#Phenytoin sodium | Explore Tumblr Posts and Blogs

healthgdwebsite · 4 months

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Trintellix side effects increase suicidal thoughts and behaviour in children, adolescents, and young adults. If you think about suicide while using Trintellix, notify your doctor. If you experience these significant side effects, seek medical attention: Suddenly losing eyesight, impaired vision, tunnel vision, eye discomfort or swelling, or seeing halos around lights are the adverse effects one can have with these antidepressants. Other significant cardiac symptoms include rapid, irregular, or hammering heartbeats, chest fluttering, shortness of breath, abrupt dizziness, lightheadedness or fainting, severe headaches, disorientation, slurred speech, arm or leg weakness, problems walking, lack of coordination, unsteadiness, tight muscles, high temperature, heavy perspiration, or tremors. Uses of Trintellix This medicine treats depression. Restoration of brain serotonin equilibrium is its mechanism. SSRI and serotonin receptor modulator vortioxetine. This medicine may boost your mood, sleep, appetite, vitality, and interest in everyday life. Before using Trintellix, also called vortioxetine, with each refill, read our blog on the Medication Guide. Your doctor may prescribe taking this medicine with or without meals once a day. The dose depends on your medical condition, treatment response, and other drugs. Inform your doctor and pharmacist of all your medications, including herbal remedies. Trintellix Dosage Start with 10 mg of Trintellix orally once a day without food. Increase dosage to 20 mg/day as tolerated. On the other hand, Trintellix interacts with drugs, supplements, and substances. Trintellix may interact with MAOIs, SSRIs, SNRIs, triptans, buspirone, tramadol, tryptophan products, NSAIDs, aspirin, warfarin, bupropion, fluoxetine, paroxetine, quinidine, rifampicin, carbamazepine, and phenytoin. Inform your doctor of any drugs and supplements. Pregnancy, Breastfeeding and Trintellix However, Trintellix's antidepressant side effects are not mild; therefore, use Trintellix only if recommended during pregnancy. It is unknown whether it affects fetuses. Thus, for precautionary measures, do not breastfeed while using Trintellix. Trintellix antidepressant side effects in the latter three months of pregnancy may produce withdrawal symptoms, significant lung difficulties, or other infant issues. However, quitting the medication may be unsafe. Do not start or discontinue Trintellix without medical approval. Before Using This Medication Those who are allergic to vortioxetine should not use Trintellix. Trintellix antidepressant side effects are worse when one stops suddenly using it; you must wait 21 days before taking an MAO inhibitor. Tell your doctor if you use stimulants, opioids, herbal items, drugs for depression, mental illness, Parkinson's disease, migraine headaches, severe infections, or nausea and vomiting prevention. Moreover, Trintellix interactions may produce serotonin syndrome. To ensure Trintellix anti-depressant side effects, inform your doctor of any history of bipolar illness, substance misuse, suicidal thoughts, glaucoma, seizures, epilepsy, bleeding issues, or low sodium levels. Some young individuals think about suicide after using an antidepressant. Visit your doctor regularly to assess your progress. Your relatives or caregivers should also notice mood or symptom changes. Threats and Acts of Suicide During the first few months of medication or dosage changes, Trintellix antidepressant side effects and other antidepressants increase the risk of suicidal thoughts and behaviour in persons under 24. More importantly, TRINTELLIX is not for kids. Depression and other mental diseases drive most suicidal thoughts and behaviours. Pay attention to any changes, remarkably abrupt mood, behaviour, cognition, or emotion changes, or suicidal thoughts or acts. Contact your doctor or emergency services immediately if you have any of these or symptoms like suicidal

thoughts or actions, impulsivity, aggressive or violent acts, depression, anxiety or panic attacks, agitation, restlessness, anger, irritability, trouble sleeping, an increase in activity or talking, or other unusual changes in behaviour or mood, especially if they are new, worse, or worrying you. What Are TRINTELLIX's Side Effects? TRINTELLIX may cause serotonin syndrome, a potentially life-threatening issue when used with certain medications. If you experience any of these serotonin syndrome symptoms, call your doctor or go to the ER: agitation, seeing or hearing things that are not real, confusion, coma, rapid heartbeat, blood pressure fluctuations, dizziness, sweating, flushing, high body temperature, shaking, rigid muscles, twitching, lack of coordination; seizures, nausea, vomiting, etc. Consult with a doctor before taking TRINTELLIX with other medicine. Taking TRINTELLIX with aspirin, NSAIDs, warfarin, or blood thinners may increase bleeding risk. Immediately report unusual bleeding or bruises to your doctor. However, bipolar disorder patients using TRINTELLIX may have manic episodes. Symptoms include increased energy, racing thoughts, lofty ideas, talking more or quicker than usual, significant sleep difficulties, risky conduct, extreme cheerfulness or anger. 1. Discontinuation Syndrome Stopping TRINTELLIX suddenly can cause nausea, sweating, mood changes, irritability, agitation, dizziness, electric shock, tremors, anxiety, confusion, headache, tiredness, problems sleeping, hypomania, ringing in the ears, and seizures. In particular, for persons with underlying eye diseases, TRINTELLIX may develop angle-closure glaucoma. You may desire an eye exam to determine your risk and obtain preventive therapy. Contact your doctor if you experience eye discomfort, vision problems, swelling, or redness. 2. Low Blood Sodium TRINTELLIX may induce life-threatening low blood sodium levels. People over 65 and those taking certain medications may have low blood salt levels. Headaches, trouble focusing, memory problems, disorientation, weakness, and unsteadiness on your feet might lead to falls. In severe or abrupt instances, symptoms include seeing or hearing things that are not real, fainting, convulsions, coma, and ceasing breathing. 3. Sexual Issues With Taking Trintellix Taking TRINTELLIX may create sexual issues. Male symptoms may include delay or inability to ejaculate, diminished sex desire, or erection problems. Reduced sex desire, delayed orgasm, or inability to orgasm are female symptoms. If your sexual function changes or you have questions or concerns during TRINTELLIX therapy, talk to your doctor. The Most Common TRINTELLIX Effects Are: Nausea Constipation Vomiting Do not take Trintellix if you have used an MAO inhibitor such as isocarboxazid, methylene blue injection, phenelzine, tranylcypromine, or others in the prior 14 days. After stopping Trintellix, you must wait 21 days before taking an MAO inhibitor. Some young individuals think about suicide after using an antidepressant. Be aware of mood or symptom changes. Report any new or worsening symptoms to your doctor, such as mood or behaviour changes, anxiety, panic attacks, trouble sleeping, impulsivity, irritability, agitation, hostility, aggression, restlessness, hyperactivity (mentally or physically), depression, or thoughts about suicide or self-harm. Never give Trintellix to children under 18 without medical guidance. This medication is not for kids. Upsides Adults with MDD may take Trintellix. Off-label, Trintellix treats generalized anxiety disorder (GAD). Severe GAD (HAMA >25) seemed to benefit the most. Trintellix is a daily oral pill. Take with or without a meal. Trintellix directly targets serotonin receptors and prevents reuptake, unlike other antidepressants. Compared to tricyclics, MAOIs, and SSRIs, Trintellix seldom causes weight gain. Most individuals should observe depression

