Due to a large number of side-effects caused by the tricyclic antidepressants and the monoamine oxidase inhibitors, efforts have been made by pharmaceutical research groups to bring out newer and safer drugs.
Selective Serotonin Reuptake Inhibitors (SSRIs)
The major drawback of conventional tricyclic antidepressants are unacceptable effects on heart (fall in BP, rhythm disturbances) anticholinergic and neurological adverse effects. Low safety margin, as fatalities are common. Slow onset of action. Propensity to precipitate fits; Sedation; Incomplete/poor response in some patients. Advent of SSRIs in 1980 have overcome above limitations to a great extent. SSRIs are becoming preferred drugs for th.el treatment of endogenous depression because of their merits, which are:
Quick onset of action.
Little or no sedation.
No interference with mental functions.
No postural fall in blood pressure so appropriate in elderly.
No precipitation of convulsions.
Little chance of overdose and heart rhythm disturbance.
Antidepressant efficacy equal to tricyclics.
Utility in anxiety, phobia and obsessive compulsive neurosis.
Adverse Effects: Nausea, interference with ejaculation, orgasm nervousness, restlessness, insomnia, loss of appetite, mild abnormal movements, headache and diarrhoea may occur. Sometimes discontinuation of SSRIs result in bowel upset, pins-needles sensations, bodyache and sleep disturbance. Importantly, these drugs may adversely interact with antihistaminics, antipsychotics, propranolol, carbamazepine and diazepam. Therefore, patients on such medications should have appropriate dose adjustments.
St John’s Wart (Hypericin, Hylax)
Hypericin is an active ingredient of aerial parts of St John’s Wart. It is an effective mood elevator and antidepressant in mild to moderate depression in a dose of 1 capsule three times twice a day. It is particularly used when depression is due to a serious medical illness, concurrent medications (amitryptyline, anti HIV drugs, theophylline and warfarin) interact with it.
Mono-amine Oxidase Inhibitors (MAO-Is)
These are older drugs effective in depression but show a lot of adverse interactions with drugs and food . The cheese reaction occurs when foods/beverages such as cheese, bean, red wine, over ripe fruits, broad beans, yeast and soya sauce (all contain a chemical tyramine) are patients on MAO-Is.
About the author:
AdvCare is one of the Canada leading pharmacy website. First established in January 2000, its mission is to become the number one site for prescription drug and drug store searches.
It should not be used in patients with a history of epilepsy or any psychiatric disorder
It should not be used in children below two years.
Avoid its use with quinine, quinidine or any other drugs which may cause disturbance of heart beat before or after mefloquine.
It should not be used during pregnancy.
Driving or operating any machinery should be avoided.
Quinine
This drug is obtained from the bark of the plant cinchona which is cultivated in eastern India. The plant originated in South America where it grew wild. For almost a century, until the 1940s, the drug enjoyed an unrivalled role in the treatment of malaria. Its value declined gradually with the discovery of newer drugs during the Second World War, which were more effective and less toxic. Its actions are similar to chloroquine. It is still used in the treatment of certain multiresistant strains of the malarial parasites causing brain fever (cerebral malaria).
Dosage: It is given in a dose of 300 to 600 mg orally, three to four times a day for 7 to 10 days. In cerebral malaria this drug has to be given by intravenous route with glucose and saline.
Adverse Effects: The adverse effects of large doses of quinine are quite serious and in some hypersensitive individuals maybe caused even by small doses. These include ringing sounds in the ears, loss of hearing, vertigo, blurring of vision, skin rashes, nausea, vomiting, diarrhoea, abdominal pain, fever, convulsions, fall in blood pressure, and depression of respiration. It may also cause destruction of red blood cells (haemolytic anaemia).
Precautions
Stop the drug immediately if allergy or pal our of skin (due to haemolytic anaemia) occur.
Avoid its use if you suffer from ringing in the ear or visual disturbances (optic neuritis).
Take the drug after meals.
Avoid its use during the first few months of pregnancy. It may cause abortion.
