PREMI-RIG

Indications

• Enzyme replacement therapy
• Digestive disorders
• Metabolic disorders
• Cancer treatment
• Antibiotic treatment enhancement

Dosage

Children: Refer to specific guidelines for enzyme replacement therapies or digestive aids, as dosing varies by enzyme type and indication.

Adults: Refer to specific guidelines for enzyme replacement therapies or digestive aids, as dosing varies by enzyme type and indication.

Mechanism of action

Enzymes function by lowering the activation energy required for a chemical reaction, thus increasing the rate of the reaction. They bind to specific substrates at their active sites, forming enzyme-substrate complexes, which then undergo a transformation to produce the desired products while regenerating the enzyme for subsequent reactions.

Pharmacodynamics

The pharmacodynamic properties of enzymes are characterized by their catalytic efficiency, often described by parameters such as Km (Michaelis constant) and Vmax (maximum reaction velocity). Enzymes can be regulated through various mechanisms, including allosteric regulation, covalent modification, and feedback inhibition, allowing for precise control over metabolic pathways.

Pharmacokinetics

The pharmacokinetics of enzymes involve their absorption, distribution, metabolism, and excretion. Enzymes administered therapeutically may be subject to degradation by proteolytic enzymes in the gastrointestinal tract, influencing their bioavailability. Their distribution may vary based on the enzyme's size and solubility, and they can undergo modifications that affect their half-life and activity in the body.

Pregnancy

The safety of enzyme therapy during pregnancy varies depending on the specific enzyme. Consultation with a healthcare provider is recommended.

Breast-feeding

The transfer of enzymes into breast milk is variable. Caution is advised when administering enzyme therapy to breastfeeding mothers.

Storage

Store in a cool, dry place, away from direct sunlight and moisture. Specific storage conditions may vary based on the type of enzyme.

Indications

• Autism Spectrum Disorders
• Attention Deficit Hyperactivity Disorder (ADHD)
• Post-Traumatic Stress Disorder (PTSD)
• Anxiety Disorders
• Depression
• Cerebral Palsy
• Physical Rehabilitation

Dosage

Children: Refer to the specific therapeutic regimen determined by a healthcare professional, as equine therapy is individualized based on patient needs.

Adults: Refer to the specific therapeutic regimen determined by a healthcare professional, as equine therapy is individualized based on patient needs.

Mechanism of action

Equine therapy operates on several levels. The physical interaction with horses can enhance gross motor skills and encourage physical fitness. Psychologically, the bond formed between horse and human can foster emotional healing, reduce anxiety, and build confidence. The rhythmic motion of riding has been shown to have a calming effect on individuals, mimicking similar movements to those experienced in a therapeutic setting. Moreover, the social interaction involved in caring for and riding horses may improve communication skills and socialization.

Pharmacodynamics

Equine therapy itself does not involve pharmacological agents; however, it may influence the psychobiological pathways in the body. The interactions evoke hormonal responses that can alter levels of cortisol and adrenaline, enhancing relaxation and reducing stress. The therapeutic environment can also promote the release of endorphins, contributing to a sense of well-being and happiness.

Pharmacokinetics

As equine therapy does not involve drugs, pharmacokinetics is not applicable. However, the effects on the body can vary based on individual patient characteristics, the specific condition treated, and the duration and frequency of the therapy sessions. Factors such as age, physical condition, and psychological state can influence therapeutic outcomes.

Pregnancy

Equine products should be used with caution during pregnancy, as there is limited data on their safety. Consultation with a healthcare professional is recommended.

Breast-feeding

Safety during breastfeeding is not well established; therefore, caution is advised when using equine products in nursing mothers.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Indications

• Schizophrenia
• Psychotic disorders
• Severe anxiety and agitation
• Nausea and vomiting
• Intractable hiccups

Dosage

Adults: The usual starting dose for adults is 25 mg to 50 mg taken orally, which can be increased gradually to achieve the

Mechanism of action

Chlorpromazine acts as an antagonist on multiple postsynaptic receptors, including dopaminergic receptors (D1, D2, D3, D4), serotonergic receptors (5-HT1, 5-HT2), histaminergic receptors (H1), alpha-adrenergic receptors (alpha1, alpha2), and muscarinic receptors (M1, M2). This blockade leads to reduced dopaminergic activity, which alleviates psychotic symptoms, while the interaction with serotonergic and histaminergic receptors contributes to its anxiolytic, sedative, and antiemetic effects. Additionally, it has a weak presynaptic inhibitory effect on dopamine reuptake, providing mild antidepressive and antiparkinsonian effects.

