Dubinor
Dubinor Uses, Dosage, Side Effects, Food Interaction and all others data.
Gabapentin is an anti-convulsant. It is a structural analog of gamma-amino-butyric-acid (GABA). All pharmacological actions following administration of Gabapentin are due to the activity of parent compound. Gabapentin binds with the alpha-2-delta subunit of voltage gated L-type Calcium channel, and inhibits branched chain amino acid transferase & probably inhibits neurotransmitter release of excitatory amino acid.
Gabapentin is an anti-convulsant medication that inhibits the release of excitatory neurotransmitters, allowing for its use against pathologic neurotransmission such as that seen in neuropathic pain and seizure disorders. It has a wide therapeutic index, with doses in excess of 8000 mg/kg failing to cause a fatal reaction in rats.
Gabapentin is ineffective in absence seizures and should be used in caution in patients with mixed seizure disorders involving absence seizures. Gabapentin has been associated with drug reaction with eosinophilia and systemic symptoms (DRESS), otherwise known as multi-organ hypersensitivity. This reaction can prove fatal and early symptoms such as fever, lymphadenopathy, and rash should be promptly investigated.
| Trade Name | Dubinor |
| Generic | Diclofenac Diethylamine + Methyl Salicylat + Gabapentin |
| Weight | 10mg |
| Type | Ointment, Tablet |
| Therapeutic Class | |
| Manufacturer | Integrace Pvt Ltd |
| Available Country | India |
| Last Updated: | September 19, 2023 at 7:00 am |
Uses
Gabapentin is used for-
- Epilepsy
- Neuropathic pain (e.g. postherpetic neuralgia) and other pain conditions
- Bipolar disorder
- Headache syndrome
- Spasticity in multiple sclerosis and spinal cord diseases
Others indication are:
- Alcohol withdrawal
- Schizoaffective disorder
- Post-traumatic stress disorder
- Agitation and behavioural disturbances
- associated with dementia
- Lesch-Nyhan syndrome
- Essential tremor
- Restless legs syndrome
- Brachioradial pruritus
- Hemichorea/hemiballismus
- Hot Flashes
Dubinor is also used to associated treatment for these conditions: Partial-Onset Seizures, Peripheral Neuropathic Pain, Postherpetic Neuralgia
How Dubinor works
The precise mechanism through which gabapentin exerts its therapeutic effects is unclear. The primary mode of action appears to be at the auxillary α2δ-1 subunit of voltage-gated calcium channels (though a low affinity for the α2δ-2 subunit has also been reported). The major function of these subunits is to facilitate the movement of pore-forming α1 subunits of calcium channels from the endoplasmic reticulum to the cell membrane of pre-synaptic neurons. There is evidence that chronic pain states can cause an increase in the expression of α2δ subunits and that these changes correlate with hyperalgesia. Gabapentin appears to inhibit the action of α2δ-1 subunits, thus decreasing the density of pre-synaptic voltage-gated calcium channels and subsequent release of excitatory neurotransmitters. It is likely that this inhibition is also responsible for the anti-epileptic action of gabapentin.
There is some evidence that gabapentin also acts on adenosine receptors and voltage-gated potassium channels, though the clinical relevance of its action at these sites is unclear.
Dosage
Dubinor dosage
Neuropathic pain: 300 mg on day-1, then 300 mg twice on day-2, then 300 mg thrice on day-3, then increase the dose according to response in steps of 300 mg daily to maximum 1800 mg daily in three divided doses.
Partial seizure/epilepsy: 300 mg on day-1, then 300 mg twice on day-2, then 300 mg thrice on day-3, then increase the dose according to response in steps of 300 mg daily to maximum 2400 mg daily in three divided doses.
In case of children:
- For 3-12 years: 10 to 15 mg/kg, Incase of titration 25-35 mg/kg daily in 3 divided doses.
- Maintenance dose is 900 mg daily (body weight 26-36 Kg) or 1.2 gm daily (body weight 37-50 Kg).
Gabapentin can be taken orally with or without food.
Side Effects
Generally Gabapentin is well tolerated but a few side effects like fatigue, dizziness , ataxia, weight gain, peripheral edema, dry mouth and somnolence, may occur. Rarely it may cause fulminate hepatic failure, or aplasticanemia.
Toxicity
The oral TDLo of gabapentin in humans is 2.86 mg/kg and the LD50 in rats has been found to be >8000 mg/kg. Symptoms of overdose are consistent with the drug's adverse effect profile and involve CNS depression (e.g. dizziness, drowsiness, slurred speech, lethargy, loss of consciousness) and gastrointestinal symptoms such as diarrhea. Management of overdose should involve symptomatic and supportive treatment. Gabapentin can be removed by hemodialysis - this may be of benefit in some patients, such as those with impaired renal function.
Multi-drug overdoses involving gabapentin, particularly in combination with other CNS depressants such as opioids, can result in coma and death - this possibility should be considered when managing overdosage.
Precaution
Patients should be instructed to take Gabapentin only as prescribed. While using Gabapentin patients should be instructed either not to drive a car or to operate other complex machinery until they have gained sufficient experiences about Gabapentin whether or not it affects their mental and/or motor performance adversely.
Interaction
Antacids may reduce the bioavailability of Gabapentin by up to 20%. Cimetidine may alter its reanal excretion. Gabapentin does not interact with other anti-epileptic drug or with oral contraceptive preparations.
Volume of Distribution
The apparent volume of distribution of gabapentin after IV administration is 58±6 L. The drug is found in the CSF in concentrations approximately 9-20% of the corresponding plasma concentrations and is secreted into breast milk in concentrations similar to that seen in plasma.