Primaquine
It is used for a complete cure. It is usually given along with or after chloroquine. Although it has prophylactic properties, it is not used for this purpose because of its toxic nature. Primaquine is given in a dose of 15 mg per day for 2 weeks, for a complete
cure.
Adverse Effects: In therapeutic doses it may cause abdominal discomfort and anaemia: Large doses may cause marked discomfort and alteration in blood (methaemoglobinaemia) and destruction of red blood cells (haemolytic anaemia) in individuals who have low level of an enzyme called G-6 PD. Spot tests are available for testing of G-6-PD deficiency state. If
C-6-PD deficiency is detected, bulaquin (AABLAQUIN) is available which is claimed to be tolerated well in a dose of 25 mg per day for 5 days.
Precautions
The drug should be taken under the supervision of a physician.
The drug should be stopped immediately if darkening of urine occurs.
Its concurrent use with quinacrine should be avoided.
Avoid its use if you are suffering from rheumatoid arthritis.
Note: Due to its toxic side-effects the drug is not allowed to be sold in regular chemist shops and is available only through the public health department.
About the author:
AdvCare is one of the leading Canada pharmacy website. First established in January 2000, its mission is to become the number one site for Discount Drugs and Generic Prescription Drugs searches.
Eye Infections
Allergic Conjunctivitis
It could be seasonal keratoconjunctivitis seen usually in summer season. Patient has complaints of eye discomfort and redness. It is treated with combination of anti-allergies and low dose of steroids. Another form of allergy is due to use of medication, for which the use of drug should be stopped.
Bacterial Infection
Infection of eye membrane (conjunctivitis) and eyelids (blepharitis) occurs both in children and adults. It may occur in a newborn baby (neonate) too. It is usually caused due to poor hygiene. There may be discharge from the eye. The eyelids may adhere to one another and it may be difficult to open the eye. Sometimes a boil may appear on the eyelash with pus in it (stye). In this case eyelash should be removed by a specialist followed with proper medication. Fomentation of the eyes with boiled water and a pinch of boric acid powder also provides some relief. Infection of cornea may be a severe condition, which if left untreated
may cause complete blindness, hence it requires aggressive treatment.
Fungal Infection
Injuries due to wooden stick or a thorn or vegetable matter can cause fungal infection. This a corneal ulcer, which is difficult to treat and needs a specialist’s intervention.
Viral Infection
Trachoma is a contagious inflammation of eye caused by Chlamydia trachomatis, which is not a true virus but resembles a virus in its properties. It develops slowly. Initially, the patients feels irritation in the eye with redness. This may progress to the formation of small follicles and scarring of eye membrane. If cornea is involved, it may lead to blindness.
Epidemic kertoconjunctivitis is usually seen after rainy season and is caused by Adenovirus. It has no specific treatment. Herpes, a common viral infection, can also cause corneal ulceration.
Treatment of Eye Infections
The treatment of infection of the eye requires anti-microbial eye drops or ointments.
About the author:
AdvCare is one of the leading Canada pharmacy website. First established in January 2000, its mission is to become the number one site for Discount Drugs and Generic Prescription Drugs searches.
]]>
‘Involuntary tremulous motion, with lessened muscular power, in part, not in action, and even when supported; with a propensity to bend the trunk forward and to pass from a walking to running pace, the senses and intellects being uninjured.’
Parkinson’s disease, or Parkinsonism, is a chronic malady of the central nervous system, more common amongst the elderly, and characterized by muscle rigidity, rhythmic tremor, akinesia or immobility, loss of associated movements, and postural instability. The presence of these signs impairs the ability of the patient to make proper voluntary movements and to maintain posture through reflexes. The patient presents a characteristic feature of an expressionless or a ‘mask-life’ face, and has tremors of the hands. It is called ’shaking palsy’.
