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Anxiolitic Treatment
Anxiolitic Treatment
XANAX,FRONTIN,ALPROX,alprazolam(alprazolamum)-10-12
2.CALMEPAM,LEXOTANIL (bromazepamum)-8-19
3.EPIRAX,LIBRIU,NAPOTON(clordiazepoxid)-5-30
18.Distonocalm
19.extraveral
20. Dalmane
(flurazepam)
4.TRANXENE,(chlorazepatum dikalicum)5.DIAZEPAM,valium(diazepamum)-24-48
6.LORANS,LORAYEPAM(lorazepamum)-8-25
7.ANSILAN,RUDOTEL,EUROZEPAM, (medazepamum)-1-2
21 Doral (quazepam)
22. Effexor (venlafaxine)
23. Halcion (triazolam)
24. Klonopin
(clonazepam)
8.OXAZEPAM,SERAX,(oxazepanum)-6-25
9.GRANDAXIN(tofisopanum)10.Atarax,HIDROXIZIN (hydroxyzinum)11.RIVOTRIL (clonazepamum)12.ANTISTRESS(combinatii)
13.TENSISPES,BUSPAR(buspironum)14.CALMOGEN (combinatii)
15.MEPROBAMAT(meprobamatum)-6-17
16.STRESSIGAL(buspironum hydrochloridum)
17.Metoprolol (betablocant)
18.Lorazepam,lorans,Ativan
Lorazepam
farmacology
Anxiolytic - Sedative
Anterograde amnesia, decreased or lack of recall of events during period of drug action, has
been reported after administration of lorazepam and appears to be dose-related.
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Indications
The short-term relief of manifestations of excessive anxiety in patients with anxiety neurosis.
Adjunct for the relief of excessive anxiety that might be present prior to surgical procedures.
Anxiety and tension associated with the stresses of everyday life usually do not require
treatment with anxiolytic drugs.
Injectable lorazepam is useful as an initial anticonvulsant medication for the control of status
epilepticus.
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Contraindications
Myasthenia gravis, acute narrow angle glaucoma, known hypersensitivity to benzodiazepines.
Lorazepam injectable is also contraindicated in patients with known hypersensitivity to
polyethylene glycol, propylene glycol or benzyl alcohol.
Lorazepam should not be injected intraarterially and care should be taken to prevent its
extravasation into tissue adjacent to an artery because of the danger of producing
arteriospasm resulting in gangrene which may require amputation.
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Warnings
Occupational Hazards:
Excessive sedation has been observed with lorazepam at standard therapeutic doses.
Therefore, patients should be warned against engaging in hazardous activities requiring
mental alertness and motor coordination, such as operating dangerous machinery or driving
motor vehicles.
Prior to i.v. use, lorazepam injection should be diluted with an equal amount of compatible
diluent (see Dosage). I.V. injection should be made slowly and with repeated aspiration. Care
should be taken to determine that any injection will not be intraarterial and that perivascular
extravasation will not take place. Partial airway obstruction may occur in heavily sedated
patients. I.V. lorazepam, when given alone in greater than the recommended dose, or at the
recommended dose and accompanied by other drugs used during the administration of
anesthesia, may produce heavy sedation; therefore, equipment necessary to maintain a patent
airway and to support respiration/ventilation should be available.
As with any premedicant, extreme care must be used in administering lorazepam injection to
elderly or very ill patients and to those with limited pulmonary reserve, because of the
possibility that apnea and/or cardiac arrest may occur. Because of the lack of sufficient
clinical experience lorazepam injection is not recommended for use in patients less than 18
years of age.
Clinical trials have shown that patients over the age of 50 years may have a more profound
and prolonged sedation with i.v. lorazepam. Ordinarily an initial dose of 2 mg may be
adequate, unless a greater degree of lack of recall is desired.
There is no evidence to support the use of lorazepam injection in coma, shock or acute
alcohol intoxication at this time. When lorazepam injection is used in patients with mild to
moderate hepatic or renal disease, the lowest effective dose should be considered since drug
effect may be prolonged.
As is true of other similar CNS acting drugs, patients receiving injectable lorazepam should
not operate machinery or engage in hazardous occupations or drive a motor vehicle for a
period of 24 to 48 hours. Impairment of performance may persist for greater intervals because
of extremes of age, concomitant use of other drugs, stress of surgery or the general condition
of the patient.
Care should be exercised when administering lorazepam to patients with status epilepticus,
especially when the patient has received other CNS depressants or is severely ill. The
possibility that respiratory arrest may occur or that the patient may have partial airway
obstruction should be considered. Proper resuscitation equipment should be available.
Pregnancy:
The safety of the use of lorazepam in pregnancy has not been established. Therefore, it is not
recommended for use during pregnancy or lactation. Several studies have suggested an
increased risk of congenital malformations associated with the use of the benzodiazepines,
chlordiazepoxide and diazepam, and meprobamate, during the first trimester of pregnancy.
Since lorazepam is also a benzodiazepine derivative, its administration is rarely justified in
women of childbearing potential. If the drug is prescribed to a woman of childbearing
potential, she should be warned to contact her physician regarding discontinuation of the drug
if she intends to become or suspects that she is pregnant.
In women, blood levels obtained from umbilical cord blood indicate placental transfer of
lorazepam and lorazepam glucuronide. Lorazepam injection should not be used during
pregnancy. There are insufficient data regarding obstetrical safety of parenteral lorazepam,
including use in cesarean section. Such use, therefore, is not recommended.
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Precautions
Elderly and debilitated patients, or those with organic brain syndrome, have been found to be
prone to CNS depression after even low doses of benzodiazepines. Therefore, medication
should be initiated in these patients with very low initial doses, and increments should be
made gradually, depending on the patient's response, in order to avoid oversedation or
neurological impairment. Extreme care must be used in administering lorazepam injection to
elderly patients, very ill patients, and to patients with limited pulmonary reserve, because of
the possibility that underventilation and/or hypoxic cardiac arrest may occur. Resuscitative
equipment for ventilatory support should be readily available.
