1. The main aim of anaesthesia is the prevention of pain during surgery and at other times.
2. Anaesthesia involves a balanced approach, in which the individual patient’s psyche and pathophysiology are taken into account and drugs are used to modify and control any aspect as required.
3. The decision to use a particular drug or technique must be made after careful consideration of the pathophysiological features of the individual case and how these may affect the phar­macokinetic handling and tissue response to the drugs available.
4. Any associated disease or pathophysiological abnormality should wherever possible be treated or corrected before operation, and potentially dangerous physiological disturbances avoided during and after anaesthesia.
5. Anaesthetic drugs are relatively non-toxic but there are some important effects. Halothane is occasionally associated with hepatitis and methoxyflurane with kidney damage. Malignant hyperpyrexia, the aetiology of which is uncertain, is a rare but often fatal condition which can be triggered off by several anaesthetic drugs in genetically susceptible individuals.
6. Drugs used in anaesthesia can be involved in significant unwanted interactions with other drugs.
7. The treatment of respiratory failure is usually the responsibility of the anaesthetist. Although ventilatory assistance, physiotherapy, etc. are often the mainstay of treatment, drugs of different pharmacological classes are used.
8. Pain perception is an individual sensation. Symptomatic treatment of acute pain should not therefore be based on a concept of the painfulness of certain conditions, although some anal­gesics may be more appropriate for pain of certain conditions.
9. Strong analgesics for severe chronic pain should preferably be given orally, in adequate dosage, and on a regular individualised dosage schedule.

General Considerations

Although achieving insensibility to pain and to unpleasant surroundings has been the goal of much human activity since prehistoric times, it is only since 1846 with the introduction of ether by Morton that this could be done with any re­liable chance of success. Anaesthesia has devel­oped and been refined considerably since that time, and several important milestones are re­cognized and worthy of recall. These include the discovery of the local anaesthetic action of co­caine by Koller in 1884 and its use to produce spinal anaesthesia by Bier in 1898, the perfec­tion of endotracheal anaesthesia by Magill and Rowbotham about 1920, the introduction of the first barbiturate for induction of anaesthesia in 1932, and the introduction of curare in 1942.
In recent years, the specialty of anaesthesia has been broadened, and its scope is well de­scribed in a definition for the US Department of Labor (Dripps 1966):

Anesthesiology is a practice of medicine dealing with:

• The management of procedures for ren­dering a patient insensible to pain during surgical procedures.
• The support of life functions under the stress of anesthetic and surgical manipu­lations.
• The clinical management of the patient unconscious from whatever cause.
• The management of problems in pain re­lief.
• The management of problems in cardiac and respiratory resuscitation.
• The application of specific methods of inhalational therapy.
• The clinical management of various fluid electrolyte and metabolic disturbances.

The modern concept is one of ‘balanced an­aesthesia’, in which the whole of the patient’s psyche and pathophysiology are taken into ac­count and drugs are used to modify and control any aspect as required. Thus, as well as general anaesthetic agents, drugs of many classes – tran­quillisers, analgesics, muscle relaxants, drugs af­fecting the autonomic system etc. – all fall within the sphere of interest of the anaesthetist. ( Some of the more important of these will be discussed further at later part – Drugs Used in Anaesthesia .)

General Information of the drug

• Miglitol works differently from other oral antidiabetes drugs, which control blood sugar levels by increasing the production of insulin or helping the body to use the hormone more efficiently.
• Miglitol delays the digestion of carbohydrates (sugars) by acting in the cells that line the small intestine, where sugar is absorbed. This results in less sugar being absorbed into the blood and therefore, a lower blood-sugar level.
• Miglitol also has some effect against the enzyme lactase, but usually does not cause lactose intolerance. Hypoglycemia (very low blood sugar) is unlikely with miglitol because of the way the drug works in diabetes.
• Miglitol may be prescribed with another antidiabetic drug if single-drug therapy is not enough to adequately control blood sugar levels.



