How do various medications treat hiccups. What causes intractable hiccups. Which non-pharmacological methods can alleviate hiccups. How effective is Ativan for hiccup management. What are the potential side effects of using Ativan for hiccups.

Understanding Hiccups: Causes and Classifications

Hiccups are involuntary contractions of the diaphragm followed by a sudden closure of the vocal cords, resulting in the characteristic “hic” sound. While occasional hiccups are common and usually harmless, persistent or intractable hiccups can significantly impact a person’s quality of life.

Classifications of Hiccups

• Acute hiccups: Lasting less than 48 hours
• Persistent hiccups: Lasting more than 48 hours
• Intractable hiccups: Lasting more than one month

Persistent and intractable hiccups can be caused by various factors, including:

• Gastrointestinal disorders
• Central nervous system abnormalities
• Metabolic imbalances
• Psychogenic factors
• Medications

Are certain individuals more susceptible to chronic hiccups? Studies have shown that males are more likely to experience intractable hiccups compared to females. A gender analysis of published case reports and case-control studies revealed this disparity, although the underlying reasons remain unclear.

Pharmacological Interventions for Persistent Hiccups

When hiccups persist beyond 48 hours or become intractable, medical intervention may be necessary. Various medications have been used to treat persistent hiccups, each targeting different aspects of the hiccup reflex arc.

Commonly Used Medications

1. Metoclopramide: An antiemetic agent that has shown efficacy in randomized controlled trials
2. Baclofen: A muscle relaxant that can help alleviate hiccups related to esophageal stents
3. Gabapentin: An anticonvulsant that has demonstrated long-term effectiveness in some cases
4. Chlorpromazine: An antipsychotic medication historically used for intractable hiccups
5. Amantadine: An antiviral drug with potential benefits for hiccup management

How effective is metoclopramide for treating intractable hiccups? A multicentre, randomized, controlled pilot study by Wang and Wang demonstrated that metoclopramide could significantly reduce hiccup severity and frequency in patients with intractable hiccups.

Ativan (Lorazepam) for Hiccup Management

Ativan, also known by its generic name lorazepam, is a benzodiazepine medication that has been used off-label for the treatment of persistent hiccups. Its effectiveness is attributed to its ability to reduce anxiety and muscle tension, which may contribute to the hiccup reflex.

Mechanism of Action

Ativan works by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity. This action can help suppress the hiccup reflex by:

• Reducing muscle spasms in the diaphragm
• Decreasing anxiety that may exacerbate hiccups
• Promoting relaxation of the nervous system

How is Ativan typically administered for hiccup management? The dosage and duration of Ativan treatment for hiccups can vary depending on the individual case. Generally, it is prescribed in low doses and for short periods to minimize the risk of side effects and dependence.

Potential Side Effects and Precautions of Using Ativan for Hiccups

While Ativan can be effective in managing persistent hiccups, it’s important to be aware of potential side effects and take necessary precautions.

Common Side Effects

• Drowsiness
• Dizziness
• Weakness
• Unsteadiness
• Confusion

Can Ativan lead to dependence when used for hiccup treatment? Yes, like other benzodiazepines, Ativan carries a risk of physical and psychological dependence, especially when used for extended periods. Therefore, it should be used under close medical supervision and for the shortest duration necessary to control symptoms.

Precautions

Healthcare providers should consider the following precautions when prescribing Ativan for hiccups:

• Assessing the patient’s medical history, including any history of substance abuse
• Monitoring for signs of tolerance or dependence
• Considering alternative treatments for patients at high risk of dependence
• Gradually tapering the medication when discontinuing treatment

Alternative Pharmacological Approaches to Hiccup Management

While Ativan is one option for treating persistent hiccups, several other medications have shown promise in managing this condition. Healthcare providers may consider these alternatives based on the patient’s specific needs and medical history.

Emerging Treatments

1. Donepezil: An acetylcholinesterase inhibitor typically used for Alzheimer’s disease
2. Midazolam: A short-acting benzodiazepine used in conscious sedation
3. Amantadine: An antiviral medication with potential benefits for hiccup relief

How effective is gabapentin in treating intractable hiccups? Several case studies have reported successful long-term management of intractable hiccups using gabapentin. A three-year follow-up study by Moretti et al. demonstrated sustained relief in a patient with hiccups due to a vascular lesion.

Non-Pharmacological Interventions for Hiccup Relief

In addition to medication, various non-pharmacological methods can be employed to alleviate hiccups. These techniques can be particularly useful for acute hiccups or as complementary approaches to medication in persistent cases.

