Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine Pharmacology

Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine

About Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine
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Mechanism of Action of Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine
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Pharmacokinets of Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine
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Onset of Action for Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine
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Duration of Action for Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine
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Half Life of Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine
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Side Effects of Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine
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Contra-indications of Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine
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Special Precautions while taking Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine
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Pregnancy Related Information
Contraindicated; since Clidinium bromide and Chlordiazepoxide are contraindicated in pregnant woman.
Old Age Related Information
N/A
Breast Feeding Related Information
Contraindicated; Chlordiazepoxide, Clidinium bromide and Dicylomine are contraindicated in lactation.
Children Related Information
N/A
Indications for Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine
It is a combination of anti-anxiety Chlordiazepoxide and antspasmodic Clidinium bromide and Dicylomine and H2 receptor antagonist Ranitidine. The combination is used to relax the digestive system and to reduce the acidity of stomach.
1.Peptic ulcer (Adjunctive therapy)
2.Irritable bowel syndrome
3.Acute enterocolitis
Interactions for Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine
N/A
Typical Dosage for Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine
Adult: Maintenance dose is 1 - 2 tablets 3 or 4 times a day administered before meals and at bedtime.
Schedule of Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine
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Storage Requirements for Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine
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Effects of Missed Dosage of Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine
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Effects of Overdose of Chlordiazepoxide + Clidinium bromide + Dicyclomine + Ranitidine
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Chlordiazepoxide

About Chlordiazepoxide
Benzodiazepine derivative, Sedative /hypnotic, Antianxiety and skeletal muscle relaxant.
Mechanism of Action of Chlordiazepoxide
Chlordiazepoxide mainly acts on Limbic system and ascending reticular formation in the CNS. It binds to the BZD receptor. The binding will facilitates GABA mediated chloride channel opening and produce hyperpolarisation. This will increase the concentration of inhibitory neurotransmitter GABA and chloride ions in the CNS and decreases firing rate of neurons. This in turn alters normal excitatory functions of the body.
Pharmacokinets of Chlordiazepoxide
Absorption: It is absorbed after oral administration. Distribution: It is distributed widely in the body. Metabolism: It is metabolised to active metabolite in the liver. Excretion: Most metabolites are excreted through urine
Onset of Action for Chlordiazepoxide
1 - 2 hour
Duration of Action for Chlordiazepoxide
12 - 24 hour
Half Life of Chlordiazepoxide
5 - 30 hour
Side Effects of Chlordiazepoxide
1.Ataxia
2.Drowsiness
3.Lethargy
4.Hallucination
5.Nausea
6.Constipation
7.Amnesia
8.Dependence
9.Pain at the site of injection
10.Confusion
11.Depression
12.Mood changes
Contra-indications of Chlordiazepoxide
Hypersensitivity to Benzodiazepines
Special Precautions while taking Chlordiazepoxide
1.Renal impairment
2.Hepatic impairment
3.Myasthenia gravis
4.Respiratory disease
5.Jaundice
6.Use caution while driving vehicles, operating machines or other dangerous activities
Pregnancy Related Information
Contraindicated.
Old Age Related Information
Use with caution
Breast Feeding Related Information
Contraindicated.
Children Related Information
Use with caution
children < 6 years: contraindicated
NEONATES- contraindicated
Indications for Chlordiazepoxide
1. Anxiety
2.Treatment of alcohol withdrawal symptom
3. Insomnia
4. Pre and post operative apprehension
Interactions for Chlordiazepoxide
Alcohol & Other CNS Depressants: Enhanced CNS effects.
Aminophylline: Antagonizes the sedative effect.
Cimetidine, Oral contraceptives, Disulfiram, Fluoxetine, Isoniazid, Ketoconazole, Metoprolol, Propoxyphene, Propranolol.
Valproic acid: Elimination of chlordiazepoxide decreased due to inhibition of hepatic metabolism leading to enhanced activity.
Digoxin: Increase in serum concentration of Digoxin.
Imipramine & Desipramine: Enhanced activity of these drugs.
Levodopa : Decrease in antiparkinsonism efficacy.
Morphine, Pethidine, Atropine and Magnesium trisilicate: Absorption of chlordiazepoxide is impaired.
Probenecid: May cause rapid onset or prolonged effect.
Rifampicin: Decreases efficacy.
Typical Dosage for Chlordiazepoxide
Adults: 5 - 10 mg 3 - 4 times daily
Severe anxiety: 20 - 25 mg 3 - 4 times daily
Treatment of alcohol withdrawal symptom: 25 - 100 mg daily; Depending on the patient`s condition dose can be reduced after 2 - 3 weeks
Pre and post operative apprehension: 5 - 10 mg 3 - 4 times daily; the drug should be given one day before surgery in pre operative apprehension
Children: 5mg 3 - 4 times daily.
Schedule of Chlordiazepoxide
H
Storage Requirements for Chlordiazepoxide
Store at temperature 15 - 30 degree C.Protect from light and moisture. Keep out of the reach of children.
Effects of Missed Dosage of Chlordiazepoxide
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose.
Effects of Overdose of Chlordiazepoxide
Give support and symptomatic treatment. Induce emesis or gastric lavage has to be done followed by charcoal administration. Flumazenil can be given as antagonist.