Causes: The real cause of this disease is not known. It is a disease of old age, but may also occur in middle age, It has a sporadic onset which is very gradual and prolonged. It is not considered a hereditary disease, although in about 6% cases, it has been found to run in families. The disease effects. 1 in 250 persons after the age of 40 years. It is degenerative disease in which the centers of brain which normally maintain stance and movements lose functional nerve cells. Parkinsonism can sometimes be due to a known cause such as a late complication of viral encephalitis, injury to brain or arteriosclerosis but such cases are not common. Certain anti-psychotic drugs like reserpine, chlopromazine, and haloperidol may cause symptoms similar to Parkinson’s disease, but not the actual disease
itself.
Although we do not know the cause of this disease, recent biochemical researches suggest that it may be due to a deficiency of a neurohormone (dopamine) and/or abundance of another neurohormone (acetylcholine) in the brain.
Treatment and Drugs
Some drugs facilitate dopaminergic transmission and reduce the symptoms. These are amantadine and l-deprenyl (Selegiline). With this knowledge, it has now become possible to at least control the symptomes by using specific drugs to correct the neurochemical imbalance, if not to provide a complete cure. Besides drug therapy, it is very important for a patient to undertake suitable physical exercises regularly, to avoid permanent stiffness of the joints. The drugs used in the treatment of Parkinson’s disease can be divided into those which correct: 1) the deficiency of dopamine; and 2) the effects caused by excessive
acetylcholine.
About the author:
AdvCare is one of the Canada leading pharmacy website. First established in January 2000, its mission is to become the number one site for prescription drug and drug store searches
Eye Infections
Allergic Conjunctivitis
It could be seasonal keratoconjunctivitis seen usually in summer season. Patient has complaints of eye discomfort and redness. It is treated with combination of anti-allergies and low dose of steroids. Another form of allergy is due to use of medication, for which the use of drug should be stopped.
Bacterial Infection
Infection of eye membrane (conjunctivitis) and eyelids (blepharitis) occurs both in children and adults. It may occur in a newborn baby (neonate) too. It is usually caused due to poor hygiene. There may be discharge from the eye. The eyelids may adhere to one another and it may be difficult to open the eye. Sometimes a boil may appear on the eyelash with pus in it (stye). In this case eyelash should be removed by a specialist followed with proper medication. Fomentation of the eyes with boiled water and a pinch of boric acid powder also provides some relief. Infection of cornea may be a severe condition, which if left untreated
may cause complete blindness, hence it requires aggressive treatment.
Fungal Infection
Injuries due to wooden stick or a thorn or vegetable matter can cause fungal infection. This a corneal ulcer, which is difficult to treat and needs a specialist’s intervention.
Viral Infection
Trachoma is a contagious inflammation of eye caused by Chlamydia trachomatis, which is not a true virus but resembles a virus in its properties. It develops slowly. Initially, the patients feels irritation in the eye with redness. This may progress to the formation of small follicles and scarring of eye membrane. If cornea is involved, it may lead to blindness.
Epidemic kertoconjunctivitis is usually seen after rainy season and is caused by Adenovirus. It has no specific treatment. Herpes, a common viral infection, can also cause corneal ulceration.
Treatment of Eye Infections
The treatment of infection of the eye requires anti-microbial eye drops or ointments.
About the author:
AdvCare is one of the leading Canada pharmacy website. First established in January 2000, its mission is to become the number one site for Discount Drugs and Generic Prescription Drugs searches.
]]>
It should not be used in patients with a history of epilepsy or any psychiatric disorder
It should not be used in children below two years.
Avoid its use with quinine, quinidine or any other drugs which may cause disturbance of heart beat before or after mefloquine.
It should not be used during pregnancy.
Driving or operating any machinery should be avoided.
Quinine
This drug is obtained from the bark of the plant cinchona which is cultivated in eastern India. The plant originated in South America where it grew wild. For almost a century, until the 1940s, the drug enjoyed an unrivalled role in the treatment of malaria. Its value declined gradually with the discovery of newer drugs during the Second World War, which were more effective and less toxic. Its actions are similar to chloroquine. It is still used in the treatment of certain multiresistant strains of the malarial parasites causing brain fever (cerebral malaria).