symptoms lessen after two weeks of medication, although Trintellix may take four weeks or more to work fully. Downsides The following adverse effects are more common if you are 18–60, take no other medicine, or have no other medical conditions: The most prevalent negative impact is nausea, which may occur in up to 32% of Trintellix 20 mg/day users. Other gastrointestinal adverse effects include diarrhea, dry mouth, constipation, and vomiting. You may also have dizziness, weird dreams, pruritus, and sexual dysfunction. Conclusion https://youtu.be/eCRxgYBk-xM As with other antidepressants, Trintellix may raise the risk of suicidal thoughts or actions, especially in children and young people under 24. However, watch for mood decline. However, Interaction or overdosage may produce serotonin syndrome (agitation, hallucinations, coma, delirium, high heart rate, dizziness, flushing, muscular tremor or stiffness, nausea, vomiting, or diarrhea). Lastly, stopping suddenly from using this may cause headaches, mood changes, irritability, dizziness, and a runny nose. It reduces to 10 mg/day per week before discontinuing. Get medical attention if Trintellix causes rash, edema, or trouble breathing.

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digitalservices99 · 9 months

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Best Phenytoin Sodium Manufacturers In India

Phenytoin Sodium Manufacturers In India Established in 1990, Kreative Organics provides Phenytoin Sodium as per the requirement of clients. We are committed to Quality, Reliability and Sustainability to our numerous clients. We are the leading, diversiﬁed and fully integrated partner to generics marketers. Due to our timely delivery and high quality of the products, we have a goodwill in the market.

Company specialization They are used to treat and avoid confiscations that may start during or after surgery to the brain or the nervous system. Phenytoin goes to a class of prescriptions called anticonvulsants. Phenytoin works by reducing irregular electrical activity in the brain. It is the sodium salt of phenytoin. This is a hydantoin derivative and non-sedative antiepileptic agent. It encourages sodium efflux from neurons positioned in the motor cortex. This will result in stabilizing the neuron and inhibiting synaptic transmission.Kreative organics are procured as one of the leading establishments, involved in offering Phenytoin Sodium. It is a multipart that contains an alkyl amine group attached at the 6-position of a purine.

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that-cunning-witch · 1 year

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Anti-modern science scumbags love to tell you that you're wrong because [insert] consumable is carcinogenic... here are a *few* things that are *actually* carcinogenic according to the IARC/WHO:

The whole point of this list is not to make you feel extitental dread. Instead, it's supposed to make you realize that if these fucking morons want to avoid cancer at all costs and harass others while doing so because of their massive superiority complex, then good fucking luck to them.

(As of May 5th, 2023) [Most explanatory notes are summarized from the NIH/NCBI or EPA] Key: (IARC/WHO notes) [my notes]

Group 2B: Possibly carcinogenic [limited evidence]

Aloe vera, whole leaf extract

Bitumens [aka asphalt]

Bracken fern

Carpentry and joinery [as in the labor]

Diesel fuel, marine

Dry cleaning

Engine exhaust (gasoline)

Fuel oils (residual, heavy)

Gasoline

Goldenseal root powder

HIV (type 2)

HPV (types 26, 53, 66, 67, 70, 73, and 82)

HPV types 5 and 8 in people with EV

Magnetic fields, extremely low frequency

Pickled vegetables (traditional Asian)

Printing processes

Progestins

Progestogen-only contraceptives

Radiofrequency electromagnetic fields [EMF]

Textile manufacturing industry

N-Nitrosopiperidine [found in cigarette smoke along with meats and cheeses preserved with sodium nitrate]

Sterigmatocystin [made by common Aspergillus fungi found in grain-based products, grains, cheeses, coffee, spices, and beer a la mold]

PhIP (2-Amino-1-methyl-6-phenylimidazo[4,5-b]pyridine) [formed when meat is cooked at high temperatures]

Acrylonitrile [used in acrylic fiber and textile productions]

Vinyl acetate [used to make paints and coatings]

Melamine [plates, utensils, paper, boards, etc.]

Furan [found in canned/jarred foodstuffs such as soups, sauces, baby foods, beans, and pasta meals]

Pyridine [used to make medicines, vitamins, food flavorings, pesticides, paints, dyes, rubber products, adhesives, and waterproofing fabrics]

Diethanolamine [helps in the formulation of laundry detergent, dishwashing detergent, cosmetics, shampoos, and conditioners]

Benzophenone [found in lip balm, nail polish, hypnotic drugs, antihistamines, plastics, and other pharmaceuticals]

Diphenylamine [plant growth regulator and to combat storage scald on apples [what we would call bruises]]

Primidone [medication used to control epilepsy and stop seizures]

Griseofulvin [antifungal treatment for ring worm, athlete's foot, and jock itch]

Carbon black [pigment, strengthens tires, uv stabilizer, etc.]

Titanium dioxide [dye used in paper, ceramics, rubbers, textiles, paints, inks, and cosmetics]

Aramite® [insecticide + acaricide]

Talc-based body powder (perineal use of)

Digoxin [known by brand names Digox, Lanoxin, and Lanoxin Pediatric, it's a medication used to help heart failure, arrhythmias, and blood pressure]

Lasiocarpine [found in Heliotropium arbainense and Heliotropium suaveolens]

Ochratoxin A [mycotoxin made by Penicillium and Aspergillus, found in water-damaged houses and heating ducts]

Zidovudine (AZT) [also goes by Retrovir, it's an HIV antiviral medication]

Monocrotaline [found in in the Crotalaria genus of plants]

Caffeic acid [made by all plants but is present in consumption levels of coffee, wine, tea, and various medications such as propolis]

Perfluorooctanoic acid (PFOA) [part of the PFAS group of chemicals, found in non-stick products, stain-resistent products, food packaging, and fire-fighting foam]

Triamterene [aka Dyrenium, medication that helps with fluid retention/edema and high blood pressure]

Metronidazole [brand names include Metrogel, MetroCream, and Nuvessa, an antibiotic used to treat infections in a wide variety of manners including STDs/STIs and rosacea)

Phenobarbital [also known as phenobarbitone, phenobarb, or brand name Luminal, it's a medication that helps with epilepsy and alcohol withdrawal]

Gentian violet [also known as Leucogentian violet, it's used to treat skin fungal infections]

Phenytoin [known by brand names Phenytek, Dilatin Infatabs, and Dilantin Kapseal, it's an anticonvulsent [treats/prevents seizures]]

Sulfasalazine [brand names include Azulfidine and Azulfidine EN-tabs, it helps with rheumatoid arthritis and ulcerative colitis]

Oxazepam [benzodiazepine medication used to help with anxiety, depression, and alcohol withdrawal]

Magenta [as in the color/dye]

Citrus Red No. 2 [used since 1956 to color oranges]

