DRUGS & SUPPLEMENTS
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Tryptomer is an antidepressant tricyclic group of compounds derived dibenzocycloheptadiene.
The mechanism of antidepressant action is associated with an increased concentration of norepinephrine in the synapses and / or serotonin in the central nervous system depression due to reverse neuronal capture of these mediators. When anxiety and depressive states this medication reduces anxiety, agitation and depressive symptoms.
Also this drug has some analgesic effect, which is believed to be associated with changes in the concentrations of monoamines in the central nervous system, especially serotonin, and the influence on the endogenous opioid system.
It has distinct peripheral and central anticholinergic action, due to a high affinity for m-cholinergic receptors, a strong sedative effect connected with affinity for histamine H1-receptors and alpha-adrenoceptor blocking action.
Has antiulcer effect mechanism is due to the ability to block histamine H2-receptors in parietal cells of the stomach and provide a sedative and m-anticholinergic action. Its efficiency in the bed-wetting is caused, apparently, anticholinergic activity, which leads to an increase in the ability of the bladder to stretch, direct beta-adrenergic stimulation, the activity of alpha-adrenergic agonists, accompanied by increased tone of the sphincter and the central blockade of serotonin reuptake.
The mechanism of therapeutic action for bulimia nervosa is not installed (possibly similar to that for depression). It shown a clear efficacy of Tryptomer in bulimia patients without depression, as well as in its presence, and the reduction of bulimia can be observed without a concomitant weakening of the most depressed.
With general anesthesia reduces blood pressure and body temperature. Tryptomer does not inhibit MAO.
The antidepressant effect develops within 2-3 weeks after application.
The bioavailability of Tryptomer is 30-60%. The plasma protein binding is 82-96%. Vd is 5-10 L / kg. This medicine is metabolized to the active metabolite nortriptyline. T1/2 is 31-46 hours. Tryptomer excreted primarily by the kidneys.
Depression, schizophrenic psychoses, mixed emotional disorders, behavioral disorders (activity and attention), nocturnal enuresis (except in patients with hypotonia of the bladder), bulimia nervosa, chronic pain syndrome (chronic pain in cancer patients, migraine, rheumatic pain, atypical facial pain, postherpetic neuralgia, posttraumatic neuropathy, diabetic neuropathy, peripheral neuropathy), prophylaxis of migraine, peptic ulcer and duodenal ulcer.
For oral administration the initial dose is 25-50 mg at night. Then, within 5-6 days the dose was increased to an individual 150-200 mg / day (most of the dose taken at night). If, during the second week of the improvement has not come, the daily dose increased to 300 mg. With the disappearance of symptoms of depression to reduce the dose of 50-100 mg / day and continue therapy for at least 3 months. In elderly patients with lung disorders the dose is 30-100 mg / day is usually 1 time / at night, after achieving the therapeutic effect switching to the minimum effective dose - 25-50 mg / day.
When nocturnal enuresis in children aged 6-10 years - 10-20 mg / overnight; at the age of 11-16 years - 25-50 mg / day.
For IM injections the initial dose is 50-100 mg / injection in 2-4 injections. If necessary, the dose can be gradually increased to 300 mg / day, in exceptional cases up to 400 mg / day.
CNS and peripheral nervous system: drowsiness, fatigue, fainting, anxiety, confusion, agitation, hallucinations, anxiety, restlessness, mania, hypomania state, aggression, memory impairment, depersonalization, increased depression, decreased ability to concentrate, insomnia, nightmares, yawning, activation of psychosis symptoms, headache, myoclonus, dysarthria, tremor (especially of hands, head and tongue), peripheral neuropathy (paresthesia), myasthenia gravis, myoclonus, ataxia, extrapyramidal syndrome, acceleration and intensification of epileptic seizures, EEG changes.
Cardiovascular system: orthostatic hypotension, tachycardia, conduction disturbances, dizziness, nonspecific ECG changes (ST interval or spike T), arrhythmias, blood pressure lability, impaired intraventricular conduction (widening complex QRS, change the interval PQ, block bundle-branch block).
Digestive system: nausea, heartburn, vomiting, gastralgia, increase or decrease in appetite (increase or decrease in body weight), disease, change in taste, diarrhea, darkening of the tongue, rarely - liver dysfunction, cholestatic jaundice, hepatitis.
Endocrine: testicular swelling, gynecomastia, breast enlargement, galactorrhea, changes in libido, reduced potency, hypo-or hyperglycemia, hyponatremia (decreased production of vasopressin), a syndrome of inappropriate secretion of ADH.
Hematopoietic system: agranulocytosis, leukopenia, thrombocytopenia, purpura, eosinophilia.
Allergic reactions: skin rash, itching, rash, photosensitivity, swelling of the face and tongue.
