By K. Shawn. Palmer College of Chiropractic.
Intramuscular (for prompt control of severe symptoms): Usual dosage is 1 mg to 2 mg ( 1 / 2 to 1 mL) by deep intramuscular injection q4 to 6h purchase dapoxetine 90mg without prescription, p purchase dapoxetine 30mg line. Only in very exceptional cases should intramuscular dosage exceed 10 mg within 24 hours safe 30 mg dapoxetine. Injections should not be given at intervals of less than 4 hours because of a possible cumulative effect generic 60mg dapoxetine amex. Note: Stelazine (trifluoperazine HCl) Injection has been usually well tolerated and there is little, if any, pain and irritation at the site of injection. This is a clear, colorless to pale yellow solution; a slight yellowish discoloration will not alter potency. If markedly discolored, solution should be discarded. DOSAGE AND ADMINISTRATION--PSYCHOTIC CHILDRENDosage should be adjusted to the weight of the child and severity of the symptoms. These dosages are for children, ages 6 to 12, who are hospitalized or under close supervision. Oral: The starting dosage is 1 mg administered once a day or b. Dosage may be increased gradually until symptoms are controlled or until side effects become troublesome. While it is usually not necessary to exceed dosages of 15 mg daily, some older children with severe symptoms may require higher dosages. Intramuscular: There has been little experience with the use of Stelazine (trifluoperazine HCl) Injection in children. However, if it is necessary to achieve rapid control of severe symptoms, 1 mg ( 1 / 2 mL) of the drug may be administered intramuscularly once or twice a day. After you stop using this medicine, your body may need time to adjust. The length of time this takes depends on the amount of medicine you are using and how long you used it. Tablet contains: Trifluoperazine HCl available in 1 mg, 2 mg, 5 mg, 10 mg. For this reason, it should be protected from light and dispensed in amber bottles. Prolixin (Fluphenazine Decanoate) is a phenothiazine, an antipsychotic medication, used to treat emotional disorders such as schizophrenia. It may also be used to treat other conditions as determined by your doctor. The onset of action generally appears between 24 to 72 hours after injection, and the effects of the drug on psychotic symptoms become significant within 48 to 96 hours. Amelioration of symptoms then continues for 1 to 8 weeks with an average duration of 3 to 4 weeks. There is considerable variation in the individual response of patients to this depot fluphenazine and its use for maintenance therapy requires careful supervision. Fluphenazine Decanoate (Prolixin, Permitil, Modecate) is indicated for the treatment of schizophrenia. Fluphenazine decanoate is not indicated for the management of severely agitated psychotic patients, psychoneurotic patients or geriatric patients with confusion and/or agitation. Patients who have shown hypersensitivity to other phenothiazines, including fluphenazine, should not be given fluphenazine decanoate. Phenothiazines should not be used in patients receiving large doses of hypnotics, due to the possibility of potentiation. It is not intended for use in children under 12 years of age. Severe adverse reactions requiring immediate medical attention may occur and are difficult to predict. Therefore, the evaluation of tolerance and response, and establishment of adequate maintenance therapy, require careful stabilization of each patient under continuous, close medical observation and supervision. Interference with Cognitive or Motor Performance: Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to this medicine. Do not become overheated in hot weather, during exercise, or other activities since heat stroke may occur while you are using this medicine. This medicine may cause increased sensitivity to the sun. Avoid exposure to the sun or sunlamps until you know how you react to this medicine. Use a sunscreen or protective clothing if you must be outside for a prolonged period. The drug should not be administered to women of childbearing potential, particularly during the first trimester, unless, in the opinion of the physician, the expected benefits outweigh the potential risks to the fetus. Seizures: Phenothiazines should be used with caution in patients with a history of convulsive disorders since grand mal seizures have been known to occur. Cardiac: Since hypotension and ECG changes suggestive of myocardial ischemia have been associated with the administration of phenothiazines, fluphenazine decanoate should be used with caution in patients with compensated cardiovascular or cerebrovascular disorders. Before using this medicine, inform your doctor or pharmacist of all prescription and over-the-counter medicine that you are