Aspirin

Suffering killers for Osteoarthritis Pain

Aspirin -- acetylsalicylic acidity -- is supposed to be to a category of relevant medication known as salicylates. It is available by mouth under many famous brands, such as Anacin, Bayer, Bufferin, Ecotrin, Excedrin, and St. John.

Aspirin reduces gentle pain and high temperature.

Side Results of Pain killers, Aspirin

The most typical adverse side effects of aspirin are abdomen pain, symptoms of heartburn, symptoms of heartburn, nausea or queasiness, and queasiness. Stomach discomfort can cause to sores and blood loss in the abdomen.

You can prevent nausea or queasiness by getting aspirin with meals or use products.

Other possible threats of aspirin include:

allergic side effects (hives, face inflammation, coughing, and asthma)
excessive blood loss and bruising
ringing in the hearing and minor deafness
If you encounter any of these effects, quit getting the treatment and contact your physician.

Arthritis Suffering Relief: When Should You Prevent Aspirin?

You should not take aspirin if you know you are hypersensitive to it. You should also avoid aspirin if you:

have abdomen ulcers
have blood loss problems
are planned for surgery
If you consume more than three alcohol addiction beverages per day, do not take aspirin. Doing so could improve your chance of abdomen irritated and stomach (GI) blood loss. If you have renal or liver organ condition, discuss to your physician before using aspirin.

Using Acetaminophen to Decrease Osteoarthritis Pain



Like aspirin, acetaminophen (Tylenol) is used in many OTC items. And like aspirin, it reduces pain and high temperature.

Acetaminophen is also the component in many items marked "aspirin-free pain reliever" or "non-aspirin pain reducer." To be sure what you are getting in a remedies, study the substances.

Muscle Cramps

Muscle cramps are caused by anything that interferes with a muscle's nutrition,
oxygen supply, and ability to rid itself of carbon dioxide. The flow of blood
through a muscle brings energy food and oxygen and carries away the carbon dioxide.
The combination of energy food and oxygen within the muscle produces muscle power.
The byproduct of this chemical action is carbon dioxide. Which must be promptly
carried away if the muscle is to continue to function. Anything that interfere's
with the flow of blood through a muscle makes it susceptible to cramping.

Overweight, anemia, poor nutrition, varicose veins, or diseases of heart and arteries
may reduce the blood supply to the muscles of the legs. A person troubled with leg
cramps should get a complete physical checkup as a means of determining the cause
of his symptom.

WHAT TO DO

1. Include sufficient milk in each day's diet. Milk contains calcium, which must be
present in the body tissues if the cells are to function normally. Calcium, phosporous,
and sodium are particularly important. Though only one part of calcium to 10,000 parts of
blood is necessary, when this quantity is reduced by onehalf, the muscles become so
irritable that they cramp. A supplement of vitamins and minerals should be taken,
particularly vitamins B,C and D.

2. Develop a program of adequate physical exercise. For the person otherwise robust, walking,
climbing stairs, swimming, golfing, and tennis offer good opportunities to develop a
better supply of blood to the muscles.



Home Treatment For Muscle Cramps & Spasm

The easiest ways to deal with muscle spasm is to have a hot water or shower or do some simple stretch exercises. This will improve blood circulation and help the connective tissue around the muscles. Before you pump up those muscles, hit the showers, it would prevent any occurrence of muscle spasm.

Muscle spasm mainly happens due to calcium deficiency, so include calcium in your diet. You can find good source of calcium in low-fat dairy products such as yoghurt, skim milk and ricotta cheese. Before eating and drinking calcium rich diet, consult your doctor.

If you are prone to muscle spasms it may be because of the acids that interfere with the body's ability to absorb calcium. Lessen the intake of acidic foods like tomatoes and vinegar. Inadequate supply of potassium to your body is another reason for muscle spasms. Increase your intake of potassium, eat good amount of bananas, potatoes, soya flour, bran wheat, ready-to-eat apricots, tomato puree and such.

Do not exert yourself by overusing your muscles. Take it easy for while and relax. Too much of physical exertion takes its toll on the body. Frequent muscle spasms could be the manifestation of this over exertion. If while doing some activity you get a muscle spasm, take a 15 minute break. This prevents muscle spasm in the long run.

Celery seeds have anti-inflammatory properties. It can reduce arthritic pain and relieve muscle spasms. Cramp bark (Viburnum opulus) can be used to treat muscle spasms. Hot and moist herbal packs are very useful in increasing blood circulation. It can treat painful areas by consuming tea or juices to soothe muscles and nerves.

Celebrex

Generic Name: CELECOXIB - ORAL
Pronounced: (sell-eh-COX-ib)

Celebrex

This medication is a nonsteroidal anti-inflammatory drug (NSAID), specifically a COX-2 inhibitor, which relieves pain and swelling (inflammation). It is used to treat arthritis, acute pain, and menstrual pain and discomfort. The pain and swelling relief provided by this medication helps you perform more of your normal daily activities.

If you are treating a chronic condition such as arthritis, ask your doctor about non-drug treatments and/or using other medications to treat your pain. See also Warning section.

This drug works by blocking the enzyme in your body that makes prostaglandins. Decreasing prostaglandins helps to reduce pain and swelling.

Steps in using Celebrex

Step 1

Determine if a condition exists that would benefit from the actions of Celebrex or ibuprofen. "Davis's Drug Guide for Nurses" indicates that both drugs produce effective treatment of pain and inflammation in osteoarthritis, rheumatoid arthritis, irritable bowel disease and ankylosing spondylitis. Celebrex also helps in the management of colorectal polyps and menstrual cramps.

Step 2

Verify if the individual requiring the drug has any health history of stomach problems. COX-1 inhibition produces gastrointestinal or stomach bleeding in some individuals. Since ibuprofen exerts an effect on COX-1, individuals with gastric bleeding must not take ibuprofen.

Step 3

Take Celebrex one to two times a day in oral doses of 100 to 400 mg to treat arthritic and other conditions. Celebrex requires a prescription from a health care provider. The Mayo Clinic reports that the oral Celebrex capsule works only on COX-2 inhibitors to block the chemicals producing pain and inflammation in disease conditions.



