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Pharmacy should be used with caution in patients with increased intracranial pressure or head injury. The respiratory depressant effects of opioids include carbon dioxide retention and secondary elevation of cerebrospinal fluid pressure, and may be markedly exaggerated in these patients. Additionally, pupillary changes (miosis) from Pharmacy may obscure the existence, extent, or course of intracranial pathology.
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Physicians mostly prescribe Pharmacy to patients who need to take painkillers for long periods of time. The medicine is considered to be less addictive than most other pain relieving drugs. The use of this medicine counteracts dental and postoperative pain. Back, using Pharmacy can also control joint and cancer-related pain. Since the medicine is used to cure medium and severe pain, it is not recommended for minor pain.
Do not take more of this medication than is prescribed for you. If the pain is not being controlled, talk to your doctor. Taking more than the prescribed amount of this medication could result in seizures or decreased breathing.
The only thing missing from the well-intentioned Pharmacy piece in JFP (McDiarmid T, Mackler L, Schneider DM, \"Clinical inquiries. What is the addiction risk associated with Pharmacy?\" J Fam Pract 2005; 54[1]:72-73) was a little common sense. The low numbers they quoted on Pharmacy addiction and detoxification seem paltry in comparison with illicit opiates (such as heroin) and diverted opiates (such as OxyContin), but the numbers can be deceptive--reporting agencies rarely know what\'s going on in the real world. In the treatment arena we see staggering amounts of Ultracet and Pharmacy addiction, with patients popping up to 30 or 40 pills daily to fill an ever-expanding mureceptor void. Many of these fall into the addiction innocently because, and I quote, \"My doctor told me that these were safe!\" Far from it. The Pharmacy mu activity is considerable in the opiate-naive patient, and even more so in the recovering opiate addict. The phenomenon of \"reinstatement,\" where any activity at the receptor level triggers old drug-seeking behavior, is well documented, and should be avoided at all costs, especially given the broad nonopiate choices available to our patients in need, including the highly effective neural modulators (such as Neurontin, Depakote, and Trazodone) and NSAID/ COX-2 families. While any primary doc can step into the waters of addiction medicine, some formal training may help avoid potential disasters.
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\"Physical dependence\" is the term used to describe the phenomenon of withdrawal when an opioid is abruptly discontinued. The severity of withdrawal is a function of the patient�s prior opioid exposure. Here we have a case of withdrawal due to physical dependence on Pharmacy even if no tolerance had developed over 2 years. The patient became nervous and agitated if the Pharmacy intake was merely delayed. When the patient missed the dose twice in a row, her withdrawal symptoms became severe, with an overwhelming need to take the drug that could appear as psychological dependence.
In single-dose models of pain following oral surgery, pain relief was demonstrated in some patients at doses of 50 mg and 75 mg. A dose of 100 mg Pharmacy tended to provide analgesia superior to codeine sulfate 60 mg, but it was not as effective as the combination of aspirin 650 mg with codeine phosphate 60 mg.
As stated in the current product label, Pharmacy is not recommended for patients with a history of drug abuse or dependence, as these patients are at high risk for abuse or dependence with Pharmacy. In addition, and of particular relevance to the issue raised by Dr. Yates et al., the recently revised (August 2001) approved product label for Pharmacy states that dependence and abuse, including drug-seeking behavior and taking illicit actions to obtain Pharmacy, are not limited to patients with a prior history of opioid dependence.
For the subset of patients for whom rapid onset of analgesic effect is required and for whom the benefits outweigh the risk of discontinuation due to adverse events associated with higher initial doses, Pharmacy 50 mg to 100 mg can be administered as needed for pain relief every four to six hours, not to exceed 400 mg per day.
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Do not drink alcohol while taking Pharmacy. Alcohol may cause a dangerous decrease in breathing and/or liver problems when used during treatment with Pharmacy.
