Wednesday, October 7, 2009

tramadol, Carisoprodol, Tamiflu, Butalbital Best manufacturer company

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Tramadol Formula : C16H25NO2 Systematic (IUPAC) name
(1R,2R)-rel-2-[(dimethylamino)methyl]- 1-(3-methoxyphenyl)cyclohexanol
Identifiers

CAS number : 27203-92-5
ATC code : N02AX02
PubChem : 33741
DrugBank : APRD00028
ChemSpider : 31105

Chemical data
Formula : C16H25NO2
Mol. mass : 263.4 g/mol
SMILES : eMolecules & PubChem
Pharmacokinetic data
Bioavailability 68–72% Increases with repeated dosing.
Protein binding 20%
Metabolism Hepatic demethylation and glucuronidation
Half life 5–7 hours
Excretion Renal

Tramadol is a centrally acting analgesic, used for treating moderate to severe pain. It is often categorized as an opioid, although it is chemically not related to the opioid class of drugs. It does, however, appear to have agonist actions at the μ-opioid receptor as well as the noradrenergic and serotonergic systems.

Tramadol is used to treat moderate to moderately severe pain and most types of neuralgia, including trigeminal neuralgiaIt has been suggested that tramadol could be effective for alleviating symptoms of depression, anxiety, and phobias because of its action on the noradrenergic and serotonergic systems.However, health professionals have not yet fully endorsed of its use on a large scale for these disorders, although it may be used when other treatments have failed.


tramadol hydrochlorideTramadol is a centrally acting analgesic. The chemical name for tramadol hydrochloride is (±)cis-2-[(dimethylamino)methyl]-1-(3-methoxyphenyr) cyclohexanol hydrochloride.Tramadol hydrochloride is a white, bitter, crystalline and odorless powder. It is readily soluble in water and ethanol and has a pKa of 9.41. The n-octanol/water log partition coefficient (logP) is 1.35 at pH 7.

How should this medicine be used?

Tramadol comes as a tablet and an extended-release (long-acting) tablet to take by mouth. The regular tablet is usually taken with or without food every 4-6 hours as needed. The extended-release tablet should be taken once a day. Take the extended-release tablet at about the same time of day every day, and either always take it with food or always take it without food. Take tramadol exactly as directed. Do not take more medication as a single dose or take more doses per day than prescribed by your doctor. Taking more tramadol than prescribed by your doctor may cause serious side effects or death.

Your doctor may start you on a low dose of tramadol and gradually increase the amount of medication you take, not more often than every 3 days if you are taking the regular tablets or every 5 days if you are taking the extended-release tablets.

Swallow the extended-release tablets whole; do not split, chew, or crush them. Do not snort (inhale powder from crushed tablet) or inject the dissolved extended-release tablets. Taking this medication in a way that is not recommended may cause serious side effects or death.

Tramadol can be habit-forming. Do not take a larger dose, take it more often, or take it for a longer period of time than prescribed by your doctor. Call your doctor if you find that you want to take extra medication or if you notice any other unusual changes in your behavior or mood.

Tramadol side effects
Get emergency medical help if you have any of these signs of an allergic reaction: 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:

* seizure (convulsions);
* a red, blistering, peeling skin rash; or
* shallow breathing, weak pulse.

Less serious side effects may include:

* dizziness, drowsiness, weakness;
* nausea, vomiting, constipation, loss of appetite;
* blurred vision;
* flushing (redness, warmth, or tingly feeling); or
* sleep problems (insomnia).

Availability

Tramadol is usually marketed as the hydrochloride salt (tramadol hydrochloride); the tartrate is seen on rare occasions, and tramadol is available in both injectable (intravenous and/or intramuscular) and oral preparations. It is also available in conjunction with acetaminophen. The solutions suitable for injection are used in Patient-Controlled Analgesia pumps under some circumstances, either as the sole agent or along with another agent such as morphine.

Tramadol comes in many forms, including:

* capsules
* tablets
* extended-release tablets
* extended-release capsules
* chewable tablets
* low-residue and/or uncoated tablets that can be taken by the sublingual and buccal routes
* suppositories
* effervescent tablets and powders
* ampoules of sterile solution for SC, IM, and IV injection
* preservative-free solutions for injection by the various spinal routes (epidural, intrathecal, caudal, and others)
* powders for compounding
* liquids both with and without alcohol for oral and sublingual administration, available in regular phials and bottles, dropper bottles, bottles with a pump similar to those used with liquid soap and phials with droppers built into the cap
* tablets and capsules containing paracetamol (acetaminophen) and aspirin and other agents

Tramadol has been experimentally used in the form of an ingredient in multi-agent topical gels, creams, and solutions for nerve pain, rectal foam, concentrated retention enaema, and a skin plaster (transdermal patch) quite similar to those used with lidocaine.

