TRAMADOL Tramadol is a narcotic-like pain reliever. Tramadol is used to treat moderate to severe pain.

Tramadol extended-release is used to treat moderate to severe chronic pain when treatment is needed around the clock. Tramadol may also be used for other purposes not listed in this medication guide. Facts 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;

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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:
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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:
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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. 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. 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:
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seizure (convulsions); a red, blistering, peeling skin rash; or

shallow breathing, weak pulse.

Less serious side effects may include:
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dizziness, drowsiness, weakness; nausea, vomiting, constipation, loss of appetite; blurred vision; flushing (redness, warmth, or tingly feeling); or sleep problems (insomnia).

NUBAIN Treating and preventing moderate to severe pain. It can also be used for pain relief before and after surgery and during childbirth. It may also be used for other conditions as determined by your doctor. Nubain is an analgesic. It works by blocking certain receptor sites in the central nervous system, which helps to decrease pain. Do NOT use Nubain if:
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you are allergic to any ingredient in Nubain or to another opioid analgesic (eg, morphine or hydromorphone) you have diarrhea due to poisoning, a certain type of bowel problem (pseudomembranous colitis), or are dependent on any medicine or substance you are taking sodium oxybate (GHB)

Contact your doctor or health care provider right away if any of these apply to you. Before using Nubain : Some medical conditions may interact with Nubain . Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
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if you are pregnant, planning to become pregnant, or are breast-feeding if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement if you have allergies to medicines or other substances if you have a history of alcoholism or substance abuse, depression or other mental or mood problems, suicidal thoughts, head injury, brain growths, increased pressure in the head, or seizures if you have asthma or other breathing problems, high blood pressure, an underactive thyroid, or liver or kidney problems, or you are having a heart attack with nausea and vomiting or other heart problems if you have problems urinating, prostate problems, or severe inflammatory bowel disease, or you are having gastrointestinal tract surgery

Some MEDICINES MAY INTERACT with Nubain . Tell your health care provider if you are taking any other medicines, especially any of the following:
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Naltrexone because it could decrease the effectiveness of Nubain Alcohol, barbiturate anesthetics (eg, thiopental), cimetidine, narcotic analgesics (eg, fentanyl), phenothiazines (eg, promethazine), or sodium oxybate (GHB) because side effects, such as increased risk of slow or difficult breathing or drowsiness leading to unresponsiveness or coma, may occur Methadone because its effectiveness may be decreased by Nubain

This may not be a complete list of all interactions that may occur. Ask your health care provider if Nubain may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine. Important safety information:

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Nubain may cause dizziness, drowsiness, or blurred vision. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Nubain . Using Nubain alone, with other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks. Avoid drinking alcohol or taking other medications that cause drowsiness (eg, sedatives, tranquilizers) while taking Nubain . Nubain will add to the effects of alcohol and other depressants. Ask your pharmacist if you have questions about which medicines are depressants. Before you have any medical or dental surgery or emergency treatment, tell the doctor or dentist that you are taking Nubain . Use Nubain with extreme caution in CHILDREN younger than 18 years of age. Safety and effectiveness in this age group have not been confirmed. PREGNANCY and BREAST-FEEDING: If you become pregnant, discuss with your doctor the benefits and risks of using Nubain during pregnancy. Use Nubain with extreme caution during labor and delivery because it may cause breathing problems or irregular heartbeat in the baby. It is unknown if Nubain is excreted in breast milk. If you are or will be breast-feeding while you are using Nubain , check with your doctor or pharmacist to discuss the risks to your baby.

When used for long periods of time or at high doses, Nubain may not work as well and may require higher doses to obtain the same effect as when originally taken. This is known as TOLERANCE. Talk with your doctor if Nubain stops working well. Do not take more than prescribed. When used for long periods of time or at high doses, some people develop a need to continue taking Nubain . This is known as DEPENDENCE or "addiction." If you suddenly stop taking Nubain , you may experience WITHDRAWAL symptoms including anxiety; diarrhea; fever, runny nose, or sneezing; goose bumps and abnormal skin sensations; nausea; vomiting; pain; rigid muscles; rapid heartbeat; seeing, hearing, or feeling things that are not there; shivering or tremors; sweating; watery eyes; stomach cramps; restlessness; and trouble sleeping.

