Promag tab 200mg myung in pharm treatment (10 blisters x 10 tablets)

Dosage form Box of 10 blisters x 10 tablets
Specifications Magnesium valproat

Ingredient

Composition information	Content
Magnesium valproat	200mg

Uses

Indications

Progmag drugs indicated in the following cases:

Grab epilepsy or part, especially the following forms of seizures: Awareness of consciousness, muscle vibration, tongeline vibration, loss of force and mixed epilepsy. Meeting neurons to ionized ionization therapy provided by GABA (gamma amino butyric acid). On the neurons isolated from a separate area, the lymph nodes at the bottom of the vagus nerves (tangle lymph nodes), Valproate also slightly reduces the lower threshold of the Ca2+ line related to clinical. This impact is similar to Ethosuximide in the hilly neuron.

Another mechanism related to GABA's metabolism can contribute to Valproate epilepsy effects. Although Valproate does not affect the response to GABA, increases the number of GABA, this can be restored from the brain after taking medicine for animals. On Vitro, Valproate can stimulate the activity of GABA synthesis enzyme, glutamic acid decarboxylase enzyme, and inhibit GABA degenerative enzymes, GABA Transaminase and Succinic Semialdehyde dehydrogenase. So far, it is still difficult to determine the relationship between increasing GABA concentration and Valproate epilepsy effects.

pharmacokinetics

valproate is absorbed quickly and completely after drinking. The peak concentration of plasma is reached from 1 to 4 hours, although it may slow down a few hours if the drug is used in the form of tablets in the intestine or drink with food.

Valproate's distribution voltage is about 0.2 liters/kg. The ability to bind to plasma proteins is usually about 90%. The biological change of valproate is mainly in the liver. The metabolic speed will be faster in children and patients taking enzyme drugs such as Phenytoin, Phenobarbital, Primidone and Carbamazepine.

Actually not Valproate is eliminated in urine or feces in constant form. When used in the treatment dose, most drugs are converted into ester associated with glucuronic acid, the rest is metabolized by mitochondria (β-oxidation and ω-oxidation). A few metabolites, notably 2-Propyl-2-Pentenoic acid and 2-Propyl-4-Pentenoic acid, they almost have anti-epilepsy effects like mother substance; However, only 2-Propyl-2-Pentenoic acid accumulates in plasma and brain significantly.

Valproate waste time is about 15 hours but reduced on patients taking other anti -epileptic drugs.

Before taking Promag tab 200mg myung in pharm treatment (10 blisters x 10 tablets)

How to use

Drugs for oral, drinking while eating.

Dosage

recommended dose:

Normally daily daily ration dose is 10-15 mg/kg, and gradually increases to the optimal dose. Overall the optimal dose is in the range of 20-30 mg/kg. However, if the seizure is not controlled with this dose, an additional dose may be increased; Should monitor patients carefully when taking the dose> 50 mg/kg.

Starting treatment:

Patients do not use other anti-dynamic drugs: It is best to gradually increase the dose every 2-3 days to achieve a maximum dose in 1 week.

Patients who have used previous anti -epileptic drugs: The change of drugs with Magnesium Valproate should be conducted slowly, the optimal dose achieved within 2 weeks and the old drug will be gradually reduced before stopping.

Should coordinate with other anti -epileptic drugs when necessary.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.

What to do when overdose?

Clinical signs of massive overdose usually include coma, muscle tone reduction, reflexes, pupils, respiratory failure.

Management

Gastric lavage is useful until 10-12 hours after overdose, diuretic, cardiovascular and respiratory monitoring. In rare cases, the separation or transmission of blood can be done.

In case of emergency, call the 115 emergency center immediately or go to the nearest local health station.

What to do when you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that double dose should not be used.

Side Effects

When using Progmag often has unwanted effects (ADR) such as:

Confusion or convulsions: Some cases have a separate state or accompanied by the appearance of seizures while treating with valproate, this phenomenon will decrease when stopping treatment or reducing dose. These cases often occur when combined treatment (especially with phenobarbital) or after sudden increase in valproate doses.