Trypan blue [blue dye used in textiles, specifically cotton]

Lead

Nickel, metallic

Zalcitabine [also known as Hivid, used for HIV/AIDS treatment]

Potassium bromate ["flour improver" and is found in many packaged goods]

Bitumens, occupational exposure to straight-run bitumens and their emissions during road paving [again, asphalt]

Pulegone [present in in the leaves of several plants in the mint family]

Kava extract

Ginkgo biloba extract

Methyleugenol [found in various plants, usually to help with pollination, but is also a volatile flavor compound in the juice of Kogyoku apples]

Group 2A: Probably carcinogenic [more evidence but disputable]

Androgenic (anabolic) steroids

Art glass, glass containers and pressed ware

Biomass fuel (primarily wood), indoor emissions from household combustion of

Frying, emissions from high-temperature

Hairdresser or barber

HPV type 68

Lead compounds, inorganic

Malaria (caused by infection with Plasmodium falciparum in holoendemic areas)

Night shift work (NB Volume 98 evaluated shiftwork that involves circadian disruption)

Nitrate or nitrite (ingested) under conditions that result in endogenous nitrosation [forming within the organism]

Non-arsenical insecticides

Petroleum refining

Red meat

Very hot beverages at above 65 °C (drinking)

Styrene

Pioglitazone [also known as Actos, used to help treat type 2 diabetes]

Malathion [brand name Ovide, often used as an insecticide and can apparently treat head lice]

Chlorozotocin [used for cancer therapy]

Chloramphenicol [antibiotic for serious bacterial infections]

Bitumens, occupational exposure to oxidized bitumens and their emissions during roofing [asphalt]

Methyl methanesulfonate [used in cancer treatment]

Cobalt metal (without tungsten carbide or other metal alloys)

Cobalt metal with tungsten carbide

Acrylamide [naturally forms when foods are cooked at high temperatures]

Group 1: Carcinogenic [nondisputable evidence]

Acheson process, occupational exposure associated with [process of making graphite]

Alcoholic beverages

Aluminium production

Areca nut [aka betel nut]

Auramine production

Coal gasification

Coal, indoor emissions from household combustion of

Engine exhaust, diesel

Estrogen therapy, postmenopausal

Estrogen-progestogen menopausal therapy (combined)

Estrogen-progestogen oral contraceptives (combined)

Firefighter (occupational exposure as a)

Hepatitis B virus (chronic infection with)

Hepatitis C virus (chronic infection with)

HIV type 1 (infection with)

HPV type 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59

Ionizing radiation (all types)

Iron and steel founding (occupational exposure during)

Isopropyl alcohol manufacture using strong acids

Leather dust

Magenta production [as in the color/dye]

Mineral oils, untreated or mildly treated

Nickel compounds

Opium consumption

Outdoor air pollution

Outdoor air pollution, particulate matter in

Painter (occupational exposure as a)

Phenacetin

Phenacetin, analgesic mixtures containing [pain and fever-reducing medication]

Processed meat (consumption of)

Rubber manufacturing industry

Salted fish, Chinese-style

Solar radiation (see Ultraviolet radiation (wavelengths 100–400 nm, encompassing UVA, UVB, and UVC); Ultraviolet radiation from welding; and Ultraviolet-emitting tanning devices)

Soot (as found in occupational exposure of chimney sweeps)

Tobacco smoke, second-hand

Tobacco smoking

Tobacco, smokeless

Ultraviolet radiation from welding (see Ultraviolet radiation (wavelengths 100–400 nm, encompassing UVA, UVB, and UVC); Ultraviolet-emitting tanning devices; and Solar radiation)

Ultraviolet radiation (wavelengths 100–400 nm, encompassing UVA, UVB, and UVC) (see Ultraviolet radiation from welding; Ultraviolet-emitting tanning devices; and Solar radiation)

Ultraviolet-emitting tanning devices (see Ultraviolet radiation (wavelengths 100–400 nm, encompassing UVA, UVB, and UVC); Ultraviolet radiation from welding; and Solar radiation)

Welding fumes

Wood dust

X- and Gamma-Radiation

Tamoxifen [estrogen modulator to help treat breast cancer]

Asbestos (all forms, including actinolite, amosite, anthophyllite, chrysotile, crocidolite, tremolite)

Aflatoxins [produced by Aspergillus fungi found in corn, peanuts, cottonseed, and tree nuts]

Treosulfan [brand name Trecondi, is given to patients prior to receiving a bone marrow transplant]

Aristolochic acid [found in plants including Aristolochia and Asarum]

Azathioprine [brand name Azasan, it's an immunosuppressive drug used to treat rheumatoid arthritis]

Formaldehyde

Cyclosporine [medication that helps prevent organ rejection]

Ethanol in alcoholic beverages

Coal-tar pitch

Benzene

Plutonium

Arsenic and inorganic arsenic compounds

Beryllium and beryllium compounds

Cadmium and cadmium compounds

Vinyl chloride [helps make PVC, wire coatings, vehicle upholstery, and plastic kitchen ware]

Acetaldehyde associated with consumption of alcoholic beverages

Misc [level not stated]

Boot and shoe manufacture and repair (see Leather dust, Benzene)

Continuous glass filament (see Glass filament)

Diesel engine exhaust (see Engine exhaust, diesel)

Foreign bodies (see Ceramic implants, Dental materials, Implanted foreign bodies, Metallic implants, Organic polymeric materials, Orthopaedic implants, Polymeric implants, Silicone breast implants)

Furniture and cabinet making (see Wood dust)

Gamma-Radiation (see X- and Gamma-Radiation)

Gasoline engine exhaust (see Engine exhaust, gasoline)

High-temperature frying (see Frying)

Household combustion of biomass fuel (see Biomass fuel, indoor emissions from household combustion of)

Household combustion of coal (see Coal, indoor emissions from household combustion)

Involuntary smoking (see Tobacco smoke, second-hand)

Mate, hot (see Very hot beverages) [we know it as yerba mate]

Nickel refining (see Nickel compounds)

Oestrogen (see Estrogen)

Oral contraceptives, combined estrogen-progestogen (see Estrogen-progestogen oral contraceptives)

Particulate matter in outdoor air pollution (see Outdoor air pollution, particulate matter in)

Paving and roofing with coal-tar pitch (see Coal-tar pitch)

Sunlamps and sunbeds (see Ultraviolet-emitting tanning devices)

Surgical implants (see Ceramic implants, Dental materials, Implanted foreign bodies, Metallic implants, Organic polymeric materials, Orthopaedic implants, Polymeric implants, Silicone breast implants)

Wood smoke (see Biomass fuel, indoor emissions from household combustion)

Talc containing asbestiform fibres (see Asbestos)

Coal tars (see Coal-tar distillation)

Bitumens, extracts of steam-refined and air-refined; steam-refined, cracking-residue and air-refined bitumens (see Bitumens, occupational exposures) [asphalt]

#science #medicine #who #world health organization #carcinogenic #modern medicine #tw drugs #tw cancer

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tumblhero · 1 year

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finarchemical · 1 year

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What Are The Top Pharmaceutical Excipients

Tablets, oral liquids, capsules, topical creams and gels, transdermal patches, injectable products, implants, eye products, nasal products, inhalers, and suppositories are just a handful of the drug dosage forms available today.