Physical Maneuvers

• Breath-holding techniques
• Valsalva maneuver
• Stimulating the vagus nerve (e.g., gargling with ice water)
• Phrenic nerve stimulation

Behavioral Approaches

• Relaxation techniques
• Mindfulness meditation
• Cognitive-behavioral therapy for psychogenic hiccups

Can acupuncture help in managing persistent hiccups? Some studies suggest that acupuncture may be beneficial in treating persistent hiccups, although more research is needed to establish its efficacy conclusively.

Diagnosing Underlying Causes of Intractable Hiccups

When hiccups persist for an extended period, it’s crucial to identify any underlying causes that may be contributing to the condition. A thorough diagnostic workup can help guide treatment and potentially resolve the hiccups by addressing the root cause.

Diagnostic Approaches

1. Comprehensive medical history and physical examination
2. Blood tests to check for metabolic imbalances
3. Imaging studies (e.g., chest X-ray, CT scan, MRI) to rule out structural abnormalities
4. Endoscopy to evaluate gastrointestinal causes
5. Neurological evaluation for central nervous system disorders

How can rare causes of intractable hiccups be identified? Advanced imaging techniques, such as F-18 fluorodeoxyglucose PET/CT, have been used to identify unusual causes of persistent hiccups, as reported by Yeatman and Minoshima.

Unusual Causes of Intractable Hiccups

Several case reports have highlighted rare causes of persistent hiccups, including:

• Chiari I malformation
• Syringobulbia and syringomyelia
• Intramedullary spinal hemangioblastoma
• Myocardial ischemia
• Herpes zoster laryngitis
• Late lead perforation in cardiac devices
• Intradiaphragmatic bronchogenic cysts

These unusual cases underscore the importance of a thorough diagnostic workup in patients with intractable hiccups.

Managing Hiccups in Special Populations

Certain populations may require special considerations when managing persistent hiccups. These include patients with advanced cancer, those undergoing dialysis, and individuals with specific medical conditions that may complicate treatment.

Hiccups in Cancer Patients

Persistent hiccups can be particularly distressing for patients with advanced cancer. Management approaches may include:

• Careful medication selection to avoid interactions with cancer treatments
• Palliative care interventions
• Addressing underlying causes such as gastric distension or brain metastases

How can hiccups be managed in patients undergoing peritoneal dialysis? A case report by Ong et al. described successful treatment of intractable hiccups in a peritoneal dialysis patient using gabapentin, highlighting the need for tailored approaches in this population.

Pediatric Considerations

Managing hiccups in children and adolescents may require different strategies:

• Age-appropriate dosing of medications
• Emphasis on non-pharmacological interventions
• Careful monitoring for side effects

A study by Uldum et al. on midazolam conscious sedation in a Danish municipal dental service for children and adolescents provided insights into the use of benzodiazepines in younger populations, which may be relevant for hiccup management in these age groups.

Future Directions in Hiccup Research and Treatment

As our understanding of the pathophysiology of hiccups continues to evolve, new treatment approaches are being explored. Future research may focus on developing targeted therapies that address specific aspects of the hiccup reflex arc.

Emerging Research Areas

• Neurostimulation techniques
• Gene therapy approaches
• Personalized medicine based on genetic factors
• Novel drug delivery systems for hiccup medications

What role might artificial intelligence play in hiccup management? AI-driven algorithms could potentially help identify patterns in hiccup occurrence and predict the most effective treatments for individual patients based on their specific characteristics and medical history.

Improving Clinical Guidelines

Efforts are underway to develop more comprehensive and evidence-based guidelines for managing persistent and intractable hiccups. These guidelines aim to:

• Standardize diagnostic approaches
• Provide clear treatment algorithms
• Incorporate the latest research findings
• Address the needs of special populations

The systematic review by Polito and Fellows on pharmacologic interventions for intractable and persistent hiccups represents a step towards developing such guidelines, highlighting the need for more robust clinical trials in this area.

In conclusion, while Ativan remains a valuable tool in the management of persistent hiccups, a comprehensive approach that considers various pharmacological and non-pharmacological interventions is essential. As research progresses, we can expect more targeted and effective treatments for this often challenging condition.

Antiemetic Agents, Anticonvulsants/Antiarrhythmics, Anesthetics, Muscle Relaxants, Analgesics, Antipsychotic Agents, Sedative/Hypnotics, Antidepressants, Tricyclic Antidepressants, Stimulants

1. Wang T, Wang D. Metoclopramide for patients with intractable hiccups: a multicentre, randomised, controlled pilot study. Intern Med J. 2014 Dec. 44(12a):1205-9. [QxMD MEDLINE Link].

