• 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.

• Using Entacapone in Parkinson’s Disease Treatment
• Treating Diabetes Type2 with Miglitol ( Glyset, Acarbose, Precose )
• Treatments Usage and Effects of Dronabinol Drug (Or Marinol )
• Amiodarone – Treating Abnormal Heart Rhythms
• Drugs Usage during Critical Medical Emergencies – Synopsis of Important Principles
• Anaesthetic Agents – Drugs Used in Anaesthesia
• Synopsis of Important Principles – Drugs in Anaesthetic Practice
• Drug Overdosage and Poisoning – Synopsis of Important Principles
• Angiotensin-Converting Enzyme Inhibitor – Vasotec Enalapril
• Gastric Aspiration and Lavage

Although unabsorbed drug in the stomach may be removed by gastric aspiration and lav­age its usefulness in practice has been seriously questioned (Proudfoot 1984). Most drugs and poisons seem to be absorbed rapidly and this technique is unlikely to be productive more than 4 hours after ingestion, unless gastric emptying has been delayed by opioid analgesics, anti­cholinergic agents, central nervous system de­pressants, and possibly salicylates. In such circumstances gastric lavage may be worthwhile up to 12 hours after ingestion.

It is said to be contraindicated after ingestion of corrosives and hydrocarbons such as paraffin because of the risks of perforation and lipoid pneumonia, respectively.

The patient must be correctly positioned head down in the left lateral position and a cuffed endotracheal tube inserted beforehand if the protective pharyngeal reflexes are depressed. It is essential to use a large bore tube (e.g. Jacques 30 gauge) and in adults lavage should be carried out with 300ml portions of warm tap water un­til the return is clear. Complications include pulmonary aspiration of stomach contents, and, rarely, oesophageal rupture.

Although gastric lavage is often unrewarding, large amounts of drug are occasionally re­covered. A common cause of failure is the use of too small a tube – an ordinary nasogastric tube is virtually useless. Large amounts of re­sidual drug have been found in the stomach postmortem after attempts at lavage with a nasogastric tube (Jenis et al. 1969), and in i case i large drug mass containing 25g of meproba­mate was removed by gastrotomy 40 hours after ingestion despite gastric lavage (Schwartz 1977).

Emetics

The comparative efficacy of induced emesis and gastric lavage is still debated. Neither guar­antees emptying of the stomach. Lavage is not always practicable in children because of the physical difficulty in passing a tube large enough to allow the passage of tablets, and emesis is probably preferable in young children. In 1 study in children poisoned with salicylates, emesis was claimed to be more effective than lavage (Boxer et al. 1969), but in another, only 10 to 15% of the amount of salicylate taken was recovered, even when emesis occurred within 1 hour of ingestion (Yaffe et al. 1970).

The major disadvantages are failure of eme­sis, particularly if central nervous system de­pressants have been taken, and toxicity, some­times fatal, from the retained emetic. Syrup of ipecac given with water is probably the best emetic, and is often effective within 15 to 30 minutes (Neuvonen et al. 1983).

Other agents which have been used include sodium chloride, copper sulphate, zinc sulphate, tartar emetic (antimony potassium tartrate), apomorphine and mustard. However, the over-enthusiastic use of sodium chloride and heavy metals can be ex­tremely dangerous and fatal poisoning with salt and copper sulphate has been reported (Gresham & Mashru 1982; Stein et al. 1976).

• Generalized Anxiety Disorder Treatment with Clorazepate ( Tranxene )
• Drug Overdosage and Poisoning – Synopsis of Important Principles
• Treating Diabetes Type2 with Miglitol ( Glyset, Acarbose, Precose )
• Amiodarone – Treating Abnormal Heart Rhythms
• Drugs Usage during Critical Medical Emergencies – Synopsis of Important Principles
• Synopsis of Important Principles – Drugs in Anaesthetic Practice
• Cathartics, Enemas and Activated Charcoal
• Methods for Enhancement of Drug Elimination
• Symptoms, Types and Treatment Options for Warts
• Pathophysiology of Circulatory Failure and Cardiopulmonary Resuscitation

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.