Observe caution in patients who are considered to have potential for psychological
dependence. Lorazepam should be withdrawn gradually if it has been used in high dosage.
As with other benzodiazepines, lorazepam injection has a low potential for abuse and may
lead to limited dependence. Although there are no clinical data available for injectable
lorazepam in this respect, physicians should be aware that repeated doses over a prolonged
period of time may result in limited physical and psychological dependence.
Lorazepam is not recommended for the treatment of psychotic or depressed patients. Since
excitement and other paradoxical reactions can result from the use of these drugs in psychotic
patients, they should not be used in ambulatory patients suspected of having psychotic
tendencies.
As with other anxiolytic-sedative drugs, lorazepam should not be used in patients with
nonpathological anxiety. These drugs are also not effective in patients with characterological
and personality disorders or those with obsessive-compulsive neurosis.
When using lorazepam, it should be recognized that suicidal tendencies may be present and
that protective measures may be required.
Since the liver is the most likely site of conjugation of lorazepam and since excretion of
conjugated lorazepam is a renal function, the usual precautions should be taken if lorazepam
is used in patients who may have some impairment of renal or hepatic function. In such cases,
the dose should be very carefully titrated.
In patients for whom prolonged lorazepam therapy is indicated, periodic blood counts and
liver function tests should be carried out.
When injectable lorazepam is used in patients with mild to moderate hepatic or renal disease,
the lowest effective dose should be considered since drug effect may be prolonged.
While lorazepam has been shown to control status epilepticus promptly, it is not
recommended for maintenance treatment of epilepsy. After seizures are controlled, agents
useful in the prevention of further seizures should be administered. In the treatment of status
epilepticus due to acute reversible metabolic derangement (e.g., hypoglycemia,
hypocalcemia, hyponatremia) immediate efforts should be made to correct the specific defect.
Drug Interactions:
If lorazepam is to be combined with other drugs acting on the CNS, careful consideration
should be given to the pharmacology of the agents to be employed because of the possible
potentiation of drug effects. The benzodiazepines, including lorazepam, produce CNS
depressant effects when administered with such medications as barbiturates or alcohol.
Lorazepam injection, like other injectable benzodiazepines, also produces depression of the
CNS when administered with ethyl alcohol, phenothiazines, barbiturates, MAO inhibitors and
other antidepressants. When scopolamine is used concomitantly with injectable lorazepam, an
increased incidence of sedation, hallucinations and irrational behaviour has been observed.
When lorazepam injection is used i.v. as the premedicant prior to regional or local anesthesia,
the possibility of excessive sleepiness or drowsiness may interfere with patient cooperation to
determine levels of anesthesia. This is most likely to occur when a dose greater than 0.05
mg/kg is given and when narcotic analgesics are used concomitantly with the recommended
dose.
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Adverse Effects
Drowsiness is the most frequently reported adverse effect. Other reported adverse effects are
dizziness, weakness, fatigue and lethargy, disorientation, ataxia, anterograde amnesia, nausea,
change in appetite, change in weight, depression, blurred vision and diplopia, psychomotor
agitation, sleep disturbance, vomiting, sexual disturbance, headache, skin rashes,
gastrointestinal, ear, nose and throat, musculoskeletal and respiratory disturbances.
Release of hostility and other paradoxical effects, such as irritability and excitability have
occurred with benzodiazepines. In addition, hypotension, mental confusion, slurred speech,
oversedation and abnormal liver and kidney function tests and hematocrit values have been
reported with these drugs.
The most frequent adverse effects seen with injectable lorazepam are an extension of the
CNS depressant effects of the drug. Excessive sleepiness and drowsiness are the main side
effects: the incidences reported depended on the dosage, route of administration, concomitant
use of other CNS depressants and the investigators' expectations concerning the degree and
duration of sedation.
When injectable lorazepam was given i.v., patients over 50 years of age had a higher
incidence of excessive sedation than patients under 50 years of age. Restlessness, confusion,
depression, crying, sobbing, delerium, hallucinations, dizziness, diplopia have been reported.
Hypertension and hypotension have occasionally been observed after injectable lorazepam.
Respiratory depression and partial airway obstruction have been observed after injectable
lorazepam. Skin rash, nausea and vomiting have been noted occasionally in patients who
have received injectable lorazepam combined with other drugs during anesthesia and surgery.
Pain at the injection site, a sensation of burning, and redness in the same area have been
reported after i.m. administration of injectable lorazepam. Pain in the immediate postinjection
period and redness at the 24 hour observation period also have been reported after i.v.
administration of injectable lorazepam.
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Overdose
Symptoms:
With benzodiazepines, including lorazepam, symptoms of mild overdosage include
drowsiness, mental confusion and lethargy. In more serious overdosage, symptoms may
include ataxia, hypotonia, hypotension, hypnosis, stages I to III coma and, very rarely, death.
Treatment:
In the case of an oral overdose, if vomiting has not occurred spontaneously and the patient is
fully awake, it may be induced with 20 to 30 mL of ipecac syrup USP. Institute gastric lavage
as soon as possible, and introduce 50 to 100 g of activated charcoal to the stomach and allow
it to remain there. Institute general supportive therapy as indicated. Vital signs and fluid
balance should be carefully monitored. An adequate airway should be maintained and
assisted respiration used as needed. With normally functioning kidneys, forced diuresis with
i.v. fluids and electrolytes may accelerate elimination of benzodiazepines from the body. In
addition, osmotic diuretics such as mannitol may be effective as adjunctive measures. In
more critical situations, renal dialysis and exchange blood transfusions may be indicated.
Published reports indicate that i.v. infusion of 0.5 to 4 mg of physostigmine at the rate of 1
mg/minute may reverse symptoms and signs suggestive of central anticholinergic overdose
(confusion, memory disturbance, visual disturbances, hallucinations, delirium); however,
hazards associated with the use of physostigmine (i.e., induction of seizures) should be
weighed against its possible clinical benefit.