Veterinary Use

Tramadol is used to treat post-operative, injury-related, and chronic (e.g., cancer-related) pain in dogs and cats [8] as well as rabbits, coatis, many small mammals including rats and flying squirrels, guinea pigs, ferrets, and raccoons. Tramadol comes in ampoules in addition to the tablets, capsules, powder for reconstitution, and oral syrups and liquids; the fact that its characteristic taste is not very bitter and can be masked in food and diluted in water makes for a number of means of administration. No data that would lead to a definitive determination of the efficacy and safety of tramadol in reptiles or amphibians is available at this time, and, following the pattern of all other drugs, it appears that tramadol can be used to relieve pain in marsupials such as North American opossums, Short-Tailed Opossums, sugar gliders, wallabies, and kangaroos among others.

Metabolism

Tramadol undergoes hepatic metabolism via the cytochrome P450 isozyme CYP2D6, being O- and N-demethylated to five different metabolites. Of these, M1 (O-Desmethyltramadol) is the most significant since it has 200 times the μ-affinity of (+)-tramadol, and furthermore has an elimination half-life of nine hours, compared with six hours for tramadol itself. In the 6% of the population that have slow CYP2D6 activity, there is therefore a slightly reduced analgesic effect. Phase II hepatic metabolism renders the metabolites water-soluble, which are excreted by the kidneys. Thus, reduced doses may be used in renal and hepatic impairment.

Tramadol is used to treat post-operative, injury-related, and chronic pain
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Tramadol is a centrally acting analgesic
tramadol pain.



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Fioricet

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Medication Quantity/Description Price(USD) Order

Butalbital/APAP/Caffeine 50/325/40 mg 90 Tabs 65 Butal APAP Caff

Fioricet 50/325/40 mg 90 Tabs 160 Fioricet

Butalbital/APAP/Caffeine(Esgic Plus) 500mg 90 Tabs 70 Esgic Plus

Carisoprodol 350 mg 90 Tablets 70 Carisoprodol

Tramadol 50 mg 180 Tablets 99 Tramadol

Fioricet, ButAPAPCaff, Butalbital/APAP/Caffeine - barbiturate sedative mixed with a non-aspirin pain medication (acetaminophen) and caffeine. This non-narcotic pain medication and relaxant is often prescribed for tension headaches caused by contractions of the muscles in the neck and shoulder area, and migraine.

Esgic Plus, ButAPAPCaffx, Butalbital/APAP/Caffeine - a strong pain reliever and relaxant, is prescribed for the relief of tension headache symptoms caused by muscle contractions in the head, neck, and shoulder area. It combines a sedative barbiturate (butalbital), a non-aspirin pain reliever (acetaminophen), and caffeine.

BUTALBITAL/ACETAMINOPHEN/CAFFEINE is used to treat tension headaches. Acetaminophen helps to decrease the pain from the headache. Caffeine helps increase the effects of acetaminophen. Butalbital is a sedative that helps to decrease anxiety and cause sleepiness and relaxation.

Carisoprodol, Generic Soma is is a muscle relaxant used to treat pain caused by muscle spasms.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.

Tramadol, Generic Ultram is an analgesic used to treat or prevent pain. 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 (INN) (pronounced /ˈtræmədɒl/) (Tramal, Ultram, Mabron, Ralivia, Ryzolt, Tradonal, Tramacet, Tridural, Ultracet, Zamadol, Zydol, Zytram) is a centrally acting analgesic, used for treating moderate to severe pain.

Tramadol was developed by the German pharmaceutical company Grünenthal GmbH in the late 1970s.[1][2]

Tramadol possesses agonist actions at the μ-opioid receptor and affects reuptake at the noradrenergic and serotonergic systems.[3][4][5] Tramadol is a compound with μ-agonist activity.

Tramadol is a synthetic analog of codeine, and, as such, an opioid. Opioids are chemical compounds which agonise one or more of the human opiate receptors, regardless of the receptor class or sub-type. The opioid agonistic effect of tramadol and its major metabolites is almost complete exclusively effects the μ-opioid receptor. This characteristic is notable, because even morphine is not exclusive to the μ-receptor, although it manifests the preponderance of its opioid agonistic effects here.