2. Kohse EK, Hollmann MW, Bardenheuer HJ, Kessler J. Chronic hiccups: an underestimated Problem. Anesth Analg. 2017 Oct. 125 (4):1169-83. [QxMD MEDLINE Link].

3. Branuelas Quiroga J, Urbano García J, Bolanos Guedes J. Hiccups: a common problem with some unusual causes and cures. Br J Gen Pract. 2016 Nov. 66 (652):584–6. [QxMD MEDLINE Link]. [Full Text].

4. Lee GW, Kim RB, Go SI, et al. Gender differences in hiccup patients: analysis of published case reports and case-control studies. J Pain Symptom Manage. 2016 Feb. 51 (2):278-83. [QxMD MEDLINE Link].

5. Vanamoorthy P, Kar P, Prabhakar H. Intractable hiccups as a presenting symptom of Chiari I malformation. Acta Neurochir (Wien). 2008 Nov. 150(11):1207-8; discussion 1208. [QxMD MEDLINE Link].

6. Jeong JH, Im SB, Shin DS, Hwang SC, Kim BT. Intractable hiccups caused by syringobulbia and syringomyelia associated with intramedullary spinal hemangioblastoma. Eur Spine J. 2015 May. 24 Suppl 4:S614-8. [QxMD MEDLINE Link].

7. Krysiak W, Szabowski S, Stepien M, Krzywkowska K, Krzywkowski A, Marciniak P. Hiccups as a myocardial ischemia symptom. Pol Arch Med Wewn. 2008 Mar. 118(3):148-51. [QxMD MEDLINE Link].

8. webmd.com”>Morinaka S. Herpes zoster laryngitis with intractable hiccups. Auris Nasus Larynx. 2009 Oct. 36(5):606-8. [QxMD MEDLINE Link].

9. Yeatman CF 2nd, Minoshima S. F-18 fluorodeoxyglucose PET/CT findings in active hiccups. Clin Nucl Med. 2009 Mar. 34(3):197-8. [QxMD MEDLINE Link].

10. Celik T, Kose S, Bugan B, Iyisoy A, Akgun V, Cingoz F. Hiccup as a result of late lead perforation: report of two cases and review of the literature. Europace. 2009 Jul. 11(7):963-5. [QxMD MEDLINE Link].

11. Zugel NP, Kox M, Lang RA, Huttl TP. Laparoscopic resection of an intradiaphragmatic bronchogenic cyst. JSLS. 2008 Jul-Sep. 12(3):318-20. [QxMD MEDLINE Link].

12. Wilcox SK, Garry A, Johnson MJ. Novel use of amantadine: to treat hiccups. J Pain Symptom Manage. 2009 Sep. 38(3):460-5. [QxMD MEDLINE Link].

13. Salanitri S, Goncalves AJ, Helene A Jr, Lopes FH. Surgical complications in hair transplantation: a series of 533 procedures. Aesthet Surg J. 2009 Jan-Feb. 29(1):72-6. [QxMD MEDLINE Link].

14. Doshi H, Vaidyalingam R, Buchan K. Atrial pacing wires: an uncommon cause of postoperative hiccups. Br J Hosp Med (Lond). 2008 Sep. 69(9):534. [QxMD MEDLINE Link].

15. Uldum B, Hallonsten AL, Poulsen S. Midazolam conscious sedation in a large Danish municipal dental service for children and adolescents. Int J Paediatr Dent. 2008 Jul. 18(4):256-61. [QxMD MEDLINE Link].

16. McGrane IR, Shuman MD, McDonald RW. Donepezil-related intractable hiccups: a case report. Pharmacotherapy. 2015 Mar. 35 (3):e1-5. [QxMD MEDLINE Link].

17. Suh WM, Krishnan SC. Violent hiccups: an infrequent cause of bradyarrhythmias. West J Emerg Med. 2009 Aug. 10(3):176-7. [QxMD MEDLINE Link]. [Full Text].

18. Polito NB, Fellows SE. Pharmacologic interventions for intractable and persistent hiccups: a systematic review. J Emerg Med. 2017 Oct. 53 (4):540-9. [QxMD MEDLINE Link].

19. Moretto EN, Wee B, Wiffen PJ, Murchison AG. Interventions for treating persistent and intractable hiccups in adults. Cochrane Database Syst Rev. 2013 Jan 31. 1:CD008768. [QxMD MEDLINE Link].

20. Steger M, Schneemann M, Fox M. Systemic review: the pathogenesis and pharmacological treatment of hiccups. Aliment Pharmacol Ther. 2015 Nov. 42 (9):1037-50. [QxMD MEDLINE Link].

