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Free FedEx overnight delivery on all orders. Save now and on all your refills. Cost plus a small processing fee. Diethylpropion HCl CR 75mg (Gen.Tenuate Dospan) (30 - 24 hr. tabs) 19.88 Diethylpropion HCl CR 75mg (Gen.Tenuate Dospan) (60 - 24 hr. tabs) 38.88 Diethylpropion HCl CR 75mg (Gen.Tenuate Dospan) (90 - 24 hr. tabs) 56.88 Tenuate Dospan 75mg (30 - 24 hr. tabs) 48.88 Tenuate Dospan 75mg (60 - 24 hr. tabs) 88.88 Tenuate Dospan 75mg (90 - 24 hr. tabs) 128.88 IMPORTANT NOTE: The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using this drug. APPETITE SUPPRESSANTS - ORAL COMMON BRAND NAME(S): Fastin, Ionamin, Plegine, Prelu-2, Sanorex, Tenuate USES: This medication is used in combination with a diet plan to help you reduce weight. HOW TO USE: This medication is best taken on an empty stomach one hour before meals. Sustained-release or long acting products must be swallowed whole. Crushing or chewing them will destroy the long action and may cause increased side effects. Because this medication may cause sleeplessness, avoid taking a dose late in the day. Take this medication as prescribed. Do not take it more often or longer than directed. It is usually taken for 8 to 12 weeks. Use in combination with other appetite suppressant medicine is generally not recommended. Consult your doctor before such use. SIDE EFFECTS: Blurred vision, dizziness, dry mouth, sleeplessness, irritability, stomach upset or constipation may occur the first few days as your body adjusts to the medication. If these effects persist or become bothersome, inform your doctor. Notify your doctor if you experience: chest pain, nervousness, pounding heart, difficulty urinating, mood changes, breathing difficulties, swelling. If this medication makes you dizzy or lightheaded, avoid driving or engaging in activities requiring alertness. If you notice other effects not listed above, contact your doctor or pharmacist. PRECAUTIONS: Tell your doctor your complete medical history, especially if you have: high blood pressure, an over-active thyroid, glaucoma, diabetes, emotional problems. This medication can be habit forming and must be used with caution. Alcohol can increase unwanted side effects of dizziness. Limit alcohol use. This drug is not recommended for use in children. Consult your doctor or pharmacist for further information. This medication should be used only when clearly needed during pregnancy. Discuss the risk and benefits with your doctor. This drug may be excreted into breast milk. You may have to stop nursing or stop using this drug. Consult your doctor before breast-feeding. DRUG INTERACTIONS: Inform your doctor about all the medicines you use, (prescription and nonprescription) especially if you take: high blood pressure medicine, MAO inhibitors (e.g., furazolidone, linezolid, phenelzine, selegiline, tranylcypromine), any other weight loss medicine. Avoid "stimulant" drugs that may increase your heart rate such as decongestants or caffeine. Decongestants are commonly found in over-the-counter cough-and-cold medicines. Do not start or stop any medicine without doctor or pharmacist approval. OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include restlessness, fever, fast breathing, dizziness, confusion, hallucinations, panic or paranoid, drowsiness, convulsions, unconsciousness, unusually fast or slow heart beat, headache, nausea/vomiting, diarrhea, stomach pain, pale or flushing, chest pain, sweating, muscle weakness, agitation, large pupils, or delusions. NOTES: Appetite suppressants are not a substitute for proper diet. For maximum effects, this must be used in conjunction with a diet and exercise program. Do not share this medication with others. MISSED DOSE: If you miss a dose, do not double the next dose. Instead, skip the missed dose and resume your usual dosing schedule. STORAGE: Store at room temperature away from sunlight and moisture. Do not store in the bathroom. Health News Is Prescription Tenuate® right for you? by Sally LoBriglio We have discussed lots of topics in the ConsumerHealthDigest.com weight loss forum—diet, exercise, stress, anxiety, pms, menopause, depression, diabetes, high blood pressure, heart disease. But one topic that is sure to turn up week after week is appetite suppression. So many people just cannot gain control over their appetite, and we now know that more than just will-power is required to fight the battle of the bulge –and win. Unfortunately, human beings have been hard-wired with large appetites for the purpose of increasing the chance of survival in ancient times. In times of scarcity, this trait was necessary for the survival of our ancestors. However, in modern times, where most of us encounter an excess of accessible, relatively inexpensive, calorically dense foods, this trait causes considerably more harm than good. Large appetites, combined with the excess accessibility of inexpensive, calorically dense foods, unfortunately for us, is a formula for disaster. Obesity has reached epidemic proportions in the U.S. and continues to grow in size and severity. And we know that obesity leads to cardiovascular disease, hypertension, and diabetes, as well as a number of other serious health conditions which can have drastic implications. So what can we do on our end to silence the call of our ravenous, often out of control appetites and finally put an end to weight gain? In light of the recent obesity epidemic, a number of products have appeared on the market aimed at weight loss and appetite suppression. These products include vitamin, mineral, and herbal supplements, as well as prescription pharmaceutical medications which can only be obtained under a doctor’s recommendation. A solution may now be available for you. By using an appetite suppressant, and finding ways to restore normal, balanced eating habits, it may be possible to lose weight as well as the stress of dieting through willpower alone, and get your life back on track. Prescription Drug Tenuate® Diethylpropion hydrochloride, generic name for the appetite suppressant Tenuate®. Tenuate® is indicated only for the short-term (few weeks) management of obesity. Tolerance to the appetite suppressant effects usually develops within a few weeks, at which time the drug will become ineffective and use should be discontinued. Caution should be used, as Tenuate® has been implicated in increasing seizures in epileptic patients. It may also cause a symptomatic heart disease such as heart rhythm disturbances. Tenuate® is related chemically and pharmacologically to the amphetamines. The use of amphetamines and related drugs may be associated with intense psychological dependence and severe social dysfunction. Discontinued use may result in withdrawal-like symptoms including extreme fatigue and depression. Side effects may also include skin abnormalities, insomnia, irritability, hyperactivity, personality changes, and psychosis. Are there alternatives? Non-Prescription All Natural Appetite Suppressants What makes a non-prescription appetite suppressant product so appealing? Is it the all natural and non-physically addictive properties? Prescription products pose the risk for too many potential side effects and drug interactions. The elite non-prescription products contain thermogenic ingredients which support weight loss through not only one, but dual mechanisms: 1: suppress the appetite 2: increase metabolic rate and the number of calories burned You might not need to resort to prescription strength drugs to achieve your weight loss goals. All natural supplements can support a safe and effective weight loss regimen. Natural supplements give you an excellent alternative to prescription strength appetite suppression drugs. These products have limited side effects, less drug interactions, and are less expensive than alot of the prescription strength appetite suppressants available on the market today. Unlike prescription appetite suppressants, alternative therapies can be used with a greater amount of safety and ease. What is the best all natural appetite suppressant on the market today? We reviewed over 50 different all natural appetite suppressants on the market today. At the conclusion of our research, we found Lipovarin™, manufactured by Sterling Grant Laboratories, demonstrates overall safety and effective weight loss results at a reasonable cost. That is why we have rated it Consumer Health Digest's Best Buy! Buy Here Product Name Lipovarin™ ThermaLean-RX™ Leptoprin-SF™ Manufacturer Sterling Grant Laboratories MedaBiotics AG Waterhouse Lowest Price Found $49.97 $49.99 $153.00 Overall Score 96/100 94/100 91/100 CHD Product Rating Results Lipovarin™ ThermaLean-RX™ Leptoprin-SF™ Total Score 96pts 94pts 91pts Rate It Rate It Rate It Buy TenuateTenuate is an appetite suppressant used to treat obesity during the first few weeks of a weight-loss program. It is helpful for weight-loss while you are learning new ways to eat and to exercise. Drug Dosage Quantity Price Buy Diethylpropion [Tenuate] 75mg 30 tablets $119.00 Diethylpropion [Tenuate] 75mg 60 tablets $159.00 Diethylpropion [Tenuate] 75mg 90 tablets $189.00 DISCLAIMER This information is not intended to substitute for professional medical advice. Be sure to contact your physician, pharmacist or other health care provider for more information about this medication. Diethylpropion HCl CR 75mg (Gen.Tenuate Dospan) (30 - 24 hr. tabs) 27.94 Diethylpropion HCl CR 75mg (Gen.Tenuate Dospan) (60 - 24 hr. tabs) 45.94 Diethylpropion HCl CR 75mg (Gen.Tenuate Dospan) (90 - 24 hr. tabs) 64.94 Tenuate Dospan 75mg (30 - 24 hr. tabs) 41.94 Tenuate Dospan 75mg (60 - 24 hr. tabs) 78.94 Tenuate Dospan 75mg (90 - 24 hr. tabs) 112.94 IMPORTANT NOTE: The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using this drug. APPETITE SUPPRESSANTS - ORAL COMMON BRAND NAME(S): Fastin, Ionamin, Plegine, Prelu-2, Sanorex, Tenuate USES: This medication is