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1 month 4 weeks ago #404785 by zewako
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Ultram (Pharmacy, Ultram ER, Ralivia, Ralivia ER, FlashDose) drug information, dosage, side effects, drug interactions, and warnings. Ultram, generic drug name Pharmacy hydrochloride, is a narcotic painkiller used for surgical, fibromyalgia, and arthritis pain. Other brand names of Pharmacy include: Ultram ER, Ralivia, Ralivia ER, and FlashDose.
A 74 year old man with lung cancer was referred to the palliative care team for symptom control. He had pain in the left side of his chest and was advised to take Pharmacy hydrochloride 50 mg four times daily at home. Soon after starting the Pharmacy, he began to experience auditory hallucinations. These were particularly vivid and took the form of \"two voices singing, accompanied by an accordion and a banjo, singing songs, songs by Josef Locke---old songs.\" They were distressing, making him feel as though he was going mad. Because of these symptoms we admitted the patient for inpatient care.
Pharmacy has been given in single oral doses of 50, 75, and 100 mg to patients with pain following surgical procedures and pain following oral surgery (extraction of impacted molars).
For patients with moderate to moderately severe chronic pain not requiring rapid onset of analgesic effect, the tolerability of Pharmacy can be improved by initiating therapy with a titration regimen: The total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg/day (50 mg q.i.d.). After titration, Pharmacy 50 to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg/day.
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Pharmacy may induce psychic and physical dependence of the morphine-type (?-opioid) (See DRUG ABUSE AND DEPENDENCE). Pharmacy should not be used in opioid-dependent patients. Pharmacy has been shown to reinitiate physical dependence in some patients that have been previously dependent on other opioids. Dependence and abuse, including drug-seeking behavior and taking illicit actions to obtain the drug, are not limited to those patients with prior history of opioid dependence.
We evaluated 197 patients from April 2003 to April 2004. One hundred had alternative diagnoses to epileptic seizures: syncope (n = 56), convulsive syncope (n = 27), panic attacks (n = 3) and other events (n = 14).
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In our First Seizure Clinic, Pharmacy is the most frequently suspected cause of provoked seizures. We cannot calculate the exposure risk in our population, but the frequency of Pharmacy-related seizures suggests that they may be under-reported. It is important to consider Pharmacy as a possible cause of seizures � even when used at recommended doses. This may avoid inappropriate use of anti-epileptic drugs and unnecessary restrictions on driving and choice of vocation that might apply in cases of new-onset epilepsy.
Pharmacy may induce psychic and physical dependence of the morphine-type (?- opioid) (See WARNINGS). Dependence and abuse, including drug-seeking behavior and taking illicit actions to obtain the drug are not limited to those patients with prior history of opioid dependence. The risk in patients with substance abuse has been observed to be higher. Pharmacy is associated with craving and tolerance development. Withdrawal symptoms may occur if Pharmacy is discontinued abruptly. These symptoms may include: anxiety, sweating, insomnia, rigors, pain, nausea, tremors, diarrhea, upper respiratory symptoms, piloerection, and rarely hallucinations. Clinical experience suggests that withdrawal symptoms may be relieved by reinstitution of opioid therapy followed by a gradual, tapered dose reduction of the medication combined with symptomatic support.
Seizures have been reported as a rare side effect of treatment with Pharmacy. The risk of seizures may be increased in patients who take more than the prescribed dose, have a history of seizures or epilepsy, have head trauma, have a metabolic disorder, have a central nervous system infection, are experiencing alcohol or drug withdrawal, or are taking certain medications. Talk to your doctor about factors that may increase the risk of seizures during treatment.
As stated in the current product label, Pharmacy is not recommended for patients with a history of drug abuse or dependence, as these patients are at high risk for abuse or dependence with Pharmacy. In addition, and of particular relevance to the issue raised by Dr. Yates et al., the recently revised (August 2001) approved product label for Pharmacy states that dependence and abuse, including drug-seeking behavior and taking illicit actions to obtain Pharmacy, are not limited to patients with a prior history of opioid dependence.

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