Q: My family physician has advised me to take Feliz-S Plus (Torrent), which contains Escitalopram-10 mg and Clonazepam-0.5 mg. I have already started the new medicine and I feel better than Xet-12.5. I get a good sleep and the symptoms have slightly improved. Is Feliz-s Plus better than Xet in terms of mode of action? Is long term use of this drug habit forming? Will this drug have side effects on my working since my work requires agile presence of mind and alertness?

A:It is always better, and safer, to give medicines separately rather than in one Fixed-Dose Combination. When given separately, it is possible to titrate dose of individual drugs and also to monitor side effects. Due to lax laws, hundreds of irrational combinations are being sold in India. A combination of Escitalopram with clonazepam is not permitted to be sold in any advanced country. Xet contains Paroxetine, which has the same mode of action as escitalopram. Hence changing from Xet (paroxetine) to escitalopram is not very material and not scientifically very sound. If at all the response to one medicine is not adequate, one needs to replace it with another medicine with a different mode of action. Clonazepam is primarily indicated for epilepsy though it can also be used for panic disorders. It causes drowsiness and decreases altertness; hence driving or operating machinery or other acts needing alertness have to be avoided. If at all this medicine is to be taken, it should be taken in a single dose at bed time.