Uses

Tramadol is used to treat moderate to moderately severe pain and most types of neuralgia, including trigeminal neuralgia.[6] Tramadol is like levorphanol, somewhat, pharmacologically, as both opioids are also NMDA-antagonists which also have SNRI activity. It has been suggested that tramadol could be effective for alleviating symptoms of depression, anxiety, and phobias[7] because of its action on the noradrenergic and serotonergic systems.[8] However, health professionals have not yet fully endorsed its use on a large scale for these disorders, although it may be used when other treatments have failed (under the supervision of a psychiatrist).

[edit] Availability

Tramadol is usually marketed as the hydrochloride salt (tramadol hydrochloride); the tartrate is seen on rare occasions, and tramadol is available in both injectable (intravenous and/or intramuscular) and oral preparations. It is also available in conjunction with acetaminophen. The solutions suitable for injection are used in Patient-Controlled Analgesia pumps under some circumstances, either as the sole agent or along with another agent such as morphine.

Tramadol comes in many forms, including:

* capsules

* tablets

* extended-release tablets

* extended-release capsules

* chewable tablets

* low-residue and/or uncoated tablets that can be taken by the sublingual and buccal routes

* suppositories

* effervescent tablets and powders

* ampoules of sterile solution for SC, IM, and IV injection

* preservative-free solutions for injection by the various spinal routes (epidural, intrathecal, caudal, and others)

* powders for compounding

* liquids both with and without alcohol for oral and sublingual administration, available in regular phials and bottles, dropper bottles, bottles with a pump similar to those used with liquid soap and phials with droppers built into the cap

* tablets and capsules containing paracetamol (acetaminophen) and aspirin and other agents

Tramadol has been experimentally used in the form of an ingredient in multi-agent topical gels, creams, and solutions for nerve pain, rectal foam, concentrated retention enaema, and a skin plaster (transdermal patch) quite similar to those used with lidocaine.

Tramadol has a characteristic taste which is mildly bitter but much less so than morphine and codeine. Oral and sublingual drops and liquid preparations come with and without added flavouring. Its relative effectivness via transmucousal routes (sublingual, buccal, rectal) is around that of codeine, and, like codeine, it is also metabolised in the liver to stronger metabolites (see below).

The maximum dosage for tramadol in any form is 400 mg/day. Certain manufacturers or formulations have lower maximum doses. For example, Ultracet (37.5 mg/325 mg tramadol/APAP tablets) is capped at 8 per day (300 mg/day). Other popular formulations such as Ultram ER are available in 100, 200, and 300 mg/day doses. Patients with impaired liver function or using SSRIs should consult with their doctor regarding adjusted dosing.

[edit] Off-label and investigational uses

* diabetic neuropathy[11][12]

* postherpetic neuralgia[13][14]

* fibromyalgia[15]

* restless legs syndrome[16]

* opiate withdrawal management[17][18]

* migraine headache[19]

* obsessive-compulsive disorder[20]

* premature ejaculation[21]

Veterinary

Tramadol is used to treat post-operative, injury-related, and chronic (e.g., cancer-related) pain in dogs and cats[22] as well as rabbits, coatis, many small mammals including rats and flying squirrels, guinea pigs, ferrets, and raccoons. Tramadol comes in ampoules in addition to the tablets, capsules, powder for reconstitution, and oral syrups and liquids; the fact that its characteristic taste is not very bitter and can be masked in food and diluted in water makes for a number of means of administration. No data that would lead to a definitive determination of the efficacy and safety of tramadol in reptiles or amphibians is available at this time, and, following the pattern of all other drugs, it appears that tramadol can be used to relieve pain in marsupials such as North American opossums, Short-Tailed Opossums, sugar gliders, wallabies, and kangaroos among others.

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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 tramadol if you have ever been addicted to drugs or alcohol.

Seizures (convulsions) have occurred in some people taking tramadol. You may be more likely to have a seizure while taking tramadol 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, or medicine for nausea and vomiting.

Take tramadol exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. Do not take more than 300 milligrams of tramadol in one day.

Seek emergency medical attention if you think you have used too much of this medicine. A tramadol overdose can be fatal. Overdose symptoms of a tramadol overdose may include drowsiness, shallow breathing, slow heartbeat, extreme weakness, cold or clammy skin, feeling light-headed, fainting, or coma. Tramadol may be habit-forming and should be used only by the person it was prescribed for. Tramadol 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. Tramadol 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. Do not stop using tramadol suddenly, or you could have unpleasant withdrawal symptoms such as anxiety, sweating, nausea, diarrhea, tremors, chills, hallucinations, trouble sleeping, or breathing problems. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication. 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 tramadol if you have ever been addicted to drugs or alcohol, if you are currently intoxicated (drunk), or if you have recently used any of the following drugs:

*

alcohol;

*

narcotic pain medicine;

*

sedatives or tranquilizers (such as Valium);

*

medicine for depression or anxiety;

*

medicine for mental illness (such as bipolar disorder, schizophrenia); or

*

street drugs.