• People taking miglitol should have their blood sugar checked periodically to see how well the drug is working. Your blood glucose should be carefully monitored if you add or withdraw any of these drugs while taking miglitol or acarbose. It is common for patients to equip themselves with Home Glucose Monitors, which is widely available.
• Thiazides and other diuretics, corticosteroid anti-inflammatory drugs, phenothiazines, thyroid drugs, estrogens, contraceptive drugs, phenytoin, nicotinic acid, stimulants, calcium channel blockers, and isoniazid may increase blood sugar levels.
• Miglitol and acarbose add to the blood-sugar-lowering effect of sulfonylureas, insulin, and other antidiabetes drugs and may increase the risk of hypoglycemia (low blood sugar) associated with these drugs.
• Miglitol may interfere with the absorption of several drugs into the blood, including propranolol, ranitidine, digoxin, glyburide, and metformin. Seek advise with your doctor as he/she may need to adjust your dose of these drugs.
• Digestive enzyme preparations, charcoal, kaolin (an ingredient in Kaopectate), and antacids—as well as other drugs intended to absorb stomach contents—reduce the effects of miglitol and acarbose. Separate dosing of these drugs by at least 2 hours.
• Combining acarbose and digoxin may increase the effects of digoxin.
• As Miglitol prevents the breakdown of table sugar, if you take Miglitol in combination with insulin or a sulfonylurea prescription drugs, make sure to have a quick source of glucose (dextrose) with you to treat hypoglycemia ( symptoms include increased hunger, tiredness, sweating, increased heart rate, and numbness in the arms and legs ).
• Take your dose with the first bite of each meal. The drug has to be present in your intestine to prevent the absorption of sugar into your blood.
• As Miglitol cannot work unless there is food in your stomach, if you do forget to take a dose of miglitol with your meal, skip the dose you forgot. At the beginning of your next meal, continue with your regular dose .
• Before buying any nonprescription drug, seek advice with your pharmacist to be sure if it is safe for diabetics to take together with acarbose.

Cautions

• Do not take miglitol if you are sensitive or allergic to any of its ingredients
• If you have diabetic ketoacidosis, cirrhosis of the liver, inflammatory bowel disease, ulcers in the colon, intestinal obstruction, absorption or digestion diseases, or if intestinal gas, it will be a severe problem. Consult your doctor before taking this prescription.
• Acarbose may lead to liver inflammation.
• People with kidney disease retain higher levels of miglitol in the blood, but this does not affect the drug’s action because it acts locally in cells lining the small intestine. For patients with severe kidney disease should not take this drug due to drug retention in the blood.

Dosage and Possible Overdose ( This Prescription is not for Child )

• Acarbose :- Adult: 25-100 mg with breakfast, lunch, and dinner.
• Miglitol :- Adult: 25-100 mg with breakfast, lunch, and dinner.
• Miglitol must be taken with the first bite of each main meal.
• Unlike other antidiabetic medicines, a miglitol overdose does not cause hypoglycemia. Overdose symptoms are likely to include gas, diarrhea, and pain.
• Follow your doctor’s instructions especially for dietary plan, exercise, and blood- sugar testing. ( See Possible Side Effects below )

Possible Side Effects
a. Acarbose
Intestinal side effects of acarbose tend to improve or go away after a few weeks.
Most common:

• stomach gas (in 75% of people who take it),
• abdominal pain,
• and diarrhea.

( These side effects may be worse if you don’t restrict the amount of carbohydrate in your diet. Consult your doctor on proper dietary plan )

Less common or Rarely Occurs :

• skin rashes.
• swelling and itching,
• hepatitis or yellowing of the skin or whites of the eyes,
• abdominal distress,
• abdominal obstruction,
• liver irritation,
• abnormalities in blood tests.

b. Miglitol ( Most side effects of miglitol go away with continued use of the drug )
Most common:  gas, diarrhea, and abdominal pain.
Less common or Rare Effects : rash and low blood iron.

** For Unusual Side Effects that you may notice, seek your doctor advise immediately !

Pregnancy/Breast-feeding period :
Nursing Mothers who must take this drug should use infant formula, as the safety of using miglitol during pregnancy is not known, but small amounts of miglitol pass into breast milk. ( Diabetes during pregnancy is usually treated with insulin. )

Seniors Adult Consumption
Seniors with severe kidney disease should avoid this medication.

