Midax is a new atypical antipsychotic drug which blocks dopaminergic, serotoninergic, antihistaminic, muscarinic, and dopaminergic receptors.
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Maintenance doses of Midax can also be given to people with schizophrenia by depot injection. There is a separate medicine leaflet providing more information about this, called Midax long-acting injection.
Midax (oh lan' za peen) is a thienobenzodiazepine derivative which appears to act as a dopamine (D1-4) and serotonic (5-HT2A/2C and 5-HT6) receptor antagonist. Midax was approved for use in schizophrenia in the United States in 1996 and continues to be used for this indication. Midax is also used in mood disturbances of bipolar I disorder and in combination with other agents for treatment of resistant depression in adults. Midax is available as tablets of 2.5, 5, 7.5, 10, 15 and 20 mg generically and under the brand name Zyprexa; formulations for parenteral use and orally disintegrating tablets are also available, as are fixed combinations with antidepressants such as fluoxetine (Symbyax and generics). A typical dose regimen is 5 to 20 mg daily, starting with a low dose and increasing cautiously. Common side effects include sedation, increased appetite, weight gain, constipation, orthostatic hypotension, dizziness, dry mouth, weakness and akathisia (restlessness).
Midax has occasionally been seen to improve pre-existing tardive cervical dystonia (SEDA-27, 59). However, two patients developed acute dystonias while taking the lowest therapeutic dose of Midax (5 mg/day) (95 A ).
Neuroleptic malignant syndrome associated with Midax has previously been reported (SEDA-25, 64; SEDA-26, 62; SEDA-27, 60), and two further cases have been reported.
A 16-year-old boy developed fever, generalized rigidity, leukocytosis, and increased serum trans-aminase and creatine kinase activities while taking Midax and lithium; when both drugs were withdrawn, his fever and rigidity subsided and the biochemical tests returned to normal, without any complications (96 A ).
A 75-year-old man developed typical neuroleptic malignant syndrome while taking Midax; he had previously had haloperidol-associated neuroleptic malignant syndrome (97 A ).
The incidence of seizures with Midax, which has been estimated at 0.9% of treated patients, is probably comparable to that with other antipsychotic drugs (SEDA-27, 60).
A 32-year-old woman with genetically confirmed Huntington's disease of 6 year's duration, who was treated with increasing doses of Midax and responded well to 30 mg/day, had a seizure (98 A ).
The author pointed out that seizures are common in juvenile-onset Huntington's disease but rare in adult-onset Huntington's disease.
Can Midax cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with Midax. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.
Getting the most from your treatment
- Your treatment will require careful monitoring to make sure that you get the best possible benefit from Midax. Keep your regular doctor's appointments so that your progress can be checked. You will need to have some tests from time to time.
- Treatment with Midax is usually long-term unless you experience an adverse effect. Keep taking it unless your doctor tells you otherwise. Stopping Midax suddenly can cause problems, so your doctor may want you to reduce your dose gradually if this becomes necessary.
- If you drink alcohol, ask your doctor for advice. Alcohol increases the risk of side-effects from Midax so it is best avoided.
- If you have diabetes you may need to check your blood glucose more frequently, as Midax may affect the levels of sugar in your blood. Your doctor will advise you about this.
- Some medicines similar to Midax can cause the skin to become more sensitive to sunlight than normal. It may be advisable to use a sunscreen in bright sunlight until you know how your skin reacts.
- Smoking may affect the amount of Midax in your body. Let your doctor know if you either start or stop smoking while you are taking Midax.
- A small number of people taking medicines for mood disorders can have thoughts about harming themselves or ending their lives, particularly when a new medicine is started. It is very important that you tell your doctor about this if it happens to you.
- If you are due to have any medical or dental treatment, tell the person carrying out the treatment which medicines you are taking. This is important because Midax may interfere with any anaesthetic you receive.
- If you buy or take any 'over-the-counter' medicines or herbal remedies, please check with a pharmacist that they are suitable for you to take with Midax.
Midax is currently FDA-approved for acute and maintenance treatment of BPD in adults. 283 Frazier and co-workers 284 openly treated 23 children with BPD (5 to 14 years of age) with Midax for 8 weeks. 284 Of the 23 patients who completed this study, 61% responded (defined as more than 30% reduction in YMRS). These patients also experienced significant reductions in depressive symptomatology. The major s > 285, 286 Midax is available in injectable, tablet, and Zydis (melts on the tongue) forms. Midax is typically initiated at 2.5 to 5 mg and can be titrated up to 20 mg. Midax is metabolized, by way of glucuronidation (primary) and oxidation via CYP 1A2. 236 Grothe and colleagues 287 studied the pK of Midax in adolescents, observing a mean serum half-life of 37.2 ± 5.1 hours; boys and smokers metabolized it more rapidly.
Tell your doctor if you have either a liver disease or other problems with your liver; heart disease or other heart problems such as high blood pressure, a previous heart attack, or irregular heartbeats; seizures or epilepsy; diabetes; ever been diagnosed with breast cancer; an enlarged prostate or difficulty urinating; or glaucoma.