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Dosage
Dosage must be individualized and carefully titrated in order to avoid excessive sedation or
mental and motor impairment. As with other anxiolytic sedatives, short courses of treatment
should usually be the rule for the symptomatic relief of disabling anxiety in psychoneurotic
patients and the initial course of treatment should not last longer than 1 week without
reassessment of the need for a limited extension. Initially, not more than 1 week's supply of
the drug should be provided and automatic prescription renewals should not be allowed.
Subsequent prescriptions, when required, should be limited to short courses of therapy.
The initial daily dose in elderly and debilitated patients should not exceed 0.5 mg and should
be very carefully and gradually adjusted, depending upon tolerance and response.
i.m. (2 to 3 hours before surgery). As with all premedicant drugs, the dose should be
individualized. Doses of other CNS depressant drugs should ordinarily be reduced.
When a rapid onset of action is required, lorazepam may be given i.v., 15 to 20 minutes
before surgery. The usual i.v. dose is 44 mcg/kg or 2.0 mg total, whichever is smaller.
Status Epilepticus:
Adults:
The usual recommended initial dose of lorazepam is 0.05 mg/kg up to a maximum of 4 mg
given by slow i.v. injection. If seizures are terminated, no additional lorazepam is required. If
seizures continue or recur after a 10 to 15 minute observation period, an additional i.v. dose
of 0.05 mg/kg may be administered. If the second dose does not result in seizure control after
another 10 to 15 minute observation period, other measures to control status epilepticus
should be employed. A maximum of 8 mg only, of lorazepam, should be administered during
a 12 hour period.
Administration:
The sublingual tablet, when placed under the tongue, will dissolve in approximately 20
seconds. The patients should not swallow for at least 2 minutes to allow sufficient time for
absorption.
When given i.m., lorazepam injection, undiluted, should be injected deep into a muscle mass.
Lorazepam injectable can be used with atropine sulfate, narcotic analgesics, other
parenterally used analgesics, commonly used anesthetics and muscle relaxants. The use of
scopolamine with lorazepam injection is not recommended since this combination has been
associated with a higher incidence of adverse reactions.
Immediately prior to i.v. use, lorazepam injection must be diluted with an equal volume of
compatible solution. When properly diluted the drug may be injected directly into the vein or
into the tubing of an existing i.v. infusion. The rate of injection should not exceed 2
mg/minute. Parenteral drug products should be inspected visually for particulate matter and
discoloration prior to administration. Do not use if solution is discolored or contains a
precipitate.
Lorazepam injection is compatible for dilution purposes with the following solutions: Sterile
Water for Injection, USP, Sodium Chloride Injection, USP, 5% Dextrose Injection, USP,
Bacteriostatic Sodium Chloride Injection, USP with benzyl alcohol, Bacteriostatic Water for
Injection, USP with parabens, Bacteriostatic Water for Injection, USP with benzyl alcohol.
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Supplied
Oral Tablets:
Each white tablet contains: Lorazepam 0.5 mg (round, imprinted 0.5 on one side and "W" on
the other), 1 mg (scored, oblong, imprinted "1" on one face and "ATIVAN" on other) or 2 mg
(scored, ovoid, imprinted "2" on one face and "ATIVAN" on other). Also contains lactose.
Energy: 0.84 kJ (0.20 kcal)/0.5 mg; 1.63 kJ (0.39 kcal)/1 mg; 2.05 kJ (0.49 kcal)/2 mg.
Gluten-free and tartrazine-free. Bottles of 100, 1000 and 2500 (1 mg and 2 mg). Bottles of
100, 500 and 1000 (0.5 mg).
Sublingual Tablets:
Each round, flat tablet, imprinted W on one side, contains: Lorazepam 0.5 mg (green,
imprinted 0.5 on the other side), 1 mg (white, imprinted 1 on the other side) or 2 mg (blue,
imprinted 2 on the other side). Also contains lactose. Energy: 0.59 kJ (0.14 kcal)/0.5 and 1
mg; 0.80 kJ (0.19 kcal)/2 mg. Gluten-free and tartrazine-free. Bottles of 100.
Injection:
Each 1 mL vial contains: Lorazepam 4 mg. Also contains benzyl alcohol 2%, polyethylene
glycol 18% and propylene glycol 80%. Keep refrigerated and protect from light. Do not use if
solution is discolored or contains a precipitate. Boxes of 10 and 100.
BENZODIAZEPINE
alprazolamum
XANAX, FRONTIN,alprazolam tablete
Compozitie: Xanax tablete 0,25 mg: Fiecare tablet contine: Alprazolam 0,25
mg, celuloz microcristalin, lactoz, stearat de magneziu, amidon de gru,
docusat de sodiu (85%) + benzoat de sodiu (15%), dioxid de silicon coloidal.
Xanax tablete 0,5 mg: Fiecare tablet contine: Alprazolam 0,5 mg, celuloz
microcristalin, lactoz, stearat de magneziu, amidon de gru, docusat de sodiu
(85%) + benzoat de sodiu (15%), dioxid de silicon coloidal, lac eritrosine de
aluminiu sodiu. Xanax tablete 1 mg: Fiecare tablet contine: Alprazolam 1mg,
celuloza microcristalin, lactoz, stearat de magneziu, amidon de gru, docusat
de sodiu (85%) + benzoat de sodiu (15%), dioxid de silicon coloidal, lac
eritrosine de aluminiu sodiu, lac aluminiu FD ti C albastru nr. 2. Xanax tablete 2
mg: Fiecare tablet contine: Alprazolam 2 mg, celuloza microcristalin, lactoz,
stearat de magneziu, amidon de gru, docusat de sodiu (85%) + benzoat de
sodiu (15%), dioxid de silicon coloidal.
Form de prezentare: Xanax tablete n doze de 0,25 mg, 0,5 mg, 1 mg, ti 2 mg.
bromazepamum
CALMEPAM
Prezentare farmaceutic: Tablete a 1,5 ti 3 mg bromazepam (cutii cu 10 buc.)
