Revenor Tablet

Introduction

Revenor Tablet 25 mg (INN, also known as triquinil and tetrabenazinum) is a drug used to treat symptoms of chorea (involuntary, jerky movement) and Huntington's disease. It is an analogue of monoamine-depleting agent reserpine.

Uses

Revenor Tablet 25 mg is used to treat hyperkinetic movement disorders, such as the symptoms of Huntington's disease, tardive dyskinesia, and to some degree narcolepsy. It is also being studied for its potential use in treating Tourette syndrome and Alzheimer’s disease.

Brand Name	Revenor
Type	Tablet
Weight	25 mg
Generic	Tetrabenazine
Manufacturer	Genvio Pharma Ltd.
Available in	English বাংলা

Mechanism of Action

Revenor Tablet 25 mg works by blocking the vesicular monoamine transporter 2 (VMAT2), which is responsible for the uptake of dopamine, serotonin, and norepinephrine into their respective presynaptic vesicles. This reduces the amount of monoamines available to be released into synapses, resulting in reduced postsynaptic receptor activation.

How Long Does it Take to Work?

The onset of action for tetrabenazine is slow, usually between 1 and 3 weeks.

Absorption

Revenor Tablet 25 mg is rapidly absorbed when taken orally, with peak levels occurring between 0.5 and 2 hours after dosing. It is approximately 80-90% bioavailable, and does not undergo first-pass metabolism.

Route of Elimination

Revenor Tablet 25 mg is metabolized primarily in the liver, and it is excreted in both urine and feces.

Dosage

Recommended dosing for Tetrabenazine: Tetrabenazine can be taken with or without food. Individualization of dose with careful weekly titration is required.

1st week's starting dose: 12.5 mg daily.
2nd week: 25 mg (12.5 mg twice daily).
Then slowly titrate at weekly intervals by 12.5 mg to a tolerated done that reduces chorea. Doses of 37.5 mg and up to 50 mg per day should be administered in three divided doses per day with a maximum recommended single dose not to exceed 25 mg.
Patients requiring doses above 50 mg per day should be genotyped for the drug-metabolizing enzyme CYP2D6 to determine if the patient is a poor metabolizer or an extensive metabolizer.
Maximum daily dose in poor metabolizers: 50 mg with a maximum single dose of 25 mg.
Maximum daily dose in Extended and intermediate metabolizers: 100 mg with a maximum single dose of 37.5 mg.
If serious adverse reactions occur, titration should be stopped and the dose should be reduced. If the adverse reactions do not resolve, consider withdrawal of Tetrabenazine.

Pediatric & geriatric use: Safety and effectiveness in pediatric patients have not been established. The pharmacokinetics of Tetrabenazine and its primary metabolites have not been formally studied in geriatric subjects. For the treatment of movement disorders, the usual starting dose of tetrabenazine is 12.5-25 mg/day, given in 2-3 divided doses. The dose should be gradually titrated over several weeks to maximize effectiveness and minimize adverse reactions. The maximum recommended dose is 100 mg/day.

Administration

Revenor Tablet 25 mg is taken orally, usually 1-3 times per day, with or without food.

Side Effects

Common side effects of tetrabenazine include drowsiness, dizziness, headache, nausea, vomiting, constipation, diarrhea, fatigue, tremors, and insomnia.

Toxicity

Overdoses of tetrabenazine can result in serious adverse reactions including coma, respiratory depression, and cardiovascular collapse.

Precaution

Revenor Tablet 25 mg should be used with caution in patients with a history of depression, dementia, or other mental health conditions, as there is a risk of worsening of symptoms. It should also be used with caution in patients with a history of liver or kidney disease, as it may worsen their condition.

Interaction

Revenor Tablet 25 mg may interact with monoamine oxidase inhibitors (MAOIs), alcohol, and other drugs metabolized by the CYP3A4 enzyme.

Disease Interaction

Use of tetrabenazine with certain medical conditions like depression, dementia, liver or kidney disease, and Parkinson’s disease should be done with caution.

Drug Interaction

Revenor Tablet 25 mg should not be taken with monoamine oxidase inhibitors (MAOIs) or drugs metabolized by the CYP3A4 enzyme due to the risk of serious interactions.

Food Interactions

Food does not significantly affect the absorption of tetrabenazine.

Pregnancy Use

Revenor Tablet 25 mg should not be used by pregnant women, as it may harm the unborn baby.

Lactation Use

It is not known if tetrabenazine is secreted in human breastmilk, so the use of tetrabenazine by women who are breastfeeding should be done with caution.

Acute Overdose

Signs of an overdose of tetrabenazine include coma, difficulty breathing, and cardiovascular collapse. Treatment of an overdose should include supportive and symptomatic measures.

Contraindication

Revenor Tablet 25 mg is contraindicated in patients with a known hypersensitivity or allergy to the drug. It is also contraindicated in patients with a known sensitivity to reserpine.