You may not be able to take Midax, or you may require a dosage adjustment or special monitoring during treatment, if you have any of the conditions listed above.
Hyperglycemia (increased blood sugar) has been reported in patients treated with atypical antipsychotics including Midax. Talk to your doctor if you experience any signs of hyperglycemia including excessive thirst, frequent urination, excessive hunger, or weakness.
The orally disintegrating tablet (Zyprexa® and Zydis®) form of this medication contains phenylalanine. Talk to your doctor before using this formulation if you have phenylketonuria (PKU).
Midax is in the FDA pregnancy category C. This means that it is not known whether Midax will be harmful to an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant or could become pregnant during treatment.
Furthermore, it is not known whether Midax passes into breast milk. Do not take Midax without first talking to your doctor if you are breast-feeding a baby.
What should I do if I forget a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule.
Do not take a double dose to make up for a missed one.
What side effects can this medication cause?
The sections below will provide you with more specific information and guidelines related to Midax and its correct use. Please read them carefully.
Midax was approved by the FDA in 1996.
Midax was the second atypical antipsychotic to gain approval by the Food and Drug Administration and has become one of the most commonly used atypical antipsychotics. Midax has been approved by the FDA for the treatment of schizophrenia, acute mania in bipolar disorder, agitation associated with schizophrenia and bipolar disorder, and as maintenance treatment in bipolar disorder.
It has also been established in treating depression off-label because of its mood-stabilizing properties and its ability to increase the efficacy of antidepressants.
Why is this medication prescribed?
Midax is an antipsychotic medication. It works by changing the actions of chemicals in the brain.
Furthermore, this medication is used to treat psychotic mental disorders, such as schizophrenia, bipolar disorder, and agitation that occurs with schizophrenia and bipolar mania.
Midax is sold as Zyprexa®, Zydis®, or in combination with fluoxetine, as Symbyax®.
This medicine should not be used to treat behavioral problems in older adult patients who have dementia.
Other uses for this medicine
Midax is also sometimes used for the treatment of other emotional or behavioral problems like maniac-depressive illness.
However, it is important that you talk to your doctor about the possible risks of using this drug for your particular condition before ever taking it.
Dosage and using this medicine
Take Midax exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
Swallow each tablet with a full glass of water. Midax can also be taken with or without food.
Midax is usually taken once a day. Please follow your doctor’s instructions.
Midax is also available in an injectable dose form that is usually administered intramuscularly by a health care provider. Talk to your healthcare provider if you have any questions regarding the administration of injectable Midax.
It is important to take Midax regularly to get the most benefit.
Do not stop taking Midax without first talking to your doctor. It may be 4 weeks or more before you begin to feel better, and you may require continuous treatment for quite some time. Talk to your doctor before you stop taking this medication.
When taking orally-disintegrating tablets (Zyprexa® and Zydis®):
Using dry hands, open the sachet and peel back foil on blister. Do not push tablet through foil.
Immediately upon opening the blister, remove the tablet and place it in the mouth.
Tablet disintegration occurs rapidly in saliva so it can be easily swallowed with or without liquid.
What special precautions should I follow?
GENERIC NAME(S): Midax
OTHER NAME(S): Zyprexa Tablet
There may be a slightly increased risk of serious, possibly fatal side effects (such as stroke, heart failure, fast/irregular heartbeat, pneumonia) when this medication is used by older adults with dementia. This medication is not approved for the treatment of dementia-related behavior problems. Discuss the risks and benefits of this medication, as well as other effective and possibly safer treatments for dementia-related behavior problems, with the doctor.
If you are using Midax in combination with other medication to treat depression, also carefully read the drug information for the other medication.
Midax is used to treat certain mental/mood conditions (such as schizophrenia, bipolar disorder). It may also be used in combination with other medication to treat depression. This medication can help to decrease hallucinations and help you to think more clearly and positively about yourself, feel less agitated, and take a more active part in everyday life.
Midax belongs to a class of drugs called atypical antipsychotics. It works by helping to restore the balance of certain natural substances in the brain.
Talk to the doctor about the risks and benefits of treatment (especially when used by teenagers). See also Precautions section.
What Are Midax Withdrawal Symptoms?
Withdrawal symptoms for Midax can be extremely harsh, especially if an individual decides to quit “cold turkey.” In this type of abrupt stoppage, individuals may find themselves struggling with severe symptoms as the brain attempts to adapt without the drug.
The exact number of symptoms, the nature of their severities and how long they persist will vary by individual. Some of these withdrawal symptoms may include:
- Appetite change
- Body aches
- Difficulty concentrating
- Excessive sweating
- Feeling dizzy
- High anxiety
- Memory problems
- Panic attacks
- Sensory sensitivity
- Sleep problems
- Suicidal thoughts
- Weight loss
- Weird dreams
Treatment for Midax Withdrawal
The best method for treating Midax withdrawal is to taper off use gradually over time. Tapering off can take weeks. This process for this works best with the help of a doctor or substance abuse treatment provider, only when abuse of other drugs has ceased.