Actiune terapeutic: Bromazepam este complet absorbit prin tubul digestiv ti
atinge concentratia plasmatic maxim n una pn la patru ore dup
administrarea oral. Timpul de njumttire a concentratiei plasmatice variaz
ntre 7,0 pn la 10,3 ore. Bromazepam este metabolizat n metaboliti inactivi,
care sunt eliminati sub form de glucuronoconjugati ai 3-hidroxibromazepam
(27%), derivati de 3-hidroxibenzoilpiridin (40%), bromazepam intact (2,3%),
benzoilpiridin intact (0,66%). Bromazepamul este bazic. Se leag n proportie
de 70% de proteinele plasmatice. Calmepam este folosit ca sedativ, anxiolitic,
relaxant muscular ti are proprietti amnezice.
Indicatii: Calmepam este folosit: n tratamentul anxiettii, strilor de tensiune ti
de agitatie; n controlul spasmelor musculare ca n tetanos; n tratamentul
sindromului de sevraj; pregtirea n pacientilor pentru interventii chirurgicale
minore, endoscopie, cardioversie; n tulburri functionale ale aparatului cardiovascular, ca de ex. pseudoangina pectoris, anxietatea precordial, tahicardia,
tratamentul hipertensiunii neurogene; n tulburri functionale ale aparatului
respirator, ca de ex. dispneea ti hiperventilatia; n tulburrile functionale ale
aparatului genito-urinar, ca de ex. vezica iritabil ti polakiuria; n tulburrile
functionale ale tractului gastro-intestinal, ca de ex. durerea epigastric,
sindromul de colon iritabil, colita ulcerohemoragic. Calmepam este de
asemenea util n cefaleea psihogen ti n tulburrile psihosomatice.
bromazepamum
LEXOTANIL
Prezentare farmaceutic: Comprimate a 1,5 mg, 3 mg ti 6 mg bromazepam
(cutii cu 30 ti 100 buc.).
Actiune terapeutic: n doze mici, Lexotanil reduce selectiv tensiunea ti
anxietatea. La doze mari, apar efecte sedative ti miorelaxante.
Indicatii: Tulburri emotionale: anxietate ti stri tensionale, dispozitie anxioas,
depresiv, tensiune nervoas, agitatie ti insomnie. Anxietate ti stare tensional
legate de: tulburri functionale ale sistemelor respirator ti cardiovascular, cum
ar fi: pseudoangina pectoris, anxietate precordial, tahicardie, hipertensiune de
natur emotional, dispnee ti hiperventilatie; tulburri functionale ale tractului
gastro-intestinal, incluznd sindromul colonului iritabil, colit ulcerativ,
durerea epigastric, spasmele, meteorismul ti diareea; tulburri ale tractului
genito-urinar, de exemplu vezica iritabil, mictiuni frecvente ti dismenoreea;
alte tulburri psihosomatice, ca de exemplu cefaleea psihogen ti dermatoza
psihogen. n plus, Lexotanil este util n tratamentul anxiettii ti strilor de
tensiune avnd la origine bolile cronice organice ti ca adjuvant al psihoterapiei
n psihoneuroze.
Mod de administrare: Doza uzual: doza medie pentru terapia ambulatorie - 1,53 mg, de pn la 3 ori pe zi. Cazuri severe, n special spitalizare: 6-12 mg, de
dou sau trei ori pe zi. Aceste valori vor fi privite ca recomandri generale,
dozele trebuind s fie individualizate. Tratamentul ambulatoriu trebuie nceput
cu doze mici, creterea fcndu-se gradat, pn la nivelul optim. Dup cteva
sptmni, dar nu mai mult de trei luni, n functie de progresul terapeutic,
trebuie s se tenteze ntreruperea tratamentului. De regul, tratamentul cu durat
de trei luni sau mai putin nu pune probleme. n caz c este necesar continuarea
tratamentului dup acest punct, ntreruperea medicatiei trebuie fcut treptat.
Instructiuni posologice speciale: dac medicamentul se prescrie la copii, este
necesar ajustarea dozelor n functie de greutatea lor corporal redus. Pacientii
vrstnici ti debilitati necesit doze mai mici datorit variatiilor individuale ale
sensibilittii ti farmacocineticii.
Reactii adverse: Lexotanil este bine tolerat n dozele terapeutice. La doze mari
pot aprea fatigabilitate, somnolen ti, rareori, slbiciune muscular. Aceste
simptome regreseaz la reducerea dozei. Deti n practica clinic nu s-au
observat efecte toxice sanguine, hepatice sau renale, n terapia de lung durat
se recomand controlarea numrului elementelor figurate sanguine ti a functiei
hepatice. Dup tratamente de durat cu doze mari, ca de altfel n cazul tuturor
preparatelor hipnotice, sedative ti tranchilizante, indivizii predisputi pot
dezvolta dependen. Tratamentul cu Lexotanil trebuie ntrerupt dac apar
reactii paradoxale ca anxietate acut, halucinatii, insomnie sau excitatie.
Interactiuni: Efectul Lexotanil, ca al tuturor substanelor psihoactive, poate fi
intensificat de alcool. Dac se asociaz cu alte medicamente active la nivel
central, ca neuroleptice, tranchilizante, antidepresive, hipnotice, analgezice ti
anestezice, efectul sedativ central al Lexotanil poate fi amplificat.
Supradozare: Supradozarea intentionat sau accidental doar a Lexotanil, pune
rareori viaa n pericol. Simptomele iau n principal forma unei intensificri a
efectului terapeutic (sedare, slbiciune muscular, somn profund) sau a unei
agitatii paradoxale. n cele mai multe cazuri sunt suficiente monitorizarea
functiilor vitale ti ateptarea revenirii la normal a pacientului. Dozele extrem de
mari, n special n asociatie cu alte medicamente cu actiune asupra sistemului
nervos central, pot s produc com, areflexie, depresie a functiei cardiace ti
respiratorii ti apnee. Msurile terapeutice sugerate sunt lavajul gastric,
supravegherea medical ti, ca terapie specific, administrarea de Anexate
(substana activ: flumazenil).