taking. This includes guanethidine and medicines used to treat depression and bladder or bowel spasms. Inform your doctor of any other medical conditions including depression, seizure disorders, allergies, pregnancy, or breast-feeding. Use with other drugs: The effects of atropine or other drugs with similar action may be potentiated in patients receiving phenothiazines because of added anticholinergic effects. Paralytic ileus, even resulting in death, may occur especially in the elderly. Fluphenazine decanoate should be used cautiously in patients exposed to extreme heat or phosphorus insecticides. Side effects that may go away during treatment, include drowsiness, dizziness, nasal congestion, blurred vision, dry mouth, or constipation. If they continue or are bothersome, check with your doctor. CHECK WITH YOUR DOCTOR AS SOON AS POSSIBLE if you experience changes in vision; changes in breasts; changes in menstrual period; sore throat; inability to move eyes; muscle spasms of face, neck, or back; difficulty swallowing; mask-like face; tremors of hands; restlessness; tension in legs; shuffling walk or stiff arms or legs; puffing of cheeks; lip smacking or puckering; twitching or twisting movements; or weakness of arms or legs. Of the 354 cases of deliberate or accidental overdose involving fluvoxamine maleate reported, there were 19 deaths. Of the 19 deaths, 2 were in patients taking fluvoxamine maleate alone and the remaining 17 were in patients taking fluvoxamine maleate along with other drugs. No further injections should be given until the patient shows signs of relapse and the dosage then should be decreased. An unobstructed airway should be established with maintenance of respiration as required. Severe hypotension calls for the immediate use of an i. Extrapyramidal symptoms may be treated with antiparkinsonian agents.
Comment: This patient group was highly selected: All participants were healthy 60 mg dapoxetine with visa, had no medical conditions that could impair sexual function generic dapoxetine 30 mg on line, and had no sexual dysfunction prior to antidepressant treatment 30 mg dapoxetine mastercard. Nevertheless dapoxetine 90mg mastercard, these results indicate that sexual dysfunction in at least half of these SRI-treated patients improved with Viagra treatment. Treatment of antidepressant-associated sexual dysfunction with sildenafil: A randomized controlled trial. Neuroleptics or antipsychotics are prescribed for Bipolar Disorder and Schizophrenia. They are used to treat a variety of psychiatric problems, such as preoccupation with troublesome and recurring thoughts, overactivity, and unpleasant and unusual experiences such as hearing and seeing things not normally seen or heard. Some of the benefits of these antipsychotics may occur in the first few days, but it is not unusual for it to take several weeks or months to see the full benefits. In contrast, many of the side effects are worse when you first start taking it. In women, this can lead to an increase in breast size and irregular periods. In men, it can lead to impotence and the development of breasts. Most of the typical antipsychotic drugs, risperidone (Risperidal) and amisulpride have the worst effect. The best known function of prolactin is the stimulation and maintenance of lactation, but it has also been found to be involved in over 300 separate functions including involvement in water and electrolyte balance, growth and development, endocrinology and metabolism, brain and behavior, reproduction and immunoregulation. In humans, prolactin is also thought to play a role in the regulation of sexual activity and behavior. It has been observed that orgasms cause a large and sustained (60 min) increase in plasma prolactin in both men and women, which is associated with decreased sexual arousal and function. Furthermore, increased prolactin is thought to promote behaviors that encourage long-term partnership. Studies of patients who are treatment-naive or who have been withdrawn from treatment for a period of time indicate that schizophrenia per se does not affect prolactin concentrations. He/she may be able to reduce your dose or change your medication. In fact, many discontinue treatment because of the sexual side effects. The effects of conventional antipsychotics on prolactin are well known. Over 25 years ago, the sustained elevation of serum prolactin to pathological levels by conventional antipsychotics was demonstrated by Meltzer and Fang. The most important factor regulating prolactin is the inhibitory control exerted by dopamine. Any agent that blocks dopamine receptors in a non-selective manner can cause elevation of serum prolactin. Most studies have shown that conventional antipsychotics are associated with a two-to ten-fold