What are the precautions when taking celecoxib

Before taking celecoxib, tell your doctor or pharmacist if you are allergic to it; or to aspirin, other NSAIDs (e.g., ibuprofen), other COX-2 inhibitors; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: aspirin-sensitive asthma (a history of worsening breathing with runny/stuffy nose after taking aspirin or other NSAIDs), recent heart bypass surgery (CABG).

Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood flow problem in the brain.

Tramadol

Generic Name: tramadol (TRAM a dol)
Brand names: ConZip, Rybix ODT, Ryzolt, Ultram, Ultram ER

What is tramadol?

Tramadol is a narcotic-like pain reliever.

Tramadol is used to treat moderate to severe pain. Tramadol extended-release is used to treat moderate to severe chronic pain when treatment is needed around the clock.

Tramadol may also be used for other purposes not listed in this medication guide.

Important information about tramadol

You should not take this medication if you are allergic to tramadol, if you have ever been addicted to drugs or alcohol, or if you have ever attempted suicide. Do not take tramadol while you are intoxicated (drunk) or taking any of the following: alcohol or street drugs, narcotic pain medicine, sedatives or tranquilizers, or medicine for depression, anxiety, or mental illness.

Seizures (convulsions) have occurred in some people taking this medicine. Tramadol may be more likely to cause a seizure if you have a history of seizures or head injury, a metabolic disorder, or if you are taking certain medicines such as antidepressants, muscle relaxers, narcotic, or medicine for nausea and vomiting.

Seek emergency medical attention if you think you have used too much of this medicine. A tramadol overdose can be fatal.

Tramadol may be habit-forming and should be used only by the person it was prescribed for. Keep the medication in a secure place where others cannot get to it.

Do not crush the tramadol tablet. This medicine is for oral (by mouth) use only. Powder from a crushed tablet should not be inhaled or diluted with liquid and injected into the body. Using this medicine by inhalation or injection can cause life-threatening side effects, overdose, or death.

Before taking tramadol

You should not take this medication if you are allergic to tramadol, if you have ever been addicted to drugs or alcohol, or if you have ever attempted suicide.

Do not take tramadol while you are intoxicated (drunk) or taking any of the following:

-- alcohol or street drugs;

-- narcotic pain medicine;

-- sedatives or tranquilizers (such as Valium);

-- medicine for depression or anxiety; or

-- medicine for mental illness (such as bipolar disorder, schizophrenia).

How should I take tramadol?

Take tramadol exactly as prescribed. Never take tramadol in larger amounts, or for longer than recommended by your doctor. Follow the directions on your prescription label. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Tramadol can be taken with or without food, but take it the same way each time.

Do not crush, chew, or break a tramadol tablet. Swallow it whole. Breaking the pill may cause too much of the drug to be released at one time. This medicine is for oral (by mouth) use only. Powder from a crushed tablet should not be inhaled or diluted with liquid and injected into the body. Using this medicine by inhalation or injection can cause life-threatening side effects, overdose, or death.

To take tramadol orally disintegrating tablets (Rybix ODT):

-- Keep the tablet in its blister pack until you are ready to take it.

-- Using dry hands, remove the tablet and place it in your mouth. It will begin to dissolve
right away.

-- Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.

-- Swallow several times as the tablet dissolves. If desired, you may drink liquid to help
swallow the dissolved tablet.

If you use the tramadol extended-release tablet, the tablet shell may pass into your stools (bowel movements). This is normal and does not mean that you are not receiving enough of the medicine.

Do not stop using tramadol suddenly, or you could have unpleasant withdrawal symptoms. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication.

Store tramadol at room temperature away from moisture and heat. Keep track of the amount of medicine used from each new bottle. Tramadol is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

Tramadol side effects

Get emergency medical help if you have any of these signs of an allergic reaction to tramadol: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using tramadol and call your doctor at once if you have any of these serious side effects:



-- agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting,
diarrhea, loss of coordination, fainting;

-- seizure (convulsions);

-- a red, blistering, peeling skin rash; or

-- shallow breathing, weak pulse.

Less serious tramadol side effects may include:

-- dizziness, spinning sensation;

-- constipation, upset stomach;

-- headache;

-- drowsiness; or

-- feeling nervous or anxious.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Tramadol Dosing Information

Usual Adult Tramadol Dose for Pain:

For mild to moderate severe chronic pain not requiring rapid onset of analgesic effect:
Initial dose: 25 mg every morning
Titration: increase in 25 mg increments as separate doses every 3 days to reach 100 mg per day taken as 25 mg 4 times per day. Then the total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg per day taken as 50 mg 4 times per day.
Maintenance: After titration, tramadol 50 mg to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg per day.

For the management of moderate to moderately severe chronic pain in adults who require around-the-clock treatment of their pain for an extended period of time:
Extended-Release Tablets:
Initial Dose: 100 mg once daily and titrated up as necessary by 100 mg increments every five days to relief of pain and depending upon tolerability.
Maximum Dose: Extended-release tablets should not be administered at a dose exceeding 300 mg per day.

For patients in 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 dose:
Dose: 50 mg to 100 mg can be administered as needed for pain relief every 4 to 6 hours, not to exceed 400 mg per day.

Carisoprodol

What is carisoprodol?

Carisoprodol is a muscle relaxer that works by blocking pain sensations between the nerves and the brain.

Carisoprodol is used together with rest and physical therapy to treat injuries and other painful musculoskeletal conditions.

Carisoprodol may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about carisoprodol?

This medication may be habit-forming and should be used only by the person it was prescribed for. Carisoprodol should never be given to another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. You may have withdrawal symptoms when you stop using carisoprodol after using it over a long period of time. Do not stop using this medication suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely. Carisoprodol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol. It can increase drowsiness and dizziness caused by carisoprodol.

What should I discuss with my healthcare provider before taking carisoprodol?