• Generalized Anxiety Disorder Treatment with Clorazepate ( Tranxene )
• Treating Diabetes Type2 with Miglitol ( Glyset, Acarbose, Precose )
• Treatments Usage and Effects of Dronabinol Drug (Or Marinol )
• Angiotensin-Converting Enzyme Inhibitor – Vasotec Enalapril
• Amiodarone – Treating Abnormal Heart Rhythms
• Anaesthetic Agents – Drugs Used in Anaesthesia
• Treating Hypertension with Lexxel Generic Drug
• Drugs Usage during Critical Medical Emergencies – Synopsis of Important Principles
• Synopsis of Important Principles – Drugs in Anaesthetic Practice
• Fosfomycin – Urinary anti-infection drug

General Information

• Amiodarone works by decreasing the sensitivity of heart tissue to nervous impulses within the heart. It should be prescribed only in situations where the abnormal rhythm is so severe as to be life-threatening and does not respond to other drug treatments.
• It has not been proven that people taking this drug will live longer than those with similar conditions who do not take it.
• Amiodarone may exert its effects 2-5 days after you start taking it, but often takes 1-3 weeks to affect your heart.
• Amiodarone’s antiarrhythmic effects can last for weeks or months after you stop taking it.

How does the drug Interact ?

• Amiodarone increases the effects of metoprolol and other beta blockers, calcium channel blockers such as verapamil and dittiazem, cyclosporine, dextromethorphan, digoxin, disopyramide, flecainide, fentanyl, lidocaine, methotrexate, procainamide, quinidine, theophylline, and warfarin and other anticoagulants. These interactions can take from 2 or 3 days to several weeks to develop. Some can be life threatening, and for others, drug dosage adjustments may be enough to avoid a serious problem.
• Fluoroquinolones, azole antifungals, and macrolide antibiotics increase the effects of amiodarone. which can cause life-threatening abnormal heart rhythms.
• When amiodarone and phenytoin are taken together, both drugs can be affected. Amiodarone can be antagonized by phenytoin and other hydantoin anticonvulsants, and the effect of phenytoin can be increased by amiodarone.
• Cholestyramine interferes with the absorption of amiodarone into the bloodstream.
• Cimetidine and ritonavir interfere with the breakdown of amiodarone, leading to high drug blood levels and the increased possibility of side effects.
• Azithromycin can interfere with the effectiveness of amiodarone. This interaction may lead to dizziness and cardiac instability.

Cautions ( This drug has fatal effects ! )

• Amiodarone can cause potentially fatal drug side effects too ! At high doses, 10% or more of people taking this drug can develop potentially fatal lung and respiratory effects, beginning with cough and progressive breathing difficulties.
• Do not take amiodarone if you are allergic or sensitive to any of its ingredients or if you have heart block or a very slow heart rate.
• Amiodarone can also cause heart block, a drastic slowing of electrical impulse movement between major areas of the heart, or extreme slowing of the heart rate. Amiodarone heart block occurs about as often as heart block caused by some other antiarrhythmic drugs, but its effects may last longer than those of the other drugs.
• Amiodarone can also worsen existing abnormal heart rhythms in 2-5% of people who take the drug. These effects can be fatal.
• Liver damage caused by amiodarone is usually mild. In rare cases. amiodarone has been associated with liver failure that resulted in death.
• People taking amiodarone may develop optic nerve irritation, leading to partial or complete loss of vision. Most adults who take amiodarone for 6 months or more develop tiny deposits in the corneas of their eyes. These deposits may cause blurred vision or halos in up to 10% of people taking amiodarone. Some people develop dry eyes and sensitivity to bright light.
• One in ten people taking amiodarone can experience unusual sensitivity to the effects of the sun. Use an appropriate sunscreen product and reapply it frequently.
• Amiodarone can cause thyroid abnormalities. It may worsen an already sluggish thyroid gland in 2-10% of people taking the drug, and increase thyroid activity in 2% of people taking it.
• Amiodarone has also been associated with an increase in risk of thyroid tumors.
• Antiarrhythmic drugs are less effective and cause abnormal rhythms if blood potassium is low.