Clidinium Bromide

About Clidinium Bromide
It is a quaternary ammonium compound with anticholingeric properties, Antispasmodics (Systemic).
Mechanism of Action of Clidinium Bromide
Clidinium bromide is an anticholinergic drug. It exerts its action by inhibiting muscarinic cholinergic receptors on smooth muscles, cardiac muscles and prevents the effect of Acetylcholine. Inhibition of Acetylcholine produces relaxation of smooth muscles and prevents the muscle spasm in irritable bowel syndrome.
Pharmacokinets of Clidinium Bromide
Absorption: Clidinium bromide is poorly absorbed about (10 - 25 %) after oral administration.
Distribution:It does not penetrate CNS and eye.
Metabolism: It is extensively metabolised in the small intestine (by hydrolysis) and in the liver to inactive metabolites.
Excretion: Drug and its metabolites are excreted mainly in the urine.
Onset of Action for Clidinium Bromide
60 minute
Duration of Action for Clidinium Bromide
3 hours
Half Life of Clidinium Bromide
N/A
Side Effects of Clidinium Bromide
1.Dry mouth
2.Nausea
3.Vomiting
4.Constipation
5.Muscle weakness
6.Blurred vision
7.Drowsines
Contra-indications of Clidinium Bromide
1.Hypersensitivity to Clidinium bromide and other anticholinergic drugs
2.Narrow angle glaucoma
3.Obstructive gastro intestinal tract
4.Bladder neck obstruction
5.Prostatic hypertrophy
Special Precautions while taking Clidinium Bromide
1.Renal impairment
2.Hepatic impairment
3.Cardiovascular diseases- Hypertension
4.Use caution while performing driving or performing other works requiring mental alertness
Pregnancy Related Information
Contraindicated
Old Age Related Information
Use with caution.
Breast Feeding Related Information
Contraindicated
Children Related Information
Contraindicated
NEONATES: contraindicated
Indications for Clidinium Bromide
1.Peptic ulcer
2.Gastritis
3.Irritable bowel syndrome
4.Nervous dyspepsia
Interactions for Clidinium Bromide
Amantadine : Increase in anticholingeric side effects.
Atenolol, Digoxin: Efficacy of atenolol and digoxin enhanced .
Phenothiazines : Decreases antipsychotic activity, and increases anticholingeric activity.
TCAs: Increased anticholinergic side effects ( Dry mouth, constipation, urinary retention)
Typical Dosage for Clidinium Bromide
Adult: 2.5 - 5 mg 3 - 4 times daily before meals and at bed time.
Children: not recommended.
Schedule of Clidinium Bromide
H
Storage Requirements for Clidinium Bromide
Store at below 30 degree C in a tightly closed container. Protect from moisture and sunlight.
Keep out of the reach of children
Effects of Missed Dosage of Clidinium Bromide
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Clidinium Bromide
Give supportive measures and symptomatic treatment. Drug can be removed from the body by gastric lavage or inducing emesis. Absorption of the drug can be reduced by administration of activated charcoal.