Contraindicatii: Lexotanil nu trebuie administrat pacientilor cu hipersensibilitate
cunoscut la benzodiazepine. Pacientii cu dependen cunoscut sau presupus
de alcool, medicamente sau droguri nu trebuie s ia Lexotanil dect n rare
cazuri ti numai sub strict supraveghere medical. n cazul prescrierii de
mai eficient ti mai bine tolerat. n dismenoree, tratamentul ncepe cu 3-4 zile
naintea aparitiei menstrei. Se va administra naintea meselor ti la culcare.
chlordiazepoxidum
NAPOTON
Prezentare farmaceutic: Drajeuri continnd clordiazepoxid 10 mg (flac. cu 30
buc.).
Actiune terapeutic: Tranchilizant ti miorelaxant din grupa benzodiazepinelor,
cu efect relativ durabil.
Indicatii: Stri de anxietate, tensiune psihic (ti implicatii - insomnie, cefalee
etc.), sindrom psihovegetativ, stri depresive cu agitatie, sindrom de abstinen
la alcoolici, tulburri de comportament la copii; medicatie pre - ti
postoperatorie; spasme reactive ale musculaturii striate (psiho - neurogene,
miogene sau reumatice), stri spastice la copii (tetraplegie, atetoz dubl, boala
Little).
Mod de administrare: Adulti: obinuit un drajeu (10 mg) de 2-3 ori/zi (la btrni
1/2 drajeu de 1-2 ori/zi); pentru indicatiile psihiatrice se poate crete la 6-12
drajeuri/zi; copii: 1/2-2 drajeuri/zi.
Reactii adverse: n general minore: somnolen, oboseal (mai ales la btrni),
apatie, stare de agitatie, cefalee, ameeli, ataxie, hipotensiune ortostatic, grea,
constipatie, mai rar diaree, impoten sexual, tulburri menstruale, polakiurie,
eruptii cutanate; foarte rar disfunctie hepatic ti discrazii sanguine. Oprirea
brusc a tratamentului ndelungat cu doze mai mari poate provoca un sindrom
de abstinen, uneori chiar convulsii.
Contraindicatii: Stri comatoase, colaps, insuficien pulmonar acut,
deprimare respiratorie, miastenie grav, alergie la clordiazepoxid ti alte
benzodiazepine; pruden n timpul sarcinii ti alptrii, la debilitati, btrni, n
insuficiena renal ti hepatic, insuficien pulmonar cronic (doze mai mici);
pruden la oferi ti la cei care folosesc matini; este necesar evitarea buturilor
alcoolice ti pruden n administrarea altor deprimante centrale ti a
antiepilepticelor.
Sinonime: Elenium, Librium, Redepur.
chlorazepatum dikalicum
TRANXENE, capsule 5 mg sau 10 mg
diazepamum
DIAZEPAM
lorazepamum
LORANS
Prezentare farmaceutic: Comprimate continnd lorazepam 1 mg ti 2,5 mg
(cutie cu 30 buc.).
Actiune terapeutic: Tranchilizant.
Indicatii: Nevroze anxioase, stri reactive, tulburri psihice n boli somatice ti
psiho-somatice.
Mod de administrare: n general se administreaz 1 comprimat seara, nainte de
culcare.
Reactii adverse: Pot aprea: hipersensibilizare la produs, grea, vom, vertij.
Contraindicatii: Alergie la produs, insuficien hepatic ti renal n cursul
sarcinii ti alptrii.
medazepam
ANSILAN
Compozitie: O capsul contine 10 mg medazepam. O capsul mite contine 5 mg
medazepam. Medazepam este nume generic pentru 7-clor-2,3-dihidro-1-metil5-fenil-1H-1,4 benzodiazepin.
Actiune: Ansilanul determin ndeprtarea ncordrii ti a anxiettii, astfel nct
influeneaz favorabil simptome psihovegetative. S-a dovedit ca fiind foarte
eficace n tratarea unui tir de reactii psihosomatice.
Indicatii: Nelinite psihomotorie, iritabilitate, agitatie, nevroze, tulburarea
concentrrii, stri de ncordare psihic, anxietate, tulburri comportamentale.
Tulburri cardiovasculare psihosomatice (tahicardie, tulburri de circulatie,
dificultti pseudopectanginoase, tulburri precordiale). Tulburri respiratorii
psihosomatice (sindrom de hiperventilatie, senzatie de presiune ti tulburri
toracice). Tulburri gastrointestinale psihosomatice (grea, senzatie de
ncrcare a stomacului, spasme, colon iritabil).
Contraindicatii: ntrebuinarea medazepamului este contraindicat n caz de
miastenia gravis.
Msuri de precautie: Dac medazepamul se administreaz mpreun cu
neuroleptice, tranchilizante, antidepresive, hipnotice ti analgezice pe baz de
morfin, se poate produce potenarea actiunii sedative centrale, astfel c dozele
acestor medicamente trebuie acomodate cu dozele medazepamului n mod
medazepanum
RUDOTEL
Substan activ: Medazepam.
CompoziTie: 1 comprimat conTine: Medazepam 10 mg.
AcTiune terapeutic: Rudotel se folosete pentru susTinerea tratamentului n
stri de agitaTie, agresiune ti anxietate, n reacTii fizice declanate de tensiuni
psihice (tulburri psihosomatice ti psihovegetative, cum ar fi anumite forme de
insomnie, cefalee, dureri stomacale, tulburri cardiace etc.) ti n tratamentul
asociat al unor boli nevrotice (stri psihotice de anxietate ti agitaTie).