21. webmd.com”>Moretti R, Torre P, Antonello RM, Ukmar M, Cazzato G, Bava A. Gabapentin as a drug therapy of intractable hiccup because of vascular lesion: a three-year follow up. Neurologist. 2004 Mar. 10(2):102-6. [QxMD MEDLINE Link].

22. Ong AM, Tan CS, Foo MW, Kee TY. Gabapentin for intractable hiccups in a patient undergoing peritoneal dialysis. Perit Dial Int. 2008 Nov-Dec. 28(6):667-8. [QxMD MEDLINE Link].

23. Marinella MA. Diagnosis and management of hiccups in the patient with advanced cancer. J Support Oncol. 2009 Jul-Aug. 7(4):122-7, 130. [QxMD MEDLINE Link].

24. Turkyilmaz A, Eroglu A. Use of baclofen in the treatment of esophageal stent-related hiccups. Ann Thorac Surg. 2008 Jan. 85(1):328-30. [QxMD MEDLINE Link].

25. Colorado B, Decker G. Persistent hiccups after an epidural steroid injection successfully treated with baclofen: a case report. PM R. 2017 Dec. 9 (12):1290-3. [QxMD MEDLINE Link].

26. Thompson AN, Ehret Leal J, Brzezinski WA. Olanzapine and baclofen for the treatment of intractable hiccups. Pharmacotherapy. 2014 Jan. 34 (1):e4-8. [QxMD MEDLINE Link].

27. Neuhaus T, Ko YD, Stier S. Successful treatment of intractable hiccups by oral application of lidocaine. Support Care Cancer. 2012 Nov. 20(11):3009-11. [QxMD MEDLINE Link].

28. Go SI, Koo DH, Kim ST, Song HN, Kim RB, Jang JS, et al. Antiemetic corticosteroid rotation from dexamethasone to methylprednisolone to prevent dexamethasone-induced hiccup in cancer patients treated with chemotherapy: randomized, single-blind, crossover phase III trial. Oncologist. 2017 Nov. 22 (11):1354-61. [QxMD MEDLINE Link].

29. Chang CC, Chang ST, Lin JC, Li TY, Chiang SL, Tsai KC. Resolution of intractable hiccups after near-infrared irradiation of relevant acupoints. Am J Med Sci. Aug 2006. 332(2):93-6. [QxMD MEDLINE Link].

30. Chang CC, Chang YC, Chang ST, et al. Efficacy of near-infrared irradiation on intractable hiccup in custom-set acupoints: evidence-based analysis of treatment outcome and associated factors. Scand J Gastroenterol. 2008. 43(5):538-44. [QxMD MEDLINE Link].

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32. Choi TY, Lee MS, Ernst E. Acupuncture for cancer patients suffering from hiccups: a systematic review and meta-analysis. Complement Ther Med. 2012 Dec. 20(6):447-55. [QxMD MEDLINE Link].

33. Farin A, Chakrabarti I, Giannotta SL, Vaynman S, Samudrala S. Microvascular decompression for intractable singultus: technical case report. Neurosurgery. 2008 May. 62(5):E1180-1; discussion E1181. [QxMD MEDLINE Link].

34. Johnson DL. Intractable hiccups: treatment by microvascular decompression of the vagus nerve. Case Report. J Neurosurg. 1993 May. 78(5):813-6. [QxMD MEDLINE Link].

Hiccups

SYMPTOM OVERVIEW

Hiccups are an underreported respiratory complication that can significantly impair an individual’s quality of life. Responsible for at least 4000 hospital admissions annually, they often are not considered significant in the need to care for a patient’s other pressing comorbidities such as malignancy.¹

ETIOLOGY

Hiccups occur secondary to an involuntary spasm of the diaphragm and intercostal muscles, which is followed by the sudden closure of the glottis generating the “hic” sound. These involuntary spasms occur at a rate of 4 to 60 per minute and predominantly involve the left hemidiaphragm.¹ The pathogenesis of hiccups is complex with a variety of etiologies, resulting in the neurophysiologic effect of the condition (Table 1).^1-4

The hiccup reflex arc is composed of efferent and afferent limbs, as well as a central hiccup center. The nerves that are involved in this reflex include the vagus, phrenic, and elements of the sympathetic nervous chain—primarily in the thoracic region.^1,5 This chain of nerves can be activated at multiple points, making the true cause of an individual’s hiccups hard to discern and treat. In addition, there is a male predominance of those with hiccups in most reports.1 Most hiccups are benign and self-limiting with cessation in minutes; however, some can last longer and become persistent or intractable hiccups, which are defined as lasting longer than 48 hours and 1 month, respectively. ^1,5

When diagnosing intractable hiccups, a careful physical and laboratory review should be performed to evaluate the myriad of possible causes. Intractable hiccups can result in anxiety, increased depression, sleep loss, impaired nutrition and fluid intake, aspiration, and induction of cardiac arrhythmias via activation of underlying cardiac pathology.^1,5 This may result in significant impairment, and more rarely, death of the patient.