Do not use this medication if you are allergic to carisoprodol or meprobamate (Equanil, Miltown), or if you have porphyria.

Before using this medication, tell your doctor if you are allergic to any drugs, or if you have:

-- epilepsy or other seizure disorder;
-- liver disease; or
-- kidney disease.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take carisoprodol.

This medication may be habit-forming and should be used only by the person it was prescribed for. Carisoprodol should never be given to another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. You may have withdrawal symptoms when you stop using carisoprodol after using it over a long period of time. Withdrawal symptoms include stomach pain, sleep problems, headache, nausea, and seizure (convulsions). Do not stop using this medication suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether carisoprodol passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give this medication to a child younger than 12 years old..

Carisoprodol side effects



-- drowsiness, dizziness, tremor;

-- headache;

-- depression, feeling irritable;

-- blurred vision;

-- sleep problems (insomnia); or

-- nausea, vomiting, hiccups, upset stomach.

How should I take carisoprodol?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Take each dose with a full glass of water. Store carisoprodol at room temperature away from moisture and heat.

Methocarbamol

Generic Name: methocarbamol (meth oh KAR ba mal)
Brand names: Robaxin, Robaxin-750, Carbacot, Skelex

What is methocarbamol?

Methocarbamol is a muscle relaxant. It works by blocking nerve impulses (or pain sensations) that are sent to your brain.

Methocarbamol is used together with rest and physical therapy to treat skeletal muscle conditions such as pain or injury.

Methocarbamol may also be used for purposes not listed in this medication guide.

Important information about methocarbamol

You should not use this medication if you are allergic to methocarbamol.
Before using methocarbamol, tell your doctor if you have myasthenia gravis.

You may need to reduce your methocarbamol dose after the first 2 or 3 days of treatment. Follow your doctor's instructions regarding the number of tablets you take each day.

Methocarbamol may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Drinking alcohol can increase certain side effects of this medicine.

Before taking methocarbamol

You should not use this medication if you are allergic to methocarbamol.

Before using methocarbamol, tell your doctor if you have myasthenia gravis.

FDA pregnancy category C. It is not known whether methocarbamol will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether methocarbamol passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take methocarbamol?

Take methocarbamol exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

You may need to reduce your methocarbamol dose after the first 2 or 3 days of treatment. Follow your doctor's instructions regarding the number of tablets you take each day.

Methocarbamol can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using this medicine.

Methocarbamol is only part of a complete program of treatment that may also include rest, physical therapy, or other pain relief measures. Follow your doctor's instructions.

Store at methocarbamol room temperature away from moisture and heat.

What should I avoid while taking methocarbamol?

Methocarbamol may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Drinking alcohol can increase certain side effects of methocarbamol.

What other drugs will affect methocarbamol?

Before using methocarbamol, tell your doctor if you regularly use other medicines that make you sleepy (such as cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can add to sleepiness caused by methocarbamol.

Tell your doctor about all other medicines you use, especially pyridostigmine (Mestinon).

This list is not complete and other drugs may interact with methocarbamol. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Abreva

ABREVA (docosanol)

Company: AVANIR PHARMACEUTICALS
Approval Status: Approved July 2000
Treatment for: oral-facial herpes simplex
Areas: Immune System

General Information

ABREVAeva is a docosanol 10% cream for the topical treatment of recurrent oral-facial herpes simplex episodes (cold sores or fever blisters). The active ingredient is n-docosanol, also known as behenyl alcohol, a saturated 22-carbon aliphatic alcohol which exhibits antiviral activity against many lipid enveloped viruses including herpes simplex virus (HSV).
It is being marketed by SmithKline Beecham and will be available without prescription in the over-the-counter market.

Abreva is the only over-the-counter medication approved by the FDA that is proven to shorten healing time. It contains 10% Docosanol — a unique, patented ingredient that speeds healing and helps protect healthy cells against the cold sore infection. Abreva cold sore treatment penetrates deep to the root of your cold sore to heal it faster.

When you use Abreva at the first tingle, you’ll notice it immediately soothes your cold sore. The medicine goes deep into the skin to strengthen the cell membranes surrounding your healthy skin cells. It actually turns these cells into barriers against the cold sore virus — blocking the virus from entering healthy cells. With Abreva, you’ll get cold sore relief and shorten healing time.

Clinical Results

Two clinic-initiated, double-blind, placebo-controlled multicenter trials of docosanol 10% cream were held to establish its effectiveness in treating recurrent oral-facial herpes simplex. Patients that were otherwise healthy were randomized to either docosanol 10% cream or placebo. The cream was applied at the beginning of an outbreak, before the development of a lesion, five times daily. Total healing occurred when there was no longer evidence of an active lesion.

Studies showed that the average healing time of a recurrent oral-facial herpes simplex episode in the 370 docosanol 10% cream-treated patients was approximately one day shorter than that observed in the 367 placebo treated patients. The noted difference in healing times between the two groups was statistically significant in both trials (p ~ 0.01). In addition to the positive treatment effect for the primary efficacy parameter in the trials, docosanol 10% cream also demonstrated statistically significant reductions - when compared to placebo - in the duration of the important oral-facial herpes simplex associated symptoms of pain and/or burning, itching or tingling (p < 0.03). A subgroup in the trial noted that docosanol stopped cold sore episodes from progressing to the blister stage in 34% of patients who applied it at the early sign of an outbreak (redness) compared to 23% in the equivalent placebo group. Side Effects

Headache was the most common side effect, but it occurred with the same frequency in patients treated with placebo as with docosanol.

Additional Information

Cold sore episodes can be caused by stress, fever, fatigue and exposure to sunlight. Sufferers have reported that they avoid family and friends during outbreaks, which usually last about a week, but can last as long as two weeks. Up to 15 percent of sufferers have reported staying home from work during an outbreak. Due in part to the fact that there have been few effective treatments, only a small percentage of patients seek professional care.

80% of adults in the United States are carriers of the virus that causes cold sores. Every year, 20 to 40 percent of these - more than 50 million adults - develop symptomatic episodes. The number of treatable episodes ranges from 100 to 130 million outbreaks annually, with 70 to 80% of these episodes treated by products in the over-the-counter (OTC) market.