Pharmaceutical excipients are chemicals that are added to a pharmaceutical dosage form for reasons other than their direct therapeutic benefits, such as manufacturing aid, protection, support, or stability enhancement, as well as patient acceptability or bioavailability.

They may also aid in product identification and improve the product's overall performance or safety while being used or stored.

Excipients are required for the production of stable dosage forms, medication administration, and the drug development process. A bad excipient choice can even result in dangerous intoxications, as epileptic patients taking phenytoin capsules in Australia learned in the late 1960s.

So, if you're undecided about which excipient to utilise, pay attention to what comes next!

Di-isopropanolamine- It is used in pharmaceutical formulations as an alkaliser and buffer. The vast majority of its dosage forms are topically applied. Due to high demand, the top di-isopropanolamine manufacturers in India, such as Finar, are expanding rapidly.

Propylene Carbonate- This excipient is generally used in oral and topical pharmaceutical formulations as a solvent and dispensing solvent for modest doses of active medications.

N-Methyl-2-Pyrrolidone- It is frequently used as a solubilizer in pharmaceutical formulations of various types when processing different dosage forms, such as solid orals and other NDDS products.

Succinic Acid- This acid is employed in pharmaceutical formulations as a pH modifier. It's utilised in both oral and parenteral forms.

Tetraethyl orthosilicate- It is a frequent component in pharmaceutical treatments, particularly topical medications (i.e. Transdermal patches). Tetraethyl orthosilicate suppliers have gained significant traction in recent years.

Sodium Metabisulphite- In oral, parenteral, and opiate pharmaceutical formulations, sodium metabisulfite, is utilized in the form of an antioxidant at doses ranging from 0.01 to 1.0% w/v and at roughly 27% w/v in intramuscular injectable preparations.

Tartaric acid- It is a common excipient used as a stabilizer and effervescent agent. Solid oral and parenteral dose formulations are preferred for application.

Tert Butanol- This ingredient is found in formulations used to treat multiple myeloma, cancer, and neoplasms. It is also used as a solvent or co-solvent in lyophilisation.

Meta Cresol- Meta cresol manufacturers in India make these substances to be utilized as an antibacterial and preservative excipient in pharmaceutical formulations.

Ammonium Acetate- Ammonium acetate is used in pharmaceutical formulations as a buffering agent and pH modifier. It is typically found in injectable and parenteral preparations.

Benzyl alcohol- This happens to be an antibacterial preservative used in pharmaceutical formulations such as parenteral and oral drugs.

The excipients listed above are largely used in the pharmaceutical sector. As a result, the pharmaceutical industry would be incomplete without their manufacturing! So, if you're looking for the best and most appropriate pharmaceutical excipients, go to Finar's website to get your hands on them all!

#Diisopropanolamine manufacturers in India #tetraethyl orthosilicate suppliers #meta cresol manufacturers in india #finar

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rogersip · 1 year

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10 Pharma Companies Fined Record by UK Competition Watchdog

The UK competition watchdog has just fined a number of pharma companies a record amount of money. This includes Pfizer, Accord Healthcare, Waymade and Casio. In total, ten different companies have been slapped with a multi-million-pound fine.

Pfizer

UK competition watchdog has fined Pfizer and its partner Flynn Pharma Limited over price hikes for phenytoin sodium capsules, an antiepilepsy drug used to prevent seizures. Pfizer and Flynn allegedly abused their dominant position to charge excessive prices.

The UK Competition and Markets Authority has fined Pfizer PS63 million and Flynn PS6.7 million for excessive pricing. It is the highest fine imposed by the CMA to date.

The National Health Service (NHS) in the UK spends millions each year on these capsules to treat epilepsy. In 2013, the bill for the capsules climbed to 50 million pounds.

The drug has a 25mg, 50mg, 100mg and 300mg strength. Before Flynn's deal with Pfizer, the capsules were sold under the brand name Epanutin. But in September 2012, the capsules were debranded, allowing firms to charge more.

JD Sports/Footasylum

JD Sports PLC has been fined for breaking competition rules by the U.K. Competition and Markets Authority (CMA). It was revealed that a series of meetings between Footasylum executives and JD executives allegedly included commercially sensitive information.

A Sunday Times investigation reported that JD Sports and Footasylum executives met in the car park of a Bury, Greater Manchester shopping centre. The meeting included discussions about Footasylum's financial performance, plans to close stores and stock allocations from key brands.

The CMA said that the companies did not notify it immediately of the meetings. This, it claimed, made it difficult for it to act promptly. Moreover, the watchdog said that it could not get any agendas, notes or other documents relating to the meetings.

Casio

Casio Electronics has been fined by the UK competition watchdog for restricting online retailers from offering discounts on their products. The firm was found to have breached the Competition Act 1998, as it implemented a policy that restricted retailers from setting their own prices.

Casio, which is headquartered in Tokyo, sells a wide range of consumer electronics, from watches to digital cameras. In addition, the company sells musical instruments, including electronic pianos and keyboards.

As a result of its pricing policies, Casio blocked its online retail partners from selling its products at discounts, making it harder for customers to shop around. It also pressured other online stores to report any competitors who were discounting its items.

Accord Healthcare

A UK competition watchdog recently imposed a fine on two pharmaceutical firms for overcharging the National Health Service. The CMA found that the UK's top drug makers overcharged the NHS by over a thousand times for a single pack of hydrocortisone tablets, a common steroid used for treating adrenal gland dysfunction.

According to the CMA, a group of pharmaceutical companies that included U.K. giant Accord overcharged the NHS by at least 10,000%. It was a particularly bad case of 'rigging the market' and was only surpassed by the alleged PS43 million fine that was imposed on rival Advanz Pharma.

The CMA's fines follow an investigation into a variety of pharmaceutical companies' actions. One of these was the sale of de-branded hydrocortisone tablets that were sold for over ten thousand times more than the branded version.

Waymade

Waymade Plc was recently fined by the UK competition watchdog. The company is one of several pharmaceutical firms that were found to have violated the law.

In the UK, the Competition and Markets Authority has focused on antitrust in the past few years. Its emphasis on the life sciences sector in particular has made the agency a leading authority on this topic. As such, the CMA has imposed substantial fines on drug makers.

There is no clear winner in the contest for the most expensive fine, but the CMA has hit several companies with large amounts of money. A few notable names include BMW Group, Bayerische Motoren Werke AG, and Accord Healthcare.

Advanz Pharma

The UK Competition and Markets Authority (CMA) has slapped Advanz Pharma with a record PS260 million fine for its failure to comply with competition law. It was charged with abusing market power and charging excessive prices for liothyronine tablets, a treatment for thyroid hormone deficiency.

