Why Tinnex Caroverine Injection, Caroverine 20 mg Capsules are effective Tinnitus Treatment?

Tinnex Caroverine 160 mg/8ml Injection

TINNITUS

Caroverine 20 mg Capsules

Tinnex

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KNOW YOUR TINNITUS IS TINNITUS A CURABLE DISEASE ?

Now you don’t have to live with it...

Caroverine and other therapies available for Tinnitus “Treatment of Tinnitus with the use of one or more types of the following therapy, along with the suggested guidance, helps to treat more than 90% patients of Tinnitus.”

Recently in article published for various psychopharmacological agents to treat tinnitus.

Caroverine (tinnex) clearly emerged as “potentially effective for tinnitus” among TCA’s,SSRI’s,Mood Stabilizers,sedativehypnotics/BZDs Ref- H. Belli et al. / General Hospital Psychiatry 34 (2012) 282–289 What is Tinnitus?

Tinnitus, referred as, ringing or noise in the ear, is purely, a subjective experience. In fact, there is no existence of any such sound in the environment. 60% of the inner ear diseases cause Tinnitus. Symptoms may include buzzing, roaring, ringing, whistling, or hissing sounds perceived in the ear. These sounds may be intermittent, continuous, or pulsatile. Tinnitus may interfere with normal activities and sleep, and there may be an associated decrease in the ability to hear conversations or other sounds in the environment. To understand your symptom of Tinnitus it is necessary to understand the mechanism of hearing. How Ear works?

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Functionally ear is divided into three parts 1.External ear 2. Middle Ear and 3. Inner ear External ear collects the sound and directs it to Middle ear.

Middle ear amplifies the sound.

Inner ear converts sound signals in to the electrical signals.

Normally, the inner ear generates an electric impulse, only, in response to the incoming sound signals. But if inner ear cells are damaged, it does not generate required electric signals in response to sound signals. So such patients don't hear properly. Simultaneously some time damaged inner ear hair cells may reach to the state of 'spontaneous depolarization'.

Meaning by, it goes on generating electrical signals, continuously without any incoming signals. This is the reason such patients hear such sounds continuously in the ear / head even though there is no existence of such sound in the environment.

In rare cases, such state may also appear due to damage in the neural connections between inner ear and the auditory 2

centers of the brain.

What is the cause of such inner ear damage?

Inner ear is structurally very close to middle ear. So, commonest cause is diseases of the middle ear, which extend to the inner ear. Usually, an ENT surgeon can easily diagnose this. In such patients there may be a history of ear pain, ear discharge, recurrent nasal or throat infections and/or deafness.

In majority of the cases of Tinnitus it is found that, ear drum (Tympanic membrane) and middle ear are structurally normal. These are the situations where possibilities of damage to inner ear are direct. It could be due to local cause or could be due to one or more generalized diseases or metabolic disorders.

2. Speech Discrimination Could you hear the noise, when you are in middle of work.

Blast / Ear injury(Trauma) Hyperlipidemia (disturbed Metabolism) Thyroid Excessive exposure to noise pollution (Near by Airport, Railway Station, mills & factory exposure to noise) *If 2 yes, then you are likely to suffer Tinnitus and If not then seek other medical attention.

3. Otoscopy – If ear and drums are free.

Patient History How long the patient is suffering from, Whether it is long term/short term.

1. By clenching your teeth does the frequency change?

If yes, then it is for dentist to treat.

4. Dizziness/Vertigo – Are you suffering with any kind of dizziness time to time or you have some sign of vertigo or 'sinking'/ ‘Dizzy –feeling'.

If yes, then it is easy to decide for doctor to possible treatment.

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5. Objective Audiogram – standard test for speech discrimination If ears are free and if discrimination is little louder, then it is clear that tinnitus is generated in the inner ear and that indicates it as 'Cochlear Synaptic Tinnitus' & Tinnex Inj. (Caroverine hydrochloride, Slow I.V. is to be given@2 ml/m).

Desai(Mumbai),Total number of Patients 100 (73 patients continued till the end of study). As per Study of Caroverine Capsule 75-80 % Success rate in reducing severity intensity & duration of tinnitus with enhanced hearing Caroverine Capsules has to be taken orally with the dose of 2 capsules BID(At a time) for at least 3 to 6 month.

Ever since the launch of oral formulation of Tinnex Capsule (2012) more than 4000 patients got benefitted from caroverine drug.

What to avoid with after oral caroverine therapy If there is successful result

6. Only Exception Only one sided hearing loss with Tinnitus - vertigo, a CT scan is necessary to find out Acoustic Neuroma.

As your damage is diagnosed in the cochlea, CAROVERINE is the preferred drug for you.

Recent Study “Newer Emerging Trends in Tinnitus Management” conducted by Dr Ashim 5

( B) Prevention of Tinnitus:1. Train yourself to ignore Ear ringing.

2. Avoid exposure to loud sounds.

3. Excessive use of headphone is harmful.

4. Avoid cold drinks, Ice cream.

5. Avoid tobacco in any form.

6. Avoid coffee and chocolates and any cocoa products.

7. Avoid certain ototoxic drugs and drugs like aspirin and Bruffen.

8. Early treatment of middle ear disease avoids the

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possibility of damage to the inner ear.