Digestive disorders (nausea, stomach pain) often occur in a few patients at the beginning of treatment, but usually will disappear after a few days without having to stop the drug.

Some unwanted effects and//or related to the dose are often recorded: hair loss, tremor with small amplitude.

There have been reports on fibrinogen decreased phenomenon or increased bleeding time without clinical manifestations.

Side effects on hematology: Often reduced platelets, rarely anemia, leukopenia or all bloody hemoglobin.

There are some cases of pancreatitis, sometimes fatal.

Moderate and separate ammonia increases without changes in liver function tests that can occur frequently and do not need to stop drugs.

Can gain weight, amenorrhea and irregular menstruation.

Instructions on how to handle ADR:

Notify the physician the unwanted effects when using the drug.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

Contraindicated

Progmag drugs contraindicated in the following cases:

Acute hepatitis, chronic hepatitis, family history or individual with severe hepatitis, especially by drugs.

Precautions when using

should perform liver function test before treatment and periodically in the first 6 months of treatment, especially high -risk patients.

Like most other anti -epileptic drugs, especially at the beginning of treatment, temporarily increased and individual enzymes without clinical manifestations.

Blood test (blood formula includes platelet counting, bleeding time and blood clotting test) should be performed before the beginning of treatment or before surgery and in case of bleeding or spontaneous bruises.

In patients with renal failure, there is an increase in the concentration of free valproic acid in serum, so it may be necessary to reduce the dose.

There have been reports of rare cases of pancreatitis; Therefore, patients with acute abdominal pain should be quantified serum before thinking of surgery.

Use drugs for women during pregnancy and lactation

Pregnant women

Risks related to epilepsy and anti -epileptic drugs

It is found that in children born by mothers with epilepsy treatment with any anti-epileptic drug, the deformity rate is 2-3 times higher than the deformity ratio in the common population (about 3%). Despite the increase in the number of children with deformity when using a polymer therapy, the correlation between the disease and the treatment has not been clearly verified. The common deformities are cleft and cardiovascular deformities.

Sudden stopping anti -epileptic drugs in the mother can make the disease worse and then the unwanted effect for the fetus.

Risks related to magnesium valproate

In animals: The monster effect has been noticed in mice, large mice and rabbits.

In humans: The risk of deformities when mothers use valproate during the first three months of pregnancy is not higher than other anti -epileptic drugs. Valproate seems to cause defects on the neural tube such as hernia-cerebral hernia, spinal cracking. Estimated frequency of this effect is 1-2%.

If you want to get pregnant, it is necessary to reconsider the indication of anti -epileptic drugs, so additional folate.

During pregnancy, no stop treatment for anti -epileptic drugs Valproate is effective. Should use monatlearization; Using the lowest dose effectively every day, divided into several times a day. However, it is advisable to monitor before birth to detect other neural tube defects and malformations.

breastfeeding women

Valproate's excretion in breast milk is low with a concentration of about 1-10% of the concentration of mother serum; So far, breastfed babies who have been monitored during the newborn have not seen any signs of sieve.

Medicinal interaction

Simultaneous use of alcohol or drugs that weaken the central nervous system, Monoamine oxidase inhibitors (Mao) with Valproate may increase the impact of weakness of the central nervous system.

The hypoglycin -lowering effect of valproate can increase the effects of indandione or cooumarin derivatives and can increase the risk of bleeding in patients using heparin or thrombolytic drugs.

Simultaneously using Barbiturate or Primidone with Valproate will cause a higher level of barbiturate or primidone levels in serum, which will increase the depression of the central nervous system and toxicity on the nervous system, need to adjust the dose of barbiturate or primidone.

Simultaneous use of Clonazepam with Valproate can cause consciousness.

Simultaneous use of felbamate can increase the plasma valproate levels by 35 to 50%. Valproate dose should be reduced at the beginning of treatment with felbamate.

Concentrated use of liver toxic pills with Valproate may increase the risk of liver toxicity. Caution should be carefully monitored for patients who take the drug for a long time or have a history of liver disease.

carbamazepin, phenytoin, barbiturat, antidepressants & psychotropic drugs.

Storage

Leave a cool place, avoid light, temperatures below 30⁰C.

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