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Overview

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Name

Milnacipran Hydrochloride

Precaution

Before starting **Milnacipran Hydrochloride**, patients should consult with their healthcare provider to ensure that this medication is suitable for their individual health needs. Key precautions include: - **Cardiovascular Risk**: **Milnacipran** can increase **blood pressure** and **heart rate**, especially in patients with pre-existing **hypertension** or **heart disease**. Blood pressure and heart rate should be monitored regularly, particularly during the initiation of treatment or dose increases. - **Liver and Renal Impairment**: Caution is advised in patients with **liver** or **kidney** impairment. Dosage adjustments may be necessary for those with moderate to severe renal dysfunction, as the drug is primarily excreted through the kidneys. - **Serotonin Syndrome**: **Milnacipran** is a **serotonin-norepinephrine reuptake inhibitor (SNRI)**, and combining it with other medications that affect serotonin (such as **SSRIs**, **triptans**, or **MAO inhibitors**) can increase the risk of **serotonin syndrome**, a potentially life-threatening condition characterized by symptoms like agitation, hallucinations, hyperreflexia, fever, and incoordination. - **Risk of Seizures**: There is a potential for **seizures** in patients with a history of **seizure disorders** or those at increased risk. Use with caution and monitor for any unusual symptoms. - **Pregnancy and Lactation**: **Milnacipran** should only be used during pregnancy if the benefits outweigh the risks. It is not known whether it is excreted in breast milk, so breastfeeding mothers should discuss risks with their healthcare provider.

Indication

**Milnacipran Hydrochloride** is prescribed primarily for: - **Fibromyalgia**: **Milnacipran** is commonly prescribed to treat **fibromyalgia**, a chronic condition characterized by widespread musculoskeletal pain, fatigue, and sleep disturbances. It helps by altering the balance of serotonin and norepinephrine in the brain, which can improve mood and reduce pain sensitivity. - **Major Depressive Disorder (MDD)**: It is also used to treat **major depressive disorder** in adults, especially in those who have not responded to other treatments or have not tolerated other antidepressants. - **Pain Management**: Although its primary indications are for fibromyalgia and MDD, **Milnacipran** has shown effectiveness in managing **chronic pain** syndromes as well, due to its action on the pain pathways in the nervous system.

Contra indication

**Milnacipran Hydrochloride** is contraindicated in certain situations to ensure patient safety: - **Hypersensitivity**: It should not be used in patients with a known allergy to **Milnacipran** or any of its components. - **Monoamine Oxidase Inhibitors (MAOIs)**: **Milnacipran** should not be combined with **MAOIs** or within 14 days of discontinuing an **MAOI** because of the risk of **serotonin syndrome**. - **Severe Renal Impairment**: **Milnacipran** is contraindicated in patients with severe renal impairment (creatinine clearance < 30 mL/min) due to increased risk of adverse effects from the accumulation of the drug. - **Uncontrolled Hypertension**: Due to its potential to increase blood pressure, **Milnacipran** should not be used in patients with **uncontrolled hypertension** or significant **cardiovascular disease**. - **Concurrent Use with Other SNRIs**: Using **Milnacipran** alongside other **SNRIs** or **SSRIs** increases the risk of serotonin-related side effects, including serotonin syndrome.

Side Effect

Common and severe side effects of **Milnacipran Hydrochloride** should be monitored closely: - **Common Side Effects**: - **Nausea**, **dry mouth**, and **constipation** are commonly reported, especially in the early stages of treatment. - **Headache** and **insomnia** can occur as part of the adjustment period to the medication. - **Dizziness** or **lightheadedness** may be experienced, particularly when standing up quickly, which can lead to falls. - **Serious Side Effects**: - **Hypertension** and **increased heart rate** are serious side effects, particularly in those with pre-existing heart conditions. - **Serotonin Syndrome**: Symptoms include agitation, hallucinations, rapid heart rate, fever, excessive sweating, muscle twitching, and incoordination. If any of these occur, it is crucial to seek emergency medical attention immediately. - **Liver Enzyme Elevations**: Unexplained elevations in liver enzymes may occur, necessitating regular monitoring of liver function tests. - **Seizures**: Though rare, seizures may occur, especially in individuals with a history of seizure disorders or those taking high doses.

Pregnancy Category ID

3

Mode of Action

**Milnacipran Hydrochloride** acts as a **serotonin-norepinephrine reuptake inhibitor (SNRI)**, meaning that it works by increasing the levels of two neurotransmitters in the brain, **serotonin** and **norepinephrine**. These neurotransmitters play key roles in regulating mood and pain perception. - **Serotonin and Norepinephrine Reuptake Inhibition**: By inhibiting the reuptake (reabsorption) of **serotonin** and **norepinephrine**, **Milnacipran** increases their availability in the brain. This helps to modulate mood, alleviate symptoms of depression, and reduce the sensitivity to pain, making it effective in managing **fibromyalgia** and **major depressive disorder**. - **Pain Modulation**: The increase in **norepinephrine** levels is particularly important for its pain-modulating effect, which helps reduce pain and discomfort associated with **fibromyalgia**.

Interaction

Several drugs and substances may interact with **Milnacipran Hydrochloride**, affecting its efficacy and safety: - **Monoamine Oxidase Inhibitors (MAOIs)**: Combining **Milnacipran** with **MAOIs** or within 14 days of discontinuing an **MAOI** can cause **serotonin syndrome**, a life-threatening condition. - **Other Antidepressants (SSRIs, SNRIs, TCAs)**: Taking **Milnacipran** with other **antidepressants**, especially **SSRIs** or **SNRIs**, increases the risk of serotonin syndrome and other adverse effects. - **Alcohol**: **Milnacipran** may increase the risk of **liver toxicity** when combined with alcohol. Drinking alcohol can also impair the therapeutic effects of the drug. - **CYP450 Enzyme Inhibitors**: Medications that inhibit **CYP450 enzymes**, such as **ketoconazole**, may increase the concentration of **Milnacipran** in the blood, leading to an increased risk of side effects. - **Blood Pressure Medications**: Combining **Milnacipran** with **antihypertensive drugs** may reduce their effectiveness, as **Milnacipran** can increase blood pressure and heart rate.

Pregnancy Category Note

Information not available

Adult Dose

For **Milnacipran Hydrochloride**, the typical adult dosing regimen includes: - **Fibromyalgia**: The starting dose is usually **12.5 mg** once daily for the first 2 days, then increased to **50 mg** once daily for the next 2 days. The maintenance dose is typically **100 mg** per day, divided into two doses. - **Major Depressive Disorder**: The usual starting dose is **12.5 mg** once daily for the first 2 days, followed by an increase to **25 mg** twice daily for 3 days. The target dose is **100 mg** per day, divided into two doses. - The dose can be adjusted depending on patient tolerance and the healthcare provider's recommendations.

Child Dose

**Milnacipran Hydrochloride** is not approved for use in children. There is limited data on the safety and efficacy of this medication in pediatric populations. It should be used in adults only, with careful monitoring for side effects and therapeutic response. It is crucial for patients to consult their healthcare provider before initiating **Milnacipran** treatment to ensure it is suitable for their condition and to tailor the treatment to their individual needs.

Renal Dose

**Milnacipran** should be used cautiously in patients with **renal impairment**: - For **moderate renal impairment** (creatinine clearance 30-59 mL/min), the usual dose should be reduced, with a maximum of **100 mg/day**. - In patients with **severe renal impairment** (creatinine clearance < 30 mL/min), **Milnacipran** should be avoided, or its use should be strictly monitored, as the drug is primarily excreted by the kidneys.

Administration

Information not available