Usage
Carbazochrome is a hemostatic agent primarily used to control capillary bleeding. It is prescribed for various conditions characterized by capillary fragility or increased permeability, such as:
- Epistaxis (nosebleeds)
- Retinal hemorrhage
- Hemoptysis (coughing up blood)
- Gastrointestinal hemorrhage
- Hematuria (blood in urine)
- Uterine bleeding
- Hemorrhoids
- Post-surgical bleeding
- Bleeding from wounds
- Thrombocytopenic purpura (although its effectiveness in this condition is debated)
Its pharmacological classification is hemostatic agent.
Carbazochrome’s mechanism of action involves interacting with α-adrenoreceptors on the surface of platelets. This interaction promotes platelet aggregation (clumping) and adhesion, which helps form a platelet plug at the site of bleeding, effectively stopping blood loss. It also exhibits some capillary-stabilizing properties, which further contribute to its hemostatic effects.
Alternate Names
- Adrenochrome monosemicarbazone
- Adrenostazin
Brand names vary depending on the region. Examples include:
- Apricol Forte
- CKP
- Styptochrome
- Stadren
- Stopcrome
How It Works
Pharmacodynamics: Carbazochrome primarily affects platelet function by interacting with α-adrenoreceptors on platelets. This leads to increased platelet aggregation and adhesion, forming a platelet plug at the bleeding site. It also exerts some vasoconstricting effects on capillaries.
Pharmacokinetics: Information on the pharmacokinetics of carbazochrome is limited. Absorption, metabolism, and elimination pathways have not been fully elucidated. Available data suggests it’s administered orally, intramuscularly (IM), subcutaneously (SC), or intravenously (IV). Elimination pathways are not definitively established but likely involve hepatic metabolism and renal excretion.
Mode of Action: Carbazochrome binds to α-adrenoreceptors on platelets, triggering a cascade of intracellular events, including activation of phospholipase C (PLC), leading to increased inositol trisphosphate (IP3) and diacylglycerol (DAG) production. This ultimately results in elevated intracellular calcium levels, promoting actin polymerization and myosin light chain kinase activation. These changes facilitate platelet shape change, aggregation, and adhesion.
Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation: Carbazochrome primarily acts via α-adrenoreceptor binding on platelets. It does not exhibit significant enzyme inhibition or neurotransmitter modulation.
Dosage
The dosage of carbazochrome varies depending on the patient’s age, condition, and the route of administration. It’s crucial to follow the prescribing physician’s instructions.
Standard Dosage
Adults:
- Oral: 10-30 mg three times daily.
- IM/SC: 10 mg daily.
- IV: 25-100 mg daily by injection or infusion.
Children:
Dosage in children should be determined by a physician, considering the child’s weight and age. Generally, a lower dose than the adult dose is recommended. Safety and efficacy in children have not been extensively studied.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary due to potential age-related decline in renal and hepatic function. Start with a lower dose and monitor closely.
- Patients with Renal Impairment: Caution is advised. Dose adjustment may be necessary.
- Patients with Hepatic Dysfunction: Limited information is available. Use cautiously and monitor closely.
- Patients with Comorbid Conditions: Consider individual patient factors and adjust the dose accordingly.
Clinical Use Cases:
Specific dosage guidelines for these clinical scenarios are not well established, and clinical experience guides practice. Consult with experienced colleagues or specialists for dosage recommendations.
- Intubation: Not typically indicated.
- Surgical Procedures: Pre-operative administration of 2-6 ml IM injection (1.5 mg/2ml concentration); post-operative administration of 1-2 ml IM injection every 2 hours.
- Mechanical Ventilation: Not typically indicated.
- Intensive Care Unit (ICU) Use: Dosage is based on the patient’s condition and bleeding risk.
- Emergency Situations: Dosage varies based on the specific situation.
Dosage Adjustments:
Dose adjustments are made based on patient-specific factors, such as renal/hepatic impairment, other medical conditions, and response to therapy. Close monitoring is important, especially in patients with comorbidities.