TREATMENT OPTIONS

Self-limited hiccups do not require intervention as they will generally resolve without causing significant distress. Although there is little scientific evidence to support their use, it is common for people to try a variety of nonpharmacologic interventions to resolve their hiccups. Common interventions include the pressure or stimulation of different body areas, sudden frightening experiences, ingestion of sugar or a glass of liquid, black pepper–induced sneezes, or breathing into a paper bag. ¹

Patients with persistent or intractable hiccups often require pharmacologic intervention to alleviate the condition or complications. The only US Food and Drug Administration–approved hiccup remedy is chlorpromazine, which may not be useful in many patients because of its associated side effects listed in Table 2.^2,4-20

There are no randomized, adequately powered clinical trials to determine the efficacy of pharmaceuticals for the treatment of hiccups. Many agents have been tried, with anecdotal success, and are hypothesized to work via a variety of neural mechanisms to decrease the activity of irritated nerves via sodium, calcium, or gamma-aminobutyric acid (GABA)-enervated pathways (Table 2). Each agent has a different risk-to-benefit ratio, and when assessing which agent to use, it is important to consider the patient’s level of organ function, tolerance to side effects, and risk for drug interactions.

Older anticonvulsants such as phenytoin, valproic acid, and carbamazepine were previously used, but have largely been replaced with dopamine antagonists (eg, chlorpromazine, haloperidol, metoclopramide), GABA enhancers (baclofen, gabapentin), or calcium channel blockers (nifedipine, nimodipine). In severe cases, intravenous lidocaine, which blocks sodium channels, has been used to resolve postoperative hiccups, although this practice is limited because of the risk for cardiac side effects.¹ Nebulized lidocaine has also been used in the palliative care setting to manage refractory hiccups.¹ Although diazepam is a well-documented cause of hiccups, midazolam has been used to terminate hiccups and may be useful in the setting of terminal sedation or delirium.⁸ Methylphenidate may be useful to try in the sedated patient.⁶ Acupuncture has been an effective nonpharmacologic intervention in some patients, and the use of phrenic nerve blocks has been helpful in intractable hiccups.²¹ Multiple agents have been combined in attempts to manage hiccups with variable effects; however, the limiting factor is generally the additive side effects, especially sedation.²⁰

Currently, there is little guidance on which agent should be used initially for hiccups of different etiologies. Because of the larger body of literature, most practitioners use chlorpromazine, metoclopramide, or baclofen as the initial treatment modality; a trial of multiple single agents or combinations of agents is also common. Some practitioners believe that baclofen may be the most effective agent, although it is slower to take effect than other agents.² Most agents are continued for several days after cessation of hiccups, then weaned off as tolerated. Some patients’ hiccups will recur, requiring the medication to be restarted. The goal is then to wean to the lowest effective dose.

In conclusion, although there are many reports of agents that help with the management of intractable hiccups, little current evidence exists regarding which agent, at what dose, and for which etiology should be used initially in patients. Agent and dose selection should be based on individual patient risks and comorbidities to achieve the best effect with minimal adverse consequences.

