Nexito Plus

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Last Updated December 20th, 2021

Therapeutic Indications

Nexito plus is classified as a benzodiazepine. When taken it calms the nerves and brain lowering anxiety and enhancing moods. It is also an anti-epileptic and an anti-seizure drug. The drug is used for the treatment and management of a number of conditions that include:

Anxiety
Agitation
Depression
Epilepsy
Panic disorder
Skin rash
Mental disorder
Major depressive disorder
Seizure disorder
Absence infantile spasms
Sleep disorders, REM Sleep Behaviour Disorder.
Comorbid depression
Agoraphobia
Alcohol withdrawal
Post-traumatic stress
Obsessive-compulsive disorder

Do I need a prescription?

Nexito plus tablets can be bought from the local pharmaceuticals shops and from online drug stores. A doctor’s prescription is mandatory.

Dosage

The dosage for Nexito Plus is determined by the condition being treated, the severity, the age and how you respond to the initial dose. The dosage begins with the smallest dose that is effective, this lowers the occurrence of the drugs side effects. To get the best results from the drug, the dose is increased. The following are recommended doses for Nexito Plus for a number of conditions.

Seizure Disorders

Adults: An initial dose of not more than 1.5 mg/day that is divided into three times in a day. The dose is adjusted with increments of 0.5 mg to 1 mg after every 3 days until there is control of the seizures. The maintenance dose differs for every patient because of the differences in patient response but the maximum daily dose should not be more than 20 mg. Depressant adverse effects may increase if you use multiple anticonvulsants, thus this should be considered before adding Nexito Plus to the normal existing regime.

Pediatric Patients: For children and infants up to 10 years of age and body weight of 30 kg, to reduce drowsiness the dose should lie between 0.01 mg/kg/day and 0.03 mg/kg/day that is given in two or three doses. It should not exceed 0.05mg/kg/day. Increase in the dosage should not exceed 0.25 mg to 0.5 mg every three days until a maintenance daily dose of 0.1 mg/kg to 0.2 mg/kg of the body weight until the seizures are under control. The dose for a day should be divided equally three times. If not the largest dose should be administered while retiring for the day.

Geriatric Patients: For the elderly 65 years and older, the initial dose should be a low dose and the patients are observed closely.

Panic disorder

Adults: the initial dose is 0.25 mg twice a day a target dose of 1 mg/day can be achieved by increasing the dose after 3 days. This dose is recommended from results that show optimum effects at 1 mg/day. Higher doses of 2 mg/day to 4 mg /day have been shown be to be less effective and have more adverse side effects. In the cases that benefits are better at 4 mg/day, the dose should be increased by 0.125mg to 0.25 mg twice a day after 3 days until the panic disorder is under control. The dose is reduced gradually until it is discontinued, a decrease of 0.125 mg twice a day.

Pediatric Patients: no clinical trial in panic disorder in patients below 18 years old.

Geriatric Patients: no clinical trial in panic disorder in patients above 65 years. In patients that are elderly, the dose should be low and the patients closely observed.

Chemical composition

Nexito Plus is composed of two active ingredients. The ingredients include:

Escitalopram – 5 mg
Clonazepam – 0.5 mg

Mechanism of Action (MOA)

Of the two active ingredients, escitalopram reduces sleep when taken alone while clonazepam increases sleep. When the two ingredients are used combined, they balance out sleep and thus used to cure sleep problems.

The action of GABA is increased by clonazepam. GABA is a chemical messenger that reduces the abnormal activity of nerve cells in the brain. Escitalopram is an inhibitor of the reuptake of serotonin (selective serotonin reuptake inhibitor (SSRI)), as a result, the levels of serotonin increases which improves the mood.

Facts on Nexito Plus

Nexito Plus is commonly used for the treatment of anxiety.
It can cause withdrawal symptoms when stopped suddenly and when used for a long time.
Nexito Plus, when used during pregnancy, may cause birth defects in the fetus.
Nexito Plus being a benzodiazepine is among the drugs that are associated with increased fall risk according to Medication Linked to Falls CDC flyer.
It should not be used in children and patients under the age of 18 years.
It is one of the most prescribed antidepressants with a very first growing rate in market share.

Contraindications

Nexito Plus is contraindicated for use in a number of conditions. Inform your doctor if you have any of the following conditions:

Hypersensitive to any of the active ingredients, the benzodiazepines, and SSRI. Allergic reactions symptoms include rashes or itching of the skin, loss of consciousness, shortness of breath, swelling of the throat, face, tongue, and lips.
Diseases related to the liver
Narrow-angle glaucoma
Monoamine oxidase inhibitors. If you are being treated with monoamine oxidase inhibitors then you should not use Nexito Plus tablets. The drug should be stopped at least two weeks before using Nexito Plus.
If you are taking pimozide you should avoid the use of Nexito Plus due to increased risk of heart rhythm disorder.
Epilepsy
Alcohol intoxication
Do not take Nexito Plus tablets if you are pregnant or planning to be pregnant.
Do not take Nexito Plus tablets if you are nursing as they may harm the nursing baby.
Heart diseases
If you have had or have abnormal heart rhythm
Severe kidney disease
Low sodium levels in the blood
Nexito Plus should not be taken if you are 18 years and below.

Side effects

Nexito Plus may cause a number of undesired effects apart from the required ones. The side effects depend on the dosage and the duration of use. Some side effects are common but not serious while others are rare and very serious. Call and inform your doctor of any side effects more so if they do not go away.