Dicyclomine

About Dicyclomine
Anticholinergic ,Antimuscarinic, Antispasmodic and in urinary incontinence.
Mechanism of Action of Dicyclomine
Dicyclomine is an anticholinergic drug. It exerts its action by inhibiting muscarinic (((cholinergic))) receptors on smooth muscles and prevents the effect of Acetylcholine. Inhibition of Acetylcholine produces relaxation of smooth muscles of gastrointestinal tract and genitourinary tract and reduces the painful spasm and cramp. It inhibits gastrointestinal propulsive motility and reduces gastric acid secretion. It also has a direct relaxant effect on smooth muscle. It readily crosses the blood brain barrier and produces CNS effects.
Pharmacokinets of Dicyclomine
Absorption: About 70 % of the drug is absorbed after oral administration.
Distribution: It is extensively distributed in tissue mainly in protein bound (((99%))) form. It readily crosses blood brain barrier.
Metabolism: Dicyclomine undergoes hepatic metabolism
Excretion: It is excreted mainly in the urine and small amount in the faeces.
Onset of Action for Dicyclomine
1-2 hours.
Duration of Action for Dicyclomine
4-6 hours.
Half Life of Dicyclomine
1.8 hours (((initial phase))). 9 - 10 hours (((secondary phase)))
Side Effects of Dicyclomine
1.Constipation
2.Dry mouth
3.Nausea
4.Vomiting
5.Abdominal discomfort
6.Headache
7.Dizziness
8.Confusion
9.Palpitations
10.Tachycardia
11.Increased intraocular pressure
12.Mydriasis
13.Urine retention
14.Urinary hesitancy
15.Decreased sweating
Contra-indications of Dicyclomine
1.Hypersensitivity to Dicyclomine and other anticholinergic drugs
2.Narrow angle glaucoma
3.Obstructive gastro intestinal tract
4.Obstructive uropathy
5.Reflux oesophagitis
6.Severe ulcerative colitis
7.Myasthenia gravis
8.Unstable cardiovascular status in acute haemorrhage
Special Precautions while taking Dicyclomine
1.Renal impairment
2.Hepatic impairment
3.Heart failure
4.Prostatic hypertrophy
5.Hiatus hernia associated
6.Hyperthyroidism
7.Autonomic neuropathy
8.Ulcerative colitis
9.Arrhythmia
10.Hypertension
11.Coronary artery disease
Pregnancy Related Information
Use with caution.
Old Age Related Information
Use with caution.
Breast Feeding Related Information
Contraindicated
Children Related Information
Use with caution.
NEONATES: contraindicated
Indications for Dicyclomine
1. Irritable bowel syndrome
2.Colicky pain
Interactions for Dicyclomine
N/A
Typical Dosage for Dicyclomine
Adult:
Oral: 80 mg / day in 4 divided doses 30 - 60 minutes before meals. Depending on the patient`s response dose can be increased to 160 mg / day in 4 divided doses after 1 week.
Children:
Infant colic: 5 - 10 mg every 6 - 8 hours, 15 minutes before each feed; dose is depending on the patient`s response and age.
Schedule of Dicyclomine
H
Storage Requirements for Dicyclomine
Store at 15 - 30 degree C in a tightly closed container. Protect from light.Keep out of the reach of children
Effects of Missed Dosage of Dicyclomine
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Dicyclomine
Give supportive measures and symptomatic treatment. Drug can be removed from the body by gastric lavage or by inducing emesis. Absorption of the drug can be reduced by administration of activated charcoal. Physostigmine is given to block the overdose symptoms of Dicyclomine.