Cialis

What Is Cialis?

Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Urology / Nephrology; Men's health

Tadalafil, known under the brand name Cialis for the treatment of erectile dysfunction and Adcirca for pulmonary arterial hypertension, is a PDE5 inhibitor. Its main competitors are sildenafil citrate (Viagra) and vardenafil (Levitra).

Cialis became nicknamed "the weekend pill" because its effects last 36 hours. Viagra and Levitra are effective for up to 8 hours.

A PDE5 (phosphodiesterase type 5) inhibitor is a medication used to block the degradative action of cyclic GMP (cGMP) in the smooth muscle cells that line the blood vessels that supply the corpus cavernosa (two tubes that run the length of the penis). PDE5 is also present in the smooth muscle of the walls of the arteries within the lungs - hence, it has also been explored for pulmonary hypertension treatment.

Tadalafil was initially researched and developed by the ICOS Corporation, and then later on by Lilly ICOS LLC.

Cialis tablets appear in yellow, film-coated and almond shaped tablets in 5, 10 and 20 mg doses. Cialis for daily use is available as 2.5 mg and 5 mg tablets. Patients with pulmonary arterial hypertension take 2 x 20mg tablets once a day.

Cipla, a pharmaceutical company in India, manufactures and sells tadalafil under the brand name Tadacip.

Cialis was approved by the US FDA (Food and Drug Administration) on 21st November, 2003 for the treatment of erectile dysfunction. In May 2009 tadalafil was approved by the FDA for the treatment of pulmonary arterial hypertension.

Patients with erectile dysfunction take Cialis as needed. It should not be taken more frequently than once every 24 hours. For the medication to work, the man needs to be sexually aroused - it does not provide an instant erection without sexual stimulation.

How does an erection occur? What does Cialis do?

Penile erection occurs when the penis fills with blood. This happens because the blood vessels that bring blood flow to the penis dilate, thus increasing the blood supply. Simultaneously, the blood vessels that remove blood from the penis contract, so that blood accumulates (resulting in an erection).

When a man is sexually stimulated nitric oxide is released into the penis. Nitric oxide makes guanylate cyclase (an enzyme) produce cGMP (cyclic guanosine monophosphate). cGMP controls the dilation and contraction of the blood vessels that carry blood to and from the penis - when those supplying the penis with blood are dilated, and the others that remove blood from the penis are contracted, an erection occurs.

Another enzyme, phosphodiesterase-5 destroys cGMP. When this occurs the blood vessels return to their normal size and the erection ends. Tadalafil stops phosphodiesterase-5 from destroying cGMP, i.e. it prolongs the duration of cGMP, which results in a prolonged and better erection.

Important information about Cialis

Taking Cialis with a nitrate medication can cause a serious and sudden drop in blood pressure (hypotension). Do not take tadalafil if you are on a nitrate drug prescription for heart problems or chest pain.

If during sexual activity you feel dizzy or nauseated, or if you experience numbness, tingling or pain in your jaw, arms, neck or chest, stop and call your doctor immediately. This could be one of Cialis' serious side effects (rare).

If after taking Cialis your erection last more than four hours, or if it is painful, get medical help. Priapism (prolonged erection) can damage the penis.

Cialis can sometimes (rare) undermine the blood flow to the optic nerve of the eye, causing sudden loss of vision. It is more likely to occur if the patient has hypertension, diabetes, high cholesterol, has certain pre-existing eye problems, or heart disease. Experts are not sure whether it is the tadalafil or something else that causes the vision loss.

People with the following conditions should not take Cialis (unless their doctor says it is OK):

- People with heart rhythm problems
- Patients with a recent history of congestive heart failure or stroke (within last list months)
- Those with sickle cell anemia, multiple myeloma, leukemia or another blood cell disorder
- Patients with hemophilia
- People with liver or kidney disease
- Individuals with a stomach ulcer
- Patients with retinitis pigmentosa
- People with Peyronie's disease, or some other structural deformity of the penis
- Those with heart disease
- People who have been advised not to have sexual intercourse for health reasons
- Individuals with Angina, or blood pressure problems (high or low)

Motrin

What is Motrin?

Motrin (ibuprofen) is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause inflammation and pain in the body.

Motrin is used to reduce fever and treat pain or inflammation caused by many conditions such as headache, toothache, back pain, arthritis, menstrual cramps, or minor injury.

Motrin may also be used for purposes not listed in this medication guide.

Important information about Motrin

Motrin may cause life-threatening heart or circulation problems such as heart attack or stroke, especially if you use it long term. Do not use Motrin just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Get emergency medical help if you have chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance.

This medicine may also cause serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and can occur without warning while you are taking Motrin, especially in older adults.

Call your doctor at once if you have symptoms of stomach bleeding such as black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds.

Do not take more Motrin than is recommended. An overdose of ibuprofen can cause damage to your stomach or intestines. Use only the smallest amount of Motrin needed to get relief from your pain, swelling, or fever.

Before taking Motrin

Do not use Motrin just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Motrin may cause life-threatening heart or circulation problems such as heart attack or stroke, especially if you use it long term.

This medicine may also cause serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and can occur without warning while you are taking Motrin, especially in older adults.

You should not use Motrin if you are allergic to ibuprofen, aspirin or other NSAIDs.

Ask a doctor or pharmacist if it is safe for you to take this medication if you have:

-- a history of heart attack, stroke, or blood clot;
-- heart disease, congestive heart failure, high blood pressure;
-- a history of stomach ulcers or bleeding;
-- asthma;
-- polyps in your nose;
-- liver or kidney disease;
-- systemic lupus erythematosus (SLE);
-- a bleeding or blood clotting disorder; or
-- if you smoke.

FDA pregnancy category D. Taking Motrin during the last 3 months of pregnancy may harm the unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using Motrin. It is not known whether ibuprofen passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give Motrin to a child without the advice of a doctor.

How should I take Motrin?