*Blood levels of acarbose are higher in older adults, but this is usually not considered important. Always consult your doctor if in doubt.

• Anxiety,
• tension,
• symptoms of acute alcohol withdrawal,
• partial seizures,
• fatigue,
• agitation,
• irritable bowel syndrome,
• and panic attacks.

General Information of the drug

• Clorazepate dipotassium is a benzodiazepine, which directly affect the brain. This drug is a central-nervous-system depressant, and can relax you and make you more tranquil or sleepier, or they can slow nervous system transmissions in such a way as to act as an anticonvulsant.
• Many doctors prefer benzodiazepines to other drugs that can be used to similar effect because they tend to be safer, have fewer side effects.
• Clorazepate may increase blood levels of digoxin and the chances of digoxin toxicity.
• Don’t mix it with alcohol, other sedatives, narcotics, barbiturates, monoamine oxidase inhibitor and other antidepressants, and antihistamines.
• Taking clorazepate with other similar effects drugs may result in excessive depression, tiredness, sleepiness, breathing difficulties, or related symptoms.
• Combining clorazepate with phenytoin may increase phenytoin blood concentrations and the chances of phenytoin toxicity.
• Smoking may reduce clorazepate’s effectiveness by increasing the rate at which it is broken down by the body.
• Clorazepate’s effects may be prolonged when it is mixed with cimetidine, contraceptive drugs, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, probenecid, propoxyphene, propranolol, rifampin, or valproic acid.
• If you have to take Tranxene for a prolong period of time, your doctor will need to monitor your blood counts and liver function to be sure of your health state.
• Theophylline may reduce clorazepate’s sedative effects.
• If you take antacids, separate them from your clorazepate dose by at least 1 hour to prevent them from interfering with the absorption of clorazepate into the bloodstream.
• The effect of levodopa + carbidopa may be decreased if it is taken together with clorazepate.

Cautions ( This drug may be addictive ! )

• Clorazepate may be addictive. It should be used with caution in people with a history of drug dependence.
• Do not take clorazepate if you are allergic or sensitive to any of its ingredients or to another benzodiazepine drug, including clonazepam.
• Clorazepate can aggravate narrow-angle glaucoma, but you may take it if you have open-angle glaucoma and are receiving therapy for it.
• Clorazepate should not be taken by psychotic patients because it is not effective for them and can trigger unusual excitement, stimulation, and rage.
• Clorazepate is not intended to be used for more than 3-4 months at a time. Your doctor should reassess your condition before continuing your prescription beyond that time.
• Your dosage should always be reduced gradually to prevent drug withdrawal symptoms, which may develop if you stop taking it after as few as 4 weeks of regular use but is more likely after longer use.
• Drug withdrawal symptoms may start with anxiety and progress to tingling in the hands or feet, sensitivity to bright light, sleep disturbances, cramps, tremors, muscle tension or twitching, poor concentration, flu-like symptoms, fatigue, appetite loss, sweating. and changes in mental state.
• Other conditions in which clorazepate should be avoided are: severe depression, severe lung disease, sleep apnea (intermittent cessation of breathing during sleep), liver disease, drunkenness, and kidney disease. In each of these conditions, the depressive effects of clorazepate may be enhanced or could be detrimental to your overall condition.

Note

• This drug is for Adult Only ! It is not recommended for child.
• Clorazepate is best taken on an empty stomach, but if it upsets your stomach then it may be taken with food. Consult your doctor on this.
• Clorazepate can cause tiredness, drowsiness, inability to concentrate, or similar symptoms. Be careful if you are driving, operating machinery, or performing other activities that require concentration.
• People taking clorazepate for more than 3 or 4 months at a time may develop drug withdrawal reactions if the medication is stopped suddenly (see “Cautions” section above). Do not stop taking clorazepate or increase or decrease your dosage without first consulting your doctor.
• Do not take a double dose. If you forget a dose of clorazepate, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule.

Pregnancy/Breast-feeding period :

• Clorazepate may cause birth defects if taken during the first 3 months of pregnancy.
• Avoid this drug if you are or might be pregnant, as Clorazepate may pass into breast milk. Nursing mothers who must take clorazepate should switch to use infant formula.