Ranitidine

About Ranitidine
A histamine H2-receptor antagonist, Furan derivative, Anti-secretory G.I agent,Anti ulcer.
Mechanism of Action of Ranitidine
Ranitidine is a H2 (Histamine) receptor antagonist. Histamine is the most potent stimulus of acid secretion and acts as the common mediator. H2 receptor is a G-protein coupled receptor. It induces adenylate cyclase which converts ATP to cyclic AMP. This cyclic AMP acts on proton pump and exchange extracellular potassium ion for intracellular hydrogen ion across the parietal cell membrane. Ranitidine reversibly competes with Histamine for binding to H2 receptors on the parietal cells and predominantly inhibits basal acid secretion.
Anaesthetic adjuncts: It is used in patients undergoing prolonged operations, caesarian section,obese patients those are at increased risk of gastric regurgitation and aspiration pneumonia. It raises pH of gastric juice and also reduces its volume and thus chances of regurgitation. It is now routinely used before prolonged surgery.
Pharmacokinets of Ranitidine
Absorption: Ranitidine is 50 % absorbed after oral administration. Distribution: Distributed mainly to body tissues in unbound form. Metabolism: Ranitidine undergoes metabolism in the liver. Excretion: It is excreted mainly in urine and in the faeces.
Onset of Action for Ranitidine
60 minutes
Duration of Action for Ranitidine
13hours
Half Life of Ranitidine
1.6- 2.4 hours
Side Effects of Ranitidine
1. Headache
2. Dizziness
3. Constipation
4. Vertigo
5. Confusion
6. Rash
7. Blurred vision
8. Thrombocytopenia
9. Leukopenia
Contra-indications of Ranitidine
1. Hypersensitivity to Ranitidine
Special Precautions while taking Ranitidine
1. Hepatic impairment
2. Renal impairment
3. Acute Porphyria
Pregnancy Related Information
Use with caution
Old Age Related Information
Use with caution
Breast Feeding Related Information
Use with caution
Children Related Information
Use with caution
NEONATES: Contraindicated
Indications for Ranitidine
1. Duodenal ulcer
2. Benign gastric ulcer
3. Zollinger- Ellison syndrome
4. Gastroesophageal reflux
5. Acid indigestion
6. Heart burn
7. Sour stomach
8. Stress ulcers
9. Oesophagitis
10.Preanaesthetic medication
Interactions for Ranitidine
Antacids: Ranitidine absorption may be decreased.
Diazepam: Efficacy of diazepam decreased.
Procainamide: Renal clearance of procainamide decreased.
Sulfonylureas: Hypoglycemic effects of glipizide enhanced.
Theophyllines: Increased efficacy of theophyllines with possible toxicity.
Warfarin: Increased hypoprothrombinemic effects.
Lab tests: False positive tests for urine proteins with multistix may occur.
Typical Dosage for Ranitidine
Adult: 300mg / day
Duodenal ulcer, benign gastric ulcer: 300 mg /day as single dose at bed time or in 2 divided dose (morning and bed time) for minimum of 4 weeks.
Maintenance dose: 150 mg / day at bed time.
Zollinger- Ellison syndrome: 300 - 450 mg / day in 2 - 3 divided doses; dose can be increased if necessary to a maximum up to 6g / day .
Gastroesophageal reflux: 300 mg / day as single dose at bed time or in 2 divided doses (morning and bed time) for maximum 2 months. In severe conditions dose can be increased to 600 mg / day in 4 divided doses for 3 months
Acid indigestion, Heart burn, Sour stomach: Dose: 75 mg once daily to a maximum up to 150 mg / day.
Oesophagitis: 150 mg/ day.
Dyspepsia: 75 - 300 mg / day depending on the severity of disease.
PAM: 150mg given night and in the morning before surgical procedures.
Children:
Duodenal ulcer, benign gastric ulcer: 4 - 8 mg / kg body weight / day in 2 divided doses.
Maximum dose: 300 mg / day
Schedule of Ranitidine
H
Storage Requirements for Ranitidine
Store at 15 - 30 degree C in a tightly closed container. Protect from light.
Effects of Missed Dosage of Ranitidine
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Ranitidine
Give supportive measures and symptomatic treatment. Drug can be removed from the body by inducing emesis and or by gastric lavage. Activated charcoal is given to reduce the absorption of the drug. Haemodialysis can be done if necessary.

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