References
1. Marinella MA. Diagnosis and management of hiccups in the patient with advanced cancer. J Support Oncol. 2009;7:122-127, 130.
2. Walker P, Watanabe S, Bruera E. Baclofen, a treatment for chronic hiccup. J Pain Symptom Manage. 1998;16:125-132.
3. Silverman MA, Leung JG, Schak KM. Aripiprazole-associated hiccups: a case and closer look at the association between hiccups and antipsychotics. J Pharm Pract. 2014;27:587-590.
4. Cersosimo RJ, Brophy MT. Hiccups with high dose dexamethasone administration: a case report. Cancer. 1998;82:412-414.
5. Rousseau P. Hiccups. South Med J. 1995;88:175-181.
6. Friedgood CE, Ripstein CB. Chlorpromazine (thorazine) in the treatment of intractable hiccups. J Am Med Assoc. 1955;157:309-310.
7. Moretti R, Torre P, Antonello RM, et al. Gabapentin as a drug therapy of intractable hiccup because of vascular lesion: a three-year follow up. Neurologist. 2004;10: 102-106.
8. Wilcock A, Twycross R. Midazolam for intractable hiccup. J Pain Symptom Manage. 1996;12:59-61.
9. Maréchal R, Berghmans T, Sculier P. Successful treatment of intractable hiccup with methylphenidate in a lung cancer patient. Support Care Cancer. 2003;11:126-128.
10. Wilcox SK, Garry A, Johnson MJ. Novel use of amantadine: to treat hiccups. J Pain Symptom Manage. 2009;38:460-465.
11. Stalnikowicz R, Fich A, Troudart T. Amitriptyline for intractable hiccups. N Engl J Med. 1986;315:64-65.
12. Oneschuk D. The use of baclofen for treatment of chronic hiccups. J Pain Symptom Manage. 1999;18:4-5.
13. Ramírez FC, Graham DY. Treatment of intractable hiccup with baclofen: results of a double-blind randomized, controlled, cross-over study. Am J Gastroenterol. 1992; 87:1789-1791.
14. Stueber D, Swartz CM. Carvedilol suppresses intractable hiccups. J Am Board Fam Med. 2006;19:418-421.
15. Moro C, Sironi P, Berardi E, et al. Midazolam for long-term treatment of intractable hiccup. J Pain Symptom Manage. 2005;29:221-223.
16. Tegeler ML, Baumrucker SJ. Gabapentin for intractable hiccups in palliative care. Am J Hosp Palliat Care. 2008;25:52-54.
17. Rizzo C, Vitale C, Montagnini M. Management of intractable hiccups: an illustrative case and review. Am J Hosp Palliat Care. 2014;31:220-224.
18. Mukhopadhyay P, Osman MR, Wajima T, et al. Nifedipine for intractable hiccups. N Engl J Med. 1986;314:1256.
19. Hernández JL, Fernández-Miera MF, Sampedro I, et al. Nimodipine treatment for intractable hiccups. Am J Med. 1999;106:600.
20. Thompson AN, Ehret Leal J, Brzezinski WA. Olanzapine and baclofen for the treatment of intractable hiccups. Pharmacotherapy. 2014;34:e4-e8.
21. Schiff E, River Y, Oliven A, et al. Acupuncture therapy for persistent hiccups. Am J Med Sci. 2002;323:166-168.

Intermediate-acting benzodiazepine tranquilizers.

Most popular medicines

Intermediate acting benzodiazepine tranquilizers. Most Popular Medicines

WikiReading

The most popular medicines
Ingerleib Mikhail Borisovich

Contents

Intermediate-acting benzodiazepine tranquilizers

Lorazepam

Synonyms Trapex and others

Indications: see sibazon .

Contraindications : see sibazon .

Usage : administered orally as tablets. In neurotic conditions take up to 1.25-2.5 mg per day; for mental disorders – 5 mg or more (up to 15 mg) per day.

Release form : depending on the manufacturer, tablets of 500 mcg -1 mg -2 mg -2.5 mg in vials of 20 -100 -500 -1000 pieces.

Storage : list B.

This text is an introductory fragment.

Divination about life expectancy

Divination about life expectancy
The Indians attached great importance to all kinds of divination, and some of them did not require the services of a shaman. Sometimes an ordinary person wanted to know his future and independently engaged in divination. One of the most common ways

What is the record for the duration of lethargic sleep?

What is the record for the duration of lethargic sleep?
According to the Guinness Book of Records, Nadezhda Artemovna Lebedina, who was born at 1920 in the city of Mogilev, Dnepropetrovsk region. Having quarreled with her husband in 1954, she fell asleep and woke up only

What is the world record for longest hiccups?

What is the world record for longest hiccups?
The world record for the duration of hiccups belongs to the American Charles Osborne. He hiccupped continuously from 1922 to 1991

What is the record for the longest stay of a man in space?

What is the record for the longest human stay in space?
The record for the duration of a continuous stay of a person in space belongs to Russian cosmonaut Valery Polyakov, who spent 437.75 days in near-Earth orbit (most of this time – on

Intermediate-acting glycosides

Intermediate-acting glycosides
Digoxin (Digoxinum) Synonyms: Cedoxin, Cordioxyl, Digolan, Digoxin, Dilanacin, Dixina, Lanacordin, Lanacrist, Lanicor, Lanoral, Lanoxin, Natidigoxine, Oxydigitoxin and others. twinkle shape

Tranquilizers

tranquilizers
NB! Tranquilizers should not be prescribed for reception before and during work for drivers of cars and people in other professions that require quick mental and motor reactions.
It should also be taken into account that alcohol enhances the effect of tranquilizers, therefore, in

Long-acting benzodiazepine tranquilizers

Long acting benzodiazepine tranquilizers
Sibazon (Sibazonum) Synonyms: Apaurin, Bensedin, Valium, Diazepam, Relanium, Seduxen, Ansiolin, Apaurin, Apozepam, Atilen, Bensedin, Diapam, Diazepam, Eridan, Lembrol, Pacitrian, Quetinil, Relanium, Saromet, Seduxen, Serenamin, Serensin, Sonacon, Stesolin, Ushamir, Valitran, Valium, Vatran, Vival, etc. Sibazon

Short-acting benzodiazepine tranquilizers

Short-acting benzodiazepine tranquilizers
Midazolam (Midazolam) Synonyms: Dormicum, Flormidal. Indications: premedication, sedative effect with preserved consciousness. Contraindications: see sibazon.