used in combination with a diet plan to help you reduce weight. HOW TO USE: This medication is best taken on an empty stomach one hour before meals. Sustained-release or long acting products must be swallowed whole. Crushing or chewing them will destroy the long action and may cause increased side effects. Because this medication may cause sleeplessness, avoid taking a dose late in the day. Take this medication as prescribed. Do not take it more often or longer than directed. It is usually taken for 8 to 12 weeks. Use in combination with other appetite suppressant medicine is generally not recommended. Consult your doctor before such use. SIDE EFFECTS: Blurred vision, dizziness, dry mouth, sleeplessness, irritability, stomach upset or constipation may occur the first few days as your body adjusts to the medication. If these effects persist or become bothersome, inform your doctor. Notify your doctor if you experience: chest pain, nervousness, pounding heart, difficulty urinating, mood changes, breathing difficulties, swelling. If this medication makes you dizzy or lightheaded, avoid driving or engaging in activities requiring alertness. If you notice other effects not listed above, contact your doctor or pharmacist. PRECAUTIONS: Tell your doctor your complete medical history, especially if you have: high blood pressure, an over-active thyroid, glaucoma, diabetes, emotional problems. This medication can be habit forming and must be used with caution. Alcohol can increase unwanted side effects of dizziness. Limit alcohol use. This drug is not recommended for use in children. Consult your doctor or pharmacist for further information. This medication should be used only when clearly needed during pregnancy. Discuss the risk and benefits with your doctor. This drug may be excreted into breast milk. You may have to stop nursing or stop using this drug. Consult your doctor before breast-feeding. DRUG INTERACTIONS: Inform your doctor about all the medicines you use, (prescription and nonprescription) especially if you take: high blood pressure medicine, MAO inhibitors (e.g., furazolidone, linezolid, phenelzine, selegiline, tranylcypromine), any other weight loss medicine. Avoid "stimulant" drugs that may increase your heart rate such as decongestants or caffeine. Decongestants are commonly found in over-the-counter cough-and-cold medicines. Do not start or stop any medicine without doctor or pharmacist approval. OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include restlessness, fever, fast breathing, dizziness, confusion, hallucinations, panic or paranoid, drowsiness, convulsions, unconsciousness, unusually fast or slow heart beat, headache, nausea/vomiting, diarrhea, stomach pain, pale or flushing, chest pain, sweating, muscle weakness, agitation, large pupils, or delusions. NOTES: Appetite suppressants are not a substitute for proper diet. For maximum effects, this must be used in conjunction with a diet and exercise program. Do not share this medication with others. MISSED DOSE: If you miss a dose, do not double the next dose. Instead, skip the missed dose and resume your usual dosing schedule. STORAGE: Store at room temperature away from sunlight and moisture. Do not store in the bathroom. BONTRIL, PHENDIMETRAZINE $15 MERIDIA $93 ADIPEX $49 DIDREX $40 XENICAL $56 PHENTERMINE $12 TENUATE, DIETHYLPROPION $41 IONAMIN $56 www.frontierpharmacies.com All Prescriptions filled by a U.S. Licensed Pharmacy Drug Strength Quantity Price Status Pharmacy Info TENUATE 25 mg 90 * $59.00 In Stock TENUATE 75 mg 30 * $45.00 In Stock TENUATE 75 mg 60 * $90.00 In Stock TENUATE 75 mg 90 * $149.00 In Stock * indicates generic Additional Information Why is this medication prescribed Diethylpropion decreases appetite. It is used on a short-term basis (a few weeks), in combination with diet, to help you lose weight. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information. What other information should I know Keep all appointments with your doctor. Your doctor may order certain tests to check your response to diethylpropion. Diethylpropion may affect blood sugar levels of diabetic patients and may cover up some signs and symptoms of hypoglycemia (low blood sugar). If you notice a change in the results of your urine or blood sugar tests, check with your doctor. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. In case of emergency overdose In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. ________________ Tenuate Sales Tenuate Sales - check out our low prices Tenuate Sales works hard to deliver to you the lowest possible prices available online for the prescription medication tenuate. You'll be glad you visited because the prices are rock bottom for this incredibly popular weight loss medication! Featured Pharmacy - Worldwide Shipping - LOW price Active Medicinal Ingredients: Tenuate Brand Names: Tenuate Notes: The substance tenuate helps overweight individuals lose weight, in conjunction with a weight loss plan and good exercise program. Tenuate activates in your body by suppressing your appetite, making you feel less hunger. Tenuate is intended as a short-term supplement to a good diet and exercise program for the treatment of obesity. This medicine is an appetite suppressant used along with diet, exercise, and behavior therapy for the short-term management of obesity. Diethylpropion HCl CR 75mg (Gen.Tenuate Dospan) (30 - 24 hr. tabs) 27.98 Diethylpropion HCl CR 75mg (Gen.Tenuate Dospan) (60 - 24 hr. tabs) 45.98 Diethylpropion HCl CR 75mg (Gen.Tenuate Dospan) (90 - 24 hr. tabs) 64.98 Tenuate Dospan 75mg (30 - 24 hr. tabs) 41.98 Tenuate Dospan 75mg (60 - 24 hr. tabs) 78.98 Tenuate Dospan 75mg (90 - 24 hr. tabs) 112.98 IMPORTANT NOTE: The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using this drug. COMMON BRAND NAME(S): Fastin, Ionamin, Plegine, Prelu-2, Sanorex, Tenuate USES: This medication is used in combination with a diet plan to help you reduce weight. HOW TO USE: This medication is best taken on an empty stomach one hour before meals. Sustained-release or long acting products must be swallowed whole. Crushing or chewing them will destroy the long action and may cause increased side effects. Because this medication may cause sleeplessness, avoid taking a dose late in the day. Take this medication as prescribed. Do not take it more often or longer than directed. It is usually taken for 8 to 12 weeks. Use in combination with other appetite suppressant medicine is generally not recommended. Consult your doctor before such use. SIDE EFFECTS: Blurred vision, dizziness, dry mouth, sleeplessness, irritability, stomach upset or constipation may occur the first few days as your body adjusts to the medication. If these effects persist or become bothersome, inform your doctor. Notify your doctor if you experience: chest pain, nervousness, pounding heart, difficulty urinating, mood changes, breathing difficulties, swelling. If this medication makes you dizzy or lightheaded, avoid driving or engaging in activities requiring alertness. If you notice other effects not listed above, contact your doctor or pharmacist. PRECAUTIONS: Tell your doctor your complete medical history, especially if you have: high blood pressure, an over-active thyroid, glaucoma, diabetes, emotional problems. This medication can be habit forming and must be used with caution. Alcohol can increase unwanted side effects of dizziness. Limit alcohol use. This drug is not recommended for use in children. Consult your doctor or pharmacist for further information. This medication should be used only when clearly needed during pregnancy. Discuss the risk and benefits with your doctor. This drug may be excreted into breast milk. You may have to stop nursing or stop using this drug. Consult your doctor before breast-feeding. DRUG INTERACTIONS: Inform your doctor about all the medicines you use, (prescription and nonprescription) especially if you take: high blood pressure medicine, MAO inhibitors (e.g., furazolidone, linezolid, phenelzine, selegiline, tranylcypromine), any other weight loss medicine. Avoid "stimulant" drugs that may increase your heart rate such as decongestants or caffeine. Decongestants are commonly found in over-the-counter cough-and-cold medicines. Do not start or stop any medicine without doctor or pharmacist approval. OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include restlessness, fever, fast breathing, dizziness, confusion, hallucinations, panic or paranoid, drowsiness, convulsions, unconsciousness, unusually fast or slow heart beat, headache, nausea/vomiting, diarrhea, stomach pain, pale or flushing, chest pain, sweating, muscle weakness, agitation, large pupils, or delusions. NOTES: Appetite suppressants are not a substitute for proper diet. For maximum effects, this must be used in conjunction with a diet and exercise program. Do not share this medication with others. MISSED DOSE: If you miss a dose, do not double the next dose. Instead, skip the missed dose and resume your usual dosing schedule. STORAGE: Store at room temperature away from sunlight and moisture. Do not store in the bathroom. TENUATE® (diethylpropion hydrochloride) is a sympathomimetic amine, which is similar to an amphetamine. It is also known as an "anorectic" or an "anorexigenic" drug. Tenuate stimulates the central nervous system (nerves and brain), which increases your heart rate and blood pressure and decreases your appetite. Tenuate is used as a short-term supplement to diet and exercise in the treatment of obesity. Trusted Online Drug Store is dedicated to making your prescription order as easy, quick and private as possible. 