In July, the CMA announced that Advanz had been found to have breached competition law by charging excessive prices for liothyronine. In particular, the CMA found that Advanz had breached the law by systematically increasing the price of its liothyronine tablet packs by up to 6,000%.

The company has been fined in three separate investigations. During two of the investigations, the CMA found that Advanz arranged a scheme to restrict competition by paying a rival company to prevent it from entering the market with a generic version of Advanz's hydrocortisone tablet.

#pharma

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maisnote · 2 years

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Useful formulary of acute medications

Adenosine

- CI: asthma - SE: flushing, chest pain, brief asystole / bradycardia - Indication: stable narrow-complex SVT - interrupts re-entry pathways through AV node and restore sinus rhythm - Administration: + Attach defibrillation pads and press continuous print ECG + Rapidly absorbed by RBCs and blood vessel endothelial cells and metabolised therefore needs rapid IV bolus + Now maximum 2 doses: 1st dose 6mg, 2nd dose 12mg - both followed by 20ml NS bolus - Lower dose 3mg used in patients taking dipyridamole (antiplatelet) or carbamazepine as both potentiate the effects of adenosine

Alteplase

- CI: + Significant bleeding disorder 6/12; recent major trauma, surgery or head injury 3/52; recent stroke 6/12; GI bleed 1/12; aortic dissection, severe liver disease (cirrhosis / portal HTN); recent puncture of non-compressible blood vessel; Hx of CNS damage (?neoplasm?); bacterial endocarditis, pericarditis, acute pancreatitis. + Sensitivity to Gentamicin or latex - Dilution 20mg/20ml or 50mg/50ml water (can use NaCl but NOT glucose 5%) - Stop UFH infusion or LMWH before Alteplase infusion; check APTTR after, if <2, resume (usually not advisable within 8 hours)

Massive PE + Weight >= 65kg: 100mg (10mg as IV injection / 1-2 minutes -> 90mg as IV infusion / 2hrs) + Weight <65kg: dose not to exceed 1.5mg/kg - 60kg: 10mg -> 80mg: total 90mg - 55kg: 10mg -> 70mg: total 80mg - 50kg: 10mg -> 65mg: total 75mg - 45kg: 10mg -> 55mg: total 65kg - 40kg: 10mg -> 50mg: total 60mg

Massive PE causing cardiac arrest (off-label) + 50mg IV bolus / 1-2 minutes followed by UFH infusion if there is a response

Acute myocardial infarction, accelerated regimen + Within 6 hours of onset + Accelerated regime (90') or standard (3 hours) + See BNF for dose

Acute stroke + Within 4.5 hours of onset + 900 micrograms/kg (max 90mg) + 10% of dose bolus over 2 minutes; the rest 90% infusion over 60 minutes

Amikacin

Amiodarone

Atropine

Calcium gluconate

Digoxin

Dobutamine

GTN

Isoprenaline

IVIg

Labetalol

Levetiracetam

Metaraminol

Phenytoin

Prothrombin complex

Sodium nitroprusside

Sodium valproate

#pharmacology #emergency #medications

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rx2go · 2 years

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Seizures and Phenytoin Sodium

A seizure is a brain condition that leads to involuntary and abnormal movements, sensations, behavior, and awareness of a person. Phenytoin Sodium is an anticonvulsant drug that helps stabilize the activity of electric impulses in your brain cells.

https://rx2go.com/buy/phenytoin-sodium/

#seizures #rx2go

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juniperpublishersna · 3 years

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Preparation and Application of Novel Chitosan-Guar Gum Composite as Drug Delivery Carrier-Juniper Publishers

JUNIPER PUBLISHERS-OPEN ACCESS JOURNAL OF DRUG DESIGNING & DEVELOPMENT

Abstract

The aim of present work was to prepare the composites of ionic polymer chitosan with non ionic polymer guar gum and then to evaluate it as an excipient for the fast disintegrating drug delivery systems. Chitosan gel (5%) was prepared using acetic acid solution (2%) while 5% guar gum solution was prepared using deionised water. Composite was prepared by mixing both polymers in same proportion at regulated temperature. The dried and sieved composite was characterized for its micromeritic properties, flow behaviour, swelling behaviour and surface characteristics. Six batches of tablets Were prepared with composites in different ratios viz. 5, 10, 20, 30, 40 and 50% of total tablet weight, using phenytoin sodium as model drug. These tablets were evaluated for hardness, friability, weight variation, in-vitro disintegration time, in-vitro release characteristics and stability study using official methods. All the physical parameters were found within the standard limits. Batch F2 showed best in-vitro release and released about 90% drug within first five minutes. Results revealed the fact that characteristics of all tablets did not change significantly for duration of six months. Thus it can be concluded on the basis of present study that these composites can act as excellent excipient for the fast disintegrating drug delivery systems in chronic disorders.

Figure 1: Scanning electron microscopic (SEM) photograph of the surface of chitosan-guar gum composit

Keywords: Composite; Biocompatible polymer; Fast disintegrating tablets; Stability study; phenytoin sodium

Introduction

Composites are generally formed by physical interaction between two different polymer solutions. This type of composites exhibit unique physical and chemical properties, as the interactions within the polymer gels have considerable effect. Many studies have been done to use composites of chitosan and anions for pharmaceutical applications [14]. Chitosan, poly-b-(1-4)-2-amino-2-deoxy-D-glucose, is a naturally occurring cationic polysaccharide derived from the N-deacetylation of chitin. At acidic pH ranges, the ionizable amino groups in chitosan molecules are protonated [5,6]. The formation and the properties of composite depend on various factors including nature and position of the ionic groups, charge density and concentration of both polymers; it also depends upon proportion of charges, molecular weight of the macromolecules and condition of synthesis [7-10]. Most of the natural polysaccharides are anionic in nature such as gum acacia, alginate, xanthan gum, guar gum and gellan gums etc. Guar gum is a naturally occurring polysaccharide obtained from the endosperm of Cyamopsis tetragonalobus. Structurally it is a galactomannan having galactose to mannose ratio of approximately 1:2 [11]. Guar gum is obtained from natural sources and thus a renewable resource, biodegradable and non-toxic. We expect some improvement in the properties (such as hydrophilicity) to be solely based on interaction between two different natural polymers. This paper attempts to investigate the feasibility of chitosan-guar gum composite, as excipient for fast disintegrating drug delivery system in treatment of chronic disorders using phenytoin sodium as model drug. Phenytoin sodium is commonly used anticonvulsant which is useful in the treatment of status epilepticus of the grandmal seizures type. Tablets prepared using chitosan-guar gum composite expect to show good mechanical properties in terms of better hardness and less friability as compared to single polymer used. Hence this formulation overcomes transportation and handling problems generally found in commercial fast disintegrating tablets. This type of polymer promotes oral delivery of drug within few seconds, thus better patient compliance can be achieved for unconscious patient.