Possible side effects of Nubain : All medicines may cause side effects, but many people have no, or minor, side effects.Check with your doctor if any of these most COMMON side effects persist or become bothersome: Constipation; dizziness; drowsiness; dry mouth; feeling of a whirling motion; headache; nausea; sweating/clammy skin; vomiting. Seek medical attention right away if any of these SEVERE side effects occur: Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; difficulty urinating; fainting; numbness of an arm or leg; seizures; severe headache, dizziness, or vomiting; slow heartbeat; vision changes. TYLENOL Tylenol is a pain reliever and a fever reducer. Tylenol is used to treat many conditions such as headache, muscle aches, arthritis, backache, toothaches, colds, and fevers. Tylenol may also be used for other purposes not listed in this medication guide. Important information about Tylenol Do not use more Tylenol than is recommended. An overdose of Tylenol can cause serious harm. The maximum amount of acetaminophen for adults is 1 gram (1000 mg) per dose and 4 grams (4000 mg) per day. Taking more acetaminophen could cause damage to your liver. If you drink more than three alcoholic beverages per day, talk to your doctor before taking Tylenol and never use more than 2 grams (2000 mg) per day. Do not use this medication without first talking to your doctor if you drink more than three alcoholic beverages per day or if you have had alcoholic liver disease (cirrhosis). You may not be able to use Tylenol. Before using Tylenol, tell your doctor if you have liver disease or a history of alcoholism. Do not use any other over-the-counter cough, cold, allergy, or pain medication without first asking your doctor or pharmacist. Acetaminophen (sometimes abbreviated as "APAP") is contained in many combination medicines. If you use certain products together you may accidentally use too much acetaminophen. Read the label of any other medicine you are using to see if it contains acetaminophen or APAP. Avoid drinking alcohol while taking this medication. Alcohol may increase your risk of liver damage while taking Tylenol. Before taking Tylenol Do not use Tylenol if you are allergic to acetaminophen.

If you have certain conditions, you may need a dose adjustment or special tests to safely use this medication. Ask a doctor or pharmacist about using Tylenol if you have:
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liver disease; or a history of alcoholism;

It is not known whether Tylenol will harm an unborn baby. Before using Tylenol, tell your doctor if you are pregnant. Acetaminophen 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. Tylenol side effects Get emergency medical help if you have any of these signs of an allergic reaction while using Tylenol: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have a serious side effect such as:
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low fever with nausea, stomach pain, and loss of appetite; dark urine, clay-colored stools; or jaundice (yellowing of the skin or eyes).

DEMEROL Demerol is in a group of drugs called narcotic pain relievers. It is similar to morphine. Demerol is used to treat moderate-to-severe pain. Demerol may also be used for purposes other than those listed in this medication guide. Facts about Demerol Demerol may be habit-forming and should be used only by the person it was prescribed for. Demerol 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. Do not drink alcohol while you are taking Demerol. Dangerous side effects or death can occur when alcohol is combined with a narcotic pain medicine.Check your food and medicine labels to be sure these products do not contain alcohol. Never take more than your prescribed dose of Demerol. Tell your doctor if the medicine seems to stop working as well in relieving your pain. Demerol 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 Demerol suddenly, or you could have unpleasant withdrawal symptoms. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication. Do not use this medicine if you are allergic to meperidine, or if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take Demerol before the MAO inhibitor has cleared from your body. Demerol may

be habit-forming and should be used only by the person it was prescribed for. Demerol 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. Before using Demerol, tell your doctor if you are allergic to any drugs, or if you have:
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asthma, COPD, sleep apnea, or other breathing disorders; liver or kidney disease; underactive thyroid; curvature of the spine; a history of head injury or brain tumor; epilepsy or other seizure disorder; low blood pressure; gallbladder disease; Addison's disease or other adrenal gland disorders; enlarged prostate, urination problems; mental illness; or a history of drug or alcohol addiction.