“Daytime” tranquilizers

“Daytime” tranquilizers
Afobazole (Aphobazolum) Active ingredient: Morpholinoethylthioethoxybenzimidazole. Indications: used in adults with anxiety conditions: generalized anxiety disorders, neurasthenia, adjustment disorders; in patients with various

Tranquilizers (Seduxen, Elenium, Nitrozepam)

Tranquilizers (Seduxen, Elenium, Nitrozepam)
Signs of drug intoxication: • The impression of light, as from alcohol, intoxication. • Unsteady gait, clumsiness of movements. • Loss of coordination. • Confused, slurred speech. • Drowsiness. Signs

What is the world record for longest hiccups?

What is the world record for longest hiccups?
The world record for the duration of hiccups belongs to the American Charles Osborne. He hiccupped continuously from 1922 to 1991

Indications for use and doses:

The dose is determined
individually depending on the condition
patient and clinical picture
diseases. In old age, the drug
administered in doses up to 2 mg orally. IN
outpatient basic dose
take in the evening. During the period of alcohol
abstinence syndrome is prescribed orally
5-10 mg 2-3 times a day, in severe cases
up to 60 mg per day. For severe anxiety
administered intravenously at 0.1-0.2 mg per
kg body weight (usually 20-40 mg), injections
can be repeated after 8 hours. Intravenously
injected slowly 0.5-1 ml per minute.
Avoid intra-arterial
introductions. Diazepam solution should be
administered separately from other medicines,
because it is incompatible with them.

Side effects:

When taking the drug
may experience drowsiness, fatigue,
muscle weakness, rarely – ataxia. At
parenteral administration can be observed
decrease blood pressure, hiccups.

Contraindicated
with myasthenia. Strengthens oppressive
action on the central nervous system
psychotropic drugs and alcohol.

Release form
– tablets 0. 002 g, 0.0025 g, 0.005 g, 0.01
G; dragee 0.002, 0.005 g. Syrup (1ml-0.4mg).
Solution for injection 0.5% -2 ml in ampoules.

Synonyms:
Apaurin, KRKA, Slovenia;
Apo-Diazepam (Apo-Diazepam), Apotex,
Canada; Valium, Roche,
Switzerland; diazepabene
(Diazepabene), Ludwig Merckle, Austria; Diazepam
(Diazepam), Hafshmg Nycomed, Austria;
Hemofarm, Yugoslavia;

Alkoloid,
Macedonia; IPSA, India;
Promed Exports, India; Rusan Paharma,
India;

Diazepam-Ratiopharm
(Diazepam-Ratiopharm), Germany; Diazepam
Rivopharm (Diazepam Rivopharm), Rivopharm,
Switzerland; Diazepam-Teva
(Diazepam-Teva), Teva, Israel;

Diazepam 5
(Diazepam 5), Sun Pharmaceutical,
India; Calmpouse, Ranbaxy,
India; Relanium (Relanium),
Polfa, Poland; Seduxen
(Seduxen), Gedeon Richter, Hungary;

Sikotrin
(Sicotrin), Menon Pharma, India; Faustan
(Faustan), AWD, Germany; Faustan 5
(Faustan 5), AWD, Germany.

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Clorazepate
(Clorazepate) – active substance
dipotassium clorazepate, derivative
benzodiazepines. Eliminates emotional
tension, anxiety, fear,
psychovegetative disorders.
It also has a muscle relaxant
sedative, anticonvulsant action,
weak hypnotic effect. Period
half-life 40 hours.

Indications for use:

Clorazepate
used to treat anxiety
conditions of various genesis, as well as
for short-term relief of symptoms
anxiety.

Clinic
alcoholism and drug addiction clorazepate
used for alcohol withdrawal
and in a predelirious state for
relief of tremor, acute agitation,
anxiety symptoms, sleep disturbances,
reduction or relief
somatovegetative disorders.

The drug is used
during abstinence from alcohol
the appearance of neurotic or psychopathic
sensation-related disorders
discomfort, anxiety, internal
stress, sleep disturbance,
somatovegetative disorders,
dysthymic disorders.

The drug does not have
pronounced sedative and muscle relaxant
properties, has little
impact on cognitive function
allows it to be widely recommended in
outpatient practice.