Effects due to the anticholinergic activity: dry mouth, tachycardia, accommodation disturbances, blurred vision, mydriasis, increased intraocular pressure (only those with a narrow anterior chamber angle), constipation, paralytic ileus, urinary retention, decreased sweating, confusion, delirium or hallucinations.
Other: Hair loss, tinnitus, edema, hyperpyrexia, swollen lymph nodes, pollakiuria, hypoproteinemia.
The acute period and early recovery period after myocardial infarction, acute alcohol intoxication, acute poisoning with soporific, analgesic and psychotropic drugs, angle-closure glaucoma, severe AV- and intraventricular conduction (bundle branch block feet, AV-block II degree), lactation, children under 6 years of age (for oral administration), children under 12 years (for IV and IM injections), simultaneous treatment with inhibitors and a period of 2 weeks prior to their use, increased sensitivity to Tryptomer Actavis.
Tryptomer should not be used during pregnancy, especially in the I and III trimester, except in cases of extreme necessity. Adequate and well controlled clinical studies on the safety of Tryptomer during pregnancy was not conducted.
This drug excreted in breast milk and may cause drowsiness in infants.
Taking of Tryptomer should be phased out, at least 7 weeks prior to delivery to avoid the development of withdrawal syndrome in the newborn.
In experimental studies this medicine exerted teratogenic effects.
Use Tryptomer with caution in coronary artery disease, arrhythmias, heart block, heart failure, myocardial infarction, hypertension, stroke, chronic alcoholism, thyrotoxicosis, against the background of therapy with thyroid cancer.
The therapy Tryptomer it needed a caution when sharp transition in the vertical position of the "lying" or "sitting".
With a sharp stop taking may develop withdrawal symptoms.
Tryptomer in doses of 150 mg / day lowers the threshold of convulsive readiness; it possible a risk of epileptic seizures in susceptible patients, as well as the presence of other factors that increase the risk of seizures.
It should be noted that patients with depression may attempt suicide.
In conjunction with electroconvulsive therapy it should only be used with careful medical supervision.
In predisposed patients and elderly patients may provoke the development of drug psychosis, mainly at night (after the withdrawal of the drug are within a few days).
Tryptomer can cause paralytic ileus, mainly in patients with chronic constipation who are elderly or in patients who have to comply with bed rest.
Prior to the general or local anesthesia, the anesthesiologist it should be warned that patients taking Tryptomer.
With prolonged use, an increase the frequency of dental caries. May increase the need for riboflavin.
Tryptomer may be taken no earlier than 14 days after discontinuation of MAO inhibitors.
The drug should not be used in combination with adrenergic and sympathomimetic, including with epinephrine, ephedrine, isoprenaline, norepinephrine, phenylephrine, phenylpropanolamine.
Use Tryptomer with caution in conjunction with other drugs, which have anticholinergic action.
While receiving Tryptomer to avoid drinking alcohol.
During the period of treatment you should refrain from potentially hazardous activities requiring increased attention and rapid psychomotor reactions.
When this drug applied simultaneously with:
- drugs have a depressing effect on the central nervous system, it is possibly a significant increase in inhibitory action on the central nervous system, hypotensive effect, respiratory depression.
- drugs with anticholinergic activity may increase anticholinergic effects.
- it may be enhance the action of sympathomimetic funds for the cardiovascular system and increase the risk of cardiac arrhythmia, tachycardia, severe hypertension.
- antipsychotic drugs (neuroleptics) are relatively suppressed metabolism, with a reduction in the threshold of convulsive readiness.
- antihypertensive drugs (except clonidine, guanethidine and their derivatives) may increase the antihypertensive action and the risk of orthostatic hypotension.
- with MAO inhibitors may been developed a hypertensive crisis; with clonidine, guanethidine it may be decreased the hypotensive effect of clonidine or guanethidine; with barbiturates, carbamazepine it may be decreased the action of Tryptomer by increasing its metabolism.
- with sucralfate decreases absorption of Tryptomer; with fluvoxamine - increases the concentration of Tryptomer in blood plasma and the risk of toxic effects; with fluoxetine - increased concentration of Tryptomer in plasma and develop toxic reactions due to inhibition of isoenzyme CYP2D6 under the influence of fluoxetine; with quinidine - may slow metabolism of Tryptomer; with cimetidine - may slow metabolism of Tryptomer, increasing its concentration in blood plasma and the development of toxic effects.
While taking alcohol the action of ethanol increases, especially during the first few days of therapy.
There was described a case of serotonin syndrome with simultaneously use with sertraline.
Depending on the reaction of the Tryptomer after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Tryptomer not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.Is Tryptomer addictive or habit forming?
Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.
Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.
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The information was verified by Dr. Rachana Salvi, MD Pharmacology