This medication may be harmful to an unborn baby, and could cause addiction or withdrawal symptoms in a newborn. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Demerol 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. Older adults may be more sensitive to the effects of this medication. Demerol 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. Call your doctor at once if you have any of these serious side effects:  shallow breathing, slow heartbeat;  seizure (convulsions);  cold, clammy skin;  confusion;  severe weakness or dizziness; or  feeling light-headed, fainting. Less serious Demerol side effects are more likely to occur, such as:
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constipation; nausea, vomiting, loss of appetite; dizziness, headache; dry mouth; sweating;

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itching; urinating less than usual; or loss of interest in sex.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. GERAN Contents Indications Paracetamol Tab Headache, Dysmenorrhea, myalgias, rheumatism, arthritis & other musculoskeletal disorder. Rheumatic fever, common colds & flu & other resp tract infections. Susp & drops Management of mild to moderate pain & lowering of fever. May be taken with or without food

Administration Pregnancy Category FDA) (US

Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters). Analgesics (Non-Opioid) & Antipyretics N02BE01 - Paracetamol ; Belongs to the class of anilide preparations. Used to relieve pain and fever. Non-Rx

MIMS Class ATC Classification Poison Schedule

AEKNIL

Contents Indications

Paracetamol

Pyrexia of unknown origin and for symptomatic relief of fever and pain associated with common childhood disorders, tonsillitis, upper respiratory tract infections, post-immunization reactions, after tonsillectomy and other conditions where patient is unable to take oral medications but where

paracetamol can be administered with advantage. For prevention of febrile convulsion. Headache, cold, sinusitis, muscle pain, arthritis and toothache. Dosage

Adults and Children ≥10 years: 2-3 mL. Children up to 10 years: 1-2 mL. Infants: ½-1 mL. Depending on severity of case, dose may be
repeated 4-hourly till temperature returns to normal. In severe cases, dose may be administered IV very slowly.

Overdosage

Symptoms: Nausea, vomiting, abdominal pain, diaphoresis, generalized weakness and lethargy. If an overdosage of paracetamol is suspected, blood should be withdrawn immediately for paracetamol plasma assay, without regard to the presence or absence of symptomatology. Treatment: The acute hepatotoxicity and nephrotoxicity of paracetamol can be overcome by the administration of sulfhydryl donors eg, Nacetylcysteine which should be given as soon as possible after ingestion. Treatment after 12 hrs is not effective. Paracetamol overdosage should be treated with gastric lavage if the patient is seen within 4 hrs of ingestion of Aeknil.

Contraindications Special Precautions Adverse Reactions

Nephropathy. Paracetamol should be given with care to patients with impaired hepatic or renal function.

Drug Paracetamol has rarely been found to produce any adverse effects in therapeutic doses and is usually well tolerated by aspirin-sensitive patients. Toxicity may result from a single toxic dose of the drug or from chronic ingestion. The following adverse reactions have been reported: Skin eruption, hematological toxicity eg, thrombocytopenia and leucopenia, methemoglobinaemia which can result in cyanosis, and on long-term use, renal damage can result. Click to view ADR Monitoring Website

Drug Interactions

Paracetamol may enhance the activity of coumarin anticoagulants, but the effect is not generally of clinical significance. Click here for more Interaction Checks

Pregnancy Category (US FDA) Category B: Either animal-reproduction studies have not demonstrated a

foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters). Mechanism Action of Antipyretic, analgesic. Pharmacology: Paracetamol produces analgesia by raising the threshold of the pain center in the brain and by obstructing impulses at the painmediating chemoreceptors. The drug produces antipyresis by an action on the hypothalamus; heat dissipation is increased as a result of vasodilation and increased peripheral blood flow. Pharmacokinetics: Paracetamol is rapidly and almost completely absorbed from the gastrointestinal tract. Following oral administration, peak plasma levels are attained in 10 min to 1 hr and the half-life is 75 min to 3 hrs. Distribution of paracetamol to most body tissues and fluids is both rapid and uniform. Paracetamol is excreted in the urine primarily as the glucuronide and smaller amounts as the sulfate, mercapturate and unchanged drug. Approximately 85% of a dose of paracetamol is excreted in the urine within 24 hrs after administration. MIMS Class ATC Classification Poison Schedule Analgesics (Non-Opioid) & Antipyretics N02BE01 - Paracetamol ; Belongs to the class of anilide preparations. Used to relieve pain and fever. Rx

Packing/Presentation Amp 150 mg/mL x 2 mL x 10's.