Clozapine Side Effects

clozapine side effects

Clozapine is a drug for schizophrenia patients who are not responsive to or intolerant of classical anti psychotics. Non-responsiveness here means a lack of satisfactory clinical improvement after adequate doses of at least two antipsychotics for enough durations. The definition of intolerance is the improbability of reaching clinical benefit after classical antipsychotic using because of a serious neurological side effects, such as extrapiramidal syndrome or dyskinesia.

The use of clozapine can reduce the risk of recurrent suicidal behavior in patients with schizophrenia who are at high risk for re-experiencing suicidal behavior. 

Clozapine dosage

Clozapine is an oral drug. The dosage must be given individually. The lowest effective dose must be maintained for each patient. 

• To begin therapy, dosage of clozapine is 12.5 mg once or twice in the first day, then 25 mg on the second day. 
• For elderly: only12.5 mg once (for the first day). Doses may be added for only maximum 25 mg/day.
• Maximum permissible dose is 900 mg/day. The possibility of increased clozapine side effects (such as: seizure) occuring at dosage of more than 450 mg/day.
• To terminate the therapy, a gradual reduction should be done over 1 to 2 weeks period. Patients should be monitored for recurrence of psychotic symptoms and cholinergic rebound such as headache, nausea, sweating, vomiting, and diarrhea.

Clozapine side effects

According to MIMS-UBM Medica, clozapine side effects are:

• Agranulocytosis. Clozapine and agranulocytosis are proven related. Drugs known to have a potential to depress bone marrow function such as chloramphenicol, cotrimoxazole, analgesics, penicillamine, and carbamazepine must not be used simultaneously with clozapine.
• The most common disorders: fatigue, over sweating, hyperthermia.  
• Psychiatric disorder (rare): restlessness, agitation
• Metabolic disorder: weight gain (very common), mild increased of blood glucose, hypercholesterol.
• Brain and nerve disorder (common): sedation, dizziness, headache, tremor, blurred vision, seizure, confusion, delirium.
• Cardiac disorder (very common): tachycardia, arrythmia, hypertension, syncope.
• Gastrointestinal disorder (very common): hypersalivation, constipation, nausea, vomiting, dry mouth.
• Reproductive disorder: priapism

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Testosterone Injections Side Effects

testosterone injections side effects

We have already known that testosterone is a male sex hormone that is produced in the testicles. It is the principal hormone responsible to promote development and growth of male sexual organs and maintain secondary sexual characteristics. In women, testosterone is also produced in small amounts in ovaries and adrenal system.  Nowadays, testosterone therapy is indicated for both sexes to treat conditions caused by a lack of this sex hormone, such as: impotence, puberty disorder, metastatic breast cancer (cancer that spreads to other parts of the body).

As listed in MIMS-UBM Medica, the indications of testosterone and derivative therapy are:

• Delayed puberty, male hypogonadism
• Inoperable metastatic breast cancer

Before getting testosterone injections therapy please make sure that you don't have contraindications for this such as:

• Male breast cancer
• Prostate cancer
• Pregnancy
• Allergic history to hormonal treatment

After getting the therapy, you have to be aware of the testosterone injections side effects. What are they?

• Most common: headache, nausea, confusion, appetite loss, weakness, increased thirst
• Increased frequency and erection of the penis
• Rapid weight gain
• Fluid and electrolyte retention
• Spermatogenesis disorder, priapism, gynaecomastia, prostate hyperplasia, prostate tumor (rare)
• Suppression of lactation, increased libido, oily skin, acne, hirsutism, clitoral enlargement
• Local irritation of the injection site
• Increased cholesterol, especially LDL.
• Fatal side effects: hepatitis, liver toxicity, malignant neoplasm.

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Adderall Dosage For Adults Chart

adderall dosage for adults chart

Adderall is a brand name of amphetamine-salt based drug that  manufactured by Shire US Inc, indicated for the treatment of Attention Deficit Hyperactive Disorder (ADHD) and narcolepsy.