• Hypertension ( high blood pressure ),
• heart failure,
• diabetic kidney disease,
• and heart attack treatment ( when the function of the left ventricle has been affected),
• kidney failure,
• kidney hypertension,
• managing people with a high risk of heart disease,
• chronic kidney disease,
• preventing a second stroke.

General Information of the drug

• Enalapril begins working about 1 hour after you take it and continues to work for 24 hours.
• Enalapril maleate and other ACE inhibitors work by preventing the conversion of a hormone called ‘Angiotensin I‘ to another hormone called ‘Angiotensin II‘ , a potent blood-vessel constrictor. Preventing this conversion relaxes blood vessels, thus reducing blood pressure and relieving symptoms of heart failure.
• Enalapril also affects the production of other hormones and enzymes that participate in the regulation of blood-vessel dilation.

Cautions

• Enalapril occasionally causes very low blood pressure.
• Do not take enalapril if you are allergic or sensitive to any of its ingredients. Severe sensitivity reactions can occur in hemodialysis patients taking enalapril or those undergoing venom immunization.
• Swelling of the face, extremities, or throat has been known to occur with enalapril, which can be dangerous (see below section on “Important Notes” ).
• Enalapril may affect your kidney function, especially if you have congestive heart failure. Your doctor should check your urine for protein content during the first few months of treatment. Dosage adjustment of enalapril is necessary if you have reduced kidney function.
• Enalapril can affect white-blood-cell counts, possibly increasing your susceptibility to infection. Your doctor should monitor your blood counts periodically.
• Enalapril may cause serious injury or death to the fetus if taken during pregnancy. Pregnant women should not take enalapril.
• ACE inhibitors may be less effective in some black patients with high blood pressure, especially when dietary salt intake is high. Nevertheless, they should still be considered useful blood pressure treatments. Swelling beneath the skin to form welts is more common among black patients.

How the Drug works ?

• Antacids and enalapril should be taken at least 2 hours apart.
• The blood-pressure-lowering effect of enalapril is additive with diuretic drugs and beta blockers. Any other drug that causes a rapid drop in blood pressure should be used with caution if you are taking enalapril.
• Enalapril may increase the effects of lithium; this combination should be used with caution.
• Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the blood-pressure-lowering effects of enalapril and other ACE inhibitors. The combination may cause reductions in kidney function.
• Enalapril may increase blood-potassium levels, especially when taken with dyazide or other potassium-sparing diuretics.
• Capsaicin may trigger or aggravate the cough associated with enalapril therapy.
• Rifampin may reduce the effects of enalapril.
• The combination of allopurinol and enalapril increases the chance of side effects. Avoid this combination as severe sensitivity reactions can occur in those taking allopurinol.
• Enalapril affects blood levels of digoxin. More digoxin in the blood increases the chance of digoxin-related side effects, while less digoxin in the blood can compromise its effectiveness.
• Indomethacin may reduce the blood-pressure-lowering effects of enalapril.
• Phenothiazine sedatives and antiemetics may increase the effects of enalapril.

Important Note

• Enalapril can cause swelling of the face, lips, hands, or feet. This swelling can also affect the larynx (throat) or tongue and interfere with breathing. If this happens, go to a hospital emergency room at once.
• Call your doctor if you develop a sore throat, mouth sores, abnormal heartbeat, chest pain, persistent rash, or loss of taste perception.
• Some people who start taking enalapril after they are already on a diuretic (an agent that increases urination) could experience a rapid drop in blood pressure after their first doses or when their dosage is increased. To prevent this from happening, inform your doctor before hand ( that you are taking diuretic ) , as your doctor may tell you to stop taking your diuretic 2 or 3 days before starting enalapril or to increase your salt intake during that time. Upon your doctor advise, you may then restart on taking diuretic gradually.
• You may get dizzy if you rise to your feet too quickly from a sitting or lying position when taking enalapril.
• Avoid strenuous exercise or very hot weather because heavy sweating or dehydration can cause a rapid drop in blood pressure.
• While taking enalapril, avoid over-the-counter diet pills, decongestants, and other stimulants that can raise blood pressure.
• Do not take potassium supplements or salt substitutes containing potassium without consulting your doctor.
• Never take a double dose. If you take enalapril once a day and forget to take a dose, take it as soon as you remember. If it is within 8 hours of your next dose, skip the one you forgot and continue with your regular schedule. If you take enalapril twice a day and miss a dose, take it right away. If it is within 4 hours of your next dose, take 1 dose immediately and another in 5 or 6 hours, then go back to your regular schedule.