Use Motrin exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

Do not take more Motrin than is recommended. An overdose of ibuprofen can cause damage to your stomach or intestines. The maximum amount of ibuprofen for adults is 800 milligrams per dose or 3200 mg per day (4 maximum doses). Use only the smallest amount of Motrin needed to get relief from your pain, swelling, or fever. Take Motrin with food or milk to lessen stomach upset. Shake the oral suspension (liquid) well just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

The Motrin chewable tablet must be chewed before you swallow it.

If you take Motrin for a long period of time, your doctor may want to check you on a regular basis to make sure this medication is not causing harmful effects. Do not miss any scheduled visits to your doctor.

Store Motrin at room temperature away from moisture and heat. Do not allow the liquid medicine to freeze.

Naprosyn

What is Naprosyn?

Naprosyn is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Naproxen works by reducing hormones that cause inflammation and pain in the body.

Naprosyn is used to treat pain or inflammation caused by conditions such as arthritis, ankylosing spondylitis, tendinitis, bursitis, gout, or menstrual cramps.

Naprosyn may also be used for other purposes not listed in this medication guide.

Important information about Naprosyn

Naprosyn can increase your risk of life-threatening heart or circulation problems, including heart attack or stroke. This risk will increase the longer you use Naprosyn. Do not use Naprosyn just before or after having heart bypass surgery (also called coronary artery bypass graft, or CABG).

Seek emergency medical help if you have symptoms of heart or circulation problems, such as chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance.

Naprosyn can also increase your risk of serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and gastrointestinal effects can occur without warning at any time while you are taking Naprosyn. Older adults may have an even greater risk of these serious gastrointestinal side effects.

Call your doctor at once if you have symptoms of bleeding in your stomach or intestines. This includes black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds.

Do not use any other over-the-counter cold, allergy, or pain medication without first asking your doctor or pharmacist. Many medicines available over the counter contain aspirin or other medicines similar to Naprosyn (such as ibuprofen or ketoprofen). If you take certain products together you may accidentally take too much of this type of medication. Read the label of any other medicine you are using to see if it contains aspirin, ibuprofen, or ketoprofen.

Do not drink alcohol while taking Naprosyn. Alcohol can increase the risk of stomach bleeding caused by Naprosyn. Avoid prolonged exposure to sunlight. Naprosyn can make your skin more sensitive to sunlight, and a sunburn may result.

Before taking Naprosyn

Taking an NSAID, such us Naprosyn, can increase your risk of life-threatening heart or circulation problems, including heart attack or stroke. This risk will increase the longer you use an NSAID. Do not use this medicine just before or after having heart bypass surgery (also called coronary artery bypass graft, or CABG).

NSAIDs can also increase your risk of serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and gastrointestinal effects can occur without warning at any time while you are taking an NSAID. Older adults may have an even greater risk of these serious gastrointestinal side effects.

Do not use Naprosyn if you are allergic to naproxen, or if you have a history of allergic reaction to aspirin or other NSAIDs.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use Naprosyn:

-- a history of heart attack, stroke, or blood clot;

-- heart disease, congestive heart failure, high blood pressure;

-- a history of stomach ulcers or bleeding;

-- liver or kidney disease;

-- asthma;

-- polyps in your nose;

-- a bleeding or blood clotting disorder; or

-- if you smoke.

FDA pregnancy category C. Before using Naprosyn, tell your doctor if you are pregnant or plan to become pregnant during treatment. Taking Naprosyn during the last 3 months of pregnancy may result in birth defects. Do not take Naprosyn during pregnancy unless your doctor has told you to. Naproxen can pass into breast milk and may harm a nursing baby. Do not use Naprosyn without telling your doctor if you are breast-feeding a baby. Do not give this medicine to a child younger than 2 years old without the advice of a doctor.

How should I take Naprosyn?

Take Naprosyn exactly as directed on the label, or as it has been prescribed by your doctor. Do not use the medication in larger amounts, or use it for longer than recommended.

EC-Naprosyn is a slower-acting form of naproxen and this brand should be used only for treating arthritis or ankylosing spondylitis. Follow your doctor's instructions.

Do not crush, chew, or break an enteric-coated Naprosyn tablet. Swallow the pill whole. The enteric-coated pill has a special coating to protect your stomach. Breaking the pill could damage this coating. Shake the oral suspension (liquid) well just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

If you take Naprosyn for a long period of time, your doctor may want to check you on a regular basis to make sure Naprosyn is not causing harmful effects. Do not miss any scheduled visits to your doctor.

Store Naprosyn at room temperature away from moisture and heat.

What happens if I miss a dose?

Since Naprosyn is sometimes taken only when needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include nausea, vomiting, stomach pain, confusion, drowsiness, black or bloody stools, coughing up blood, shallow breathing, fainting, or coma.

What should I avoid while taking Naprosyn?

Do not use any other over-the-counter cold, allergy, or pain medication without first asking your doctor or pharmacist. Many medicines available over the counter contain aspirin or other medicines similar to Naprosyn (such as ibuprofen or ketoprofen). If you take certain products together you may accidentally take too much of this type of medication. Read the label of any other medicine you are using to see if it contains aspirin, ibuprofen, or ketoprofen. Do not drink alcohol while taking Naprosyn. Alcohol can increase the risk of stomach bleeding caused by Naprosyn. Avoid prolonged exposure to sunlight. Naprosyn can make your skin more sensitive to sunlight, and a sunburn may result. Wear protective clothing and use sunscreen (SPF 15 or higher) when you are outdoors.

Ibuprofen

Pronunciation: EYE-bue-PROE-fen
Generic Name: Ibuprofen
Brand Name: Examples include IBU and Motrin

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It may cause an increased risk of serious and sometimes fatal heart and blood vessel problems (eg, heart attack, stroke). The risk may be greater if you already have heart problems or if you take Ibuprofen for a long time. Do not use Ibuprofen right before or after bypass heart surgery.

Ibuprofen may cause an increased risk of serious and sometimes fatal stomach ulcers and bleeding. Elderly patients may be at greater risk. This may occur without warning signs.