Materials and Methods

Material

Drug Phenytoin sodium was purchased from Alchem Laboratories, Baddi India. Sodium alginate and microcrystalline cellulose were procured from CDH Laboratory reagent, Central Drug House (P) Ltd, New Delhi, India. Chitosan (Medium molecular weight, viscosity 200.000cps) was purchased from Sigma Aldrich, Spruce Street, St. Louis. All other materials were of pharmaceutical grade and purchased as "supplied without further purification".

Preparation of chitosan-guar gum composites

5% chitosan gel was prepared using 2% acetic acid solution. Continuous agitation and heating made a gel formation at temperature about 45 °C. Further temperature was increased up to 70 °C with continuous stirring. Guar gum was added in deionized water to form homogeneous solution of 5%(w/v). Temperature of gum solution was increased slowly up to 60 °C. To prepare composites, equal proportion of both solutions was mixed with continuous stirring and temperature of mixture was reduced within the range of room temperature (25-35 °C). This solution was further dried under vacuum. Dried composite was powdered and passed through sieve #20, and stored in airtight container for further study [12].

Experimental work

Characterization of chitosan-guar gum composites

Surface morphology of composite particles: The surface characteristics of composites were observed by scanning electron microscopy ((Leo 435 VP, Carl Zeiss NTS GmbH, Oberkochen, Germany). Dried powdered composites were passed through sieve #20 and coated with gold using a sputter coater (Agar sputter coater, Agar Scientific, Stansted, UK) under high vacuum (100m Torr) and high voltage (1.2kV and 50mA). The samples were imaged using high energy electron beam.

Micromeritic properties of composite: As described by authors elsewhere apparent bulk density (g/ml), tapped sensity, Carr's Index, bulkiness and angle of repose of powdered composite was determined [12,13].

Swelling study: As discussed earlier swelling properties of composite was studied [14].

Rheological study of coacervates: To determine viscosity 1%w/v solution of composite was prepared in purified water. Viscosity of polymer was measured at shear rates from 0.1 to 2.0s-1 at 25 °C using Brookfield viscometer.

Preparation of composites based tablets

*percentage of total tablet weight

Granulation: In present research work, wet granulation technique was used to prepare matrix tablet. Drug dose (phenytoin sodium) was 30mg for each tablet and was added accordingly. According to Table 1, all the ingredients were mixed physically for 25min, using a mortar pestle. Then, appropriate amount of distilled water was added to prepare a wet mass. Wet mass was passed through sieve 20 # to obtain granules. The granules were dried at 45 °C for 24h.

Preparation of tablets: Equivalent to weight of single tablet (500mg), granules were weighted and compressed by Cadmach punching machine with 12mm diameter flat faced tolling.Tablets were compressed at compression force of 2 Newton for 10 seconds [12].

Evaluation of composites based tablets

Evaluation for weight variation: Test was carried out according to the European pharmacopoeia. Twenty tablets were randomly selected from each batch and the mean of tablet weights was calculated. Results are presented as mean value and standard deviation [12-14].

Tablet thickness testing: The thickness of the matrix tablets was determined using vernier caliper (Mitutoyo Dial Thickness Gauge, Mitutoyo, Japan) and the results were expressed as mean values of 10 determinations with standard deviations [15-17].

Evaluation for tablet hardness: Hardness of all batches was determined using Digital Force Gauge (Model:EL=500N, Electrolab). The test was carried out in triplicate for all batches as per USP XXIV monograph for uncoated tablets. The tablet hardness was expressed in Newton (N) unit and mean with standard deviation were calculated [12-14].

Friability measurement: Twenty tablets were randomly selected from each batch, accurately weighed and placed in the drum of friabilator (Erweka type, GmbH, Germany). The tablets were rotated at 25rpm for a period of 4min and then removed, dedusted and accurately re-weighed (EP 2000). The percentage loss in weight was calculated and taken as a measure of friability. The readings were shown as mean of triplicate with standard deviation [12-14].

Drug content: The tablets were powdered, and 30mg equivalent weight of phenytoin sodium in tablet powder was accurately weighted and transferred into a 100ml volumetric flask. Initially, 10ml of phosphate buffer (pH 6.6) was added and shaken for 10min. Then, the volume was made up to 100ml with buffer. Subsequently, the solution in volumetric flask was filtered, and 1ml of the filtrate was diluted and analyzed at 252nm using UV-visible spectrophotometer (Shimadzu UV-2450, Japan). The drug content of the each sample was estimated from standard curve [12-14].

In-vitro disintegration time: Tablets of all batches were selected and evaluated for disintegration time in distilled water maintained at 37±0.5 °C temperature using a disintegration apparatus (Electrolab, TDT-06T, Mumbai, India ), according to European pharmacopoeia (2002) specifications. The disintegration time was defined as the time necessary for the "Oral Disintegrating Tablet" to completely disintegrate until no solid residue remains or only a trace amount of soft residue remains on the screen. A digital stopwatch was used to measure the disintegration time to the nearest second. Only one tablet was analyzed at a time in order to ensure accuracy. All results are presented as mean value of six readings with standard deviation [12-15].

In vitro drug release study: In vitro drug release was studied using LabIndia Dissolution apparatus, with 900ml of dissolution medium (phosphate buffer pH 6.6) maintained at 37±1 °C for 90min, at 100rpm. 5ml of sample was withdrawn at particular time interval, and was replaced by an equal volume of fresh dissolution media of same pH (phosphate buffer pH 6.6). Collected samples were analyzed spectrophotometrically at measured wavelength of 252nm, and cumulative percent drug release was calculated. The data obtained in the in-vitro dissolution study was analyzed in terms of, percentage drug release with respect to time (min).

Kinetic assessment of in vitro drug release: To determine the drug release pattern based on release model, the in vitro drug release data were fitted to Zero-order (cumulative percentage amount of drug release versus time), First-order (log cumulative percentage of drug remaining to release versus time), Higuchi (fraction of drug release, Mt/Mi, versus square root of time) and Korsemeyer-Peppas (log fraction of drug released, log Mt/Mi, versus log time) models. Most suited model for drug release was decided on the basis of regression coefficient.

Stability study: Selected tablets of all formulations were stored in polyvinyl chloride (PVC) blisters covered with aluminum foil, at room temperature and 60% relative humidity for a time period of 12 months. To maintain relative humidity, ammonium nitrate (NH4NO3) saturated salt solution was used as a humidifier. Stability of all formulations was assessed by comparing the results from in vitro disintegration and dissolution studies. To investigate any changes in the physicochemical properties of composite and drug, infrared spectrum of individual compound was matched after 0, 3, 6 and 12 months interval. The results were checked for statistical significance using the one-way analysis of variance (ANOVA), F-test for testing the equality of several means. A p-value>0.05 was considered statistically insignificant [16].

Results

#value in parenthesis show standard deviation of triplicate readings.