ContraindicaTii: Rudotel nu se va administra n miastenii grave, n intoxicaTii
acute cu alcool sau medicamente deprimante centrale, n caz de dependen la
alcool, droguri sau medicamente (respectiv abuzul lor), n caz de
hipersensibilitate fa de benzodiazepine ti n timpul alptrii. Pruden
medazepanum
EUROZEPAM, capsule
Form de prezentare: Flacon cu 30 de capsule. Cutie pliant de carton cu 3
blistere a cte 10 capsule.
Compozitie: Contine 10 mg medazepam/capsul.
Proprietti: Medazepamul este un tranchilizant ti echilibrant neurovegetativ din
grupa benzodiazepinelor. Provoac relaxare psihic, echilibrare afectiv, sedare
vegetativ ti relaxarea musculaturii striate. Este deosebit de util pentru tratament
ambulator, fiind caracterizat ca tranchilizant diurn. Mecanismul de actiune al
benzodiazepinelor nu a fost nc pe deplin elucidat. Se pare c ele faciliteaz
actiunea acidului gama-aminobutiric (GABA), care este principalul
neuromediator inhibitor ce moduleaz activitatea neuronului tint, n sensul
diminurii activittii neuronale. Ca toti neuromediatorii, GABA actioneaz
fixndu-se pe receptorii specifici aflati la nivelul membranei neuronale.
Receptorul GABAA este un complex macromolecular ce are un loc de
oxazepanum
OXAZEPAM
Prezentare farmaceutic: Comprimate continnd oxazepam 10 mg (flac. cu 20
buc.).
Actiune terapeutic: Tranchilizant, miorelaxant ti anticonvulsivant
benzodiazepinic, cu efect rapid ti de relativ scurt durat.
Indicatii: Stri de anxietate, tensiune, agitatie, iritabilitate, insomnie de natur
nevrotic, psihovegetativ, psihosomatic, asociate depresiei, la btrni, n
cadrul sindromului de abstinen al alcoolicilor; este de ales la btrni ti hepatici
(bine suportat).
Mod de administrare: Obinuit, cte un comprimat dimineaa, la prnz ti 2
comprimate seara (la nevoie, doze mai mari - pn la 3 comprimate de 3-4
ori/zi); la btrni 1-3 comprimate/zi.
Reactii adverse: Somnolen, anorexie, diminuarea libidoului, tulburri de
menstruatie; rareori ameeli, cefalee, hipotensiune (mai frecvent la btrni),
oboseal, stri de agitatie (la unii bolnavi psihotici), tulburri neurologice,
grea, edeme, eruptii cutanate alergice, leucopenie, disfunctie hepatic;
tratamentul ndelungat cu doze mari poate determina dependen.
tofisopanum
GRANDAXIN
Prezentare farmaceutic: Tablete continnd 50 mg tofisopam.
Actiune terapeutic: Tofisopamul este un derivat de 2,3 benzodiazepin care
difer de grupul benzodiazepinelor din punctul de vedere al structurii chimice ti
al propriettilor farmacologice. S-a dovedit a fi un agent anxiolitic eficace care
nu posed efectul sedativ al benzodiazepinelor. Datorit absenei actiunii
musculo-relaxante este util pentru administrarea la pacientii cu afectiuni neuromusculare. Administrat n doze terapeutice, tofisopamul nu poteneaz efectul
alcoolului. Nu prezint efect cardiodepresiv. Nu s-a nregistrat dependen nici
chiar n terapia de lung durat. Datorit propriettilor non sedative,
tofisopamul este un ideal agent anxiolitic de zi.
Indicatii: n psihiatrie: tulburri vegetative, anxietate, lips de motivatie,
oboseal, apatie, nevroze, depresie reactiv, neurastenie, neurastenie sexual. n
medicina intern: pentru ameliorarea simptomelor nevrotice secundare care
nsoesc boli primare de diverse etiologii (angin pectoral, pseudoangin). n
ginecologie: pentru amendarea simptomelor produse de tulburrile de
climacteriu, n asociere cu agenti hormonali sau n administrare unic. n cadrul
sindromului de abstinen la alcoolici pentru a reduce simptomele vegetative ti
agitatia din stadiile de predelir ti delir. n neurologie: la pacientii cu miastenia
gravis, miopatie, neuropatie, atrofie muscular la care este contraindicat
administrarea anxioliticelor musculo-relaxante.
Contraindicatii: Psihopatii agresive. Nu se recomand n primele trei luni de
sarcin.
Mod de administrare: Doza uzual pentru adulti este de 1-2 tablete de 1-3 ori pe
zi (50 300 mg/zi ).
Efecte secundare: Greuri, dureri epigastrice, rash, rar hiperactivitate,
agresivitate care dispar de obicei odat cu scderea dozelor. Tulburri de somn
care pot fi evitate prin administrarea ultimei doze zilnice nainte de ora 17.
ANTIHISTAMINICE
Atarax
Ti
HIDROXIZIN
hydroxyzinum
CompoziTie: Drajeuri conTinnd 25 mg clorhidrat de hidroxizin.
AcTiune farmacoterapeutic: Tranchilizant cu spectru larg ti acTiune rapid,
miorelaxant, antiemetic, antihistaminic, slab anticolinergic.
IndicaTii: Stri de anxietate, stri de agitaTie psihomotorie, nevroze, psihoze,
tulburri de somn, alcoolism (inclusiv sindromul de abstinen), distonii
neurovegetative, preclimax ti climax, preanestezie n intervenTiile operatorii,
boli somatice cu stri de vom, urticarie, prurit ti dermatite alergice cu
component psihoafectiv, sindrom Mnire.
ReacTii adverse: n general bine suportat, chiar la folosirea ndelungat, poate
provoca rareori somnolen. Supradozarea poate avea drept efect tremor,
uscciunea gurii, convulsii.
ContraindicaTii: Alergie la hidroxizin, primul trimestru de sarcin, perioada de
alptare. Se va evita consumul buturilor alcoolice (se poteneaz reciproc).