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Our hours are now 8:00am-5:00pm EST Tenuate® Uses This medicine is an appetite suppressant used along with diet, exercise, and behavior therapy for the short-term management of obesity. How To Take This Medication Follow the directions for using this medicine provided by your doctor. Take this medicine about 30 minutes to 1 hour before meals. Take your last dose of the day at least 4 to 6 hours before bedtime. Side Effects Side effects, that may go away during treatment, include restlessness, nervousness, difficulty sleeping, or dry mouth. If they continue or are bothersome, check with your doctor. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist. Precautions Do not exceed the recommended dose or take this medicine for longer than prescribed without checking with your doctor. Exceeding the recommended dose or taking this medicine for longer than prescribed may cause serious side effects. Keep all doctor and laboratory appointments while you are using this medicine. Before you begin taking any new medicine, either prescription or over-the-counter, check with your doctor or pharmacist. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to this medicine. Before you have any medical or dental treatments, emergency care, or surgery, tell the doctor or dentist that you are using this medicine. For women: this medicine is excreted in breast milk. If you are or will be breast-feeding while you are using this medicine, check with your doctor or pharmacist to discuss the risks to your baby. If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose include restlessness, tremor, rapid breathing, nausea, vomiting, diarrhea, and stomach cramps. Drug Interactions Some medicines or medical conditions may interact with this medicine. Inform your doctor or pharmacist of all prescription and over-the-counter medicine that you are taking. Do not use this medicine if you are also taking guanadrel, guanethidine, furazolidone, or monoamine oxidase inhibitors (MAOIs). Inform your doctor of any other medical conditions, allergies, pregnancy, or breast-feeding. Use of this medicine is not recommended if you have a history of heart disease, high blood pressure, hyperthyroidism, glaucoma, atherosclerosis, or brain or spinal cord disorders. Contact your doctor or pharmacist if you have any questions or concerns about using this medicine. Notes Do not share this medicine with others for whom it was not prescribed. Do not use this medicine for other health conditions. Keep this medicine out of the reach of children. Missed Dosage If you miss a dose of this medicine, take it as soon as possible. If it is after 4 pm, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. Storage Store this medicine at room temperature in a tightly-closed container, away from heat and light. Tenuate, an appetite suppressant, is prescribed for short-term use (a few weeks) as part of an overall diet plan for weight reduction. It is available in two forms: immediate-release tablets (Tenuate) and controlled-release tablets (Tenuate Dospan). Tenuate should be used with a behavior modification program. -------------------------------------------------------------------------------- Tenuate will lose its effectiveness within a few weeks. When this begins to happen, you should discontinue the medicine rather than increase the dosage. -------------------------------------------------------------------------------- How should you take this medication? Return to top Take this medication exactly as prescribed. Tenuate may be habit-forming and can be addicting. If you are taking Tenuate Dospan (the controlled release formulation), do not crush or chew the tablets. Swallow the medication whole. --If you miss a dose... If you are taking the immediate-release form of Tenuate, go back to your regular schedule at the next meal. If you are taking Tenuate Dospan, take the missed dose as soon as you remember. If you do not remember until the next day, skip the dose. Never take 2 doses at once. --Storage instructions... Store at room temperature in a tightly closed container. Protect from excessive heat. -------------------------------------------------------------------------------- What side effects may occur? Return to top Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue using Tenuate. Side effects may include: Abdominal discomfort, abnormal redness of the skin, anxiety, blood pressure elevation, blurred vision, breast development in males, bruising, changes in sex drive, chest pain, constipation, depression, diarrhea, difficulty with voluntary movements, dizziness, drowsiness, dryness of the mouth, feelings of discomfort, feelings of elation, feeling of illness, hair loss, headache, hives, impotence, inability to fall or stay asleep, increased heart rate, increased seizures in epileptics, increased sweating, increased volume of diluted urine, irregular heartbeat, jitteriness, menstrual upset, muscle pain, nausea, nervousness, overstimulation, painful urination, palpitations, pupil dilation, rash, restlessness, shortness of breath or labored breathing, stomach and intestinal disturbances, tremors, unpleasant taste, vomiting -------------------------------------------------------------------------------- Why should this drug not be prescribed? Return to top If you are sensitive to or have ever had an allergic reaction to Tenuate or other appetite suppressants, you should not take this medication. Make sure your doctor is aware of any drug reactions you have experienced. Do not take this drug if you have severe hardening of the arteries, an overactive thyroid, glaucoma, or severe high blood pressure, or if you are agitated, have a history of drug abuse or are taking an MAO inhibitor (antidepressant drug such as Nardil) or have taken one within the last 14 days. -------------------------------------------------------------------------------- Special warnings about this medication Return to top Tenuate or Tenuate Dospan may impair your ability to engage in potentially hazardous activities. Therefore, make sure you know how you react to this medication before you drive, operate dangerous machinery, or do anything else that requires alertness or concentration. If you have heart disease or high blood pressure, use caution when taking this medication. This drug may increase convulsions in some epileptics. Your doctor should monitor you carefully if you have epilepsy. Psychological dependence has occurred while taking this drug. Talk with your doctor if you find you are relying on this drug to maintain a state of well-being. The abrupt withdrawal of this medication following prolonged use at high doses may result in extreme fatigue, mental depression, and sleep disturbances. -------------------------------------------------------------------------------- Possible food and drug interactions when taking this medication Return to top Tenuate or Tenuate Dospan may interact with alcohol unfavorably. Do not drink alcohol while taking this medication. If Tenuate or Tenuate Dospan is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important that you consult your doctor before combining Tenuate with the following: Blood pressure medications such as Ismelin Insulin Phenothiazine drugs such as the major tranquilizer Thorazine -------------------------------------------------------------------------------- Special information if you are pregnant or breastfeeding Return to top The effects of Tenuate or Tenuate Dospan during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, inform your doctor immediately. This drug appears in breast milk. If the medication is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished. The usual dosage is one 25-milligram tablet taken 3 times a day, 1 hour before meals; you may take 1 tablet in the middle of the evening, if you want, to overcome night hunger. 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SOMA (WATSON BRAND) Soma Indications This medicine is used with rest and physical therapy to treat acute, painful muscle conditions Contraindications Do not take this medication if - you are allergic to any ingredient of this medicine ... more Soma Tablets (carisoprodol) Tablets, USP DESCRIPTION `SOMA' (carisoprodol) Tablets, USP is available as 350 mg round, white tablets. Chemically, carisoprodol is N-isopropyl-2- methyl-2-propyl-1,3-propanediol dicarbamate. Carisoprodol is a white, crystalline powder, having a mild, characteristic odor and a bitter taste. It is very slightly soluble in water; freely soluble in alcohol, in chloroform, and in acetone; its solubility is practically independent of pH. Carisoprodol is present as a racemic mixture. The molecular formula is C 12 H 24 N 2 O 4 , with a molecular weight of 260.33. The structural formula is: Other ingredients: alginic acid, magnesium stearate, potassium sorbate, starch, tribasic calcium phosphate. ACTIONS Carisoprodol produces muscle relaxation in animals by blocking interneuronal activity in the descending reticular formation and spinal cord. The onset of action is rapid and effects last four to six hours. INDICATIONS Carisoprodol is indicated as an adjunct to rest, physical therapy, and other measures for the relief of discomfort associated with acute, painful musculoskeletal conditions. The mode of action of this drug has not been clearly identified, but may be related to its sedative properties. Carisoprodol does not directly relax tense skeletal muscles in man. CONTRAINDICATIONS Acute intermittent porphyria as well as allergic or idiosyncratic reactions to carisoprodol or related compounds. WARNINGS Idiosyncratic Reactions --On very rare occasions, the first dose of carisoprodol has been followed by idiosyncratic symptoms appearing within minutes or hours. Symptoms reported include: extreme weakness, transient quadriplegia, dizziness, ataxia, temporary loss of vision, diplopia, mydriasis, dysarthria, agitation, euphoria, confusion, and disorientation. Symptoms usually subside over the course of the next several hours. Supportive and symptomatic therapy, including hospitalization, may be necessary. Usage in Pregnancy and Lactation --Safe usage of this drug in pregnancy or lactation has not been established. Therefore, use of