Possible Side Effects

Refers to Side Effects on Lexxel Drug , as these drugs works in combination in most treatments condition. However, if you experience unusual effects, do consult your doctor for advise.

Pregnancy/Breast-feeding period :

• ACE inhibitors can cause fetal injury or death. Women who are or might become pregnant should not take ACE inhibitors.
• Sexually active women of childbearing age who must take enalapril must use an effective contraceptive method to prevent pregnancy.
• If you become pregnant, stop taking the medication and call your doctor immediately.
• Nursing mothers who must take this drug should use infant formula as small amounts of enalapril pass into breast milk.

For Seniors who needs to take this drug :-

Seniors may be more sensitive to the effects of enalapril drug due to age-related losses in kidney or liver function.

General Information

• Lexxel contains 5 mg of felodipine, a calcium channel blocker, and 5 mg of enalapril, an angiotensin-converting enzyme (ACE) inhibitor. The 2 drugs in this combination belong to widely prescribed groups of hypertension medication.
• Lexxel is not meant for the initial treatment of hypertension.
• Most people taking this product have taken 1 of the ingredients as an individual pill and need more medication to control their blood pressure.
• Felodipine works by blocking the passage of calcium into heart and smooth-muscle tissue, especially the smooth muscle found in arteries. Since calcium is an essential factor in muscle contraction, any drug that affects calcium in this way will interfere with the contraction of these muscles. This causes the veins to dilate (widen), reducing blood pressure. Also, the amount of oxygen used by these muscles is reduced.
• ACE inhibitors such as enalapril work by preventing the conversion of a hormone called angiotensin Ito another hormone called angiotensin II, a potent blood-vessel constrictor. Preventing this conversion relaxes blood vessels and helps to reduce blood pressure and relieve the symptoms of heart failure.
• Enalapril’s effect on other hormones may also help to promote blood-vessel dilation. It begins working about 1 hour after you take it and continues to work for 24 hours.

How does the drug reacts ?

• The blood-pressure-lowering effect of Lexxel adds to that of diuretic (agent that increases urination) drugs or beta blockers.
• Any other drug that causes a rapid blood-pressure drop should be used with caution if you are taking Lexxel.
• When taken with Dyazide or other potassium-sparing diuretics, Lexxel may raise blood-potassium levels.
• Lexxel may increase the effects of lithium; this combination should be used with caution.
• Capsaicin may cause or aggravate the cough associated with Lexxel therapy.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) may interfere with the blood-pressure-lowering effect of Lexxel.
• Phenothiazine sedatives and antiemetics may increase the effects of Lexxel.
• Rifampin may reduce the effects of Lexxel.
• Combining allopurinol with Lexxel increases the risk of an adverse drug reaction.
• Cimetidine, indinavir, nelfinavir, ritonavir, saquinavir, clarithromycin, nefazodone, ketoconazole, itraconazole, erythromycin, telithromycin, aprepitant, fluconazole, and verapamil increase the amount of felodipine in the blood, causing a slight increase in the drug’s effect and possible side effects.
• Phenytoin and other hydantoin anti-seizure drugs, carbamazepine, and barbiturate sleeping pills and sedatives may decrease the amount of felodipine in the blood, reducing its effect.
• Felodipine may increase the effects of theophylline (a drug used to treat asthma and other respiratory problems) and oral anticoagulant (blood-thinning) drugs.
• Felodipine may increase blood levels of tacrolimus. Tacrolimus dose adjustment may be needed.
• Felodipine may interact with quinidine (an antiarrhythmic) to produce low blood pressure, very slow heart rate, abnormal heart rhythms, and swelling in the arms or legs.

