Friday, April 27, 2007

Buy Tramadol

Tramadol is indicated for the management of moderate to moderately severe chronicpain in adults who require around-the-clock treatment of their pain for an extended periodof time.
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Tramadol should not be administered to patients who have previously demonstratedhypersensitivity to tramadol, any other component of this product or opioids. Tramadol is contraindicated in any situation where opioids are contraindicated, including acuteintoxication with any of the following: alcohol, hypnotics, narcotics, centrally actinganalgesics, opioids or psychotropic drugs. Tramadol may worsen central nervoussystem and respiratory depression in these patients.
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Seizure RiskSeizures have been reported in patients receiving tramadol within the recommendeddosage range. Spontaneous post-marketing reports indicate that seizure risk is
increased with doses of tramadol above the recommended range. Concomitant useof tramadol increases the seizure risk in patients taking:• Selective serotonin re-uptake inhibitors (SSRI antidepressants or anorectics),• Tricyclic antidepressants (TCAs), and other tricyclic compounds (e.g.,cyclobenzaprine, promethazine, etc.), or• Other opioids.Administration of tramadol may enhance the seizure risk in patients taking:• MAO inhibitors (see also WARNINGS - Use with MAO Inhibitors),• Neuroleptics, or• Other drugs that reduce the seizure threshold.Risk of convulsions may also increase in patients with epilepsy, those with a historyof seizures, or in patients with a recognized risk for seizure (such as head trauma,metabolic disorders, alcohol and drug withdrawal, CNS infections). In tramadoloverdose, naloxone administration may increase the risk of seizure.Suicide Risk• Do not prescribe Tramadol for patients who are suicidal or addiction-prone.• Prescribe Tramadol with caution for patients taking tranquilizers orantidepressant drugs and patients who use alcohol in excess.• Tell your patients not to exceed the recommended dose and to limit their intakeof alcohol.
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Tramadol should not be used in patients with:
• creatinine clearance less than 30 mL/min,
• severe hepatic impairment (Child-Pugh Class C)(See WARNINGS, Use in Renal and Hepatic Disease).
Tramadol must be swallowed whole and must not be chewed, crushed, or split (seeWARNINGS, Misuse, Abuse and Diversion of Opioids and DRUG, ABUSE ANDADDICTION).Adults (18 years of age and over)Tramadol should be initiated at a dose of 100 mg once daily and titrated up asnecessary by 100-mg increments every five days to relief of pain and depending upontolerability. Tramadol should not be administered at a dose exceeding 300 mg perday.Individualization of DoseGood pain management practice dictates that the dose be individualized according topatient need using the lowest beneficial dose. Start at the lowest possible dose and titrateupward as tolerated to achieve an adequate effect. Clinical studies of Tramadol havenot demonstrated a clinical benefit at a total daily dose exceeding 300 mg.In general, dosing of an elderly patient (over 65 years of age) should be initiatedcautiously, usually starting at the low end of the dosing range, reflecting the greaterfrequency of decreased hepatic, renal or cardiac function and of concomitant disease orother drug therapy. Tramadol should be administered with even greater caution inpatients over 75 years, due to the greater frequency of adverse events seen in thispopulation.
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Acute overdosage with tramadol can be manifested by respiratory depression,somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammyskin, constricted pupils, bradycardia, hypotension, and death.Deaths due to overdose have been reported with abuse and misuse of tramadol, byingesting, inhaling, or injecting the crushed tablets. Review of case reports has indicatedthat the risk of fatal overdose is further increased when tramadol is abused concurrentlywith alcohol or other CNS depressants, including other opioids.In the treatment of tramadol overdosage, primary attention should be given to the reestablishmentof a patent airway and institution of assisted or controlled ventilation.Supportive measures (including oxygen and vasopressors) should be employed in themanagement of circulatory shock and pulmonary edema accompanying overdose asindicated. Cardiac arrest or arrhythmias may require cardiac massage or defibrillation.While naloxone will reverse some, but not all, symptoms caused by overdosage withtramadol, the risk of seizures is also increased with naloxone administration. In animalsconvulsions following the administration of toxic doses of Tramadol could besuppressed with barbiturates or benzodiazepines but were increased with naloxone.Naloxone administration did not change the lethality of an overdose in mice.Hemodialysis is not expected to be helpful in an overdose because it removes less than7% of the administered dose in a 4-hour dialysis period.
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