Algita-D
Generic Name
Flunarizine + Domperidone
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Description
Overview of the medicine
Algita-D is a combination medication containing Flunarizine, a calcium channel blocker, and Domperidone, a dopamine antagonist. It is primarily used for the prophylaxis of migraine and to alleviate associated symptoms like nausea and vomiting.
Uses & Indications
Dosage
Adults
For migraine prophylaxis: Flunarizine 5 mg once daily at bedtime, for up to 6 months. Domperidone 10 mg 2-3 times daily, or as directed by physician for nausea/vomiting.
Elderly
Lower doses or careful monitoring may be required due to increased sensitivity or comorbidities, particularly for potential extrapyramidal symptoms or cardiac risks.
Renal_impairment
Use with caution. Dosage adjustment may be necessary for Domperidone due to renal excretion. Avoid if moderate to severe impairment for Domperidone.
How to Take
Take orally with a glass of water, preferably after meals for Domperidone, and Flunarizine usually at bedtime. Follow physician's instructions.
Mechanism of Action
Flunarizine acts as a selective calcium entry blocker, preventing excessive calcium influx into cells, which helps stabilize vascular tone and reduce neuronal excitability, thereby preventing migraine attacks. Domperidone, a peripheral dopamine D2 receptor antagonist, increases gastrointestinal motility and blocks dopamine receptors in the chemoreceptor trigger zone (CTZ), reducing nausea and vomiting.
Pharmacokinetics
Onset
Flunarizine: Prophylactic effect may take several weeks. Domperidone: 15-30 minutes.
Excretion
Flunarizine: Mainly via faeces (bile), minimal renal excretion. Domperidone: About 60% via faeces, 30% via urine.
Half life
Flunarizine: Highly variable, typically 18-23 days (terminal half-life). Domperidone: 7-9 hours.
Absorption
Flunarizine: Well absorbed from the GI tract. Domperidone: Rapidly absorbed after oral administration; low bioavailability due to extensive first-pass metabolism.
Metabolism
Flunarizine: Extensive hepatic metabolism. Domperidone: Rapid and extensive hepatic metabolism by CYP3A4.
Side Effects
Contraindications
- Hypersensitivity to Flunarizine or Domperidone
- History of depressive illness or Parkinson's disease (for Flunarizine)
- Prolactinoma
- Moderate to severe hepatic impairment
- Conditions where stimulation of gastric motility is harmful (e.g., GI haemorrhage, mechanical obstruction, perforation)
- Patients with known prolongation of cardiac conduction intervals (e.g., QTc) or underlying cardiac diseases
Drug Interactions
Anticholinergic drugs
Antagonize the prokinetic effect of Domperidone.
Sedatives/Hypnotics/Alcohol
Increased drowsiness with Flunarizine.
CYP3A4 inhibitors (e.g., Ketoconazole, Erythromycin, Clarithromycin, Verapamil, Diltiazem)
Increased plasma levels of Domperidone, increasing the risk of QTc prolongation.
QT prolonging drugs (e.g., antiarrhythmics, antipsychotics, antidepressants, some antibiotics)
Additive QTc prolongation risk with Domperidone.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of Flunarizine overdose may include sedation, agitation, tachycardia, and hypotonia. Domperidone overdose may cause extrapyramidal reactions, drowsiness, and disorientation. Treatment is symptomatic and supportive, including gastric lavage and activated charcoal. ECG monitoring is recommended due to risk of QTc prolongation with Domperidone.
Pregnancy & Lactation
Pregnancy: Use only if clearly needed and potential benefits outweigh risks, as safety in human pregnancy is not fully established. Lactation: Both Flunarizine and Domperidone are excreted in breast milk. Avoid during breastfeeding or discontinue breastfeeding if the medication is essential.
Side Effects
Contraindications
- Hypersensitivity to Flunarizine or Domperidone
- History of depressive illness or Parkinson's disease (for Flunarizine)
- Prolactinoma
- Moderate to severe hepatic impairment
- Conditions where stimulation of gastric motility is harmful (e.g., GI haemorrhage, mechanical obstruction, perforation)
- Patients with known prolongation of cardiac conduction intervals (e.g., QTc) or underlying cardiac diseases
Drug Interactions
Anticholinergic drugs
Antagonize the prokinetic effect of Domperidone.
Sedatives/Hypnotics/Alcohol
Increased drowsiness with Flunarizine.
CYP3A4 inhibitors (e.g., Ketoconazole, Erythromycin, Clarithromycin, Verapamil, Diltiazem)
Increased plasma levels of Domperidone, increasing the risk of QTc prolongation.
QT prolonging drugs (e.g., antiarrhythmics, antipsychotics, antidepressants, some antibiotics)
Additive QTc prolongation risk with Domperidone.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of Flunarizine overdose may include sedation, agitation, tachycardia, and hypotonia. Domperidone overdose may cause extrapyramidal reactions, drowsiness, and disorientation. Treatment is symptomatic and supportive, including gastric lavage and activated charcoal. ECG monitoring is recommended due to risk of QTc prolongation with Domperidone.
Pregnancy & Lactation
Pregnancy: Use only if clearly needed and potential benefits outweigh risks, as safety in human pregnancy is not fully established. Lactation: Both Flunarizine and Domperidone are excreted in breast milk. Avoid during breastfeeding or discontinue breastfeeding if the medication is essential.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24-36 months from manufacturing date.
Availability
Pharmacies and hospitals in Bangladesh
Approval Status
Approved (in Bangladesh)
Patent Status
Generic available
Clinical Trials
Studies have shown Flunarizine to be effective in reducing migraine frequency. Domperidone's antiemetic efficacy is well-established. Combination studies focus on overall patient outcomes in migraine with associated symptoms.
Lab Monitoring
- Regular monitoring of mood changes and extrapyramidal symptoms, especially in long-term treatment.
- ECG monitoring in patients at risk for cardiac arrhythmias (for Domperidone).
Doctor Notes
- Careful patient selection is crucial, especially regarding psychiatric history (depression, Parkinson's) and cardiac risk factors.
- Monitor for weight gain, mood changes, and movement disorders.
- Prescribe Domperidone for the shortest duration and lowest effective dose.
Patient Guidelines
- Do not exceed the prescribed dose.
- Report any unusual mood changes, tremors, or muscle stiffness to your doctor.
- Avoid alcohol. Be cautious when driving or operating machinery.
- Do not stop treatment abruptly without consulting your doctor.
Missed Dose Advice
If a dose is missed, take it as soon as you remember, unless it is almost time for the next dose. Do not double the dose.
Driving Precautions
May cause drowsiness and dizziness. Avoid driving or operating heavy machinery until you know how this medicine affects you.
Lifestyle Advice
- Maintain a regular sleep schedule.
- Identify and avoid migraine triggers (e.g., certain foods, stress, lack of sleep).
- Stay hydrated.
- Engage in regular, moderate exercise.
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