Seizures have occurred in some people taking tramadol. Your risk of a seizure may be higher if you have any of these conditions:

*

a history of drug or alcohol addiction;

*

a history of epilepsy or other seizure disorder;

*

a history of head injury;

*

a metabolic disorder; or

*

if you are also taking an antidepressant, muscle relaxer, or medicine for nausea and vomiting.

Talk with your doctor about your individual risk of having a seizure while taking tramadol.

Before taking tramadol, tell your doctor if you are allergic to any drugs, or if you have:

*

kidney disease;

*

liver disease;

*

a stomach disorder; or

*

a history of depression, mental illness, or suicide attempt.

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

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tramadol may also cause serious or fatal side effects in a newborn if the mother uses the medication during pregnancy or labor. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Tramadol 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. Tramadol should not be given to a child younger than 18 years of age.

How should I take tramadol?

Take tramadol exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. Follow the directions on your prescription label. Do not take more than 300 milligrams of tramadol in one day.

Take this medication with a full glass of water.

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

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. Do not crush, chew, break, or open a controlled-release, delayed-release, or extended-release tablet or capsule. Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

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.

Tramadol may be habit-forming. Tell your doctor if you feel the medicine is not working as well in relieving your pain. Do not change your dose without talking to your doctor. Do not stop using tramadol suddenly, or you could have unpleasant withdrawal symptoms such as anxiety, sweating, nausea, diarrhea, tremors, chills, hallucinations, trouble sleeping, or breathing problems. 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 how many pills have been used from each new bottle of this medicine. Tramadol is a drug of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

What happens if I miss a dose?

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 the 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. A tramadol overdose can be fatal.

Overdose symptoms may include drowsiness, shallow breathing, slow heartbeat, extreme weakness, cold or clammy skin, feeling light-headed, fainting, or coma.

What should I avoid while taking tramadol?

Do not drink alcohol while you are taking tramadol. Alcohol may cause a dangerous decrease in your breathing when used together with tramadol. Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by tramadol. Tell your doctor if you regularly use any of these other medicines. Tramadol 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.

Tramadol side effects

Get emergency medical help if you have any of these signs of an allergic reaction: 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:

*

seizure (convulsions);

*

a red, blistering, peeling skin rash; or

*

shallow breathing, weak pulse.

Less serious side effects may include:

*

dizziness, drowsiness, weakness;

*

nausea, vomiting, constipation, loss of appetite;

*

blurred vision;

*

flushing (redness, warmth, or tingly feeling); or

*

sleep problems (insomnia).

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect tramadol?

You may be more likely to have a seizure (convulsions) if you take tramadol while you are using certain other medicines. Do not take tramadol without telling your doctor if you also use any of the following medications:

*

an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), or selegiline (Eldepryl, Emsam); or

*

an antidepressant such as amitriptyline (Elavil), citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), imipramine (Tofranil), nortriptyline (Pamelor); paroxetine (Paxil), or sertraline (Zoloft).

Before taking tramadol, tell your doctor if you also use:

*

carbamazepine (Tegretol);

*

warfarin (Coumadin);

*

digoxin (Lanoxin, Lanoxicaps);

*

ketoconazole (Nizoral);

*

erythromycin (E-Mycin, E.E.S., Ery-Tab);

*

rifampin (Rifadin, Rimactane, Rifater);

*

St. John's wort;

*

quinidine (Quinaglute, Quinadex, Cardioquin, Quinora); or

*

drugs that make you sleepy (such as cold medicine, other pain medications, muscle relaxants, and medicine for seizures, depression or anxiety).

This list is not complete and there may be other drugs that can interact with tramadol. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

* Your pharmacist can provide more information about tramadol.

* Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

* Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

The molecular weight of tramadol hydrochloride is 299.8. Tramadol hydrochloride is a white, bitter, crystalline and odorless powder. It is readily soluble in water and ethanol and has a pKa of 9.41. The n-octanol/water log partition coefficient (logP) is 1.35 at pH 7. ULTRAM tablets contain 50 mg of tramadol hydrochloride and are white in color. Inactive ingredients in the tablet are corn starch, hypromellose, lactose, stearate, microcrystalline cellulose, polyethylene glycol, polysorbate 80, sodium starch glycolate, titanium dioxide and wax.