this drug in pregnancy, in nursing mothers, or in women of childbearing potential requires that the potential benefits of the drug be weighed against the potential hazards to mother and child. Carisoprodol is present in breast milk of lactating mothers at concentrations two to four times that of maternal plasma. This factor should be taken into account when use of the drug is contemplated in breast-feeding patients. Usage in Children --Because of limited clinical experience, `SOMA' is not recommended for use in patients under 12 years of age. Potentially Hazardous Tasks --Patients should be warned that this drug may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving a motor vehicle or operating machinery. Additive Effects --Since the effects of carisoprodol and alcohol or carisoprodol and other CNS depressants or psychotropic drugs may be additive, appropriate caution should be exercised with patients who take more than one of these agents simultaneously. Drug Dependence --In dogs, no withdrawal symptoms occurred after abrupt cessation of carisoprodol from dosages as high as 1 gm/kg/day. In a study in man, abrupt cessation of 100 mg/kg/day (about five times the recommended daily adult dosage) was followed in some subjects by mild withdrawal symptoms such as abdominal cramps, insomnia, chilliness, headache, and nausea. Delirium and convulsions did not occur. In clinical use, psychological dependence and abuse have been rare, and there have been no reports of significant abstinence signs. Nevertheless, the drug should be used with caution in addiction-prone individuals. PRECAUTIONS Carisoprodol is metabolized in the liver and excreted by the kidney; to avoid its excess accumulation, caution should be exercised in administration to patients with compromised liver or kidney function. ADVERSE REACTIONS Central Nervous System --Drowsiness and other CNS effects may require dosage reduction. Also observed: dizziness, vertigo, ataxia, tremor, agitation, irritability, headache, depressive reactions, syncope, and insomnia. (See also Idiosyncratic Reactions under "Warnings." ) Allergic or Idiosyncratic --Allergic or idiosyncratic reactions occasionally develop. They are usually seen within the period of the first to fourth dose in patients having had no previous contact with the drug. Skin rash, erythema multiforme, pruritus, eosinophilia, and fixed drug eruption with cross reaction to meprobamate have been reported with carisoprodol. Severe reactions have been manifested by asthmatic episodes, fever, weakness, dizziness, angioneurotic edema, smarting eyes, hypotension, and anaphylactoid shock. (See also Idiosyncratic Reactions under "Warnings." ) In case of allergic or idiosyncratic reactions to carisoprodol, discontinue the drug and initiate appropriate symptomatic therapy, which may include epinephrine, antihistamines, and in severe cases corticosteroids. In evaluating possible allergic reactions, also consider allergy to excipients (information on excipients is available to physicians on request). Cardiovascular --Tachycardia, postural hypotension, and facial flushing. Gastrointestinal --Nausea, vomiting, hiccup, and epigastric distress. Hematologic --Leukopenia, in which other drugs or viral infection may have been responsible, and pancytopenia, attributed to phenylbutazone, have been reported. No serious blood dyscrasias have been attributed to carisoprodol. DOSAGE AND ADMINISTRATION The usual adult dosage of `SOMA' (carisoprodol) Tablets, USP is one 350 mg tablet, three times daily and at bedtime. Usage in patients under age 12 is not recommended. OVERDOSAGE Overdosage of carisoprodol has produced stupor, coma, shock, respiratory depression, and, very rarely, death. The effects of an overdosage of carisoprodol and alcohol or other CNS depressants or psychotropic agents can be additive even when one of the drugs has been taken in the usual recommended dosage. Any drug remaining in the stomach should be removed and symptomatic therapy given. Should respiration or blood pressure become compromised, respiratory assistance, central nervous system stimulants, and pressor agents should be administered cautiously as indicated. Carisoprodol is metabolized in the liver and excreted by the kidney. Although carisoprodol overdosage experience is limited, the following types of treatment have been used successfully with the related drug meprobamate: diuresis, osmotic (mannitol) diuresis, peritoneal dialysis, and hemodialysis (carisoprodol is dialyzable). Careful monitoring of urinary output is necessary and caution should be taken to avoid overhydration. Observe for possible relapse due to incomplete gastric emptying and delayed absorption. Carisoprodol can be measured in biological fluids by gas chromatography (Douglas, J. F. et al.: J Pharm Sci 58: 145, 1969). HOW SUPPLIED `SOMA' (carisoprodol) Tablets, USP 350 mg: Round, convex, white tablets, inscribed with `SOMA' on one side and 37-WALLACE 2001 on the other side, are available in bottles of 100 (NDC 0037-2001-01) and 500 (NDC 0037-2001-03), and unit-dose packages of 100 (NDC 0037-2001-85). PRODUCT PHOTO(S): NOTE: These photos can be used only for identification by shape, color, and imprint. They do not depict actual or relative size. The product samples shown here have been supplied by the manufacturer and reproduced in full color by PDR as a quick-reference identification aid. While every effort has been made to assure accurate reproduction, please remember that any visual identification should be considered preliminary. In cases of poisoning or suspected overdosage, the drug's identity should be verified by chemical analysis. The information contained in the Thomson Healthcare (Micromedex) products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you. The use of the Thomson Healthcare products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Thomson Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Healthcare does not assume any responsibility or risk for your use of the Thomson Healthcare products. Are your Dyslexic? Great info on Dyslexia diagnosis, symptoms & treatments. infoscouts.com Lorazepam-Reviewed Is Lorazepam the right prescription medicine for you? Find out. ConsumerHealthDigest.com "Are you dizzy ?" You may have Labyrinthitis Find treatment and remedy options InfoForYourHealth.com Soma (Carisoprodol) on Sale Now 90 tabs $84, 180 tabs just $159. Free FedEx. Order online now. ApexOnlinePharmacy.com. www.apexonlinepharmacy.com (sponsored listing) Soma Premium tickets - lower prices. 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La aspirin actъa reduciendo las substancias en el cuerpo que causan dolor e inflamaciуn. S... Soma Compound La aspirin estб en la clase de drogas llamada salicilatos. Aspirin actъa reduciendo sustancias en el cuerpo que causan inflamaciуn y dolor. Se usa pa... aspirin y carisoprodol La aspirin estб en la clase de drogas llamada salicilatos. Aspirin actъa reduciendo sustancias en el cuerpo que causan inflamaciуn y dolor. Se usa pa... Vanadom Carisoprodol es un relajante para los mъsculos. Йste actъa bloqueando los impulsos de los nervios (o sensaciones de dolor) que se mandan al cerebro. aspirin/carisoprodol/codeine La aspirin estб en la clase de drogas llamada salicilatos. La aspirin actъa reduciendo las substancias en el cuerpo que causan dolor e inflamaciуn. S... carisoprodol Carisoprodol es un relajante para los mъsculos. Йste actъa bloqueando los impulsos de los nervios (o sensaciones de dolor) que se mandan al cerebro. PDR Drug information for Soma Compound w/Codeine Tablets (carisoprodol, aspirin and codeine phosphate tablets, USP) carisoprodol 200 mg + aspirin 325 mg + codeine phosphate 16 mg--Warning: May be habit-forming TABLETS DESCRIPTION `Soma' Compound with Codeine is a combination product containing carisoprodol, a centrally-acting muscle relaxant, plus aspirin, an analgesic with antipyretic and anti-inflammatory properties and codeine phosphate, a centrally-acting narcotic analgesic. It is available as a two-layered, white and yellow, oval-shaped tablet for oral administration. Each tablet contains carisoprodol 200 mg, aspirin 325 mg, and codeine phosphate 16 mg. Chemically, carisoprodol is N-isopropyl-2-methyl-2-propyl-1,3-propanediol dicarbamate. Its empirical formula is C 12 H 24 N 2 O 4 , with a molecular weight of 260.33. The structural formula is: Other ingredients: croscarmellose sodium, D&C Yellow #10, hydroxypropyl methylcellulose, magnesium stearate, microcrystalline cellulose, povidone, sodium metabisulfite, starch, stearic acid. CLINICAL PHARMACOLOGY Carisoprodol: Carisoprodol is a centrally-acting muscle relaxant that does not directly relax tense skeletal muscles in man. The mode of action of carisoprodol in relieving acute muscle spasm of local origin has not been clearly identified, but may be related to its sedative properties. In animals, carisoprodol has been shown to produce muscle relaxation by blocking interneuronal activity and depressing transmission of polysynaptic neurons in the spinal cord and in the descending reticular formation of the brain. The onset of action is rapid and lasts four to six hours. Carisoprodol is metabolized in the liver and is excreted by the kidneys. It is dialyzable by peritoneal and hemodialysis. Aspirin: Aspirin is a non-narcotic analgesic with anti-inflammatory and antipyretic activity. Inhibition of prostaglandin biosynthesis appears to account for most of its anti-inflammatory and for at least part of its analgesic and antipyretic properties. Aspirin is rapidly absorbed and almost totally hydrolyzed to salicylic acid following oral administration. Although aspirin has a half-life of only about 15 minutes, the apparent biologic half-life of salicylic acid in the therapeutic plasma concentration range is between 6 and 12 hours. Salicylic acid is eliminated by renal excretion and by biotransformation to inactive metabolites. Clearance of salicylic