacterial, fungal and viral) has occurred in some cases.

Pregnancy & Lactation of Ophthalmic Suspension/Eye Drop:-Ocusol 1% 5ml drop (AS A Prednisolone Acetate Glucocorticoids).

There are no adequate and well controlled studies in pregnant women. Prednisolone Acetate BP 1% ophthalmic suspension should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether topical ophthalmic administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk. So, this drug should be used in nursing mother only if the potential benefit justifies the potential risk to the fetus.

Precautions & Warnings of Ophthalmic Suspension/Eye Drop:-Ocusol 1% 5ml drop (AS A Prednisolone Acetate Glucocorticoids).

If signs and symptoms fail to improve after 2 days, the patient should be re-evaluated. As fungal infections of the cornea are particularly prone to develop coincidentally with long-term local corticosteroid applications, fungal invasion should be suspected in any persistent corneal ulceration where a corticosteroid has been used or is in use. Fungal cultures should be taken when appropriate. If Ocusol is used for 10 days or longer, intraocular pressure should be monitored. Do not touch dropper tip to any surface as this may contaminate Ocusol.

Overdose Effects of Ophthalmic Suspension/Eye Drop:-Ocusol 1% 5ml drop (AS A Prednisolone Acetate Glucocorticoids).

Overdosage will not ordinarily cause acute problems. If accidentally ingested, drink fluids to dilute.

Therapeutic Class of Ophthalmic Suspension/Eye Drop:-Ocusol 1% 5ml drop (AS A Prednisolone Acetate Glucocorticoids).

Glucocorticoids

Ocular complications prevent করার জন্য Oral prednisolone দিবে।

Tablet 3.Cortan 20mg (AS A Prednisolone AS A Glucocorticoids).

Gabapentine ও লাগতে পারে কারো কারো ক্ষেত্রে.

neuropathic pain কমানোর জন্য sodium valproate দিবে।(প্রয়োজন সাপেক্ষে)

Tablet 4.Valoate CR 300mg (AS A Sodium Valproate AS A Primary anti-epileptic drugs).

Indications of Tablet:-Valoate CR 300mg (AS A Sodium Valproate AS A Primary anti-epileptic drugs).

Valoate CR 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.

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

Composition

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:-Valoate CR 300mg (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:-Valoate CR 300mg (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:-Valoate CR 300mg (AS A Sodium Valproate AS A Primary anti-epileptic drugs).

Valoate CR 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:-Valoate CR 300mg (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:-Valoate CR 300mg (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. Valoate CR 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 Valoate CR.

Pregnancy & Lactation

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.

Precautions & Warnings

Liver functions should be monitored before therapy and during first 6 months especially in patients most at risk, No undue potential for bleeding before starting and before major surgery must be ensured, Care should be taken in renal impairment, pregnancy, breast-feeding and systemic lupus erythematosus. Valoate CR is partially eliminated in the urine as a ketone metabolite, which may lead to a false interpretation of the urine ketone test. Sudden withdrawal of therapy should be avoided. Valoate CR should not be used during pregnancy and in women of childbearing potential.

Therapeutic Class of Tablet:-Valoate CR 300mg (AS A Sodium Valproate AS A Primary anti-epileptic drugs).

Primary anti-epileptic drugs

আর সেকেন্ডারি ইনফেকশন প্রিভেন্ট করার জন্য এন্টিবায়োটিক দিতে হবে।

এন্টিবায়োটিক আই ড্রপ (Moxifloxacin/skin infection prevent করার জন্য Flucloxacillin)

Capsule 7.Fluclox 500 mg (AS A Flucloxacilline AS A Penicilline Resistant Penicilline.)

eye involved হয়ে গেলে অবশ্যই ophthalmologist এর কাছে রেফার করে দিবে।

Rx of Shingle :

Tab: Valovir 1000 mg

1+1+1 (10 days)

Tab- Napa one

1+1+1 (5 days)

Cream- Virux

Apply locally 8 hourly.

Incase of severe pain short course of steroid can be Given..

Tab- Cortan 20 mg

1+1+0 (5 days)

1+0+0 (5 days)

Tab- Fexo 120 mg

0+0+1 (3 Weeks)

Tab- Pantonix 20 mg

1+0+1 (10 days)

ইনফেকশন ভালো হয়ে যাওয়ার পরেও অনেকের পেইন থাকতে পারে, যাকে Neuropathic pain বলে.. তখন Pregabalin অথবা Duloxetine দিবে..

Tab- Pregaba 25 mg

0+0+1 (7days) if pain not decrease then…

1+0+1 (7 days)

Dose can be increase till 75 mg BD.

Or tab-

Dulox 30 mg

1/2+0+0 (7 days)

1+0+0 (3 month)

Raiyyan Tahsan Date:28-01-2025 Tuesday Time:2-25-43 PM

Raiyyan Tahsan

Raiyyan Tahsan