Ibuprofen is used for:

Treating rheumatoid arthritis, osteoarthritis, menstrual cramps, or mild to moderate pain. It may also be used for other conditions as determined by your doctor.

Ibuprofen is an NSAID. Exactly how it works is not known. It may block certain substances in the body that are linked to inflammation. NSAIDs treat the symptoms of pain and inflammation. They do not treat the disease that causes those symptoms.

Do NOT use Ibuprofen if:

you are allergic to any ingredient in Ibuprofen
you have had a severe allergic reaction (eg, severe rash, hives, trouble breathing, growths in the nose, dizziness) to aspirin or an NSAID (eg, ibuprofen, celecoxib)
you have recently had or will be having bypass heart surgery
you are in the last 3 months of pregnancy
Contact your doctor or health care provider right away if any of these apply to you.

Before using Ibuprofen:

Some medical conditions may interact with Ibuprofen. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding
if you are taking any prescription or nonprescription medicine, herbal product, or dietary supplement
if you have allergies to medicines, foods, or other substances
if you have a history of kidney or liver disease, diabetes, or stomach or bowel problems (eg, bleeding, perforation, ulcers)
if you have a history of swelling or fluid buildup, lupus, asthma, or growths in the nose (nasal polyps), or mouth inflammation
if you have high blood pressure, blood disorders, bleeding or clotting problems, heart problems (eg, heart failure), or blood vessel disease, or if you are at risk for any of these diseases
if you have poor health, dehydration or low fluid volume, or low blood sodium levels, you drink alcohol, or you have a history of alcohol abuse
Some MEDICINES MAY INTERACT with Ibuprofen. Tell your health care provider if you are taking any other medicines, especially any of the following:

Anticoagulants (eg, warfarin), aspirin, corticosteroids (eg, prednisone), heparin, or selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine) because the risk of stomach bleeding may be increased
Probenecid because it may increase the risk of Ibuprofen's side effects
Cyclosporine, lithium, methotrexate, or quinolones (eg, ciprofloxacin) because the risk of their side effects may be increased by Ibuprofen
Angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril) or diuretics (eg, furosemide, hydrochlorothiazide) because their effectiveness may be decreased by Ibuprofen
This may not be a complete list of all interactions that may occur. Ask your health care provider if Ibuprofen may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Ibuprofen:

Use Ibuprofen as directed by your doctor. Check the label on the medicine for exact dosing instructions.

-- Ibuprofen comes with an extra patient information sheet called a Medication Guide. Read it
carefully. Read it again each time you get Ibuprofen refilled.
-- Take Ibuprofen by mouth with or without food. It may be taken with food if it upsets your
stomach. Taking it with food may not lower the risk of stomach or bowel problems (eg,
bleeding, ulcers). Talk with your doctor or pharmacist if you have persistent stomach upset.
-- Take Ibuprofen with a full glass of water (8 oz/240 mL) as directed by your doctor.
-- If you miss a dose of Ibuprofen and you are taking it regularly, take it as soon as possible.
If it is almost time for your next dose, skip the missed dose. Go back to your regular dosing
schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about the proper use of Ibuprofen.

Important safety information:

-- Ibuprofen may cause dizziness or drowsiness. These effects may be worse if you take it with
alcohol or certain medicines. Use Ibuprofen with caution. Do not drive or perform other
possibly unsafe tasks until you know how you react to it.

-- Serious stomach ulcers or bleeding can occur with the use of Ibuprofen. Taking it in high
doses or for a long time, smoking, or drinking alcohol increases the risk of these side
effects. Taking Ibuprofen with food will NOT reduce the risk of these effects. Contact your
doctor or emergency room at once if you develop severe stomach or back pain; black, tarry
stools; vomit that looks like blood or coffee grounds; or unusual weight gain or swelling.

-- Do NOT take more than the recommended dose or use for longer than prescribed without checking
with your doctor

-- Ibuprofen has ibuprofen in it. Before you start any new medicine, check the label to see if
it has ibuprofen in it too. If it does or if you are not sure, check with your doctor or
pharmacist.

-- Do not take aspirin while you are using Ibuprofen unless your doctor tells you to.

-- PREGNANCY and BREAST-FEEDING: Ibuprofen may cause harm to the fetus. Do not take it during
the last 3 months of pregnancy. If you think you may be pregnant, contact your doctor. You
will need to discuss the benefits and risks of taking Ibuprofen while you are pregnant. It is
not known if Ibuprofen is found in breast milk. Do not breast-feed while taking Ibuprofen.

What is naproxen?

Naproxen is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). It works by reducing hormones that cause inflammation and pain in the body.

Naproxen is used to treat pain or inflammation caused by conditions such as arthritis, ankylosing spondylitis, tendinitis, bursitis, gout, or menstrual cramps.

Naproxen may also be used for other purposes not listed in this medication guide.

Important information about naproxen

Naproxen can increase your risk of life-threatening heart or circulation problems, including heart attack or stroke. This risk will increase the longer you use naproxen. Do not use this medicine just before or after having heart bypass surgery (also called coronary artery bypass graft, or CABG).

Seek emergency medical help if you have symptoms of heart or circulation problems, such as chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance.

Naproxen can also increase your risk of serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and gastrointestinal effects can occur without warning at any time while you are taking naproxen. Older adults may have an even greater risk of these serious gastrointestinal side effects.

Call your doctor at once if you have symptoms of bleeding in your stomach or intestines. This includes black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds.

Do not use any other over-the-counter cold, allergy, or pain medication without first asking your doctor or pharmacist. Many medicines available over the counter contain aspirin or other medicines similar to naproxen (such as ibuprofen or ketoprofen). If you take certain products together you may accidentally take too much of this type of medication. Read the label of any other medicine you are using to see if it contains aspirin, ibuprofen, or ketoprofen. Do not drink alcohol while taking naproxen. Alcohol can increase the risk of stomach bleeding caused by naproxen. Avoid prolonged exposure to sunlight. Naproxen can make your skin more sensitive to sunlight, and a sunburn may result.