How to use
and doses:

Clorazepate is taken
inside, 2-3 times a day in equal doses.
Dose of the drug and duration of administration
determined individually depending on
on the effectiveness of therapy and tolerability.
Average doses are 10-30 mg per day. At
necessary – up to 50 mg per day.

Side effects:

Rarely seen
drowsiness, muscle weakness.

Contraindicated
with myasthenia gravis, pregnancy, respiratory
insufficiency. Potentiates action
benzodiazepines, phenothiazines,
antidepressants, alcohol.

Form:
capsules 0.005 g and 0.01 g Synonyms:
Tranex, Zdravie, Yugoslavia
Tranxen, France.

Clobazam
(Clobasam) – active substance
clobazam, a benzodiazepine derivative,
reduces emotional tension
arousal, promotes normalization
sleep, has anticonvulsant and
central muscle relaxant action,
active in psychovegetative and
psychosomatic disorders.

Clinic
alcoholism and drug addiction clobazam
used to treat withdrawal symptoms, and
during the period of abstinence from consumption
alcohol. Thanks to the positive
impact on reverse dynamics
neurotic disorders
clobazam facilitates the course and shortens
withdrawal period, and also prolongs
state of remission.

How to use
and doses:

Initial dose
0.002 g per day, dose as needed
can be increased to 0.003 g per day,
elderly patients should be prescribed 0.01
g per day.

Side effects:

Possible reduction
reaction speed, slight tremor of the fingers
hands, muscle weakness, reversible
articulation disorders, rarely – dryness
in the mouth, anorexia, constipation, bronchospasm.

Contraindicated
with a history of drug dependence,
acute alcohol poisoning, neuroleptics,
antidepressants, respiratory failure
in a dream. The drug may cause drug
dependence, in this regard it should not be
appoint for a period of more than 4 weeks. Considering
the possibility of developing a withdrawal syndrome,
doses of the drug should be reduced gradually.
During treatment, it is necessary to control
liver function. With great care
should be given to patients
myasthenia gravis, spinal and cerebellar
ataxia. The drug potentiates the effect
alcohol. Means that suppress
monooxygenase system (cimetidine),
may prolong the action of clobazam.

Form
– tablets of 0.005 g, 0.01 g, 0.02 g, 50 pieces per
packaging. Synonyms: Frizium
(Frizium), Hoechst, Germany.

Lorazepam
(Lorazepam) –
the active substance is lorazepam, from the group
benzodiazepines, has a sedative
action on the central nervous system
suppresses feelings of fear, anxiety,
tension, reduces psychomotor
excitation, causes central
muscle relaxation, anticonvulsant
activity, moderate sleeping pills
effect.

Clinic
alcoholism Lorazepam is used
for the relief of withdrawal symptoms,
as well as in remission as
anti-relapse agent.

Greatest effect
when using lorazepam noted
in the treatment of alcohol withdrawal symptoms
syndrome accompanied by increased
irritability, anxiety
affective feeling of fear, anxiety,
suspicion, sleep disturbance,
somatovegetative dysfunctions.

Within 1-2 days
weakening or disappearance
indicated symptoms followed by
decrease in depression and cravings
to alcohol.

If available in
remission of neurotic disorders,
lorazepam, stopping the existing symptoms,
prevents relapse
diseases.

How to use
and doses:

The drug is used
inside. Average therapeutic dose
1.25 mg-5 mg 2-3 times a day. For improvement
sleep -1.25 mg. For severe anxiety and
agitation up to 5 mg 2-3 times a day. On cancellation
the drug should be gradually reduced
its dosage.

Side effects:

Possible dryness
in the mouth, general weakness, ataxia. Maybe
develop addiction and drug
dependency, therefore not assigned
more than 5-10 days.

Contraindicated
with myasthenia gravis, glaucoma, pregnancy.
Formulation – tablets 1 mg, 2
mg and 25 mg, 20, 50 and 100 pieces per pack.

Synonyms:
Merlit (Merlit), Ebewe Arzneimittel ges. m.
b. H., Austria; Apo-Lorazepam
(Apo-Lorazepam), Apotex, Canada;
Ativan Wyeth Group,
Germany; U-PAN (U-PAH), Sawai,
Japan.

Medazepam
(Medazepam) – active substance
medazepam hydrochloride, daily
a tranquilizer from the 1,4 benzodiazepine group.
The drug has anxiolytic,
muscle relaxant action, and
has no pronounced anticonvulsant
action and stabilizing effect
on the normalization of vegetative disorders.

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Clinic
alcoholism medazepam is indicated for
alcohol withdrawal states,
as well as during the period of remission.