Pharmacodynamics

Chlorpromazine primarily exhibits its effects at subcortical levels of the central nervous system. It is recognized for its strong antiadrenergic effects and weaker peripheral anticholinergic activity. The drug also shows slight antihistaminic and antiserotonin activity, contributing to its broad spectrum of effects on mood, behavior, and various physiological functions.

Pharmacokinetics

Chlorpromazine is well-absorbed following oral administration and is extensively metabolized in the liver. The drug's half-life varies significantly among individuals, typically ranging from 30 to 50 hours, but can be longer in some patients. It is primarily excreted in the urine as metabolites, with minimal unchanged drug being eliminated. The pharmacokinetics of chlorpromazine may be influenced by factors such as age, liver function, and concurrent medications.

Contra-indications

• Hypersensitivity to chlorpromazine or any of its components
• Comatose states
• Severe central nervous system depression
• Bone marrow depression
• Porphyria
• Severe liver dysfunction
• Pheochromocytoma

Adverse effects

• Sedation
• Weight gain
• Orthostatic hypotension
• Extrapyramidal symptoms
• Dry mouth
• Blurred vision
• Constipation
• Urinary retention
• Tachycardia
• Sexual dysfunction
• Akathisia
• Neuroleptic malignant syndrome

Interactions

• CNS depressants (e.g., alcohol, benzodiazepines) may enhance sedative effects
• Antihypertensive agents may have additive hypotensive effects
• Anticholinergic drugs may exacerbate anticholinergic effects
• Dopamine agonists may have reduced efficacy

Precautions

• Use with caution in patients with a history of seizures
• Monitor for signs of tardive dyskinesia
• Use cautiously in elderly patients, particularly those with dementia-related psychosis
• Regular monitoring of blood pressure is advised
• Consider the risk of metabolic syndrome

Pregnancy

Chlorpromazine should only be used in pregnancy if the potential benefit justifies the potential risk to the fetus. It is categorized as a pregnancy category C drug.

Breast-feeding

Chlorpromazine is excreted in breast milk. Caution should be exercised when administering to nursing mothers.

Storage

Store in a cool, dry place away from light. Keep out of reach of children.

Formulations

• Tablets (various strengths)
• Oral solution
• Injectable solution

Indications

• Primary immunodeficiency disorders
• Secondary immunodeficiency (e.g. due to HIV infection)
• Chronic inflammatory demyelinating polyneuropathy (CIDP)
• Immune thrombocytopenic purpura (ITP)
• Kawasaki disease
• Prevention of infections in at-risk populations (e.g. following bone marrow transplant)

Dosage

Children: Refer to the BNF for Children for age-appropriate dosing guidelines; specific doses depend on the clinical condition and patient age.

Adults: Refer to specific guidelines for dosing based on indication; typically varies based on clinical scenario and patient condition.

Mechanism of action

Immunoglobulin exerts its effects primarily through the neutralization of pathogens and toxins, opsonization, and the activation of the complement system. It modulates immune responses by influencing the activity of various immune cells, including B cells, T cells, and macrophages, thereby enhancing antibody production and regulating inflammation.

Pharmacodynamics

The pharmacodynamics of immunoglobulin involve its ability to bind to specific antigens, effectively neutralizing them and facilitating their clearance. It also plays a crucial role in modulating the immune response, providing immediate passive immunity and promoting the establishment of active immunity over time. The diverse mechanisms through which immunoglobulin operates include antibody-dependent cell-mediated cytotoxicity (ADCC) and inhibition of pro-inflammatory cytokines.

Pharmacokinetics

Immunoglobulin is typically administered intravenously or subcutaneously. After administration, it is distributed throughout the extracellular space. The half-life of immunoglobulin varies but is generally in the range of 21 to 30 days, depending on the specific formulation and the patient's individual characteristics. It is primarily eliminated through the reticuloendothelial system, with catabolism occurring in various tissues.

Contra-indications

• Hypersensitivity to immunoglobulin preparations
• Selective IgA deficiency with a history of hypersensitivity
• Severe hyperprolinemia

Adverse effects

• Headache
• Nausea
• Fever
• Chills
• Fatigue
• Rash
• Anaphylactic reactions
• Thromboembolic events

Interactions

• Live attenuated vaccines may be less effective if administered concurrently with immunoglobulin therapy
• Caution is advised when administering with other blood products

Precautions

• Monitor for signs of anaphylaxis during and after administration
• Use with caution in patients with renal impairment
• Hydrate adequately to prevent renal dysfunction
• Consider the risk of thrombosis in patients with a history of thromboembolic events

Pregnancy

Immunoglobulin can be used during pregnancy if indicated, as it is considered safe based on available data.

Breast-feeding

Immunoglobulin is excreted in breast milk, but is generally considered safe during breastfeeding.

Storage

Store at 2-8 degrees Celsius. Do not freeze. Protect from light. Use before expiry date.

