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Medicines for Weakness: 1900 to c. 1950
Published in John K. Crellin, A Social History of Medicines in the Twentieth Century, 2020
Tonics were used for both general ill health and for specific medical conditions in which lack of energy and weakness were cardinal symptoms. Above all, the scourge of tuberculosis during the first half of the twentieth century encouraged their use whatever other treatments were tried. Moreover, tonics and other medications—restorers of strength and vitality—fitted very much into the widely touted concept of building resistance. Marmite, for instance, was promoted in the 1930s for "increasing the resistance to infections of all kinds."81
Functional Properties of Milk Yam (Ipomoea Digitata L.)
Published in Megh R. Goyal, Hafiz Ansar Rasul Suleria, Ramasamy Harikrishnan, The Role of Phytoconstitutents in Health Care, 2020
K. M. Vidya, N. S. Sonia, P. C. Jessykutty
Ayu Muscle Tone is an ayurvedic muscle tablet containing milk yam along with Shatavari (Asparagus racemosus), Ashwagandha (Withania somnifera) and Amalaki (Emblica officinalis). It is recommended as a bone and muscular tonic consumed at a dose of two tablets twice a day. Lukowin tablets another product contain 80 mg of milk yam and is recommended at a dose of 2 tablets with water daily for curing menstrual disorders [35].
The Prevention of Insanity and the General Principles of the Treatment of the Insane
Published in Francis X. Dercum, Rest, Suggestion, 2019
The various tonic remedies may be employed as indications arise. The so-called nerve tonics are of little value. Strychnin is of decided benefit in cases with marked depression of the circulation. Its action upon the nervous system in mental diseases is unimportant. Digitalis, strophanthus and nitroglycerin are also useful, at times, if there be cardiac weakness.
Personalized dosing of clozapine stratified by patients’ ancestry – international consensus guidelines
Published in Nordic Journal of Psychiatry, 2023
While the risk of clozapine-induced granulocyte toxicity is not dose-dependent, there are many other serious side effects that are associated with dose or plasma concentration, e.g. tonic-clonic seizure, myocarditis, pneumonia, hyper salivation and obstipation/ileus [1]. Together these concentration-dependent side effects are more severe than granulocyte toxicity in terms of clozapine-induced morbidity and mortality [1]. Combined with the fact that clinical effect of clozapine is also associated with the plasma concentration [2], therapeutic drug monitoring (TDM) can be used for individualized dose titration of clozapine to hit the evidence-based target concentration range defined in official guidelines, i.e. 350–600 ng/mL (∼1070–1850 nmol/L) [3], which usually (not always) provides the best clinical outcome. In a pharmacological context, less than a two-fold difference between the upper and lower target concentration is indeed compliant with a narrow therapeutic index, justifying the use of TDM as a tool for dose titration of clozapine. In real-world practice with antipsychotic polypharmacy etc., sufficient clinical response may be obtained at lower concentrations than 350 ng/mL (1070 nmol/L), which is the reason why many laboratories operate with reference ranges below 1070 nmol/L, e.g. 300 nmol/L. It is therefore important to monitor the clinical effect and tolerability closely during dose up-titration of clozapine.
The implementation of risk minimization measures to prevent teratogenic pregnancy outcomes related to oral retinoid and valproate use in Belgium
Published in Acta Clinica Belgica, 2022
Xander Bertels, Els Mehuys, Koen Boussery, Lies Lahousse
Therefore, the EMA adjusted the risk minimization measures (RMMs) of both medicine classes in 2018. From this point onward, the use of valproate is strictly contraindicated in pregnant women at all stages of pregnancy, as was already the case for oral retinoids. Per exception, valproate can still be considered in pregnant women with epilepsy when no alternative treatment is sufficient, given the risks of status epilepticus with hypoxia and tonic-clonic seizures. Furthermore, the former PPPs of retinoid-containing preparations were harmonized and a valproate PPP was introduced. Compliance with the PPP is mandatory. If not, the use of these medicines by women of childbearing age is also contraindicated. Even though there are minor differences between the PPPs, they both require awareness of the teratogenic risks by patients and healthcare providers (HCP), oblige appropriate contraception and pregnancy testing, and indicate the responsibilities of patients, specialists, general practitioners and pharmacists. In addition to these measures, educational materials were revised and harmonised for oral retinoids, and educational materials were introduced for valproate to ensure proper implementation of the respective PPPs. Lastly, a boxed warning was placed on the medicines’ outer packaging to highlight the risk to patients, remind healthcare providers about the need to inform about teratogenicity, and encourage patients to look for additional information [21,22].
Dosing methods in electroconvulsive therapy: should the Scandinavian time-titration method be resumed?
Published in Nordic Journal of Psychiatry, 2022
Per Bergsholm, Tor Magne Bjølseth
Direct observation of tonic convulsion as the dosing criterion may seem crude, however, so is the dosing criteria of the other methods, including seizure threshold determination. Formal reliability studies are lacking for all the methods. However, the validity of the time-titration dosing is supported by good clinical results over several decades. It requires experience by the observer, pressing and releasing the stimulus button, and the feet must not be covered with socks or clothes. As soon as the feet and big toes are extended maximally in a tonic position the current is interrupted. A common error is releasing the button too early. This may result in one of two submaximal convulsions [17]. The one is ‘dissociate convulsion,’ which superficially resembles an optimal seizure, but is followed by early awakening. The other is ‘clonic convulsion’, which has no tonic phase, ends abruptly and simultaneously in the whole body, and usually lasts only 10–20 s. The dose of succinylcholine chloride should be 0.50–0.75 mg/kg [17]. If a larger dose is required the Hamilton cuff technique used on the right ankle may be applied [37,75].