Other Possible Side Effects

• Side effects are very common with amiodarone. About 75% of people taking 400 mg or more of amiodarone a day develop some drug side effects. As many as 18% have to stop taking the drug because of a side effect.
• Amiodarone stays in the body for months, so side effects may remain even after the drug is stopped.
• Unusual sun sensitivity is the most common skin reaction to amiodarone, but people taking this drug can develop a blue skin discoloration that may not go away completely when the drug is stopped.
• Other skin reactions are sun rashes, hair loss, and black-and-blue spots.
• Amiodarone can cause heart failure, reduced heart rate, and abnormal rhythms.
• Up to 9% of people taking amiodarone develop abnormalities in liver function

See your doctor for an eye exam if your vision changes at all while taking amiodarone.

Call your doctor if you develop chest pain. breathing difficulties, spitting up blood, nausea, vomiting, abnormal heartbeat, bloating in your feet or legs. tremors, fever, chills, sore throat, unusual bleeding or bruising, changes in skin color, unusual sunburn, or any other unusual side effect.

Common Side Effects of the drug :-

• fatigue,
• not feeling well,
• tremors,
• unusual involuntary movements,
• loss of coordination,
• an unusual walk,
• muscle weakness,
• low blood pressure,
• dizziness,
• tingling in the hands or feet,
• reduced sex drive,
• sleeplessness,
• headache,
• nervous-system problems,
• nausea,
• vomiting,
• constipation,
• appetite loss,
• abdominal pain,
• dry eyes,
• unusual sensitivity to bright light,
• seeing halos around bright lights.

Rare Side Effects :-

• inflammation of the lung or fibrous deposits in the lungs,
• changes in thyroid function,
• changes in taste or smell,
• bloating,
• unusual salivation,
• changes in blood clotting.

Note

• Amiodarone can make you dizzy or lightheaded. Take care while driving a car or performing complex tasks.
• If you take amiodarone once a day and forget to take a dose, but remember within 12 hours, take it as soon as possible.
• If you do not remember until later, skip the dose you forgot and continue with your regular schedule.
• If you take amiodarone twice a day and remember within 6 hours of your regular dose, take it as soon as you remember.
• Call your doctor if you forget to take 2 or more doses in a row, ask for doctor advise on what to do next – Do not take a double dose.
• Pregnancy and/or Breast-feeding : In high doses, amiodarone has been found to be toxic to animal fetuses. Women of childbearing age should use an effective contraceptive while taking amiodarone. If you are or might be pregnant and this drug is considered crucial by your doctor, its potential benefits must be weighed against its risks.
  Amiodarone passes into breast milk. Nursing mothers who must take this drug should use infant formula.
• Seniors : Dosage reduction may be needed in seniors with poor liver function.

Usual Dose ( Doctor Instruction Should Be followed Closely )

• Starting dose 800-1600 mg a day, taken in 1 or 2 doses, usually for 1-3 weeks. Then, 600-800 mg a day for approximately a month. Maintenance dose 400 mg a day.
• You should take the lowest effective dose in order to minimize side effects.
• Amiodarone should be taken on an empty stomach, as food delays its absorption into your bloodstream.
• If amiodarone upsets your stomach, however, you may take it with food but then always take it with food to be consistent.
• Do not drink grapefruit juice during treatment with amiodarone because grapefruit juice affects how amiodarone is absorbed in the stomach.

Over Dosage Effect(s)

• The effects of amiodarone overdose include low blood pressure. shock, slow heartbeat, and liver toxicity.
• Overdose victims should be taken to a hospital emergency room for treatment.
• ALWAYS bring the prescription bottle or container.

• Generalized Anxiety Disorder Treatment with Clorazepate ( Tranxene )
• Treating Diabetes Type2 with Miglitol ( Glyset, Acarbose, Precose )
• Using Entacapone in Parkinson’s Disease Treatment
• Gastric Aspiration and Lavage
• Treating Hypertension with Lexxel Generic Drug
• Drugs Usage during Critical Medical Emergencies – Synopsis of Important Principles
• Synopsis of Important Principles – Drugs in Anaesthetic Practice
• Treatments Usage and Effects of Dronabinol Drug (Or Marinol )
• Anaesthetic Agents – Drugs Used in Anaesthesia
• Drug Overdosage and Poisoning – Synopsis of Important Principles