Formulations

• Intravenous immunoglobulin (IVIG)
• Subcutaneous immunoglobulin (SCIG)
• Intramuscular immunoglobulin (IMIG)

Dosage

Children: Refer to specific product guidelines for dosing information.

Adults: Refer to specific product guidelines for dosing information.

Adverse effects

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Headache
• Dizziness
• Fatigue

Precautions

• Use with caution in patients with a history of gastrointestinal disorders.
• Monitor for signs of allergic reactions.

Pregnancy

Safety in pregnancy has not been established, use only if clearly needed.

Breast-feeding

Consult a healthcare provider before use while breastfeeding.

Storage

Store in a cool, dry place away from direct sunlight.

Mechanism of action

Chlorpromazine acts as an antagonist (blocking agent) on different postsysnaptic receptors -on dopaminergic-receptors (subtypes D1, D2, D3 and D4 - different antipsychotic properties on productive and unproductive symptoms), on serotonergic-receptors (5-HT1 and 5-HT2, with anxiolytic, antidepressive and antiaggressive properties as well as an attenuation of extrapypramidal side-effects, but also leading to weight gain, fall in blood pressure, sedation and ejaculation difficulties), on histaminergic-receptors (H1-receptors, sedation, antiemesis, vertigo, fall in blood pressure and weight gain), alpha1/alpha2-receptors (antisympathomimetic properties, lowering of blood pressure, reflex tachycardia, vertigo, sedation, hypersalivation and incontinence as well as sexual dysfunction, but may also attenuate pseudoparkinsonism - controversial) and finally on muscarinic (cholinergic) M1/M2-receptors (causing anticholinergic symptoms like dry mouth, blurred vision, obstipation, difficulty/inability to urinate, sinus tachycardia, ECG-changes and loss of memory, but the anticholinergic action may attenuate extrapyramidal side-effects). Additionally, Chlorpromazine is a weak presynaptic inhibitor of Dopamine reuptake, which may lead to (mild) antidepressive and antiparkinsonian effects. This action could also account for psychomotor agitation and amplification of psychosis (very rarely noted in clinical use). The principal pharmacologic effects of chlorpromazine are similar to those of other propylamino derivatives of phenothiazine. Chlorpromazine has strong anticholinergic and sedative effects and moderate extrapyramidal effects. Chlorpromazine has strong antiemetic and adrenergic blocking activity and weak ganglionic blocking, antihistaminic, and antiserotonergic activity. The development of phenothiazine derivatives as psychopharmacologic agents resulted from the observation that certain phenothiazine antihistaminic compounds produced sedation. In an attempt to enhance the sedative effects of these drugs, promethazine and chlorpromazine were synthesized. Chlorpromazine is the pharmacologic prototype of the phenothiazines. The pharmacology of phenothiazines is complex, and because of their actions on the central and autonomic nervous systems, the drugs affect many different sites in the body. Although the actions of the various phenothiazines are generally similar, these drugs differ both quantitatively and qualitatively in the extent to which they produce specific pharmacologic effects. /Phenothiazine General Statement/ In the CNS, phenothiazines act principally at the subcortical levels of the reticular formation, limbic system, and hypothalamus. Phenothiazines generally do not produce substantial cortical depression; however, there is minimal information on the specific effects of phenothiazines at the cortical level. Phenothiazines also act in the basal ganglia, exhibiting extrapyramidal effects. The precise mechanism(s) of action, including antipsychotic action, of phenothiazines has not been determined, but may be principally related to antidopaminergic effects of the drugs. There is evidence to indicate that phenothiazines antagonize dopamine-mediated neurotransmission at the synapses. There is also some evidence that phenothiazines may block postsynaptic dopamine receptor sites. However, it has not been determined whether the antipsychotic effect of the drugs is causally related to their antidopaminergic effects. Phenothiazines also have peripheral and/or central antagonistic activity against alpha-adrenergic, serotonergic, histaminic (H1-receptors), and muscarinic receptors. Phenothiazines also have some adrenergic activity, since they block the reuptake of monoamines at the presynaptic neuronal membrane, which tends to enhance neurotransmission. The effects of phenothiazines on the autonomic nervous system are complex and unpredictable because the drugs exhibit varying degrees of alpha-adrenergic blocking, muscarinic blocking,

Pharmacodynamics

Chlorpromazine is a psychotropic agent indicated for the treatment of schizophrenia. It also exerts sedative and antiemetic activity. Chlorpromazine has actions at all levels of the central nervous system-primarily at subcortical levels-as well as on multiple organ systems. Chlorpromazine has strong antiadrenergic and weaker peripheral anticholinergic activity; ganglionic blocking action is relatively slight. It also possesses slight antihistaminic and antiserotonin activity.