Dosage: It is given in a dose of 300 to 600 mg orally, three to four times a day for 7 to 10 days. In cerebral malaria this drug has to be given by intravenous route with glucose and saline.
Adverse Effects: The adverse effects of large doses of quinine are quite serious and in some hypersensitive individuals maybe caused even by small doses. These include ringing sounds in the ears, loss of hearing, vertigo, blurring of vision, skin rashes, nausea, vomiting, diarrhoea, abdominal pain, fever, convulsions, fall in blood pressure, and depression of respiration. It may also cause destruction of red blood cells (haemolytic anaemia).
Precautions
Stop the drug immediately if allergy or pal our of skin (due to haemolytic anaemia) occur.
Avoid its use if you suffer from ringing in the ear or visual disturbances (optic neuritis).
Take the drug after meals.
Avoid its use during the first few months of pregnancy. It may cause abortion.
Primaquine
It is used for a complete cure. It is usually given along with or after chloroquine. Although it has prophylactic properties, it is not used for this purpose because of its toxic nature. Primaquine is given in a dose of 15 mg per day for 2 weeks, for a complete
cure.
Adverse Effects: In therapeutic doses it may cause abdominal discomfort and anaemia: Large doses may cause marked discomfort and alteration in blood (methaemoglobinaemia) and destruction of red blood cells (haemolytic anaemia) in individuals who have low level of an enzyme called G-6 PD. Spot tests are available for testing of G-6-PD deficiency state. If
C-6-PD deficiency is detected, bulaquin (AABLAQUIN) is available which is claimed to be tolerated well in a dose of 25 mg per day for 5 days.
Precautions
The drug should be taken under the supervision of a physician.
The drug should be stopped immediately if darkening of urine occurs.
Its concurrent use with quinacrine should be avoided.
Avoid its use if you are suffering from rheumatoid arthritis.
Note: Due to its toxic side-effects the drug is not allowed to be sold in regular chemist shops and is available only through the public health department.
About the author:
AdvCare is one of the leading Canada pharmacy website. First established in January 2000, its mission is to become the number one site for Discount Drugs and Generic Prescription Drugs searches.
Phenformin (DBI-TD. DBI), Metformin (Glyciphage)
These drugs decrease the intestinal absorption of carbohydrates, promote their oxidation in the tissues, and also reduce conversion of fats and proteins into glucose in the liver. They reduce elevated blood glucose levels only and do not produce hypoglycemia (fall in blood glucvose levels below normal). Metformin is used alone in obese-diabetics but can be given along with sulfonylureas. Usual dose is 250 mg to 500 mg to be taken thrice a day with meals (maximum 3 g in a day)
Adverse Effects: Phenformin causes abdominal discomfort, nausea, vomiting, and diarrhoea in 15% to 25% of cases, but with its sustained release preparation, the frequency of these adverse effects is much less. The most serious adverse effect of this drug is lactic acidosis (accumulation of lactic acid in the body) which not only causes muscular pain in the legs and difficulty in breathing, but can also prove to be fatal. The drug may also cause allergy in the form of skin rashes and itching; in rare cases it may cause allergic shock. Phenformin is rarely used in India. Metformin is a better tolerated drug and is less likely to cause lactic acidosis.
Precautions
In case of severe abdominal discomfort the drug should be taken along with breakfast.
If there are any symptoms of lactic acid accumulation such as pain in the muscle, the drug should be stopped immediately. Also stop the drug if allergic reactions occur.
Metformin decreases the absorption of vitamin B12 in high doses.
It should be used cautiously by those suffering from a heart, kidney, or liver disease.
It causes harmful effects to the unborn child and should not be taken during pregnancy.
It should be used with caution by the old and by those who eat poorly or irregularly.
