Tricalm
Generic Name
Etizolam
Manufacturer
MediPharma Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| tricalm 2 mg tablet | ৳ 5.00 | ৳ 50.00 |
Description
Overview of the medicine
Tricalm 2 mg Tablet is a thienodiazepine derivative, structurally related to benzodiazepines, used for the short-term treatment of anxiety disorders, insomnia, and panic attacks. It has anxiolytic, hypnotic, sedative, anticonvulsant, and muscle relaxant properties.
Uses & Indications
Dosage
Adults
Anxiety: 0.5 mg to 1 mg, 2-3 times daily. Insomnia: 1 mg to 2 mg at bedtime. Max 3 mg/day for anxiety, 2 mg/day for insomnia.
Elderly
Lower doses are recommended, e.g., 0.5 mg once daily, adjusted carefully.
Renal_impairment
Use with caution; dose reduction may be necessary. Not recommended in severe impairment.
How to Take
Orally, with or without food. For insomnia, take shortly before bedtime.
Mechanism of Action
Etizolam binds to the benzodiazepine site on the GABA-A receptor, enhancing the inhibitory effects of GABA, leading to central nervous system depression. This results in anxiolytic, hypnotic, sedative, anticonvulsant, and muscle relaxant effects.
Pharmacokinetics
Onset
30-60 minutes for anxiolytic/sedative effects.
Excretion
Primarily excreted in the urine as metabolites, with a small amount excreted in feces.
Half life
Approximately 3-6 hours (Etizolam), and its active metabolite (alpha-hydroxyetizolam) has a half-life of 6-9 hours.
Absorption
Rapidly and well absorbed from the gastrointestinal tract. Peak plasma concentrations are typically reached within 0.5-2 hours.
Metabolism
Extensively metabolized in the liver, primarily via CYP450 enzymes (mainly CYP2C9 and CYP3A4), to active and inactive metabolites. Alpha-hydroxyetizolam is an active metabolite.
Side Effects
Contraindications
- Hypersensitivity to etizolam or other benzodiazepines
- Myasthenia gravis
- Severe respiratory insufficiency
- Sleep apnea syndrome
- Severe hepatic insufficiency
- Acute narrow-angle glaucoma
Drug Interactions
Alcohol
Increased CNS depression, respiratory depression.
Opioids
Increased risk of profound sedation, respiratory depression, coma, and death.
CYP3A4 inducers (e.g., rifampicin, carbamazepine, phenytoin)
May decrease etizolam levels, leading to reduced effects.
Other CNS depressants (e.g., antidepressants, antipsychotics, antihistamines)
Additive CNS depressant effects.
CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin, grapefruit juice)
May increase etizolam levels, leading to increased effects.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms include somnolence, confusion, diminished reflexes, hypotension, respiratory depression, and coma. Management involves supportive care, maintaining airway, vital signs monitoring, and intravenous fluids. Flumazenil may be considered in severe cases, but use with caution in patients on chronic benzodiazepine therapy.
Pregnancy & Lactation
Pregnancy: Category D. Avoid during pregnancy, especially during the first trimester and near term, due to potential for fetal harm and neonatal withdrawal syndrome. Lactation: Not recommended as etizolam is excreted in breast milk.
Side Effects
Contraindications
- Hypersensitivity to etizolam or other benzodiazepines
- Myasthenia gravis
- Severe respiratory insufficiency
- Sleep apnea syndrome
- Severe hepatic insufficiency
- Acute narrow-angle glaucoma
Drug Interactions
Alcohol
Increased CNS depression, respiratory depression.
Opioids
Increased risk of profound sedation, respiratory depression, coma, and death.
CYP3A4 inducers (e.g., rifampicin, carbamazepine, phenytoin)
May decrease etizolam levels, leading to reduced effects.
Other CNS depressants (e.g., antidepressants, antipsychotics, antihistamines)
Additive CNS depressant effects.
CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin, grapefruit juice)
May increase etizolam levels, leading to increased effects.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms include somnolence, confusion, diminished reflexes, hypotension, respiratory depression, and coma. Management involves supportive care, maintaining airway, vital signs monitoring, and intravenous fluids. Flumazenil may be considered in severe cases, but use with caution in patients on chronic benzodiazepine therapy.
Pregnancy & Lactation
Pregnancy: Category D. Avoid during pregnancy, especially during the first trimester and near term, due to potential for fetal harm and neonatal withdrawal syndrome. Lactation: Not recommended as etizolam is excreted in breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24-36 months
Availability
Pharmacies, Hospitals
Approval Status
Approved in many countries (e.g., Japan, India), prescription required. Not FDA approved in the US.
Patent Status
Expired (Generic versions available)
Clinical Trials
Numerous clinical trials have demonstrated the efficacy of Etizolam in short-term treatment of anxiety and insomnia, showing comparable efficacy to other benzodiazepines with a potentially more favorable side-effect profile in some aspects.
Lab Monitoring
- Liver function tests (periodically with prolonged use)
- Renal function tests (in patients with kidney impairment)
Doctor Notes
- Emphasize short-term use to minimize dependence risk.
- Counsel patients on withdrawal symptoms and gradual tapering.
- Assess for co-morbid substance use disorders.
Patient Guidelines
- Take exactly as prescribed by your doctor.
- Do not stop taking suddenly, as it can cause withdrawal symptoms.
- Avoid alcohol while taking this medicine.
- Do not exceed the recommended dose.
- Inform your doctor about all other medications you are taking.
Missed Dose Advice
If a dose is missed, take it as soon as remembered, unless it is almost time for the next dose. Do not double the dose to catch up.
Driving Precautions
This medicine may cause drowsiness, dizziness, and impaired concentration. Avoid driving or operating heavy machinery until you know how it affects you.
Lifestyle Advice
- Practice good sleep hygiene (consistent sleep schedule, dark quiet room).
- Incorporate stress-reduction techniques (meditation, yoga).
- Avoid caffeine and heavy meals before bedtime.
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