Vesinac 5

Indications

Levamdocal is used to manage symptoms of urge incontinence, increased urinary frequency, and urgency due to overactive bladder syndrome. It can be administered alone or alongside other antihypertensive medications to effectively lower blood pressure, thereby mitigating the risk of cardiovascular events like strokes and heart attacks.

Pharmacology

Levamdocal, a competitive muscarinic receptor antagonist, targets M3, M1, and M2 receptors. The M3 receptors, which are primarily responsible for detrusor muscle contraction, are blocked to prevent bladder contractions. Additionally, antagonizing the M2 receptors helps reduce smooth muscle contractions within the bladder. It is the active isomer in the racemic mixture found in amlodipine.

Dosage & Administration

• Adults and Elderly: Start with 5 mg once daily. This can be increased to 10 mg once daily if necessary.
• Children: Not recommended as safety and efficacy are not established.

Interactions

• Anticholinergics: May enhance effects and side effects. Allow about a week before switching to other anticholinergic therapies.
• CYP3A4 Inhibitors: Co-administration with strong CYP3A4 inhibitors like Ketoconazole should be avoided, or dose adjusted to a maximum of 5 mg daily.
• CYP3A4 Inducers: Effects are not well documented. Monitor for potential interactions.

Contraindications

Levamdocal is contraindicated in patients with known hypersensitivity to the drug, myasthenia gravis, urinary retention, uncontrolled narrow-angle glaucoma, severe gastrointestinal conditions, or those undergoing hemodialysis. It should not be used in severe hepatic or renal impairment patients or with strong CYP3A4 inhibitors.

Side Effects

• Common: Dry mouth, dizziness, and abdominal pain.
• Rare: Urinary tract infections, constipation, and hallucinations.

Pregnancy & Lactation

The effects of Levamdocal during pregnancy are not well-studied. It should be used cautiously in pregnant women. The drug is excreted in animal milk and could affect breastfeeding infants, hence, it is generally advised to avoid during lactation.

Precautions & Warnings

Assess for other causes of frequent urination before starting treatment. Use with caution in patients with gastrointestinal obstruction, significant bladder outflow obstruction, or severe renal/hepatic impairment. Monitor closely when using potent CYP3A4 inhibitors.

Use in Special Populations

• Renal Impairment: Caution in severe cases; dose should not exceed 5 mg daily.
• Hepatic Impairment: Use with caution in moderate hepatic impairment; maximum dose of 5 mg daily.
• Potent CYP3A4 Inhibitors: Limit to 5 mg daily with concurrent use.

Overdose Effects

Symptoms of overdose include severe anticholinergic effects. Treatment may involve activated charcoal, and symptomatic treatment for complications like hallucinations or tachycardia. Special care is needed for patients with a history of QT prolongation or cardiac issues.

Therapeutic Class

Anticholinergics/Antimuscarinics, Anti-spasmodics.

Storage Conditions

Store in a cool, dry place, protected from light. Keep out of reach of children.