Thiazolidinediones
Pioglitazone (Piozone, Pioglit), Rosiglitazone (Rosicon, Rosinorm)
Pioglitazone: It enhances entry of glucose in muscles and fats. Pioglitazone reduces formation of glucose from fats and proteins in liver. These effects are due to enhanced effects of insulin on tissues and are brought about by changes in functions of gene that regulates fat metabolism. An added advantage is that bad lipids (triglycerides) are reduced and good lipid (HOL) levels are increased. It is not useful in juvenile (type-1) OM. For type-2 OM it can be used alone or in a combination with metformin or glimepiride. Pioglitazone is used in a dose of 15 to 30 mg once a day and its maximum dose is 45 mg per day.
Adverse Effects: The drug may increase body weight. It may cause headache, muscle pain and anaemia. Hypoglycemia usually does not occur when pioglitazone is used alone. One requires monitoring of liver function. Women taking oral contraceptives may have unwanted pregnancy due to adverse interaction. Therefore, other methods of preventing pregnancy should be adopted.
Rosiglitazone: It has same effects except changes in lipid levels do not occur. It is given in a dose of 2 mg once or twice daily with maximum 8 mg per day.
About the author:
AdvCare is one of the leading Canada pharmacy website. First established in January 2000, its mission is to become the number one site for Discount Drugs and Generic Prescription Drugs searches.
]]>
Eye Infections
Allergic Conjunctivitis
It could be seasonal keratoconjunctivitis seen usually in summer season. Patient has complaints of eye discomfort and redness. It is treated with combination of anti-allergies and low dose of steroids. Another form of allergy is due to use of medication, for which the use of drug should be stopped.
Bacterial Infection
Infection of eye membrane (conjunctivitis) and eyelids (blepharitis) occurs both in children and adults. It may occur in a newborn baby (neonate) too. It is usually caused due to poor hygiene. There may be discharge from the eye. The eyelids may adhere to one another and it may be difficult to open the eye. Sometimes a boil may appear on the eyelash with pus in it (stye). In this case eyelash should be removed by a specialist followed with proper medication. Fomentation of the eyes with boiled water and a pinch of boric acid powder also provides some relief. Infection of cornea may be a severe condition, which if left untreated
may cause complete blindness, hence it requires aggressive treatment.
Fungal Infection
Injuries due to wooden stick or a thorn or vegetable matter can cause fungal infection. This a corneal ulcer, which is difficult to treat and needs a specialist’s intervention.
Viral Infection
Trachoma is a contagious inflammation of eye caused by Chlamydia trachomatis, which is not a true virus but resembles a virus in its properties. It develops slowly. Initially, the patients feels irritation in the eye with redness. This may progress to the formation of small follicles and scarring of eye membrane. If cornea is involved, it may lead to blindness.
Epidemic kertoconjunctivitis is usually seen after rainy season and is caused by Adenovirus. It has no specific treatment. Herpes, a common viral infection, can also cause corneal ulceration.
Treatment of Eye Infections
The treatment of infection of the eye requires anti-microbial eye drops or ointments.
About the author:
AdvCare is one of the leading Canada pharmacy website. First established in January 2000, its mission is to become the number one site for Discount Drugs and Generic Prescription Drugs searches.
This drug belongs to the category of iminostilbenes and is used in the treatment of psychomotor and grand mal epilepsy. Nowadays it is considered as the drug of first choice for grand-mal epilepsy. It provides partial or complete relief to at least 65% of the patients. It is useful In the treatment of neuralgia (a condition in which there is severe neural pain in some area of the face) uncontrollable hiccoughs manic depressive illness and acute mania. It is preferred in young girls because it does not have cosmetic adverse effects of phenytoin.
Dosage: The average daily oral dose of carbamazepine is 0.4 to 1.2 g in 2 or 3 divided doses.
Adverse effects: Its adverse effects may be mild, causing nausea, loss of appetite, drowsiness, and sedation. The drug may also cause pigmentation or discolouration of skin in about 3% cases and rarely depression of the bone marrow. Dose related neurotoxicity, ataxia, double vision, unsteadiness and occasionally seizures, may also occur. Water retention with low blood sodium concentration may occur in elderly.