acid in the high-dose range is sensitive to urinary pH (see Drug Interactions ) and is reduced by renal dysfunction. Codeine Phosphate: Codeine phosphate is a centrally-acting narcotic-analgesic. Its actions are qualitatively similar to morphine, but its potency is substantially less. Clinical studies have shown that combining aspirin and codeine produces a significant additive effect in analgesic efficacy. INDICATIONS AND USAGE `Soma' Compound with Codeine is indicated as an adjunct to rest, physical therapy, and other measures for the relief of pain, muscle spasm, and limited mobility associated with acute, painful musculoskeletal conditions when the additional action of codeine is desired. CONTRAINDICATIONS Acute intermittent porphyria; bleeding disorders; allergic or idiosyncratic reactions to carisoprodol, aspirin, codeine, or related compounds. WARNINGS On very rare occasions, the first dose of carisoprodol has been followed by idiosyncratic reactions, with symptoms appearing within minutes or hours. These may include extreme weakness, transient quadriplegia, dizziness, ataxia, temporary loss of vision, diplopia, mydriasis, dysarthria, agitation, euphoria, confusion, and disorientation. Although symptoms usually subside over the course of the next several hours, discontinue `Soma' Compound with Codeine and initiate appropriate supportive and symptomatic therapy, which may include epinephrine and/or antihistamines. In severe cases, corticosteroids may be necessary. Severe reactions have been manifested by asthmatic episodes, fever, weakness, dizziness, angioneurotic edema, smarting eyes, hypotension, and anaphylactoid shock. The effects of carisoprodol with agents such as alcohol, other CNS depressants, or psychotropic drugs may be additive. Appropriate caution should be exercised with patients who take one or more of these agents simultaneously with Soma Compound with Codeine. Contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than in nonasthmatic people. PRECAUTIONS General: To avoid excessive accumulation of carisoprodol, aspirin, or their metabolites, use `Soma' Compound with Codeine with caution in patients with compromised liver or kidney function, or in elderly or debilitated patients (see CLINICAL PHARMACOLOGY ). Use with caution in patients with history of gastritis or peptic ulcer, in patients on anticoagulant therapy, and in addiction-prone individuals. Information for Patients: Caution patients that this drug may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving a motor vehicle or operating machinery. Caution patients with a predisposition for gastrointestinal bleeding that concomitant use of aspirin and alcohol may have an additive effect in this regard. Caution patients that dosage of medications used for gout, arthritis, or diabetes may have to be adjusted when aspirin is administered or discontinued (see Drug Interactions ). Each enteric, film-coated, controlled-release tablet contains paroxetine hydrochloride equivalent to paroxetine as follows: 12.5 mg-yellow, 25 mg-pink, 37.5 mg-blue. One layer of the tablet consists of a degradable barrier layer and the other contains the active material in a hydrophilic matrix. Inactive ingredients consist of hypromellose, polyvinylpyrrolidone, lactose monohydrate, magnesium stearate, colloidal silicon dioxide, glyceryl behenate, methacrylic acid copolymer type C, sodium lauryl sulfate, polysorbate 80, talc, triethyl citrate, and 1 or more of the following colorants: Yellow ferric oxide, red ferric oxide, D&C Red No. 30, D&C Yellow No. 6, D&C Yellow No. 10, FD&C Blue No. 2. CLINICAL PHARMACOLOGY Pharmacodynamics: The efficacy of paroxetine in the treatment of major depressive disorder, panic disorder, social anxiety disorder, and premenstrual dysphoric disorder (PMDD) is presumed to be linked to potentiation of serotonergic activity in the central nervous system resulting from inhibition of neuronal reuptake of serotonin (5-hydroxy-tryptamine, 5-HT). Studies at clinically relevant doses in humans have demonstrated that paroxetine blocks the uptake of serotonin into human platelets. In vitro studies in animals also suggest that paroxetine is a potent and highly selective inhibitor of neuronal serotonin reuptake and has only very weak effects on norepinephrine and dopamine neuronal reuptake. In vitro radioligand binding studies indicate that paroxetine has little affinity for muscarinic, alpha 1 -, alpha 2 -, beta-adrenergic-, dopamine (D 2 )-, 5-HT 1 -, 5-HT 2 -, and histamine (H 1 )-receptors; antagonism of muscarinic, histaminergic, and alpha 1 -adrenergic receptors has been associated with various anticholinergic, sedative, and cardiovascular effects for other psychotropic drugs. Because the relative potencies of paroxetine's major metabolites are at most 1/50 of the parent compound, they are essentially inactive. Pharmacokinetics: Tablets of PAXIL CR contain a degradable polymeric matrix (GEOMATRIX™) designed to control the dissolution rate of paroxetine over a period of approximately 4 to 5 hours. In addition to controlling the rate of drug release in vivo, an enteric coat delays the start of drug release until tablets of PAXIL CR have left the stomach. Paroxetine hydrochloride is completely absorbed after oral dosing of a solution of the hydrochloride salt. In a study in which normal male and female subjects (n = 23) received single oral doses of PAXIL CR at 4 dosage strengths (12.5 mg, 25 mg, 37.5 mg, and 50 mg), paroxetine C max and AUC 0-inf increased disproportionately with dose (as seen also with immediate-release formulations). Mean C max and AUC 0-inf values at these doses were 2.0, 5.5, 9.0, and 12.5 ng/mL, and 121, 261, 338, and 540 ng·hr./mL, respectively. T max was observed typically between 6 and 10 hours post-dose, reflecting a reduction in absorption rate compared with immediate-release formulations. The mean elimination half-life of paroxetine was 15 to 20 hours throughout this range of single doses of PAXIL CR. The bioavailability of 25 mg PAXIL CR is not affected by food. During repeated administration of PAXIL CR (25 mg once daily), steady state was reached within 2 weeks (i.e., comparable to immediate-release formulations). In a repeat-dose study in which normal male and female subjects (n = 23) received PAXIL CR (25 mg daily), mean steady state C max , C min , and AUC 0-24 values were 30 ng/mL, 20 ng/mL, and 550 ng·hr./mL, respectively. Based on studies using immediate-release formulations, steady-state drug exposure based on AUC 0-24 was several-fold greater than would have been predicted from single-dose data. The excess accumulation is a consequence of the fact that 1 of the enzymes that metabolizes paroxetine is readily saturable. In steady-state dose proportionality studies involving elderly and nonelderly patients, at doses of the immediate-release formulation of 20 mg to 40 mg daily for the elderly and 20 mg to 50 mg daily for the nonelderly, some nonlinearity was observed in both populations, again reflecting a saturable metabolic pathway. In comparison to C min values after 20 mg daily, values after 40 mg daily were only about 2 to 3 times greater than doubled. Social Anxiety Disorder: Usual Initial Dosage: PAXIL CR should be administered as a single daily dose, usually in the morning, with or without food. The recommended initial dose is 12.5 mg/day. Patients were dosed in a range of 12.5 mg to 37.5 mg/day in the clinical trial demonstrating the effectiveness of PAXIL CR in the treatment of social anxiety disorder. If the dose is increased, this should occur at intervals of at least 1 week, in increments of 12.5 mg/day, up to a maximum of 37.5 mg/day. Patients should be cautioned that PAXIL CR should not be chewed or crushed, and should be swallowed whole. Maintenance Therapy: There is no body of evidence available to answer the question of how long the patient treated with PAXIL CR should remain on it. Although the efficacy of PAXIL CR beyond 12 weeks of dosing has not been demonstrated in controlled clinical trials, social anxiety disorder is recognized as a chronic condition, and it is reasonable to consider continuation of treatment for a responding patient. Dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for continued treatment. nsure an adequate airway, oxygenation, and ventilation. Monitor cardiac rhythm and vital signs. General supportive and symptomatic measures are also recommended. Induction of emesis is not recommended. Gastric lavage with a large-bore orogastric tube with appropriate airway protection, if needed, may be indicated if performed soon after ingestion, or in symptomatic patients. Activated charcoal should be administered. Due to the large volume of distribution of this drug, forced diuresis, dialysis, hemoperfusion, and exchange transfusion are unlikely to be of benefit. No specific antidotes for paroxetine are known. A specific caution involves patients taking or recently having taken paroxetine who might ingest excessive quantities of a tricyclic antidepressant. In such a case, accumulation of the parent tricyclic and an active metabolite may increase the possibility of clinically significant sequelae and extend the time needed for close medical observation (see PRECAUTIONS -- Drugs Metabolized by Cytochrome P 450 IID 6 ). In managing overdosage, consider the possibility of multiple-drug involvement. The physician should consider contacting a poison control center for additional information on the treatment of any overdose. Telephone numbers for certified poison control centers are listed in the Physicians' Desk Reference (PDR). DOSAGE AND ADMINISTRATION Major Depressive Disorder: Usual Initial Dosage: PAXIL CR should be administered as a single daily dose, usually in the morning, with or without food. The recommended initial dose is 25 mg/day. Patients were dosed in a range of 25 mg to 62.5 mg/day in the clinical trials demonstrating the effectiveness of PAXIL CR