According to MIMS, a diagnosis of ADHD marked by the presence of hyperactive, impulsive and inattentive symptoms that were present before the age of seven years old. ADHD consists of symptoms that can cause a significant impairment such as in social, occupational, academic ability, etc.  There are lack of attention to details, lack of sustained attention, failure to follow orders, poor listener, poor organization, easily distracted, and forgetful. For the hyperactive and impulsive type, at least 6 of these following symptoms must be presented for 6 months or more: leaving seat, inappropriate climbing and/or running, difficulty with quiet activities, fidgeting, excessive talking, blurting answers, intrusive, can't wait turn, etc. The combined type needs both hyperactive impulsive and inattentive criteria to be found.

Adderall is indicated as a part of holistic treatment program for ADHD that consists of psychological, educational, and social therapy. Drug treatment only are not indicated for all ADHD children. Appropriate educational placement and psychosocial treatment is very needed. The decision to prescribe Adderall depends on the physician's assessment on the severity and chronicity of the symptoms. There is no sufficient data to support the long term use of Adderall.

Adderall dosage for adults chart

Adderall should be administered at the individual dosage, e.g. the lowest effective one and must be reviewed and adjusted depends on the therapeutic needs and patients' respond.

• ADHD: not recommended for children under 3 years old.
• For 2-5 years old : start with 2.5 mg daily, and may be raised slowly
• More than 6 years: start with 5 mg once or twice daily
• Narcolepsy: start with 5 mg daily.

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Side Effects Of Viagra And Cialis

side effects of viagra and cialis

What is Viagra and Cialis?

Viagra and Cialis are drugs of choice for erectile dysfunction and pulmonary arterial hypertension treatment. It was first available on the market at 1998.

The content of Viagra is sildenafil citrate, manufactured by Pfizer. According to MIMS.com, the recommended dose for most patients is 50 mg taken as needed, 1 hour before sexual intercourse. However, Viagra may be taken anytime from 4 hours until 0.5 hour before sexual activity. Based on its effectiveness, eficacy, and tolerance, dose of Viagra may be increased to a maximum dose of 100 mg, once per day, or decreased until 25 mg, once per day.  In patients with renal and liver impairment, the plasma level becomes higher, so the starting dose must be reduced to 25 mg. Based on the pharmacokinetic data, it is recommended not to exceed a minimum single dose of 25 mg in 48 hours period. It can be taken with or without food.

Here are some contraindications of Viagra:

• Newborn, children, women
• Patients with a known allergy to Viagra's component
• The use of nitrates after taking Viagra must be careful, but it is better not to administer both of them together.

Side effects of Viagra:

• Flushing
• Headache
• Dizziness
• Abdominal discomfort (dyspepsia)
• Diarrhea
• Urinary tract infection
• Nasal congestion
• Abnormal vision
• Rash

Special precautions must be considered at this conditions:

• Men with cardiovascular inadequacy and because of that, sexual activity is not recommended (post myocardial infarction, stroke, arrhytmia)
• Congestive heart disease
• Coronary heart disease and angina
• Resting hypotension (under 90/50) and severe hypertension (more than 170/100)

Cialis was first available on the market at 2003 in United States, discovered by GlaxoSmithKline and in 2007 was owned by Eli Lilly. The difference of Viagra and Cialis is that Cialis has a longer duration of action. The dose of Cialis is 10 mg taken with or without food, 30 minutes before sexual activity. Contraindications of Cialis are:

• Women or people under 18 years old
• Patients with any cardiovascular disease

Side effects of Cialis are nearly similar to side effects of Viagra, such as:

• Abdominal discomfort
• Headache, dizziness
• Flushing
• Nasal congestion, runny nose
• Back pain and muscle pain
• Swelling of palpebra (eyelid), eye pain, and conjunctival hyperaemia (very rare)

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