Chitosan-guar gum composite was synthesized and characterized for micromeritic properties and flow behaviour; findings of these studies are shown in Table 2. Scanning electron microscopic study of composites easily depict the fact that surface of composite particles were rough in nature. As per the table 3, the formulated matrix tablets met the Pharmacopoeial requirement of uniformity of weight. They also confirmed, to the requirement of assay, as per USP. Hardness, percentage friability and thickness were all within acceptable limits. The hardness of tablets was determined and was found to be in the range of 20.08 to 20.88 N. The values for all batches showed that tablets have sufficient hardness and further friability was studied for all batches. Friability was obtained between 0.112 to 0.212%, which was below 1% indicating sufficient mechanical integrity and strength of the prepared tablets. Thickness of tablets was also measured to evaluate efficacy of process of formulation development. Thickness of tablet was found in between 3.74 to 4.10mm. Drug content was also measured to evaluate the accuracy of procedure. Good and uniform drug content values for all batches are able to show that this particular process was quite efficient.

Results of in vitro release study showed that all studied tablets released more than 95% drug within 60min as shown in Figure 2. Batch F2, batch F3 and batch F6 release more than 90% drug within 15min and which is comparatively better than batch F1, batch F4 and batch F5 (Figure 2). Results obtained from in vitro drug release were fitted to Zero order, First order, Higuchi kinetics and Korsmeyer-Peppas diffusion model (Table 3). Model that best fitted the release data was evaluated on the basis of correlation coefficient (r). Findings of Table 4 easily predict that none of the formulation showed better regression value when fitted to zero order equation (Qt=Q0+K0t). When release data was plotted according to first order equation (Qt=Q0e-K1t),batch F1, F2, F4 and F5 showed linearity, with regression value 0.944, 0.929, 0.904 and 0.979 respectively. Higuchi kinetics was fairly shown by batch F5 with regression value 0.919, other batches did not show significant regression valve when fitted in Higuchi kinetic equation (Qt=Kh t1/2). Diffusion mechanism of drug release was studied by fitting in vitro drug release data in to Korsmeyer-Peppas diffusion model (Qt/Qt=Kktn). All batches except Batch F5 showed good linearity of regression coefficient with this model. On the basis of regression value of all batches it was concluded that batch F1, F5 and F6 follow First order kinetics (release rate of drug from matrix, is proportional to the amount of drug remaining in the matrix) while batch F2, F3 and F4 follow Korsmeyer-Peppas diffusion kinetics (drug release based on more than one phenomenon) with n value less than 0.5 (fickian diffusion).

Values in parenthesis shows standard deviation.

¶r=Correlation Coefficient; K0=Zero Order Release Rate Constant; K1= First Order Release Rate Constant; D=Diffusion Coefficient and n= Release Exponent

After 12 months of stability study at controlled environmental conditions no significant differences (p<0.05) in disintegration time and in vitro drug release rate of the prepared tablets were observed. On the basis of infrared spectroscopic studies during the stability study, it can be concluded that there was no change in the physico-chemical properties of both composite and drug (Table 4).

Discussion

Findings of present investigation demonstrate that the properties of composites are entirely different from the properties of each single polymer from which that complex is synthesized. Synthesized composites have characteristics properties in terms of micromeritic properties and flow behaviour (Table2) . Micromeritic study data is important in predicting the flow property of polymer as well as for granules obtained after granulation. The synthesized composites showed better flow properties hence depicting the fact that this complex when used as polymer would enhance the flow characteristic of the formed granules. Flow property is emphasized because, it decides the ease of compaction of powder or granules into a tablet dosage form. Carr's index was studied with the aim to evaluate compressibility characteristics of the composite. All these parameters ranged between the reported limits. Results also reveal the fact (Table 3)that micromeritic properties and flow characteristics does not changed significantly when different powder blends were prepared using composite. Post compression study such as hardness and friability were all within acceptable limits. These are important physical properties which demonstrate that the tablet formulated can be handled easily without any physical damage. These two data show the importance of formulation over commercial fast disintegrating tablets which have problem during transportation and storage. Thickness of tablets was also measured to evaluate efficacy of process of formulation development. Almost uniform thickness of tablets showed that this process is efficient enough to produce tablet. Drug content was measured to evaluate the efficiency. Uniform drug content values for all batches show that this particular process was highly efficient and can be used at industrial level to formulate fast disintegrating tablet for a particular disease condition. The in vitro drug release was studied in terms of % drug release vs time (min) graph, and showed that all batches released drug within a small duration of time. Hence, release characteristics are able to demonstrate that all the formulations can be used for the commercialization of product. The drug release data for the various chitosan-guar gum composite tablets fitted into the classical power law expression. This indicates that drug release from these matrix tablets followed non-Fickian kinetics, due probably to rapid swelling and erosion of the matrix structure formed by the interaction of chitosan and guar gum. It is likely that the incorporation of composite into tablets would enhance initial swelling, followed by erosion of matrix. Data obtained during stability study demonstrate that these tablets were stable during the period of stability study (Table 4). Properties of tablets did not change significantly during the study. So these types of tablets can be stored in the environmental condition (temperature-25 °C, relative humidity 40% to 60%).

It can be concluded by all the physico-chemical parameters and in vitro disintegration and in vitro dissolution study that batch F2 was optimized formulation among the six batches of tablets. The batch F2 showed less friability and greater hardness when compared to other batches. In vitro disintegration time and in vitro dissolution time were also less comparatively. The tablets released 98.98% of drug. It can be concluded on behalf of obtained results that neither the drug nor the polymers show any interaction, thus removing the uncertainty of cause of any chemical interaction. This is utmost important while formulating any dosage form, so that individual characteristics of compound is retained Table 5.

┼valves in parenthesis shows standard deviation of triplicate readings

Conclusion

The study demonstrated that physical interaction took place during the formation of chitosan-guar gum composites which helped in enhancing the release of drug from the tablets within few minutes. Thus, this may prove to be efficient means of formulating fast disintegrating tablets for the treatment of chronic disorders at the initial stage of attack/onset.

Acknowledgement

Authors are highly thankful to "Sophisticated Analytical Instrumentation Facility (DST)" Department of Anatomy, All India Institute of Medical Sciences, New Delhi India, to carry out scanning electron microscopic (SEM) study of chitosan-guar gum composite.

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Phenytoin Sodium

Common Brand Names: Dilantin

Therapeutic Class: A hydantoin-derivative anticonvulsant structurally related to the barbiturates.

Common Injectable Dosage Forms:

Injection: 50 mg/mL in vials and syringes (46 mg phenytoin)

Dosage Ranges:

To achieve therapeutic serum concentrations (10-20 µg/mL) within 1-2 hours for status epilepticus, a dose of 10-15 mg/kg may be given at a rate not exceeding 50 mg/minute. In children, give 250 mg/m2. Most clinicians recommend doses of 15-18 mg/kg at a rate of 25-50 mg/minute and children may receive 10-15 mg/kg at a rate of 0.5-1.5 mg/kg/minute to a maximum of 20 mg/kg in 24 hours. Maintenance therapy is generally instituted at 100 mg every 8 hours, with dosages titrated individually until desired response is obtained. Patients should be converted to oral therapy as soon as feasible.