Precautions
The drug should not be taken on an empty stomach.
It should not be taken by those suffering from heart disease or high blood pressure.
Total and differential white blood cell count should be done periodically.
The drug should be stopped immediately if there are any signs of allergy such as a sore throat, fever, or skin rash.
Phenobarbital (Luminal)
This drug, which is a barbiturate, has been in use in the treatment of grand mal epilepsy since 1912, and is still employed since it is inexpensive and has low toxicity. This is employed either alone or in combination with diphenylhydantoin.
Dosage: The usual daily oral dosage of phenobarbital is 100 to 300 mg given in divided parts.
Adverse Effects: The adverse effects of this drug is mild in nature. The most common effect is drowsiness which can be minimized by giving the drug in divided doses at suitable intervals. Moreover, the patients soon develop tolerance to this adverse effect. These drugs may cause impairment in learning and memory and mild allergic reactions which are in the
form of skin rashes in 1 to 2% cases. Severe types of allergy are extremely rare. Like phenytoin, long term use of phenobarbital may cause vitamin D and folic acid deficiency.
Precautions
Do not stop these drugs abruptly as this may precipitate a severe epileptic attack.
If any abnormal response in the form of excitation is seen, which happens in children, the drugs should not be repeated and the doctor consulted immediately.
Consumption of alcohol and other depressant-drugs may cause marked sedation and should be avoided.
About the author:
AdvCare is one of the leading Canada pharmacy website. First established in January 2000, its mission is to become the number one site for Discount Drugs and Generic Prescription Drugs searches.
Due to a large number of side-effects caused by the tricyclic antidepressants and the monoamine oxidase inhibitors, efforts have been made by pharmaceutical research groups to bring out newer and safer drugs.
Selective Serotonin Reuptake Inhibitors (SSRIs)
The major drawback of conventional tricyclic antidepressants are unacceptable effects on heart (fall in BP, rhythm disturbances) anticholinergic and neurological adverse effects. Low safety margin, as fatalities are common. Slow onset of action. Propensity to precipitate fits; Sedation; Incomplete/poor response in some patients. Advent of SSRIs in 1980 have overcome above limitations to a great extent. SSRIs are becoming preferred drugs for th.el treatment of endogenous depression because of their merits, which are:
Quick onset of action.
Little or no sedation.
No interference with mental functions.
No postural fall in blood pressure so appropriate in elderly.
No precipitation of convulsions.
Little chance of overdose and heart rhythm disturbance.
Antidepressant efficacy equal to tricyclics.
Utility in anxiety, phobia and obsessive compulsive neurosis.
Adverse Effects: Nausea, interference with ejaculation, orgasm nervousness, restlessness, insomnia, loss of appetite, mild abnormal movements, headache and diarrhoea may occur. Sometimes discontinuation of SSRIs result in bowel upset, pins-needles sensations, bodyache and sleep disturbance. Importantly, these drugs may adversely interact with antihistaminics, antipsychotics, propranolol, carbamazepine and diazepam. Therefore, patients on such medications should have appropriate dose adjustments.
St John’s Wart (Hypericin, Hylax)
Hypericin is an active ingredient of aerial parts of St John’s Wart. It is an effective mood elevator and antidepressant in mild to moderate depression in a dose of 1 capsule three times twice a day. It is particularly used when depression is due to a serious medical illness, concurrent medications (amitryptyline, anti HIV drugs, theophylline and warfarin) interact with it.
Mono-amine Oxidase Inhibitors (MAO-Is)
These are older drugs effective in depression but show a lot of adverse interactions with drugs and food . The cheese reaction occurs when foods/beverages such as cheese, bean, red wine, over ripe fruits, broad beans, yeast and soya sauce (all contain a chemical tyramine) are patients on MAO-Is.
About the author:
AdvCare is one of the Canada leading pharmacy website. First established in January 2000, its mission is to become the number one site for prescription drug and drug store searches.