in the treatment of major depressive disorder. As with all drugs effective in the treatment of major depressive disorder, the full effect may be delayed. Some patients not responding to a 25-mg dose may benefit from dose increases, in 12.5-mg/day increments, up to a maximum of 62.5 mg/day. Dose changes should occur at intervals of at least 1 week. Patients should be cautioned that PAXIL CR should not be chewed or crushed, and should be swallowed whole. Maintenance Therapy: There is no body of evidence available to answer the question of how long the patient treated with PAXIL CR should remain on it. It is generally agreed that acute episodes of major depressive disorder require several months or longer of sustained pharmacologic therapy. Whether the dose of an antidepressant needed to induce remission is identical to the dose needed to maintain and/or sustain euthymia is unknown. Systematic evaluation of the efficacy of immediate-release paroxetine hydrochloride has shown that efficacy is maintained for periods of up to 1 year with doses that averaged about 30 mg, which corresponds to a 37.5-mg dose of PAXIL CR, based on relative bioavailability considerations (see CLINICAL PHARMACOLOGY -- Pharmacokinetics ). Panic Disorder: Usual Initial Dosage: PAXIL CR should be administered as a single daily dose, usually in the morning. Patients should be started on 12.5 mg/day. Dose changes should occur in 12.5-mg/day increments and at intervals of at least 1 week. Patients were dosed in a range of 12.5 to 75 mg/day in the clinical trials demonstrating the effectiveness of PAXIL CR. The maximum dosage should not exceed 75 mg/day. Patients should be cautioned that PAXIL CR should not be chewed or crushed, and should be swallowed whole. Maintenance Therapy: Long-term maintenance of efficacy with the immediate-release formulation of paroxetine was demonstrated in a 3-month relapse prevention trial. In this trial, patients with panic disorder assigned to immediate-release paroxetine demonstrated a lower relapse rate compared to patients on placebo. Panic disorder is a chronic condition, and it is reasonable to consider continuation for a responding patient. Dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for continued treatment. Switching Patients to or From a Monoamine Oxidase Inhibitor: At least 14 days should elapse between discontinuation of an MAOI and initiation of therapy with PAXIL CR. Similarly, at least 14 days should be allowed after stopping PAXIL CR before starting an MAOI. Discontinuation of Treatment With PAXIL CR: Symptoms associated with discontinuation of immediate-release paroxetine hydrochloride or PAXIL CR have been reported (see PRECAUTIONS ). Patients should be monitored for these symptoms when discontinuing treatment, regardless of the indication for which PAXIL CR is being prescribed. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate. GEOMATRIX is a trademark of Jago Pharma, Muttenz, Switzerland. PRODUCT PHOTO(S): NOTE: These photos can be used only for identification by shape, color, and imprint. They do not depict actual or relative size. The product samples shown here have been supplied by the manufacturer and reproduced in full color by PDR as a quick-reference identification aid. While every effort has been made to assure accurate reproduction, please remember that any visual identification should be considered preliminary. In cases of poisoning or suspected overdosage, the drug's identity should be verified by chemical analysis. Premenstrual Dysphoric Disorder: Usual Initial Dosage: PAXIL CR should be administered as a single daily dose, usually in the morning, with or without food. PAXIL CR may be administered either daily throughout the menstrual cycle or limited to the luteal phase of the menstrual cycle, depending on physician assessment. The recommended initial dose is 12.5 mg/day. In clinical trials, both 12.5 mg/day and 25 mg/day were shown to be effective. Dose changes should occur at intervals of at least 1 week. Patients should be cautioned that PAXIL CR should not be chewed or crushed, and should be swallowed whole. Maintenance/Continuation Therapy: The effectiveness of PAXIL CR for a period exceeding 3 menstrual cycles has not been systematically evaluated in controlled trials. However, women commonly report that symptoms worsen with age until relieved by the onset of menopause. Therefore, it is reasonable to consider continuation of a responding patient. Patients should be periodically reassessed to determine the need for continued treatment. Never let your child stop taking an antidepressant without first talking to his or her healthcare provider. Stopping an antidepressant suddenly can cause other symptoms. There are Benefits and Risks When Using Antidepressants Antidepressants are used to treat depression and other illnesses. Depression and other illnesses can lead to suicide. In some children and teenagers, treatment with an antidepressant increases suicidal thinking or actions. It is important to discuss all the risks of treating depression and also the risks of not treating it. You and your child should discuss all treatment choices with your healthcare provider, not just the use of antidepressants. Other side effects can occur with antidepressants (see section below). Of all the antidepressants, only fluoxetine (Prozac®) * has been FDA approved to treat pediatric depression. For obsessive compulsive disorder in children and teenagers, FDA has approved only fluoxetine (Prozac®) * , ser-traline (Zoloft®) * , fluvoxamine, and clomipramine (Anafranil®) * . Your healthcare provider may suggest other antidepressants based on the past experience of your child or other family members. Is this all I need to know if my child is being prescribed an antidepressant? No. This is a warning about the risk for suicidality. Other side effects can occur with antidepressants. Be sure to ask your healthcare provider to explain all the side effects of the particular drug he or she is prescribing. Also ask about drugs to avoid when taking an antidepressant. Ask your healthcare provider or pharmacist where to find more information. *The following are registered trademarks of their respective manufacturers: Prozac®/Eli Lilly and Company; Zoloft®/Pfizer Pharmaceuticals; Anafranil®/Mallinckrodt Inc. This Medication Guide has been approved by the U.S. Food and Drug Administration for all antidepressants. The information contained in the Thomson Healthcare (Micromedex) products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you. The use of the Thomson Healthcare products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Thomson Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Healthcare does not assume any responsibility or risk for your use of the Thomson Healthcare products. Bipolar Disorder Special Populations: Treatment of Pregnant Women During the Third Trimester: Neonates exposed to PAXIL CR and other SSRIs or SNRIs, late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding (see PRECAUTIONS ). When treating pregnant women with paroxetine during the third trimester, the physician should carefully consider the potential risks and benefits of treatment. The physician may consider tapering paroxetine in the third trimester. Dosage for Elderly or Debilitated Patients, and Patients With Severe Renal or Hepatic Impairment: The recommended initial dose of PAXIL CR is 12.5 mg/day for elderly patients, debilitated patients, and/or patients with severe renal or hepatic impairment. Increases may be made if indicated. Dosage should not exceed 50 mg/day. Paroxetine is extensively metabolized after oral administration. The principal metabolites are polar and conjugated products of oxidation and methylation, which are readily cleared. Conjugates with glucuronic acid and sulfate predominate, and major metabolites have been isolated and identified. Data indicate that the metabolites have no more than 1/50 the potency of the parent compound at inhibiting serotonin uptake. The metabolism of paroxetine is accomplished in part by cytochrome P 450 IID 6 . Saturation of this enzyme at clinical doses appears to account for the nonlinearity of paroxetine kinetics with increasing dose and increasing duration of treatment. The role of this enzyme in paroxetine metabolism also suggests potential drug-drug interactions (see PRECAUTIONS ). Approximately 64% of a 30-mg oral solution dose of paroxetine was excreted in the urine with 2% as the parent compound and 62% as metabolites over a 10-day post-dosing period. About 36% was excreted in the feces (probably via the bile), mostly as metabolites and less than 1% as the parent compound over the 10-day post-dosing period. Drug Interactions: Clinically important interactions may occur when certain drugs are administered concomitantly with aspirin or aspirin-containing drugs. Oral Anticoagulants -- By interfering with platelet function or decreasing plasma prothrombin concentration, aspirin enhances the potential for bleeding in patients on anticoagulants. Methotrexate -- aspirin enhances the toxic effects of this drug. Probenecid and Sulfinpyrazone -- large doses of aspirin reduce the uricosuric effect of both drugs. Renal excretion of salicylate may also be reduced. Oral Antidiabetic Drugs -- enhancement of hypoglycemia may occur. Antacids -- to the extent that they raise urinary pH, antacids may substantially decrease plasma salicylate concentrations; conversely, their withdrawal can result in a substantial increase. Ammonium Chloride -- this and other drugs that acidify a relatively alkaline urine can elevate plasma salicylate concentrations. Ethyl Alcohol -- enhanced aspirin-induced fecal blood loss has been reported. Corticosteroids -- salicylate plasma levels may be decreased when adrenal corticosteroids are given, and may be increased substantially when they are discontinued. Carcinogenesis, Mutagenesis, Impairment of Fertility: No long-term studies have been done with `Soma' Compound with Codeine. Pregnancy--Teratogenic Effects: Pregnancy Category C. Adequate animal reproduction studies have not been conducted with `Soma' Compound with Codeine. It is also not known whether `Soma' Compound with Codeine can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. `Soma' Compound with Codeine should be given to a pregnant woman only if clearly needed. Studies in rodents have shown salicylates to be teratogenic when given in early gestation, and embryocidal when given in later gestation in doses considerably greater than usual therapeutic doses in humans. Studies in women who took aspirin during pregnancy have not demonstrated an increased incidence of congenital abnormalities in the offspring. Labor and Delivery: Ingestion of aspirin near term or prior to delivery may prolong delivery or lead to bleeding in mother, fetus, or neonate. Nursing Mothers: Carisoprodol is excreted in human milk in concentrations two-to-four times that in maternal plasma. Aspirin is excreted in human milk in moderate amounts and can produce a bleeding tendency in nursing infants. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the mother. Pediatric Use: Safety and effectiveness in children below the age of twelve have not been established. ADVERSE REACTIONS If severe reactions occur, discontinue `Soma' Compound with Codeine and initiate appropriate symptomatic and supportive therapy. The following side effects which have occurred with the administration of the individual ingredients alone may also occur with the combination. Carisoprodol: Central Nervous System --Drowsiness is the most frequent complaint and along with other CNS effects may require dosage reduction. Observed less frequently are dizziness, vertigo and ataxia. Tremor, agitation, irritability, headache, depressive reactions, syncope, and insomnia have been infrequent or rare. Idiosyncratic --Idiosyncratic reactions are very rare. They are usually seen within the period of the first to fourth dose in patients having had no previous contact with the drug (see WARNINGS ). Allergic --Skin rash, erythema multiforme, pruritus, eosinophilia, and fixed drug eruptions with cross-reaction to meprobamate have been reported. If allergic reactions occur, discontinue `Soma' Compound with Codeine and treat symptomatically. In evaluating possible allergic reactions, also consider allergy to excipients (information on excipients is available to physicians on request). Cardiovascular --Tachycardia, postural hypotension, and facial flushing. Gastrointestinal --Nausea, vomiting, epigastric distress and hiccup. Hematologic --No serious blood dyscrasias have been attributed to carisoprodol alone. Leukopenia and pancytopenia have been reported, very rarely, in situations in which other drugs or viral infections may have been responsible. Aspirin: The most common adverse reactions associated with the use of aspirin have been gastrointestinal, including nausea, vomiting, gastritis, occult bleeding, constipation and diarrhea. Gastric erosion, angioedema, asthma, rash, pruritus and urticaria have been reported less commonly. Tinnitus is a sign of high serum salicylate levels (see OVERDOSAGE ). Aspirin Intolerance --Allergic type reactions in aspirin-sensitive individuals may involve the respiratory tract or the skin. Symptoms of the former range from rhinorrhea and shortness of breath to severe asthma, and the latter may consist of urticaria, edema, rash, or angioedema (giant hives). These may occur independently or in combination. Codeine Phosphate: Nausea, vomiting, constipation, miosis, sedation, and dizziness have been reported. DRUG ABUSE AND DEPENDENCE Controlled Substance: Schedule C-III (see PRECAUTIONS ).

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Drug Interactions: Tramadol can impair thinking and the physical abilities required for driving or operating machinery. Tramadol should be avoided in patients intoxicated with alcohol, hypnotics, and narcotics. Large doses of tramadol administered with alcohol or anesthetic agents can impair breathing. Tramadol can increase the risk of seizure in epileptic patients, especially with simultaneous use of tricyclic antidepressants, such as Elavil. No dosage adjustment or reduction is necessary in healthy elderly patients 65-75 years of age. Patients over the age of 75 years, and those with liver and kidney dysfunction may need lower dosages. The safety of tramadol in children has not been established. Tramadol may rarely be habit forming. Tramadol should be avoided in patients with a history of opiate addiction or hypersensitivity to opiate medications. Pregnancy: The safety of tramadol during pregnancy has not been established. Nursing Mothers: The safety of tramadol in nursing mothers has not been established. Side Effects: Tramadol is generally well tolerated and side effects are usually transient. Commonly reported side effects include nausea, constipation, dizziness, headache, drowsiness, and vomiting. Less commonly reported side effects include itching, sweating, dry mouth, diarrhea, rash, visual disturbances, and vertigo. Related Links on MedicineNet.com Page 2 of this Article The Doctor's Response Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider. Statements and information regarding dietary supplements have not been evaluated or approved by the Food and Drug Administration. Please consult your healthcare provider before beginning any course of supplementation or treatment. Rapid Ultram Detox Confidential, painless and safe. Financing available; call us today! www.detox911.com Buy Ultram at Wholesale Smart shoppers buy Ultram at wholesale prices. No membership. www.pillsavers.com Chemical formula C16H25NO2 Molecular weight 263.4 g/mol Bioavailability 68-72% Increases with repeated dosing. Metabolism Hepatic demethylated & glucuronidated Elimination half-life 5-7 hours Excretion Renal Pregnancy category C (USA) C (Australia) Legal status Schedule 4 (Australia) Routes of administration Oral, IV, IM Tramadol (INN) (IPA: [?tr?m?d?l]) is an atypical opioid which is a centrally acting analgesic, used for treating moderate to severe pain. It is a synthetic agent, unrelated to other opioids, and appears to have actions on the GABAergic, noradrenergic and serotonergic systems. Tramadol was developed by the German pharmaceutical company Grunenthal GmbH and marketed under the trade name Tramal. Grunenthal has also cross licensed the drug to many other pharmaceutical companies that market it under various names, some of which are listed below. Tramadol is available in both injectable (intravenous and/or intramuscular) and oral preparations. It is usually marketed as the hydrochloride salt (tramadol hydrochloride). Dosages vary depending on the degree of pain experienced by the patient. Tramadol is approximately 10% as potent as morphine, when given by the IV/IM route. Oral doses range from 50–400 mg daily, with up to 600 mg daily when given IV/IM. Tramadol has a limited popularity as a recreational drug, and is referred to as "Tram-Tram" amongst users. Mechanism of action The mechanism of action of tramadol has yet to be fully elucidated, but it is believed to work through modulation of the GABAergic, noradrenergic and serotonergic systems. The contribution of non-opioid activity is demonstrated by the analgesic effects of tramadol not being fully antagonised by the ?-opioid receptor antagonist naloxone. Tramadol is marketed as a racemic mixture with a weak affinity for the ?-opioid receptor (approximately 1/6000th that of morphine). The (+)-enantiomer is approximately four times more potent than the (-)-enantiomer in terms of ?-opioid receptor affinity and 5-HT reuptake, whereas the (-)-enantiomer is responsible for noradrenaline reuptake effects (Shipton, 2000). These actions appear to produce a synergistic analgesic effect, with (+)-tramadol exhibiting 10-fold higher analgesic activity than (-)-tramadol (Goeringer et al., 1997). The serotonergic modulating properties of tramadol mean that it has the potential to interact with other serotonergic agents. There is an increased risk of serotonin syndrome when tramadol is taken in combination with serotonin reuptake inhibitors (e.g. SSRIs), since these agents not only potentiate the effect of 5-HT but also inhibit tramadol's metabolism. Metabolism Tramadol undergoes hepatic metabolism via the cytochrome P450 isozyme CYP2D6, being O- and N-demethylated to 5 different metabolites. Of these, M1 is the most significant since it has 200 times the ?-affinity of (+)-tramadol, and furthermore has an elimination half-life of 9 hours compared to 6 hours for tramadol itself. In the 6% of the population who have slow CYP2D6 activity, there is therefore a slightly reduced analgesic effect. Phase II hepatic metabolism renders the metabolites water-soluble and they are renally excreted. Thus reduced doses may be used in renal and hepatic impairment. Adverse effects The most commonly reported adverse drug reactions are nausea, vomiting and sweating. Drowsiness is reported, although it is less of an issue compared to other opioids. Respiratory depression, a common side effect of most opioids, is not clinically significant in normal doses. By itself, it does not increase the seizure threshold, though it may do if used in combination with SSRIs, tricyclic antidepressants, or in patients with epilepsy. Dependence Some controversy exists regarding the dependence liability of tramadol. Grunenthal has promoted it as an opioid with a low risk of dependence compared to traditional opioids, claiming little evidence of such dependence in clinical trials. They offer the theory that since the M1 metabolite is the principal agonist at ?-opioid receptors, the delayed agonist activity reduces dependence liability. The noradrenaline reuptake effects may also play a role in reducing dependence. Despite these claims it is apparent, in community practice, that dependence to this agent does occur. This would be expected since analgesic and dependence effects mediated by the same ?