Pruden la bolnavi cu insuficien renal, cu glaucom cu unghi nchis, la cei
trataTi cu deprimante centrale ti la anticoagulante cumarinice (efectul acestora
este potenat). Nu se va prescrie n ambulator la bolnavii a cror profesiune
impune performane psihomotorii (conductori auto, dispeceri). De asemenea,
se va administra cu pruden datorit interacTiunilor n asociere cu
analgezicele opioide. SoluTia este incompatibil cu tiopentalul ti cu soluTiile cu
pH alcalin. De aceea, nu se vor amesteca n aceeati sering. SoluTia injectabil
nu se administreaz subcutanat sau intraarterial.
Mod de administrare: AdulTi ti copii peste 10 ani: oral - 2-4 drajeuri pe zi ( 50100 mg), intramuscular profund - 1/2-2 fiole pe zi (50 -200 mg), intravenos
foarte lent - 1/2-2 fiole, diluat n soluTie salin izoton. Copii peste 1 an: 1
mg/kg corp/zi; injectarea se va face numai n cazurile de urgen ti n
pregtirea preoperatorie.
Form de prezentare: Flacoane cu 30 de drajeuri.
CondiTii de pstrare: La adpost de lumin, umiditate ti la maxim 25 grade
Celsius.
clonazepamum
RIVOTRIL
trebuie utilizat doar excepTional, atunci cnd calea i.v. nu poate fi utilizat.
Doza maxim zilnic este de circa 13 mg i.v. Rivotril poate fi diluat cu
urmtoarele soluTii, n raport de 1 fiol (1 mg) la 85 ml: clorur de sodiu 0,9%;
sau clorur de sodiu 0,45% + glucoz 2,5% sau glucoz 10%. Aceste amestecuri
sunt stabile la temperatura camerei timp de 24 ore. Substana activ,
clonazepamul, poate fi parTial absorbit prin materialul PVC. Din aceast cauz
se recomand s se utilizeze fie containere de sticl sau, n cazul utilizrii
sistemelor de perfuzie din PVC, amestecul s fie perfuzat cu o vitez de 60 ml
pe or. IndicaTii posologice speciale: rivotril poate fi utilizat mpreun cu unul
sau mai multe alte medicamente antiepileptice. n acest caz, dozajul individual
al fiecrui medicament n parte se va face spre a obTine efectul maxim. Ca ti n
cazul altor medicamente antiepileptice, Rivotril nu trebuie ntrerupt brusc, ci
doza trebuie sczut treptat.
ReacTii adverse: Rivotril nu are efecte negative asupra sngelui, rinichilor sau
ficatului ti este bine tolerat de tractul digestiv. Chiar ti n cazul unui tratament
de lung durat, Rivotril nu a avut efecte negative asupra vreunui organ.
ReacTiile adverse produse n urma tratamentului cu Rivotril sunt de natur
sedativ ti relaxant a musculaturii ti se manifest cel mai frecvent sub form de
oboseal, somnolen ti ataxie, simptome care sunt dependente de doz.
Ulterior, n cursul tratamentului, mai ales la copii, pot aprea tulburri de
comportament, de exemplu fenomene de excitaTie, iritabilitate ti agresivitate. Sau putut observa ocazional: depresie respiratorie, incontinen urinar,
hipotonie muscular, tulburri vizuale ti de coordonare. ReacTiile adverse sunt
pasagere ti dispar spontan n cursul tratamentului. Ele apar de obicei la
nceputul tratamentului ti pot fi reduse sau evitate, dac doza este crescut lent.
Rivotril la sugari sau la copii mici poate crete cantitatea secreTiilor salivare sau
brontice, motiv pentru care este necesar atenTie deosebit n asigurarea
libertTii cilor respiratorii.
InteracTiuni: Alcoolul poate modifica acTiunea Rivotril dac este luat
concomitent n sensul afectrii rezultatelor terapeutice sau al apariTiei unor
reacTii adverse imprevizibile. Administrarea concomitent a inductorilor
enzimelor hepatice, ca barbituricele sau hidantoina, poate accelera
metabolizarea clonazepamului, fr a influena fixarea sa de proteine.
Clonazepamul singur nu pare a activa ns propriile sale enzime metabolizante.
Supradozare: Simptomele supradozrii sunt: somnolena, confuzia, coma,
apneea. n caz de supradozare se recomand spltura gastric, supravegherea
funcTiilor vitale ti rehidratarea, ca ti terapia specific cu antagonistul
benzodiazepinelor Anexate (principiu activ: flumazenil).
ContraindicaTii: Fiolele de Rivotril conTin alcool benzilic ca mijloc de
conservare. S-au semnalat cazuri de tulburri neuropsihice ti insuficiene
organice sistemice, care au fost asociate alcoolului benzilic. Din aceast cauz,
nu se va utiliza acest preparat la nou-nscuTi, n special la prematuri.
PrecauTie: La bolnavi cu afecTiuni renale sau hepatice, stabilirea dozei se va
face cu atenTie, strict individualizat. La fel ca ti alte medicamente de acelati tip,
Rivotril poate influena viteza de reacTie (de ex., capacitatea de a conduce un
vehicul, comportamentul n cazul traficului stradal), n funcTie de sensibilitatea
individual ti de doz.
Sarcin ti alptare: Studiile efectuate pe animale au avut rezultate inconstante,
dar au demonstrat clar efecte nedorite la ft. Nu exist studii controlate la
femeile gravide. n aceast situaTie, medicamentul se va utiliza numai atunci
cnd avantajele potenTiale ale acestuia depesc riscul potenTial pentru ft.
ntruct Rivotril trece n laptele matern, mamele care sunt tratate cu acest
medicament nu vor alpta.
ANTISTRESS
combinaTii
Form de prezentare: Comprimate filmate. Flacoane cu 30 comprimate.