increase in prolactin levels. Prolactin is a hormone in the blood that helps to produce milk and is involved in breast development. However, increased prolactin can lead to a decrease in libido when it is not needed. The increase in prolactin that occurs through the use of conventional antipsychotics develops over the first week of treatment and remains elevated throughout the period of use. Once treatment stops, prolactin levels return to normal within 2-3 weeks. In general, second-generation atypical antipsychotics produce lower increases in prolactin than conventional agents. Some agents, including olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon) and clozapine (Clozaril) have been shown to produce no significant or sustained increase in prolactin in adult patients. However, in adolescents (age 9-19 years) treated for childhood-onset schizophrenia or psychotic disorder, it has been shown that after 6 weeks of olanzapine treatment prolactin levels were increased beyond the upper limit of the normal range in 70% of patients. Second-generation antipsychotics that have been associated with increases in prolactin levels are amisulpride, zotepine and risperidone (Risperidal). The most common clinical effects of hyperprolactinaemia (high prolactin levels) are:amenorrhoea (loss of period)gynaecomastia (swollen breasts)galactorrhoea (abnormal breast milk production)azoospermia (no sperm are present in the ejaculate)galactorrhoea (occasionally) (abnormal breast milk production)Less frequently, hirsutism (excessive hairiness) in women, and weight gain have been reported. Sexual function is a complex area that includes emotions, perception, self-esteem, complex behavior and the ability to initiate and complete sexual activity. Important aspects are the maintenance of sexual interest, the ability to achieve arousal, the ability to achieve orgasm and ejaculation, the ability to maintain a satisfying intimate relationship, and self-esteem. The impact of antipsychotics on sexual functioning is difficult to evaluate, and sexual behavior in schizophrenia is an area in which research is lacking. Data from short-term clinical trials may greatly underestimate the extent of endocrine adverse events. One thing we do know is that drug-free patients with schizophrenia have lower sexual libido, decreased frequency of sexual thoughts, a decreased frequency of sexual intercourse and higher requirements for masturbation. Sexual activity was also found to be reduced in patients with schizophrenia compared with the general population; 27% of schizophrenia patients reported no voluntary sexual activity and 70% reported having no partner. While untreated schizophrenia patients exhibit decreased sexual desire, neuroleptic treatment is associated with restoration of sexual desire, yet it entails erectile, orgasmic and sexual satisfaction problems. Atypical antipsychotics are also known to contribute to the development of hyperprolactinaemia. The PDR states that "olanzapine elevates prolactin levels, and a modest elevation persists during chronic administration. For Seroquel (quetiapine), the PDR states, "an elevation of prolactin levels was not demonstrated in clinical trials", and no adverse effects relating to sexual dysfunction are listed as "frequent". The PDR states that " Risperdal (risperidone) elevates prolactin levels and the elevation persists during chronic administration. Before initiating antipsychotic treatment, a careful examination of the patient is necessary. In routine situations, clinicians should examine patients for evidence of sexual adverse events, including menorrhagia, amenorrhoea, galactorrhoea and erectile / ejaculatory dysfunction. This is an important prerequisite to differentiate between adverse effects due to the current medication, those remaining from the previous medication or symptoms of the illness. Furthermore, such checks should be repeated at regular intervals. The current recommendation is that a rise in prolactin concentrations should not be of concern unless complications develop, and until such time no change in treatment is required. Increased prolactin may be due to the formation of macroprolactin, which does not have serious consequences for the patient. If there are doubts that hyperprolactineamia is related to antipsychotic treatment, other possible causes of the hyperprolactinaemia have to be excluded; these include pregnancy, nursing, stress, tumours and other drug therapies. When treating antipsychotic-induced hyperpro-lactinaemia, decisions should be made on an individual basis after a full and frank discussion with the patient. These discussions should include consideration of the benefits of antipsychotic therapy, as well as the potential impact of any adverse effects.