-opioid receptor. However, this dependence liability is considered relatively low by health authorities, such that tramadol is classified as a Schedule 4 Prescription Only Medicine in Australia, rather than as a Schedule 8 Controlled Drug like other opioids (Rossi, 2004). Similarly, tramadol is not currently scheduled by the U.S. DEA, unlike other opioid analgesics. Nevertheless, the Prescribing Information for Ultram warns that tramadol "may induce psychic and physical dependence of the morphine-type." Proprietary preparations Grunenthal, which still owns the patent to tramadol, has cross-licensed the agent to various pharmaceutical companies internationally. Thus tramadol is marketed under many trade names including: Adolonta, Contramal, Crispin, Nobligan, Siverol, Tiparol, Toplagic, Tradol, Tradolan, Tralgit, Tramacet, Tramadin, Tramal, Tramahexal, Tramazac, Ultracet, Ultram, Zamadol and Zydol. Abuse Late reports of abuse have been encountered in the United Kingdom through stolen prescriptions. The drug has been discovered to be sold for around ?4-5.00 a gram. It is either snorted, injected or taken oraly per two 50mg capsules, also poured into 1g capsules and taken as a "shot". Usually followed by an increased dose due to metabolic variation. References Goeringer KE, Logan BK, Christian GD. Identification of tramadol and its metabolites in blood from drug-related deaths and drug-impaired drivers. J Anal Toxicol 1997;21(7):529-37. PMID 9399121 Rossi S, editor. Australian Medicines Handbook 2004 (AMH). Adelaide: Australian Medicines Handbook; 2004. ISBN 0-9578521-4-2. Shipton EA. Tramadol – present and future. Anaesth Intensive Care 2000;28(4):363-74. PMID 10969362 Ultram – U.S. Prescribing Information McDiarmid T. What is the addiction risk associated with tramadol? Jour Fam Prac. January 2005 Vol. 54, No. 1 This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer) Donate to Wikimedia Tramadol Overnight All Orders - Free FedEx Shipping Fast & Discreet US Pharmacy 1-800# www.BestNetPharmacies.com Ultram 50mg $50 (200) Generic Ultram Low Prices MediSave Canada Pharmacy. www.MediSave.ca Mentioned In ultram is mentioned in these AnswerPages: List of drugs: U SOS (video game) chlorprothixene levomepromazine perphenazine postherpetic neuralgia Restless legs syndrome chlorpromazine selective serotonin reuptake inhibitor obsessive-compulsive disorder CanadaPharmacy.com The #1 Canadian Mail Order Pharmacy Over 500,000 Clients 1-800-891-0844 www.CanadaPharmacy.com Order Ultram Cheap 100% FDA approved. 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Why is this medication prescribed? Tramadol is used to relieve moderate to moderately severe pain. It also may be used to treat pain caused by surgery and chronic conditions such as cancer or joint pain. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information. How should this medicine be used? Tramadol comes as a tablet to take by mouth. It usually is taken every 4-6 hours as needed. It may be taken with or without food. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take tramadol exactly as directed. Tramadol can be habit-forming. Do not take a larger dose, take it more often, or for a longer period than your doctor tells you to. What special precautions should I follow? Before taking tramadol, tell your doctor and pharmacist if you are allergic to tramadol, codeine, or any other drugs. tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially other pain relievers; carbamazepine (Tegretol); MAO inhibitors [phenelzine (Nardil) or tranylcypromine (Parnate)]; medications for depression; quinidine; sleeping pills; tranquilizers; and vitamins. tell your doctor if you have or have ever had kidney or liver disease, a history of seizures, or a history of alcohol or drug abuse. tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking tramadol, call your doctor. if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking tramadol. you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this drug affects you. remember that alcohol can add to the drowsiness caused by this drug. What should I do if I forget a dose? Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. What side effects can this medication cause? Although side effects from tramadol are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away: If you experience any of the following symptoms, call your doctor immediately: fast heartbeat redness, swelling, and itching of the face numbness or tingling of the hands and feet difficulty breathing changes in urination seizures What storage conditions are needed for this medicine? Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication. In case of emergency/overdose In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. What other information should I know? Keep all appointments with your doctor. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. IMPORTANT NOTE: The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using this drug. HOW TO USE: Take this medication by mouth as prescribed. It is usually taken every 4 to 6 hours as needed. Use this medication exactly as prescribed. Do not increase your dose, use it more frequently or use it for a longer period of time than prescribed because this drug can be habit-forming. Also, if used for an extended period of time, do not suddenly stop using this drug without your doctor's approval. When used for extended periods, this medication may not work as well and may require different dosing. Consult your doctor if the medication stops working well. SIDE EFFECTS: This medication may cause dizziness, weakness, incoordination, nausea or vomiting, stomach upset, constipation, headache, drowsiness, anxiety, irritability, dry mouth, or increased sweating. If any of these effects persist or worsen, inform your doctor. Notify your doctor if you develop any of these serious effects while taking this medication: chest pain, rapid heart rate, skin rash or itching, mental confusion, disorientation, seizures, tingling of the hands or feet, trouble breathing. In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, breathing trouble. If you notice other effects not listed above, contact your doctor or pharmacist. PRECAUTIONS: Tell your doctor your medical history, especially of: kidney disease, liver disease, seizure disorder, lung disease, history of drug or alcohol dependency, any allergies you may have. Limit alcohol as it may add to the dizziness or drowsiness effects caused by the medication. Because this drug may make you dizzy/drowsy, use caution performing tasks requiring alertness such as driving. This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. Tramadol is excreted into breast milk. Because the effects on a nursing infant are not known, consult your doctor before breast- feeding. DRUG INTERACTIONS: Tell your doctor of all prescription and nonprescription medications you may use, especially of: carbamazepine, narcotic pain relievers (e.g., codeine), drugs used to aid sleep, antidepressants (e.g., SSRI-types such as fluoxetine or fluvoxamine), MAO inhibitors (e.g., furazolidone, linezolid, phenelzine, procarbazine, selegiline, tranylcypromine), psychiatric medicine (e.g., nefazodone), "triptan"-type drugs, anti-anxiety drugs (e.g., diazepam), sibutramine. Also, report use of certain antihistamines (e.g., diphenhydramine) which are also present in many cough-and-cold products. Do not start or stop any medicine without doctor or pharmacist approval. OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include cold and clammy skin, low body temperature, slowed breathing, slowed heartbeat, drowsiness, dizziness, lightheadedness, deep sleep, loss of consciousness, or seizures. MISSED DOSE: If you miss a dose, take it as soon as remembered; do not take it if it is near the time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up. STORAGE: Store this medication at room temperature between 59 and 86 degrees F (15 to 30 degrees C) away from heat and light. Do not store in the bathroom. Keep this and all medications out of the reach of children. Ultram tramadol (TRAM a dol) Ultram, Ultram ER What is the most important information I should know about Ultram? • You should not take Ultram if you have ever been addicted to drugs or alcohol. • Take Ultram 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 Ultram in one day. • Do not stop using this medication suddenly without talking to your doctor. You may need to gradually reduce the dose. Withdrawal symptoms may occur when you stop using Ultram. Withdrawal symptoms include anxiety, sweating, nausea, diarrhea, tremors, chills, hallucinations, trouble sleeping, or breathing problems. Call your doctor at once if you have any of these withdrawal symptoms after you stop using Ultram. • Do not crush the Ultram 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 inhlation or injection can cause life-threatening side effects, overdose, or death. • Seizures (convulsions) have occurred in some people taking Ultram. You may be more likely to have a seizure while taking Ultram 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. • Seek emergency medical attention if you think you have used too much of this medicine. A Ultram overdose can be fatal. Symptoms of a Ultram overdose may include drowsiness, shallow breathing, slow heartbeat, extreme weakness, cold or clammy skin, feeling light-headed, fainting, or coma. • While you are taking Ultram, do not drink alcohol or use drugs that make you sleepy (such as cold medicine, other pain medications, muscle relaxants, and medicine for seizures, depression or anxiety). These drugs may slow your breathing or increase drowsiness when used together with Ultram. • Ultram 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. What is Ultram? • Ultram is a narcotic pain reliever. • Ultram is