Cautions

• Do not take Lexxel if you are allergic or sensitive to any of its ingredients. It could causes very low blood pressure, although rarely occurs.
• Lexxel should be used with caution by people with kidney disease, as it may also affect your kidneys, especially if you have congestive heart failure (CHF). Your doctor should check your urine for protein content during the first few months of treatment.
• Enalapril may affect white-blood-cell counts, possibly increasing your susceptibility to infection. Your doctor should monitor your blood counts periodically.
• ACE inhibitors can cause injury or death to a developing fetus in the last 2 trimesters. Pregnant women should not take Lexxel or any ACE inhibitor.
• People taking a beta-blocking drug who begin taking felodipine may develop heart failure or increased angina pain. Angina pain may also increase if your felodipine dosage is increased.
• People with severe liver disease break down felodipine much more slowly than those with less severe disease or normal livers.
• While taking any ACE inhibitor, sudden and painless swelling in the hands, face, feet, lips, tongue, or throat may develop. If this happens,  stop taking the medication at once , and contact your doctor. This condition usually goes away on its own, though antihistamines may also prove helpful.

Usual Dose and Intakes

• This drug is for adult only.
• 1 tablet a day. ( May be increased to 2 tablets if further blood pressure reduction is necessary after 1-2 weeks of treatment. )
• Overdose may cause low blood pressure. ( In case of overdose, contact your doctor or go to a hospital for emergency attention. ALWAYS bring the prescription bottle or container. )
• Lexxel may be taken without regard to food or meals ( you may take it with food if it upsets your stomach. )
• Avoid grapefruit juice while you are on Lexxel.
• Do not break, crush, or chew Lexxel tablets.
• Maintain good dental hygiene while taking Lexxel and use extra care when brushing or flossing teeth because of the increased risk of oral infection associated with Lexxel.
• Avoid over-the-counter diet pills, decongestants. and stimulants while taking Lexxel; they may raise blood pressure.

Possible Side Effects and Notes

*Side effects are more common with higher dosages and increasing age.
Most common side effects includes :-

• swelling in the ankles, feet, and legs;
• dizziness;
• lightheadedness;
• muscle weakness or cramps;
• facial flushing;
• headache;
• fatigue;
• nausea;
• chronic- (long-term) cough.  ( The cough usually goes away a few days after you stop taking the medication. )

Rare and Less common side effects ( Contact Your Doctor for advise )  :-

• respiratory infection,
• cough,
• tingling in the hands or feet,
• upset stomach,
• abdominal pain,
• chest pain,
• constipation,
• diarrhea,
• heart palpitations,
• sore throat,
• runny nose,
• back pain, rash,
• angina (condition characterized by brief attacks of chest pain),
• vomiting,
• bronchitis,
• urinary tract infection,
• breathing difficulties,
• Unusual condition affecting your heart, muscles and joints, stomach and intestines, sexual function, kidney or liver, and other body parts.

Hypertension may be present without symptoms, thus continue taking your medication and follow any instructions for diet restriction or other treatments to help maintain lower blood pressure, even if you feel well.

Do not take a double dose.

- If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule.

For those under Pregnancy/Breast-feeding period

Women who are or might be pregnant should not take Lexxel. ACE inhibitors have caused low blood pressure, kidney failure, slow skull formation, and death in the fetus when taken during the last 6 months of pregnancy.

Women of childbearing age who must take Lexxel must use an effective contraceptive method.

If you become pregnant, stop taking the medication and call your doctor immediately.
Nursing mothers who must take Lexxel should use infant formula, as small amounts of enalapril + felodipine are known to pass into breast milk.

Seniors citizen :-

• Especially those with liver disease, may be more sensitive to the drug’s effects. Take it with care., it is best to consult doctor before taking it.

Parkinson’s disease

• Chronic (persistent) disorder of part of the brain, which affects the way the brain co-ordinates the movements of the muscles in various parts of the body.

General Information of the drug
Entacapone is always used in combination with levodopa + carbidopa. It is prescribed For Parkinson’s disease patients for whom levodopa + carbidopa loses its effectiveness between doses.

Entacapone enhances the effect of levodopa + carbidopa by reversing the action of an enzyme known as catechol-O-methyltransferase (COMT), which is primarily responsible for breaking down levodopa in the body.

Some patients experience signs and symptoms of an end-of-dose “wearing-off” effect with these drugs.