Side Effects
Common Side Effects:
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Injection site pain
- Dizziness
- Headache
- Skin rash
- Anorexia
- Stomach discomfort
Rare but Serious Side Effects:
- Hypersensitivity reactions (including allergic reactions)
- Muscle weakness
- Difficulty breathing
Long-Term Effects:
Limited data are available regarding long-term effects.
Adverse Drug Reactions (ADR):
Serious ADRs are rare but necessitate immediate medical attention. Report any suspected ADRs.
Contraindications
- Hypersensitivity to carbazochrome or any of its components.
- History of thrombotic events (use with caution).
- Pre-existing blood clotting disorders.
- Allergy to salicylic acid (for carbazochrome salicylate formulations).
Drug Interactions
- Anticoagulants (e.g., warfarin, heparin): May reduce the efficacy of carbazochrome.
- Fibrinolytic agents (e.g., streptokinase): May counteract the hemostatic effects of carbazochrome.
- Antacids (e.g., aluminum hydroxide): May interfere with the absorption of carbazochrome.
- Antihistamines and Anticholinergics: Their vasodilating effects might counteract carbazochrome’s hemostatic action.
Pregnancy and Breastfeeding
- Pregnancy: Safety in pregnancy has not been established. Use only if the potential benefit outweighs the risk to the fetus.
- Breastfeeding: It’s unknown whether carbazochrome passes into breast milk. Consult with a physician to assess the risks and benefits.
Drug Profile Summary
- Mechanism of Action: Promotes platelet aggregation and adhesion, stabilizes capillaries.
- Side Effects: Nausea, vomiting, diarrhea, injection site pain, hypersensitivity reactions.
- Contraindications: Hypersensitivity, thrombotic events, blood clotting disorders.
- Drug Interactions: Anticoagulants, fibrinolytic agents, antacids, antihistamines, anticholinergics.
- Pregnancy & Breastfeeding: Safety not established; use with caution.
- Dosage: Varies depending on route and indication; see detailed dosage section.
- Monitoring Parameters: Monitor bleeding, signs of hypersensitivity, and other adverse effects.
Popular Combinations
Specific popular combinations for carbazochrome are not well documented. Its use is often determined by the specific clinical situation.
Precautions
- Assess for allergies, bleeding disorders, and renal/hepatic impairment before initiating treatment.
- Pregnant Women: Carefully evaluate risks and benefits.
- Breastfeeding Mothers: Assess potential neonatal exposure.
- Children & Elderly: Exercise caution and adjust dosage accordingly.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Carbazochrome?
A: Dosage varies based on age, condition, and route of administration. See the detailed dosage section for specifics.
Q2: How is Carbazochrome administered?
A: Carbazochrome can be administered orally, intramuscularly, subcutaneously, or intravenously.
Q3: What are the primary side effects of Carbazochrome?
A: Common side effects include nausea, vomiting, diarrhea, and injection site pain. Rarely, hypersensitivity reactions can occur.
Q4: Is Carbazochrome safe during pregnancy?
A: Safety during pregnancy is not well established. Use only if the potential benefit outweighs the potential risk to the fetus.
Q5: Can Carbazochrome be used in patients with kidney problems?
A: Use with caution in patients with renal impairment. Dose adjustment may be necessary.
Q6: What is the mechanism of action of Carbazochrome?
A: Carbazochrome interacts with α-adrenoreceptors on platelets, enhancing platelet aggregation and adhesion. It also has some capillary stabilizing effects.
Q7: Does Carbazochrome interact with other medications?
A: Yes, it can interact with anticoagulants, fibrinolytic agents, and antacids.
Q8: What should I monitor in patients taking Carbazochrome?
A: Monitor for signs of bleeding control, hypersensitivity reactions, and other adverse effects. Closely observe patients with renal/hepatic impairment.
Q9: What is Carbazochrome used for?
A: Carbazochrome is a hemostatic agent used to control capillary bleeding in various conditions like epistaxis, hematuria, and post-surgical bleeding.
Q10: Are there any contraindications to using Carbazochrome?
A: Yes, contraindications include hypersensitivity to carbazochrome and pre-existing blood clotting disorders. Use with caution in patients with a history of thrombotic events.