Before taking naproxen

Taking an NSAID can increase your risk of life-threatening heart or circulation problems, including heart attack or stroke. This risk will increase the longer you use an NSAID. Do not use Naproxen just before or after having heart bypass surgery (also called coronary artery bypass graft, or CABG).

NSAIDs can also increase your risk of serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and gastrointestinal effects can occur without warning at any time while you are taking an NSAID. Older adults may have an even greater risk of these serious gastrointestinal side effects.

Do not use this medication if you are allergic to naproxen, or if you have a history of allergic reaction to aspirin or other NSAIDs.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use naproxen:

-- a history of heart attack, stroke, or blood clot;

-- heart disease, congestive heart failure, high blood pressure;

-- a history of stomach ulcers or bleeding;

-- liver or kidney disease;
asthma;

-- polyps in your nose;

-- a bleeding or blood clotting disorder; or

-- if you smoke.

FDA pregnancy category C. Before using naproxen, tell your doctor if you are pregnant or plan to become pregnant during treatment. Taking naproxen during the last 3 months of pregnancy may res

ult in birth defects. Do not take this medicine during pregnancy unless your doctor has told you to. Naproxen can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give Naproxen to a child younger than 2 years old without the advice of a doctor.

What is Fioricet?

Fioricet contains a combination of acetaminophen, butalbital, and caffeine. Acetaminophen is a pain reliever and fever reducer.

Butalbital is in a group of drugs called barbiturates. It relaxes muscle contractions involved in a tension headache. Caffeine is a central nervous system stimulant. It relaxes muscle contractions in blood vessels to improve blood flow.

Fioricet is used to treat tension headaches that are caused by muscle contractions.

Fioricet may also be used for purposes not listed in this medication guide.

Important information about Fioricet

Do not use Fioricet if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.
Tell your doctor if you have ever had alcoholic liver disease (cirrhosis) or if you drink more than 3 alcoholic beverages per day. You may not be able to take medicine that contains acetaminophen. Do not take more Fioricet than is recommended. An overdose of acetaminophen can damage your liver or cause death. Ask a doctor or pharmacist before using any other cold, allergy, pain, or sleep medication. Acetaminophen (sometimes abbreviated as APAP) is contained in many combination medicines. Taking certain products together can cause you to get too much acetaminophen which can lead to a fatal overdose. Check the label to see if a medicine contains acetaminophen or APAP.

Avoid drinking alcohol. It may increase your risk of liver damage while taking Fioricet due to the acetaminophen component.

Before taking Fioricet

Do not use Fioricet if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects. Tell your doctor if you have ever had alcoholic liver disease (cirrhosis) or if you drink more than 3 alcoholic beverages per day. You may not be able to take medicine that contains acetaminophen. You should not take Fioricet if you are allergic to acetaminophen, butalbital, or caffeine, or if you have porphyria.

To make sure you can safely take Fioricet, tell your doctor if you have any of these other conditions:

kidney disease,

liver disease; or

a history of mental illness or suicidal thoughts.

Butalbital may be habit forming and should be used only by the person it was prescribed for. Never share Fioricet with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

FDA pregnancy category C. It is not known whether Fioricet will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Acetaminophen, butalbital, and caffeine can pass into breast milk and may harm a nursing baby. Do not use Fioricet without telling your doctor if you are breast-feeding a baby.

TRAMADOL - SUMMARY

EXECUTIVE SUMMARY





Tramadol is a centrally acting synthetic analgesic of the aminocyclohexanol group with opioid-like effects. Its mode of action is not completely understood but it appears to act by modifying
transmission of pain impulses via inhibition of noradrenaline and serotonin re-uptake and also by weakly binding to mu-opioid receptors.

In Australia it is marketed under the trade name Tramadol and is available as capsules (50mg),
sustained release tablets (100mg, 150mg, 200mg) and ampoules (100mg/2ml) for relief of moderate
to severe pain.On the basis of published evidence, tramadol appears to have reasonable dose related efficacy in comparison with other opioid analgesics, with a relative lack of respiratory depression, major organ toxicity or abuse potential.Because of its side-effect profile in comparison with other analgesics, tramadol may have a role in patients who are intolerant of conventional opioid and other non-opioid analgesics, those who have pre-existing cardiopulmonary disease, such as the elderly or obese, and those in whom codeine use is inappropriate. In the acute and post-operative settings, it may have a place in multi-modal analgesia, where opioid and non-opioid drugs are given in combination to achieve analgesia, with a reduction in the incidence and severity of side effects. Similarly, in chronic pain conditions, tramadol may be considered (as a single agent or in combination) where non-opioid analgesics have proven ineffective or where multimodal therapy might be advantageous in order to limit side-effects (eg where a reduction in NSAID dosage is desirable). The reduced constipating effect of tramadol compared with other opioids may be useful in patients with chronic cancer pain, although nausea may be a dose-limiting side-effect and sustained-release morphine is more effective in severe cancer pain. Because of its extended duration of effect, the sustained release formulation may provide convenience in ambulatory patients with chronic pain. However, studies of long-term use have not yet been reported and the potential for serious drug-drug interactions with tramadol should not be under-estimated.

As a single agent, tramadol’s place in therapy is likely to be limited by both cost and tolerability (particularly nausea). In the majority of patients it offers few advantages at considerable additional cost. However, it may be a useful alternative to other analgesics in selected patients with moderate to severe pain.

TRAMADOL-CLINICAL USE

CLINICAL USE





Publications reporting the clinical use of tramadol are numerous. A number of reviews of the
clinical use of tramadol have also been published.

