Irreversibility and severity
Hepatobiliary and Gastroenterology: Take Lansoprazole 30mg and Promethazine 3.84mg (Gastric Mebendazole) before breakfast, and KASCOAL after meals.
Hepatobiliary and Gastroenterology: Take Promethazine 3.84mg (Gastric Mebendazole) before lunch, and KASCOAL after meals.
Dialicon Hepatobiliary and Gastroenterology: Take Promethazine 3.84mg (Gastric Mebendazole) before dinner, and KASCOAL after meals.
Psychiatry: Before bedtime: Leeyo (Escitalopram) 10mg * 2 tablets, Lendormin 0.25mg * 2 tablets, Eurodin 2mg * 2 tablets, Lorazepam 0.5mg * 4 tablets.
Dermatology: Before bedtime: Doxepin 25mg * 2 tablets, Lyrica (Pregabalin) 75mg * 2 tablets, Xyzal 5mg (for skin itching that disrupts sleep).
Metabolism: Metformin HCL 850mg.
Urology: Tamsulosin 0.2mg.
1.
Due to bloating, I have been treated for a gastric ulcer at the Hepatobiliary and Gastroenterology department with Promethazine 3.84mg taken three times a day for a long term of 5 months.
According to the medication leaflet, it seems that this medication should not be taken for such a long duration.
My doctor still allowed me to take it for 5 months.
Is there a high probability that I will develop tardive dyskinesia, which is characterized by involuntary movements of the face, tongue, and limbs, and has potential irreversible and severe consequences?
2.
I have already stopped taking this medication, but I am very concerned about the possibility of developing tardive dyskinesia.
If it occurs, does that mean there is no treatment available for the rest of my life? Since I have stopped taking this medication, when might I expect to see symptoms of tardive dyskinesia? If symptoms appear, should I go to the hospital immediately? I am currently very worried.
3.
What irreversible side effects might occur from long-term use of KASCOAL? Thank you, doctor, for your patient responses.
I am very anxious at the moment.
eroo, 30~39 year old female. Ask Date: 2020/08/07
Dr. Ye Qianyu reply Family Medicine
Hello! In response to your questions: 1.
+2.
You mentioned the possible side effects of Promeran, which can cause extrapyramidal symptoms (such as bradykinesia, akathisia, and tremors).
These side effects are more commonly observed in children and adolescents, typically occurring within the first 1-3 hours of treatment initiation.
Symptoms usually improve after discontinuation of the medication.
If you have been using it for five months, there should be no concerns regarding this, and it is unlikely to cause any permanent sequelae.
3.
The mechanism of action of KASCOAL is through its anti-foaming properties, which help relieve bloating.
According to the package insert, the side effects state, "This medication is well tolerated; however, some patients may occasionally experience soft stools, gastric discomfort, diarrhea, abdominal pain, vomiting, belching, a feeling of heaviness in the stomach, and loss of appetite." There are no permanent sequelae associated with its use.
Reply Date: 2020/08/07
More Info
Tardive dyskinesia (TD) is a serious and often irreversible condition characterized by involuntary, repetitive movements, typically affecting the face, tongue, and limbs. It is most commonly associated with long-term use of antipsychotic medications, particularly the older, first-generation antipsychotics. However, it can also occur with the use of certain other medications, including some antiemetics like Promethazine (Promeran), which you mentioned in your treatment regimen.
1. Risk of Tardive Dyskinesia with Long-Term Use of Promethazine: While Promethazine is primarily used to treat nausea and vomiting, it can also have dopaminergic effects, which may contribute to the risk of developing tardive dyskinesia, especially with prolonged use. The risk increases with the duration of treatment and the cumulative dose. Since you have been taking Promethazine for five months, it is understandable to be concerned about the potential for developing TD. However, the incidence of TD with Promethazine is generally considered lower than with typical antipsychotics. Nevertheless, it is crucial to monitor for any unusual movements or symptoms.
2. Concerns About Developing Tardive Dyskinesia After Discontinuation: If you have already stopped taking Promethazine, the risk of developing tardive dyskinesia does not disappear immediately. Symptoms can emerge even after discontinuation, sometimes weeks or months later. However, not everyone who has taken medications associated with TD will develop the condition. If you notice any involuntary movements, it is essential to consult your healthcare provider promptly. Early recognition and intervention can be crucial in managing symptoms.
3. KASCOAL and Long-Term Use: KASCOAL is typically used as an antacid and may contain ingredients that can have side effects with prolonged use. Long-term use of antacids can lead to complications such as electrolyte imbalances, kidney issues, and potential interactions with other medications. While KASCOAL itself may not be directly linked to tardive dyskinesia, it is essential to discuss any long-term medication use with your healthcare provider to ensure that you are not at risk for other adverse effects.
In summary, while the risk of tardive dyskinesia from Promethazine exists, it is not guaranteed that you will develop it, especially since you have discontinued the medication. Monitoring for symptoms is essential, and if you experience any involuntary movements, seek medical attention immediately. Additionally, ensure that you have regular check-ups with your healthcare provider to discuss the long-term use of any medications, including KASCOAL, and to evaluate your overall treatment plan. Your health and safety should always be the priority, and open communication with your healthcare team is vital in managing your concerns and treatment effectively.
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