Cautions

• If you are allergic or sensitive to any of its ingredients -> Do not take entacapone !
• People with liver disease should use entacapone with caution as they may accumulate twice as much of this drug in their blood as people with normal liver function.
• Entacapone may cause kidney toxicity.
• Entacapone may increase the risk of dizziness or fainting when rising from a sitting or lying down position.
• Do not take entacapone with phenelzine or tranyleypromine -> Serious reaction may occur.
• Hallucinations have been reported with other Parkinson’s disease drugs.
• Entacapone has been rarely associated with the formation of fibrous tissues in unusual places such as the urinary tract and lungs. It has also caused fluid in the lungs.

Intake and Dosage

• Adult Dose Intake :- 200 mg with each levodopa + carbidopa dose, up to 1600 mg a day.
• Entacapone may be taken with or without food. However, Do Not Mix entacapone with the monoamine oxidase inhibitor (MAGI) antidepressants phenelzine or tranylcypromine.
• Entacapone may be taken with the MA01 selegiline.
• Other drugs broken down by COMT will also be affected by entacapone.
• lsoproterenol, epinephrine, ephedrine, norepinephrine, isoetharine, and others will interact with entacapone, even when taken by inhalation. The result may be increased heart rate, arrhythmias, and excessive changes in blood pressure.
• Cholestyramine, probenecid, erythromycin, rifampin, ampicillin, and chioramphenicol may interfere with the elimination of entacapone from the body.
• Entacapone may enhance the effects of sedatives and other nervous system depressants.
• Although there have been no reports of significant entacapone overdose as of publcation. But theoretically, a massive entacapone overdose could prove lethal by completely inhibiting COMT throughout the body.
• Doses up to 800 mg have been taken and side effects were mainly abdominal pain and loose stools.
• Other effects that might be expected include difficulty breathing, loss of muscle coordination, reduced level of activity, and convulsions.
• Overdose victims should be taken to a hospital emergency room as soon as possible ( ALWAYS bring along the prescription bottle or container. )
  

Important Note

• This drug can cause dizziness, nausea, sweating, or fainting when rising quickly from a sitting or lying position, especially at the beginning of treatment.
• Always take your entacapone dose together with your levodopa + carbidopa dose. If you forget a dose. take it as soon as you remember. ( If it is within 2 hours of your next dose. skip the dose you forgot and continue with your regular schedule. )
• If you experience an increased body movements and twitching, twisting, or uncontrolled tongue, lip, face, arm, or leg movement, consult your doctor as he may need to adjust your dose of levodopa + carbidopa.
• Until your body has become accustomed to the effects of entacapone, it’s highly advisable to be caution when performing tasks, such as driving, that require coordination and concentration.
• Gradually reducing the dose of entacapone decreases some drug side effects.
• Patients who stop using entacapone should be monitored as rapid withdrawal of the drug can cause high fever, sweating, unstable blood pressure, stupor, and muscular rigidity.
• If your urine to turn a brownish-orange color after taking Entacapone,  it is usually harmless.

Possible Side Effects

Most of the common effects after taking this drugs are :-

• difficulty performing voluntary muscle functions,
• excessive muscle activity,
• nausea,
• urine discoloration,
• diarrhea,
• reduced muscle activity,
• dizziness,
• fatigue,
• constipation,
• abdominal pain.

Less common side effects or rarely occurs side effects ( Consult your doctor immediately ) :-

• low blood pressure and fainting ( especially when rising from a sitting or lying position ),
• hallucinations,
• anxiety,
• agitation,
• gastritis or other stomach disorders,
• dry mouth,
• vomiting,
• increased sweating,
• back pain,
• taste changes,
• shortness of breath,
• easy bruising,
• weakness,
• bacterial infection,
• muscle damage or death,
• high fever,
• confusion.

Pregnancy/Breast-feeding period :

• When this drug is considered crucial by your doctor, its potential benefits must be weighed against its risks.
• Entacapone causes birth defects, miscarriage and abortion in pregnant animals. It has been known that Entacapone passes into the breast milk of animals, but at the moment if publication, there is no information on humans is available. Nursing mothers who must take this drug should use infant formula.