Intra-operative and Post-operative Analgesia

Comparison with placebo

A pooled analysis of 9 single-dose, double-blind, randomised, placebo-controlled studies
included a total of 1594 patients with post-operative pain following caesarean section or general surgical procedures. Analysis showed that analgesic efficacy of tramadol at doses equal to or greater than 50mg was superior to that of placebo (statistical value not reported). Likewise, pooled analysis of 9 double-blind, randomised studies involving 1859 patients with dental extraction pain evaluated single oral doses of tramadol ranging from 50mg to 200mg. Analysis demonstrated a significantly greater efficacy for tramadol than for placebo at all doses evaluated. (The majority of these studies have not been published.) A subsequent meta-analysis of these 18 studies confirmed the effectiveness of tramadol in comparison with placebo and demonstrated a significant dose response. Multi-dose studies have also demonstrated a superior effect of oral tramadol over placebo in both pain after dental extraction and pain after orthopaedic surgery.

Comparison with morphine

Tramadol (up to 3 doses of 50mg iv) was compared with morphine (up to 3 doses of 5mg iv) over 6
hours in a double-blind, randomised study of 150 patients after gynaecological surgery. In those patients who reported moderate pain, the two drugs were equally effective. However, morphine was
superior in patients starting with severe pain. Respiratory depression (as measured by oxygen
desaturation) occurred in 13% of the morphine group but not at all in the tramadol group. Sedationand nausea were also more common in the morphine group.

Comparison with pethidine

Tramadol was compared to pethidine in 30 patients undergoing gynaecological surgery. Using
patient controlled analgesia during the first 24 hours post-operatively, tramadol was demonstratedto be of equivalent potency to pethidine. Mean 24 hour consumption of tramadol was 642mg (SD190mg, range 180-840mg) and for pethidine 606mg (SD 172mg, range 360-780mg). The estimate of relative potency of tramadol to pethidine was 0.94 (95% CI: 0.72-1.17).

In a randomised study in 50 patients presenting for caesarean section under spinal anaesthesia with lignocaine 25, tramadol 1.5mg/kg was as effective as pethidine 1mg/kg intramuscularly. There was no significant difference in side effects between the two groups, including neonatal APGAR scores.

Chronic Pain

Tramadol has been included as a step 2 analgesic in the second edition of the World Health
Organisation’s recommendations for treatment of cancer pain.
Twenty cancer patients with strong pain unresponsive to previous pain treatment were randomised
to receive oral tramadol or morphine solution in a randomised, double-blind, cross-over study.
Doses were individually titrated and cross-over occurred on day 4. Pain scores were similar on day 4, although pain scores were higher in the tramadol group on days 1 and 2. There was a statistically significant reduction in side-effects (particularly nausea and constipation) with tramadol.

There was no significant difference in analgesic efficacy between the two groups. Antiemetics, laxatives, neuroleptics and steroids were prescribed significantly more frequently in the morphine group; the use of other adjuvants was similar in both groups. Constipation, neuropsychological symptoms and pruritus were observed significantly more frequently with low dose morphine. Other symptoms had similar frequencies in both groups.

Oral tramadol was evaluated in a double-blind study over a 4 week period in 390 patients over 65
years of age with chronic pain due to a variety of conditions. Patients were initially treated with either tramadol 50mg orally or paracetamol/codeine 300mg/30mg and were then allowed to titrate the dose according to pain severity to a total of eight capsules per day. Mean pre-treatment pain intensities were moderate for both groups. At the end of the study, average daily doses were 244mg of tramadol and 1,407mg/140.7mg of paracetamol/codeine.

Both treatments were rated as good, very good or excellent by 55% of patients in each group. There was no significant difference in the incidence of adverse effects in each group, but adverse effects resulted in discontinuation in a significantly higher proportion of patients taking tramadol (18.8% vs 9.6%, p<0.05).

Oral tramadol (100mg eighth hourly) was compared with a fixed dose combination of paracetamol/codeine (1000mg/60mg eighth hourly) in a randomised, double-blind cross-over study
in 55 patients suffering from refractory chronic back pain.Efficacy was similar in the two arms.
Although the combination analgesic was reported by the authors as better tolerated than tramadol, the difference was not statistically significant.

TRAMADOL BACKGROUND

BACKGROUND





Tramadol is a centrally acting, synthetic analgesic of the aminocyclohexanol group, which has
opioid-like effects

1. It has been in clinical use in Europe since the late 1970s

2. Its mode of action is not completely understood but it appears to have a dual mechanism of
action, which involves inhibition of re-uptake of serotonin (5-HT) and/or noradrenaline as
well as weak affinity for opioid (mu) receptors

3. Since tramadol does not affect prostaglandin synthesis, it does not have antipyretic
or anti-inflammatory effects
4. In Australia, tramadol is marketed under the trade name Tramal
and is available as capsules (50mg), sustained-release tablets (100mg, 150mg, 200mg) and
ampoules (100mg/2ml). It is approved for oral, intravenous (iv) and intramuscular (im)
administration for relief of moderate to severe pain. (Government subsidy for the immediate
and sustained-release formulations is limited to use for pain where aspirin and/or
paracetamol alone are inappropriate or have failed.) In Australia it is not recommended for
use in children, although in other countries, licence for use in children over
the age of one year exists.
5 Tramadol has high oral bioavailability

6. Tramadol is extensively metabolised
the production of the only known active metabolite, M1
(mono-o-desmethyltramadol) is dependent on the CYP2D6 isoenzyme of the cytochrome P-450
enzyme system and hepatic impairment results in decreased metabolism of both the parent
compound and the active metabolite

7. Patients who metabolise drugs poorly via CYP2D6 may
obtain reduced benefit from tramadol due to reduced formation of M11. However, there is still
measurable analgesia with tramadol in these patients, in contrast to the complete lack of
analgesic efficacy with codeine in such patients (7% of Caucasians are poor metabolisers)
In such patients there may be an argument for using tramadol as an alternative to codeine

8. Tramadol causes a minor delay in colonic transit, but has no effect on upper gastrointestinal
transit or gut smooth muscle tone

9. It has no significant effect on the Sphincter of Oddi or intrabiliary
pressure and it has weak spasmolytic properties

10.The recommended dose for moderate to severe pain is 50-100mg every four to six hours (or 100-
200mg twice daily for the sustained-release formulation), to a maximum daily dosage of 400mg
for oral therapy or 600mg parenterally.