MSM (Primidone)
Class and Category of Drug
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Chemical class: Prodrug of phenobarbital
Therapeutic class: Anticonvulsant
Pregnancy category: Not rated
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Drug Indications and Dosages
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To manage generalized tonic-clonic seizures, nocturnal myoclonic seizures, complex partial seizures, and simple partial seizures caused by epilepsy
Chewable Tablets, Oral Suspension, Tablets
Adults and children age 8 and over. Initial: 100 or 125 mg at bedtime for first 3 days; then increased to 100 or 125 mg b.i.d. for next 3 days, followed by 100 or 125 mg t.i.d. for next 3 days. On 10th day, begin maintenance dosage as prescribed. Maintenance: 250 mg t.i.d. or q.i.d., adjusted as needed. Maximum: 2 g daily. Children up to age 8. Initial: 50 mg at bedtime for first 3 days; then increased to 50 mg b.i.d. for next 3 days, followed by increase to 100 mg b.i.d. for next 3 days. On 10th day, begin maintenance dosage. Maintenance: 125 to 250 mg t.i.d., adjusted as needed.
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Contraindications of Drug
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Hypersensitivity to primidone, phenobarbital, or their components; porphyria
Generic Drug Interactions
Drugs
acetaminophen: Decreased acetaminophen effectiveness, increased risk of hepatotoxicity adrenocorticoids, chloramphenicol, cyclosporine, dacarbazine, disopyramide, doxycycline, levothyroxine, metronidazole, mexiletine, oral anticoagulants, oral contraceptives (estrogen-containing), quinidine, tricyclic antidepressants: Decreased effectiveness of these drugs amphetamines: Possibly delayed absorption of primidone
anticonvulsants: Possibly altered pattern of seizures
carbamazepine: Decreased effectiveness of primidone
carbonic anhydrase inhibitors: Increased risk of osteopenia
CNS depressants: Possibly enhanced CNS and respiratory depressant effects of both drugs
cyclophosphamide: Reduced half-life and increased leukopenic activity of cyclophosphamide
enflurane, halothane, methoxyflurane: Increased risk of hepatotoxicity; increased risk of nephrotoxicity (with methoxyflurane)
fenoprofen: Decreased elimination half-life of fenoprofen
folk acid: Increased folk acid requirements griseofulvin: Decreased antifungal effects of griseofulvin
guanadrel, guanethidine: Possibly aggravated orthostatic hypotension haloperidol, loxapine, maprotiline, molin-done, phenothiazines, thioxanthenes: Possibly lowered seizure threshold and increased CNS depression
leucovorin: Possibly decreased anticonvul-sant effects of primidone (with large doses)
MAO inhibitors: Possibly prolonged primidone effects and altered seizure pattern methylphenidate: Possibly increased blood primidone level, resulting in toxicity phenobarbital: Increased sedative effects of either drug, possibly altered seizure pattern
phenylbutazone: Decreased primidone effectiveness, increased metabolism and decreased half-life of phenylbutazone
rifampin: Decreased blood primidone level
valproic acid: Increased blood primidone level, leading to increased CNS depression and neurotoxicity; decreased valproic acid half-life and increased hepatotoxicity risk vitamin D: Decreased effects of vitamin D
xanthines: Increased metabolism and clearance of xanthines (except dyphylline)
Activities
alcohol use: Possibly increased CNS and respiratory depressant effects of primidone
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Drugs Adverse Reactions
Central Nervous System: Ataxia, confusion, dizziness, drowsiness, excitement, mental changes, mood changes, restlessness
Eyes, Ears, Nose, And Throat: Diplopia, nystagmus
Gastrointestinal: Anorexia, nausea, vomiting
Genitourinary: Impotence
Respiratory: Dyspnea
Other: Folk acid deficiency
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Nursing Considerations for Generic Drugs
• Monitor blood levels of primidone and phenobarbital (its active metabolite), as ordered, to determine therapeutic level or detect toxic levels.
• Anticipate that drug may cause confusion, excitement, or mood changes in elderly patients and children.
• Assess for signs of folk acid deficiency: mental dysfunction, neuropathy, tiredness, and weakness.
Do I need a prescription to buy generic MSM (Primidone) in your online drug store?
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