For glycoside-induced arrhythmias, 100 mg IV has been given at 5-minute intervals until normal rhythm resumes or until a maximum of 1 gram is reached.

Therapeutic Drug Level: Between 10-20 µg/mL

Administration and Stability: Direct IV injection in a large vein of undiluted solution (50 mg/mL) is recommended at a rate not to exceed 50 mg/minute. Although dilution for IV infusion is generally not recommended, it has been used by diluting with a compatible solution (NS) to a concentration less than 6.7 mg/mL and infusing immediately while observing carefully for precipitation. Use of in-line 0.22-5-micron filter recommended for IVPB solutions due to high potential for precipitate to form. IM administration has been used when other routes are unavailable, but, since absorption is erratic, is not generally recommended and has been specifically limited to 1 week of therapy. Stable for 14 hours at room temperature when diluted to 2 mg/mL with NS. pH 10-12.3

Pharmacology/Pharmacokinetics: Phenytoin limits seizure activity by reducing the post-tetanic potentiation of synaptic transmission. This is accompanied by reducing the passive influx of sodium ions or increasing sodium pump activity to eliminate accumulation of sodium ions during tetanic stimulation. Therapeutic plasma concentrations are obtained in 1-2 hours following the administration of an IV loading dose, with steady state therapeutic levels of 7.5-20 mcg/mL achieved within 7-10 days in the absence of a loading dose. Phenytoin is highly protein bound (95%) with a plasma half-life of approximately 22 hours. Phenytoin is metabolized in the liver by a saturable process to inactive metabolites and excreted in the urine (unchanged drug 2-5%).

Drug and Lab Interactions: Since phenytoin is highly protein bound and metabolized in the liver, drugs which possess either of these qualities may interact with this drug. Drugs which increase phenytoin levels by inhibition of metabolism include sulfonamides, phenylbutazone, PHENOTHIAZINES, isoniazid, WARFARIN, and benzodiazepines. PHENOBARBITAL and CARBAMAZEPINE may decrease phenytoin levels by induction of the hepatic enzyme system. Phenytoin may increase the levels of such drugs as thyroid supplements and methotrexate by competitive protein binding. Tricyclic antidepressants may increase chance of seizures and oral contraceptives may increase plasma levels of phenytoin be decreasing hepatic metabolism and/or decreasing protein binding.

Contraindications/Precautions: Contraindicated in patients with known hypersensitivity to other hydantoin agents, sinus bradycardia, sinoatrial block, second- or third-degree atrioventricular block, or Adams-Strokes syndrome. Should be used with caution in pregnant patients and levels monitored frequently due to altered metabolism, and also in patients with respiratory depression, MI, CHF, or otherwise damaged myocardium. Antiepileptic drugs should not be abruptly discontinued because of the possibility of increased seizure frequency. If hypersensitivity occurs, rapid substitution of an alternative therapy may be required. Use with caution in patients with impaired hepatic function. Stop use if rash develops. Pregnancy Category D.

Monitoring Parameters: BP, vitals, plasma phenytoin level, CBC, LFTs

Adverse Effects: Adverse effects are varied, frequent, and may occasionally be serious in nature. More serious effects include exfoliative dermatitis, Stevens-Johnson syndrome, lymphadenopathy, blood dyscrasias, and CNS toxicity related to high serum levels. Other effects reported include hirsutism, gingival hyperplasia, thrombophlebitis, tissue necrosis at injection sites, osteomalacia, and GI effects.

Common Clinical Applications: Frequently utilized as initial treatment of generalized tonic-clonic seizures, complex partial seizures, and cortical focal seizures. Also used in treatment of digitalis-induced cardiac arrhythmias.

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مثبطات إعادة امتصاص السيروتونين الانتقائية (Selective serotonin reuptake inhibitor) والكورتيزون (Corticosteroid): الاستخدام المقترن مع مضادات الالتهابات غير الاسترودية يزيد من خطورة حدوث نزيف الجهاز الهضمي فيوصى في هذه الحاله استخدام الادية الواقية من قرحة المعده.

الكوليسترامين Cholestyramine والكوليستيبول Colestipol: يقللان من تأثير العقار (والمضادات الغير الاسترودية الاخرى) بتقليل امتصاصه من الامعاء ولذلك يجب تناول قبل الكوليسترامين بساعه او بعده ب 4 ساعات.

أدوية الحموضة المحتوية علي الألومنيوم أو المغنسيوم (الجرعة العالية): تقلل من إمتصاص الدواء في الدم و بالتالي تأثيره لذا يجب أن تؤخذ بعيداً عن الدواء بمدة لا تقل عن ساعة.

مثبطات CYP2C9 القوية مثل فلوكونازول fluconazole وسولفينبيرازون (Sulfinpyrazone): يمكن أن يزيدا من تركيز الدواء في الدم و بالتالي يحتاج إلي تقليل الجرعة.

- الجرعة:

البالغين: 75 : 150 مجم في اليوم كجرعة واحدة أو مقسمة على جرعات.

الاطفال (من عمر 1: 12 سنه): 1 : 3 مجم لليوم مقسمة على جرعات.

*لا يستخدم الحقن لمده اكثر من يومين ولا في الاطفال اقل من 3 سنوات.

*عند تسريب (حقن بقسطرة) الوريدي للعقار مع محلول ملح 0.9% او جلوكوز 5% يجب معالجتهم قبلها بصوديوم بيكربونات.

- الجرعة الزائدة:

ليس لها صورة اكلينيكية نموذجية فقد تسبب اعراض مثل القئ, نزيف الامعاء, انخفاض ضغط الدم, هبوط الجهاز التنفسي, الاسهال, الدوخة, الطنين أو التشنجات وفي حالات التسمم الكبيرة قد يحدذ فشل كلوي حاد او تلف في الكبد.

علاجها كغيرها من مضادات الالتهابات غير الاسترودية يتكون بصفة اساسية من علاج داعم وعلاج لأعراض المضاعفات وعند تناول جرعات كبيرة يجب وضع في الاعتبار استخدام الكربون النشط والتنظيف المعوي (مثل القيئ).

- الحمل والرضاعة:

الخصوبة: كغيره من مضادات الغير الاسترودية الاخرى يسبب قصور في الخصوبة.

الحمل: يمر الدواء عبر المشية ,ففي الثلاث شهور الاولى والثانية من الحمل الاول يعتبر الدواء فئة سلامة الحمل B فيجب عدم تعاطيه الا عند الضرورة وبجرة قليلة ولفترة قصيرة قدر الامكان, وفي الثلث الاخير ممنوع استخدامه لانه قد يثبط عملية الولادة. بالاضافة الى تاثيره السلبي على جهاز القلب والاوعية الدموية الخاص بالجنين.

الرضاعة: كغيره من مضادات الغير الاسترودية الاخرى ينتقل في لبن الرضاعة بكميات صغيرة فيفضل تجنب استخدامه بدون استشارة الطبيب.

- الشركة المنتجة: تبوك.

#متى يبدأ مفعول رابيدوس

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