If you have any questions about combining Precose with other medications dapoxetine 30mg, be sure to discuss them with your doctor buy dapoxetine 30 mg with visa. If you are taking Precose along with other diabetes medications cheap dapoxetine 60mg online, be sure to have some source of glucose available in case you experience any symptoms of mild or moderate low blood sugar dapoxetine 60 mg amex. Contact your doctor immediately if the symptoms occur. When you take Precose with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before taking Precose with the following:Calcium channel blockers (heart and blood pressure medications)Digestive enzyme preparationsThe effects of Precose during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, tell your doctor immediately. Since studies suggest the importance of maintaining normal blood sugar levels during pregnancy, your doctor may prescribe injected insulin. It is not known whether Precose appears in breast milk. Because many drugs do appear in breast milk, you should not take Precose while breastfeeding. The recommended starting dose of Precose is 25 milligrams (half of a 50-milligram tablet) 3 times a day, taken with the first bite of each main meal. Some people need to work up to this dose gradually and start with 25 milligrams only once a day. Your doctor will adjust your dosage at 4- to 8-week intervals, based on blood tests and your individual response to Precose. The doctor may increase the medication to 50 milligrams 3 times a day or, if needed, 100 milligrams 3 times a day. If you weigh less than 132 pounds, the maximum dosage is 50 milligrams 3 times a day. If you are also taking another oral antidiabetic medication or insulin and you show signs of low blood sugar, your doctor will adjust the dosage of both medications. Safety and effectiveness of Precose in children have not been established. An overdose of Precose alone will not cause low blood sugar. However, it may cause a temporary increase in gas, diarrhea, and abdominal discomfort. However, in the event of an overdose, do not take any carbohydrate drinks or meals until the symptoms have passed. Generic Name: Pioglitazone HydrochlorideActos is used to control high blood sugar in type 2 diabetes. Actos also reduces the production of unneeded sugar in the liver. Actos (and the similar drug rosiglitazone maleate) can be used alone or in combination with insulin injections or other oral diabetes medications such as glipizide, glyburide,or metformin hydrochloride. Always remember that Actos is an aid to, not a substitute for, good diet and exercise. Failure to follow a sound diet and exercise plan can lead to serious complications, such as dangerously high or low blood sugar levels. Remember, too, that Actos is not an oral form of insulin, and cannot be used in place of insulin. Actos should be taken once a day with or without meals. If you miss a dose on one day, skip it and go back to your regular schedule. Store at room temperature in a tight container, away from moisture and humidity. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Actos. Side effects may include:Headache, hypoglycemia, muscle aches, respiratory tract infection, sinus inflammation, sore throat, swelling, tooth disorderIf Actos gives you an allergic reaction, you should not take Actos. In very rare cases, a drug similar to Actos has proven toxic to the liver. The manufacturer therefore recommends that your doctor check your liver function before you begin taking Actos and periodically thereafter. If you experience symptoms of liver problems such as jaundice (yellowing of the skin and eyes), nausea, vomiting, abdominal pain, fatigue, loss of appetite, or dark urine, report them to your doctor immediately. In rare instances, Actos causes swelling and fluid retention that can lead to congestive heart failure. If you already have this problem, you should avoid Actos. If you develop symptoms that signal the problem?such as shortness of breath, fatigue, or weight gain?you should check with your doctor immediately; the drug will probably have to be discontinued. The problem is more likely when Actos is taken in combination with insulin. Actos, by itself, will not cause excessively low blood sugar (hypoglycemia). However, when you combine it with insulin injections or some other oral diabetes drugs, the chance of hypoglycemia increases. If you begin to feel symptoms of hypoglycemia?shaking, sweating, agitation, clammy skin, or blurred vision?take some fast-acting sugar, such as 4 to 6 ounces of fruit juice. Let your doctor know about the incident; you may need a lower dose of insulin or oral medication. To make sure that your blood sugar levels stay within the normal range, get regular tests of your blood sugar and glycosylated hemoglobin (a long-term measurement of blood sugar). Contact your doctor during periods of stress due to fever, infection, injury, surgery, and the like. Dosage of your diabetes medicines may need to be changed. It is possible that Actos may reduce the effectiveness of birth control pills containing ethinyl estradiol and norethindrone. To guard against an unwanted pregnancy, be sure to use some other form of contraception. If Actos is taken with certain other drugs, the effects of either could be increased, decreased, or altered.
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