Very common side effects include:

Dizziness
Constipation
Insomnia
Skin rash
A dull headache
Loss or gain of weight
Confusion
Dry mouth
Vomiting
Nausea
Back pain
Diarrhea
Anorexia
Depression
Vertigo
Fever
Tremor
Dehydration
Hair loss
Sleepiness
Nervousness
Reduced intellectual abilities
A decrease in sexual urge
Joint pain
Loss of appetite or increased appetite
Abnormal dreams
Increased sweating
Decreased orgasm

Rare and serious side effects include:

Ejaculation disorder
Flushing
Weight gain
Abnormal eye movements
Nasal congestion
Slurred speech
Palpitations
Rhinorrhea
Chest congestion
Shortness of breath
Confusion
Reduced urine output
Fast heartbeat
Blurred vision
Muscle pain
New or seizures that keep worsening
Aggression and hallucinations
Suicidal thoughts

Drug Interactions

Nexito Plus is known to interact with a number of products and drugs. Inform your doctor if you on any medication whether over the counter drugs or prescription drugs, herbal medicines, and vitamin supplements. Drug interactions may lower the effectiveness of Nexito Plus or increase the chances of adverse side effects occurring. Nexito Plus interacts the following drugs and products.

Use of Nexito Plus together with alcohol increases the chances of serious side effects.
Buprenorphine
Disulfiram
Moclobemide
Linezolid
Lithium
Selegiline
Non-selective monoamine oxidase inhibitors (MAOIs), with active ingredients being nialamide, tranylcypromine, phenelzine, isocarboxazid, and iproniazid.
Doxycycline
Itraconazole
Erythromycin
John’s Wort
Mefloquine
Antipsychotics such as risperidone,haloperidol, and thioridazine
Flecainide, metoprolol, and propafenone that are used in cardiovascular disorders
Neuroleptics used for psychosis and schizophrenia
Acetylsalicylic acid and non-steroid anti-inflammatory drugs.
Omeprazole
Cimetidine
Medicines that lower levels of magnesium and potassium in the blood.
Tryptophan
Sumatriptan
Cetirizine
Codeine
Carbamazepine
Atenolol
Cimetidine
Aspirin
Desipramine

What to do if you skip a dose?

If a dose is skipped it should be taken immediately you realize it. If it is close to the next dose, the dose can be skipped and the normal schedule continued. Do not take double the dose to compensate for the skipped dose. If you frequently ski doses, you can set a reminder or have a family member remind you when it is time to take the next dose as frequently missed doses will lower the effectiveness of the drug.

Precautions

When using Nexito Plus a number of precautions should be taken into considerations. The precautions include:

Nexito Plus should not be taken with alcohol as it may cause more adverse side effects and excessive drowsiness.
The tablets should not be used if you are pregnant or planning to be pregnant as Nexito Plus has been shown to harm the fetus.
Nexito Plus should not be used if you are breastfeeding as there is limited information on the effects it could have on the nursing baby.
Nexito Plus may cause drowsiness or dizziness and thus you should not drive or operate heavy machinery while using it.
It should not if you are 18 years and below.
It should not be used if you suffer from severe liver and kidney diseases. Dose adjustment is recommended in such cases.
Do not take the tablets if the package has been tampered with or if the expiry date of the medication has been reached.
Always store the tablets away from direct sunlight and avoid exposing them to heat.
Do not stop taking Nexito Plus tablets suddenly if you have been taking the medication for an extended time. This would result in withdrawal symptoms that include mood swings and muscle cramps.
Nexito Plus may cause thoughts of suicide, contact your doctor once you have thoughts of harming yourself.
Nexito Plus should be used with caution if you are diabetic as it may alertglucose levels in blood thus close monitoring of the sugar levels is required.
If you have a history of a bleeding disorder or being treated with aspirin, NSAIDs, and anticoagulants, this drug may increase the risk for abdominal bleeding.

Different brands and manufacturing companies of the drug

Nexito Plus tablets are manufactured by Sun Pharmaceutical Laboratories Ltd. Nexito Plus is a 5 mg tablet that contains 0.5 mg clonazepam and 5 mg escitalopram. Other tablets manufactured by Sun Pharmaceuticals include:

Nexito 10 mg tablet
Nexito Forte tablet
Nexito LS tablet

Substitutes of the drug

A number of drugs that have the same strength and composition as Nexito Plus. They include:

Camdem 0.5 mg/ 5 mg tablet – Sinsan Pharmaceuticals
Citajoy C 0.5 mg/5 mg tablet – wings Biotech Ltd
Escirise Cz 0.5 mg/5 mg tablet – Carise Pharmaceuticals Pvt Ltd
Es Ok Plus 0.5 mg/5 mg tablet – Eisai Pharmaceuticals India Pvt Ltd
Escepam 0.5 mg/5 mg tablet –Carise Pharmaceuticals Pvt Ltd
Xtaz 5 mg tablet – Medley Pharmaceuticals
S Citadep Plus 0.5 mg/5 mg tablet – Cipla Ltd
Rexipra Plus tablet – Intas Pharmaceuticals Ltd
Stalopam Miniplus tablet – Lupin Ltd
S Vocita H tablet – Shine Pharmaceuticals Ltd
Ezeepam Plus 0.5 mg/5 mg tablet – Eris Life Sciences Pvt Ltd
Feliz S Plus 0.5mg/5 mg tablet – Torrent Pharmaceuticals Ltd

References

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