Elimination Route
Absorption of gabapentin is thought to occur solely via facilitated transport by the LAT1 transporter within the intestines. As this process is saturable, the oral bioavailability of gabapentin is inversely proportional to the administered dose - the oral bioavailability of a 900mg/day regimen is approximately 60%, whereas a 4800mg/day regimen results in only 27% bioavailability. The Tmax of gabapentin has been estimated to be 2-3 hours. Food has no appreciable effect on gabapentin absorption.
Clearance
Both the plasma clearance and renal clearance of gabapentin are directly proportional to the patient's creatinine clearance due to its primarily renal elimination.
Elimination Route
Gabapentin is eliminated solely in the urine as unchanged drug. Cimetidine, an inhibitor of renal tubular secretion, reduces clearance by approximately 12%, suggesting that some degree of tubular secretion is involved in the renal elimination of gabapentin.
Pregnancy & Breastfeeding use
Pregnancy: Gabapentin is a pregnancy category C drug; it should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Lactation: Gabapentin may be secreted through the breast milk like many other drugs , so it should be used in women who are nursing, only if the benefits clearly outweigh the risks.
Contraindication
Gabapentin is contraindicated in patients who have known hypersensitivity to the drug.
Special Warning
Use in Children: Safety and effectiveness of Gabapentin in the management of neuropathic pain in pediatric patients have not been established. Safety and effectiveness of Gabapentin in the management of seizures in pediatric patients below the age of 3 years have not been established.
Renal impaired patient: In case of renal impaired patient Gabapentin doses must be reduced :
- CrCl >60 ml/min: 1200 mg/daily in 3 divided doses
- CrCl 30-60 ml/min: 600 mg/daily in 2 divided doses
- CrCl 15-30 ml/min: 300 mg/daily single dose
- CrCl <15 ml/min: 150 mg/daily single dose or 300 mg/every alternate day
- Heamodialysis: maximum 300 mg after each dialysis Gabapentin can be taken orally with or without food.
Storage Condition
Tablets should be stored below 25° C and protected from light & moisture
Innovators Monograph
You find simplified version here Dubinor
FAQ
What are the benefits taking Dubinor?
Dubinor give you extra amounts of these three key nutrients for pregnant women: Folic acid helps your baby's brain and spinal cord develop correctly. This nutrient reduces the risk of serious birth defects called spina bifida and anencephaly. Calcium protects your bones as your baby grows.
How early should I start taking Dubinor?
Ideally you should start Dubinor at least one month before pregnancy—and CERTAINLY during the first 12 weeks of pregnancy when baby's development is at its most critical point.
Do Dubinor make me gain weight?
There is no evidence that Dubinor make you gain weight. Most pregnant women gain about 25-35 pounds throughout their pregnancy whether they use a prenatal vitamin or not. And since vitamins contain zero calories, the weight gain is likely just due to the pregnancy itself.
Do Dubinor make me fertile?
Taking your Dubinor won't make you any more likely to get pregnant. This one is just a myth we're happy to bust. Prenatal vitamins will, however, make it significantly more likely that you experience a healthy pregnancy.
What happens if I accidentally take 2 Dubinor in one day?
Don't worry. Taking twice the recommended amounts of these nutrients on just one day won't harm you or your baby. But taking a double dose more often can be harmful, so it's important not to do it regularly.
Can I skip Dubinor one day?
Yes Dubinor is an important part of your pregnancy nutrition, but it never a substitute for a healthy well balanced diet. If you forget your vitamins once in a while do not panic and do not "double up" because they may make you feel sick or increase constipation.
Which fruit should I avoid during pregnancy?
Papaya– It tops the list for obvious reasons. Raw or semi ripe papaya contains latex which can induce premature contractions and that can be dangerous for your baby.
What are the side effects of Dubinor?
Most women who take Dubinor as directed by their doctor or midwife experience little or no side effects from prenatal vitamins. The iron in prenatal vitamins may cause constipation, and some women complain of nausea. You also may have diarrhea, dark stools, low appetite, and stomach upset or cramps.
How late is too late to take Dubinor?
If you wait until you get pregnant or miss your period to start folic acid supplements, you are too late. The spine forms like an open book — and it closes around 42 days from the first day of your last menstrual period, which is approximately 28 days after you ovulate or 14 days after you have missed a period.
What are the advantages of taking Dubinor?
Getting enough folic acid not only reduces your baby's risk of developing spina bifida and anencephaly by 50-70% but taking a folic acid supplement may also reduce the risk of your baby developing other defects, such as cleft lip, cleft palate, and certain heart conditions.
Is it safe to take Dubinor if I am not pregnant?
You may be tempted to take Dubinor (prenatal vitamins) because of unproven claims that they promote thicker hair and stronger nails. However, if you're not pregnant and not planning to become pregnant, high levels of certain nutrients over a long period of time may actually be more harmful than helpful.
Is it OK to take Dubinor at night?
In general, Dubinor should be taken on an empty stomach with water. If you experience nausea while taking your prenatal vitamins, take your vitamin at bedtime and with a light snack.
What happens if I don't take folic acid during pregnancy?
If you do not get enough folic acid before and during pregnancy, your baby is at higher risk for neural tube defects. Neural tube defects are serious birth defects that affect the spine, spinal cord, or brain and may cause death. These include: Spina bifida.
How many times a day do I take Dubinor?
Dubinor are often available as capsules, beverages, gummies, and even protein shakes — and ingesting them differently can aid the digestive process. Try switching from one large capsule to three gummies per day or splitting up two doses 12 hours apart.
Should I take Dubinor at the same time everyday?
Establishing a routine of taking a vitamin at the same time every day will form a healthy habit. It will also help you get the most out of your vitamin supplement.
Why does Dubinor help hair?
Specifically, Dubinor is packed with folic acid (the synthetic form of folate), a B vitamin that's responsible for healthy cell growth (which includes skin, hair, and nails).
