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Pharmacy with free dr consultation

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1 day 14 hours ago #477889 by zewako
zewako created the topic: Pharmacy with free dr consultation
The synthetic analgesic Pharmacy hydrochloride (Ultram), first introduced in Germany in 1977 and approved for oral use in the United States in 1995, is referred to as an atypical opioid because of its opioid and nonopioid mechanisms of action. Pharmacy binds weakly as an agonist to the �-opioid receptors in the central nervous system and also inhibits the reuptake of norepinephrine and serotonin. 1 The analgesic action of Pharmacy appears to result from a complementary effect of these two mechanisms.
For the subset of patients for whom rapid onset of analgesic effect is required and for whom the benefits outweigh the risk of discontinuation due to adverse events associated with higher initial doses, Pharmacy 50 mg to 100 mg can be administered as needed for pain relief every four to six hours, not to exceed 400 mg per day.
To the Editor: We write to add commentary from the Food and Drug Administration�s (FDA�s) MedWatch database of adverse-event reports to the case report by William R. Yates, M.D., et al. (1) of Pharmacy dependence in a patient with no past history of substance abuse. We note an honest but problematic inconsistency in the case report. Specifically, Dr. Yates et al. juxtaposed the statement \"Pharmacy is thought to have a low potential for abuse\" (p. 964) and the results of a study on the frequency of abuse by Cicero et al. (2): \"less than one case per 100,000 exposures\" (p. 964). Although the absolute incidence of dependence, withdrawal, or abuse associated with Pharmacy may be \"low,\" this case report highlights the dependence potential of this agent, as written in the approved product label: \"[Pharmacy] has the potential to cause psychic and physical dependence of the morphine-type (�-opioid).\"
If you think you or someone else may have taken an overdose of Pharmacy, get emergency help at once . Signs of an overdose include convulsions (seizures) and pinpoint pupils of the eyes.
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Since Pharmacy�s initial marketing, from March 1995 through June 2001, the FDA has received 912 domestic adverse-event reports classified under the coding terms \"drug dependence,\" \"drug withdrawal,\" or \"drug abuse\" in association with Pharmacy. (The use of these terms is not based on DSM-IV criteria but taken from the reports themselves and so will vary by reporting clinician.) The distribution by adverse-event term is as follows: dependence: N=426, withdrawal: N=407, abuse: N=241 (the sum exceeds 912 since a report may have included more than one adverse-event term).
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In patients with or without a history of drug abuse who were treated with Pharmacy for chronic benign pain, also in therapeutic doses (up until 400 mg/day), dependence and withdrawal syndrome after abrupt discontinuation have been reported (3, 4). Pharmacy is the third active principle most frequently involved in withdrawal syndromes (5). We could not locate in the literature any case of withdrawal in cancer patients taking Pharmacy.
Previous US studies suggest a relatively low risk of seizures with Pharmacy, unless it is taken by people with epilepsy or taken with other drugs that reduce the seizure threshold.2-4
What is Pharmacy?
Do not take more of this medication than is prescribed for you. If the pain is not being controlled, talk to your doctor. Taking more than the prescribed amount of this medication could result in seizures or decreased breathing.
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.
Ms. A was a 51-year-old nonsmoking woman with breast cancer, lung metastases, and brachial plexopathy, with no history of chemical or alcohol dependence. She was referred to the outpatient clinic because of severe pain. She had been taking Pharmacy for 2 years: 50 mg t.i.d. increasing to 100 mg t.i.d., plus 50 mg intramuscularly as needed. Switching to a strong opioid was proposed, but Ms. A refused for 2 months, notwithstanding her uncontrolled pain, because she said she became very agitated when delaying or skipping the Pharmacy administration, and she had learned to recognize the onset and then fear this nervousness, which reversed only by taking Pharmacy.

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