Overview

ATMOPRAM PLUS comprises of Escitalopram Oxalate and Clonazepam is used to treat depression and anxiety disorder. Clonazepam and escitalopram which have anxiety-lowering and mood-enhancing effects. Escitalopram is a selective serotonin reuptake inhibitor (SSRI) and Antidepressant. It works by restoring the balance of serotonin, a natural substance in the brain, which helps to improve certain mood problems and panic disorder. Clonazepam is a benzodiazepine (BZD) which increases the action of GABA, a chemical messenger that suppresses the abnormal activity of the nerve cells in the brain. 

Indications & Usage

• Depression
• Panic disorder
• Anxiety disorder
• Adjunct treatment in Schizophrenia

 

PHARMACOLOGY

PHARMACODYNAMICS

Pharmacodynamic Properties of Escitalopram Oxalate:

Escitalopram belongs to a class of antidepressant medications called SSRIs (selective serotonin reuptake inhibitors). Escitalopram is the S enantiomer of racemic Citalopram. It is 100 times more potent than R-enantiomer. Escitalopram blocks the re-uptake of neurotransmitter Serotonin from the synapse to the presynaptic nerve terminal in the CNS. This potentiates the action of Serotonin (5HT) and it is useful in the treatment of depression.

Pharmacodynamic Properties of Clonazepam:

Metformin is an oral antihyperglycemic agent that improves glucose tolerance in patients with NIDDM, lowering both basal and postprandial plasma glucose. Metformin is not chemically or pharmacologically related to any other class of oral antihyperglycemic agents. Unlike sulfonylureas, metformin does not produce hypoglycemia in either patients with NIDDM or healthy subjects and does not cause hyperinsulinemia. Metformin decreases hepatic glucose production,decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.

PHARMACOKINETICS

Pharmacodynamic Properties of Glimepiride:

Glimepiride primarily lowers blood glucose by stimulating the release of insulin from pancreatic beta cells.Sulphonylureas bind to the sulphonylurea receptor in the pancreatic beta-cell plasma membrane, leading to closure of the ATP-sensitive potassium channel, thereby stimulating the release of insulin.

Pharmacokinetics Properties of Pioglitazone Hydrochloride:

Absorption: Escitalopram is well absorbed.
BioavailabilityBio-availability of escitalopram is expected to be about 80%.
Distribution: It is widely distributed in the body.The binding of escitalopram to human plasma proteins is approximately 56%. 
Metabolism: Escitalopram undergoes metabolism in the hepatic and the metabolites are not as active as Escitalopram. It is metabolized to S-demethylcitalopram (S-DCT) and S-didemethylcitalopram (S-DDCT). Both of these are pharmacologically active
Excretion:It is excreted mainly through urine.
Half Life: Elimination half-life (t½β) about 30 hours.

Pharmacokinetic of Clonazepam:

Absorption: It is well absorbed.
Bioavailability:Bioavailability is 90%
Distribution: It is distributed widely in the body in protein bound form. Clonazepam cross the placental barrier and has been detected in maternal milk.
Metabolism: It is metabolised in the liver.The biotransformation of clonazepam involves oxidative hydroxylation and reduction of the 7-nitro group by the liver with formation of 7-amino or 7-acetylamino compounds

Excretion:Most of metabolites 50-70 % are excreted in urine and 10-30% in the faeces.
Half Life:Elimination half-life is between 20 and 60 hours (mean 30 hours).

SIDE EFFECTS

• Increased sweating
• Nausea, Vomiting
• Dry mouth
• Diarrhoea & mild stomach pain
• Sedation
• Drowsiness, Tiredness

DRUG INTERACTION

Based on the mechanism of action of SNRIs and SSRIs including escitalopram and the potential for serotonin syndrome. Certain drugs may affect the serotonergic neurotransmitter systems, such as CNS Drug,Cimetidine, Ketoconazole, Ranitidine, Triptans, Lithium, Metoprolol & Monoamine Oxidase Inhibitors (MAOIs)

Contraindications

It should not be taken if you have the following conditions : Monoamine oxidase inhibitors (MAOIs), Pimozide, Hypersensitivity to escitalopram or citalopram.

PREGNANCY & LACTATION

Pregnant and lactating women should take this medication only under the prescription of the physician