"Amitriptyline + Chlordiazepoxide"

Therapeutic Class:  Combined anxiolytics & anti-depressant drugs

Indication: Depression with Anxiety, agitation or tension.

Dosage & Administrations: 1 tablet (5 mg chlordiazepoxide/12.5 mg amitriptyline) PO three/four times daily; may increase to 6 tablets if necessary.

2 tablets reported to be effective in some patients. Elderly: Avoid; strong anticholinergic and sedative effects; may cause orthostatic hypotension (Beers criteria) Consider alternatives; if must use, initiate with lower initial dose; long-acting active metabolites 1 tablet (5 mg/12.5 mg) PO three times.

Contraindications: Hypersensitivity.

Severe cardiovascular disorders, Angle clossure glaucoma, Within 14 days of MAOIs, Any drugs or conditions that prolong QT interval, Acute recovery post-MI.

Side Effect:  Drowsiness, Dry mouth, Constipation, Blurred vision, Dizziness, Bloating, Vivid dreams, Impotence, Tremor, Confusion, Nasal congestion, Edema, Syncope, Ataxia, EEG abnormalities, Menstrual irregularities, Blood dyscrasias (agranulocytosis), Hepatic dysfunction (jaundice).

Precautions & Warnings: Children and Antidepressants

Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (age <24 yr) taking antidepressants for major depressive disorders and other psychiatric illnesses.Caution in BPH, urinary/GI retention, increased IOP, thyroid dysfunction, open-angle glaucoma, seizure disorders, brain tumor, respiratory impairment, respiratory disease. Risk of anticholinergic side-effects. May cause orthostatic hypotension. Paradoxical reactions including hyperactive or aggressive behavior reported. Both agents may cause sedation and impair ability to perform tasks requiring mental alertness. Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; monitor during the initial 1-2 months of therapy and dosage adjustments. Not approved for treatment of dementia-related psychosis. Lactation: Excretion in milk unknown; not recommended.

Pregnancy Category:  Pregnancy Category-D

There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Mode of Action:  Chlordiazepoxide: Antianxiety agent; depresses all levels of CNS, including limbic and reticular formation, possibly by increasing gamma-aminobutyric acid (GABA) activity, a major inhibitory neurotransmitter. Amitriptyline: Antidepressant; neurotransmitter (especially norepinephrine and serotonin) reuptake inhibitor; elicits anticholinergic effects.

Interaction:  There are no known drug interactions and none well documented.

"Dexmedetomidine" Medicine

Therapeutic Class: Miscellaneous sedatives & hypnotics, Miscellaneous sedatives & hypnotics.

Indication: ICU Sedation, Fiberoptic Intubation, Procedural Sedation.

Dosage & Administrations: Adult ICU sedation Loading dose: 1 mcg/kg IV infusion over 10 min. Maintenance infusion: 0.2-0.7 mcg/kg/hr

Procedural sedation Loading dose: 1 mcg/kg IV infusion over 10 min or 0.5 mcg/kg over 10 min is given for less invasive procedures eg ophth surgery. Maintenance infusion: Initially 0.6 mcg/kg/hr, titrated from 0.2-1 mcg/kg/hr to achieve desired clinical effect. Awake fiberoptic intubation patients loading dose: 1 mcg/kg IV infusion over 10 min. Maintenance infusion: 0.7 mcg/kg/hr until endotracheal tube is secured. Rate of all maintenance infusion should be adjusted to achieve the desired level of sedation.

Contraindications: 2nd or 3rd degree AV block (unless paced), uncontrolled hypotension, acute cerebrovascular disorders.

Side Effect: Hypotension, bradycardia, sinus arrest, transient HTN & dry mouth.

Precautions & Warnings: Significant CV dysfunction, advanced heart block &\/or severe ventricular dysfunction, hypovolemia, DM, chronic HTN. Renal & hepatic impairment. Do not inj by bolus or rapid IV. Do not administer for >24 hr.

Pregnancy & lactation. Elderly. Childn < 18 yr.

Pregnancy Category:  Pregnancy Category-C

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Mode of Action: Centrally acting alpha2-adrenoceptor agonist that has sedative and anesthetic properties possibly by activating G-proteins in the brainstem, which results in the inhibition of norepinephrine release.

Interaction: Enhanced pharmacologic effects of anaesth, sedatives, hypnotics, opiate agonists, other vasodilators or drugs that have negative chronotropic effects (e.g. cardiac glycosides).