9. Avoid Chinese food Totally (glutamate content).

10. Heavily sweetened breakfast cereals.

11. Avoid Fermented Food.

What foods to be taken during tinnitus: 1. Eat vegetables which contains folate.

2. Diet which contain rich Vitamin B complex.

3. Increase diets rich in omega-3 fats.

4. Magnesium Supplements.

5. High Fiber foods like Spinach, Carrots, Kidney beans.

6. Proteins like eggs, corn.

For no result with Caroverine Capsule :-

perfect programming of hearing aid are vital for this.

2. For those with normal hearing your ENT surgeon may prescribe an alternate medication. Certain combinations are proved to give better results.

3. An alternative option is Tinnitus retraining therapy (TRT).

Your audiologist may explain you better about this. In fact, it is a therapy by which your brain's attention is diverted from Tinnitus, by a specific and established method.

4. Certain foods helps in reduction of Ear ringing - Like Vitamin A, Vitamin D, Iron, Zinc, low salt diet, low sugar diet and Low fat foods are the usual food guidance.

Molecular Structure:

There are many more options available, and these options in combinations give better results.

Caroverine

Optional therapies are:

Glutamate

1. In resistance cases of tinnitus opt Tinnex injection followed by Tinnex capsule for minimum 3 months.

- Caroverine is chemically derived from isoquinoline, the basic structure of papaverin.

2. For those with deafness Programmable digital hearing aid will solve both problems together. It not only improves the hearing but also masks the Tinnitus. Large numbers of patients are benefited this way. Proper selection and

- Caroverine is Glutamate receptor antagonist, Antioxidant as well as Calcium channel blocker.

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Mechanism of Action:

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Continuous Analog wave

Discrete Analog

GP receptor

- Tinnitus as an isolated phenomenon appears to have a particular cause, namely the disturbed interplay of glutamate receptor sub-types which are independent of one another and which have been damaged to different degrees. This disturbed interplay modulates the spontaneous activity of the nerve in such a way that pathological depolarization occur, which simulate the excitation effects of sounds and are misinterpreted centrally as signals from peripheral sounds (Fig.1).

- Selectively binds with NMDA & AMPA receptors at post synapse level thus stabilizes disturbed membrane thereby inner hair cells & outer hair cells starts functioning in a normal physiological way.

Caroverine works as Glutamate Antagonistic effect Ca++ channel blocker effect Potent Free radical Scavenger effect(Antioxidant)

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- Caroverine has similar molecular structure as Glutamate hence Caroverine has high affinity for glutamate receptors and offers glutamate antagonistic effect.

Otoneuroprotective action Drug ½ Life: 2 and half hrs moreover excreted through faeces.

Caroverine in Cochlear Synaptic Tinnitus: Glutamate is likely to act as the neurotransmitter between the IHCs and their afferents. On the postsynaptic afferent dendritic membranes. Two classes of ionotropic glutamate receptor subtypes, i.e. N-methyl-d-aspartate (NMDA) and aamino-3-hydroxy- 5-methyl-4-isoxazone-propionicac id ( A M PA ) r e c e p t o rs , m e d i a t e t h e g l u t a m a t e r g i c neurotransmission. The NMDA and AMPA receptors, which determine the spontaneous and sound-induced depolarization patterns of the auditory nerve, work as a dual receptor system. Under pathological tinnitus-generating conditions, spontaneous, receptor-dependent, afferent depolarization patterns mimic sound-induced patterns, which are subjectively perceived as tinnitus, irrespective of the degree of a possible accompanying hearing loss.

CST, which is regarded as a glutamate receptor linked inner ear disease, may be associated clinically with a wide range of inner ear diseases: presbycusis, sound-induced hearing loss or sudden hearing loss. Caroverine works as competitive AMPA and non competitive NMDA antagonist as well as antioxidant.

Sensorineural Hearing Loss (SNHL) and Tinnitus - Tinnitus is a common symptom in SNHL. Approximately 91% of individuals with SNHL report that they have tinnitus in the 10

affected ear or in both ears. Tinnitus occurs at the same time as hearing loss in some individuals with SSNHL and may be the first symptom before hearing loss. Tinnitus begins some days after the hearing impairment in some individuals. The tinnitus may be caused by sound deprivation caused by the hearing loss, which is known to be able to start central nervous system reorganization processes that can lead to tinnitus and hyperacusis.

- Glutamatergic neurotoxicity is considered to be one of the key pathological factors in SNHL. Caroverine as being glutamate antagonist offers otoneuroprtection which confirms efficacy of caroverine in SNHL. (Rational Pharmacotherapy of the Inner Ear, Page no. 161) Details Tinnex 20 mg Capsules 1 Strip (10Caps) Dosage 2 Caps (at a time) twice a day (Morning & Evening) Before Meal meaning by Total 80 mg to be given at least for 3 Months & up to 6 months, the noticeable results would obtained within 1 month of therapy in some patients.

Indications Tinnitus, Presbycusis, Speech Discrimination, SNHL. Drug interactions Tinnex (Caroverine) to be avoided with frusemide, Lasix, Lasilactone, Digoxine as it may cause hypotension.

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Absolute Contraindications Should not to be given to Kidney Failure Patients.

Approval Status -It has got approved by Indian Authorities e.g., Indian FDA, DCGI (Drug Controller General of India) after all trials & Indian Studies.

-It is not approved by USFDA instead Patented in US by Prof.

Klause Ehrenberger.

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