CompoziTie:
Vitamina C 60 mg
Biotin (H) 10 mcg
Vitamina E 15 UI
Acid pantotenic (B5)
5 mg
Acid folic 400 mcg
Cupru2 mg
Vitamina B1
3 mg
Zinc 10 mg
Vitamina B2
3,4 mg
Calciu
100 mg
Vitamina B340 mg
Magneziu 25 mg
Vitamina B6
3 mg
Extract de valerian off. 75 mg
Vitamina B12
10 mcg
ProprietTi: Complex de vitamine, minerale ti extract de Valeriana officinalis,
avnd acTiune sinergic n combaterea stresului. Acest medicament acTioneaz
antistres prin cumularea a dou direcTii de acTiune: 1) ntrirea ti creterea
troficitTii sistemului nervos, datorat vitaminelor ti bioelementelor.
2)Reducerea excitabilitTii sistemului nervos central fa de factorul stres,
printr-o inhibiTie la nivel cortical datorit extractului de valerian. Vitaminele
aparTinnd grupului B (B1, B2, B3, B5, B6 ti B12), acidul folic ti biotina sunt
indispensabile pentru sistemul nervos, ele intervenind n funcTionarea normal
a acestuia prin participarea la sinteza acetilcolinei ti transmiterea influxului
nervos (B1 ti acidul pantotenic), ca trofic al sistemului nervos (B12), ca sedativ
slab al sistemului nervos (B6). Prin prezena sa, calciul intervine n
transmiterea influxului nervos iar alturi de vitamina B1, n reglarea activitTii
TENSISPES
buspironum
Prezentare farmaceutic: Comprimate a 10 mg buspiron clorhidrat (cutie cu 20
buc.).
Aciune terapeutic: Anxiolitic, sedativ, miorelaxant, anticonvulsivant,
antagonist al receptorilor 5 HT 1A presimpatici n special i mai puin
postsimpatic.
IndicaTii: Anxietate reacTional n nevroze, de adaptare, afecTiuni somatice.
Mod de administrare: n general se administeaz 5-10 mg maxim 60 mg
buspiron pe zi.
ReacTii adverse: Vertij, cefalee, grea.
ContraindicaTii: Alergie cunoscut la produs. Insuficien hepatic sau/ti
renal sever.
buspironum
BUSPAR
Descriere: Buspar, buspirona hidrocloric, este un nou anxiolitic care nu este
corelat chimic sau farmaceutic cu benzodiazepinele sau ali agenti psihotropici
cunoscuti. Buspar (buspiron hidrocloric) este livrat pentru administrare oral
sub form de tablete marcate ti albe de 5 mg ti 10 mg.
Actiune terapeutic: Buspar reprezint o nou clas de agenti farmacologici cu
activitate psihotrop. Spre deosebire de benzodiazepine ti alti agenti anxiolitici,
Efecte
Nule
4295,5
14
--
24,5 ---
--
Neuropsihice
Nr.% 10100---Premenstruale ti de menopauz Nr.% 3096,8
13,2 --Hipertiroidism
Nr.% 880 220 --Total Nr.% 1149565
--Tulburri Nr. bolnavi Efecte
Distonocalm
Foarte bune Bune Slabe Nule
Cardiovasculare Nr.% 3681 818,2 --Digestive Nr.% 2080 312 28
-Neuropsihice
Nr.% 220 660 220 -Premenstruale ti de menopauz Nr.% 2477,4
722,6 --Hipertiroidism
Nr.% 660 220 220 -Total Nr.% 8873,3
2621,7
65
-Din tabel rezult c toate persoanele tratate cu Calmogen au avut rezultate
foarte bune (95%) ti bune (5%). Tratamentul cu Distonocalm a determinat
efecte foarte bune la 73,3 % din bolnavi, bune la 21,7% ti slabe la 5%. Nu s-au
nregistrat rezultate nule la nici unul dintre produse. La 12 dintre bolnavii
trataTi au aprut efecte adverse (uscciunea gurii, somnolen) la ambele
produse. Nu a fost necesar ntreruperea tratamentului. Rezultatele menTionate,
care dovedesc o eficacitate terapeutic superioar a produsului Calmogen,
demonstreaz justeea ipotezei de lucru. Ele pledeaz pentru o abordare global
a variatelor tulburri funcTionale, constituind totodat un argument privind
intricarea fenomenelor neurovegetative cu cele nervos centrale.
Concluzii: Studiul clinic comparativ al produselor Calmogen ti Distonocalm a
demonstrat posibilitatea obTinerii de efecte terapeutice superioare cu primul
produs, ndeosebi asupra tulburrilor neuropsihice, cardiovasculare, digestive ti
tulburrilor premenstruale ti de menopauz. Produsele au fost bine tolerate. Nu
s-au inregistrat efecte adverse care s impun ntreruperea tratamentului.
meprobamatum
MEPROBAMAT
CompoziTie: Comprimate conTinnd 400 mg meprobamat.
AcTiune farmacoterapeutic: Dicarbamat al propandiolului, tranchilizant ti
miorelaxant cu efect de durat medie (6 ore); are acTiune moderat de inducTie
enzimatic. Poate favoriza apariTia somnului (prin efectul tranchilizant).
IndicaTii: n tratamentul unor stri de anxietate ti tensiune psihic, sindrom
psihovegetativ; ca miorelaxant, singur sau n asociere cu un analgezic, n
tratamentul spasmului muscular; hipnogen n hiposomnii.
buspiconum hydrochloridum
STRESSIGAL
Anxiolitic.
CompoziTie: 1 comprimat conTine: Buspiron (clorhidrat) 10 mg. ExcipienTi
q.s.
AcTiune terapeutic: Busporina aparTine grupului azo-spirodecanodionelor.
Este un anxiolitic nou ce nu prezint asemnri chimice sau farmacologice cu
benzodiazepinele sau alte antidepresive. Stressigal are proprietTi antidepresive
fr a determina miorelaxare sau acTiuni antispastice. Studiile in vitro au
demonstrat c buspirona se leag puternic de receptorii 5-H71A serotonici, dar
are afinitate redus pentru receptorii benzodiazepinelor. Stressigal administrat
oral este absorbit rapid, biodisponibilitatea sa fiind slab influenat de prezena
alimentelor n stomac. Este metabolizat la nivelul ficatului n produti