What is amlodipine?

Amlodipine is a calcium channel blocker that dilates (widens) blood vessels and
improves blood flow.

Amlodipine is used to treat chest pain (angina) and other conditions caused

by coronary artery disease.

Amlodipine is also used to treat high blood pressure (hypertension). Lowering blood

pressure may lower your risk of a stroke or heart attack.

Amlodipine is for use in adults and children who are at least 6 years old.

Important information
Before taking amlodipine, tell your doctor if you have congestive heart failure or liver
disease.

Drinking alcohol can further lower your blood pressure and may increase certain side
effects of amlodipine.

If you are being treated for high blood pressure, keep using amlodipine even if you feel
well. High blood pressure often has no symptoms. You may need to use blood pressure
medication for the rest of your lif

Amlodipine is only part of a complete program of treatment that may also include diet,
exercise, weight control, and other medications. Follow your diet, medication, and
exercise routines very closely.

Tell your doctor about all other heart or blood pressure medications you are taking.

Your chest pain may become worse when you first start taking amlodipine or when your
dose is increased. Call your doctor if your chest pain is severe or ongoing.

Before taking this medicine

You should not take amlodipine if you are allergic to it.

To make sure amlodipine is safe for you, tell your doctor if you have:

 liver disease; or
 a heart valve problem called aortic stenosis.
It is not known whether this medicine will harm an unborn baby. Tell your doctor if you
are pregnant or plan to become pregnant.

Amlodipine can pass into breast milk, but effects on the nursing baby are not known.
Tell your doctor if you are breast-feeding.

Amlodipine is not approved for use by anyone younger than 6 years old.

Amlodipine side effects

Get emergency medical help if you have signs of an allergic reaction to
amlodipine: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

In rare cases, when you first start taking amlodipine, your angina may get worse or you
could have a heart attack. Seek emergency medical attention or call your doctor
right away if you have symptoms such as: chest pain or pressure, pain spreading to
your jaw or shoulder, nausea, sweating.

Call your doctor at once if you have:

pounding heartbeats or fluttering in your chest;


 worsening chest pain;
 swelling in your feet or ankles;
 severe drowsiness; or
 a light-headed feeling, like you might pass out.
Common amlodipine side effects may include:

 dizziness;
 feeling tired;
 stomach pain, nausea; or
 flushing (warmth, redness, or tingly feeling).

Medrol is used for:

Treating severe allergies, arthritis, asthma, certain blood disorders, and skin conditions.
It may also be used for other conditions as determined by your doctor.

Medrol is a corticosteroid. It works by modifying the body's immune response to various

conditions and decreasing inflammation.

Do NOT use Medrol if:

 you are allergic to any ingredient in Medrol
 you are taking mifepristone
 you have a systemic fungal infection
 you are scheduled to have a smallpox vaccine
Contact your doctor or health care provider right away if any of these apply to you.

Before using Medrol:

Some medical conditions may interact with Medrol. Tell your doctor or pharmacist if you
have any medical conditions, especially if any of the following apply to you:

 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, foods, or other substances
 if you have a history of heart problems (eg, congestive heart failure), heart
attack, high blood pressure, kidney problems, liver problems, diabetes,
seizures, an underactive thyroid, adrenal gland problems, or any mental or
mood problems
 if you have or have recently had a fungal, bacterial, viral, or other type of
infection; herpes infection of the eye; chickenpox; measles; or shingles
 if you have HIV or tuberculosis (TB), or if you have ever had a positive TB skin
test
 if you have any stomach problems (eg, ulcers), intestinal problems (eg,
blockage, perforation, infection, unexplained diarrhea, diverticulitis, ulcerative
colitis), recent intestinal surgery, or inflammation of the esophagus
 if you have weak bones (eg, osteoporosis) or muscle problems (eg,
myasthenia gravis)
 if you have had any recent vaccinations (eg, smallpox)
Some MEDICINES MAY INTERACT with Medrol. Tell your health care provider if you are
taking any other medicines, especially any of the following:

 Barbiturates (eg, phenobarbital), carbamazepine, hydantoins (eg, phenytoin),

lithium, or rifampin because they may decrease Medrol's effectiveness
 Aprepitant, clarithromycin, cyclosporine, diltiazem, erythromycin, itraconazole,
ketoconazole, or troleandomycin because side effects, such as adrenal gland
or nervous system problems, may occur
 Aspirin, live vaccines, mifepristone, or ritodrine because their actions and the
risk of their side effects may be increased by Medrol
This may not be a complete list of all interactions that may occur. Ask your health care
provider if Medrol 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.

How to use Medrol:

Use Medrol as directed by your doctor. Check the label on the medicine for exact dosing
instructions.

 Take Medrol by mouth with or without food. If stomach upset occurs, take
with food to reduce stomach irritation.
 If you miss a dose of Medrol, take it as soon as possible. If it is almost time for
your next dose, skip the missed dose and go back to your regular dosing
schedule. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use Medrol.

Important safety information:

  Medrol may lower the ability of your body to fight infection. Avoid contact
with people who have colds or infections. Tell your doctor if you notice signs
of infection like fever, sore throat, rash, or chills. Notify your doctor of any
signs of infection, including fever, sore throat, rashes, or chills, within 12
months after stopping Medrol.
 If you have not had chickenpox, shingles, or measles, avoid contact with
anyone who does.
 Medrol may cause serious increases in blood pressure, salt and water
retention, and increased potassium loss. Dietary salt restriction and potassium
supplements may be necessary.
 Medrol may cause calcium loss and can promote the development of
osteoporosis (brittle bones). Take adequate calcium and vitamin D
supplements.
 Tell your doctor or dentist that you take Medrol before you receive any
medical or dental care, emergency care, or surgery.
 Diabetes patients - Medrol may affect your blood sugar. Check blood sugar
levels closely. Ask your doctor before you change the dose of your diabetes
medicine.
 Talk with your doctor before you receive any vaccine.
 Lab tests, such as adrenal function tests or blood pressure monitoring, may be
performed while you use Medrol. These tests may be used to monitor your
condition or check for side effects. Be sure to keep all doctor and lab
appointments.
 Corticosteroids may affect growth rate in CHILDREN and teenagers in some
cases. They may need regular growth checks while they use Medrol.
 Medrol should be used with extreme caution in CHILDREN; safety and
effectiveness in children have not been confirmed.
 PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your
doctor. You will need to discuss the benefits and risks of using Medrol while
you are pregnant. It is not known if this medicine is found in breast milk. If
you are or will be breast-feeding while you use Medrol, check with your
doctor. Discuss any possible risks to your baby.
If you stop taking Medrol suddenly, you may have WITHDRAWAL symptoms. These may
include unbalanced hormones (in both men and women).

Possible side effects of Medrol:

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:

Dizziness; facial flushing; feeling of whirling motion; headache; increased sweating.

Seek medical attention right away if any of these SEVERE side effects occur:
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest;
swelling of the mouth, face, lips, or tongue); bloody, black, or tarry stools; changes in body
fat; changes in menstrual period; chest pain; fainting; fever, chills, or sore throat; increased
hunger, thirst, or urination; mental or mood changes; muscle pain, weakness, or wasting;
seizures; severe nausea or vomiting; slow wound healing; stomach pain; sudden, severe
dizziness or headache; swelling of the feet or legs; tendon, bone, or joint pain; thinning of
 the skin; unusual bruising or bleeding; unusual skin sensation; unusual weight gain; vision
changes or other eye problems; vomit that looks like coffee grounds.

This is not a complete list of all side effects that may occur. If you have questions about
side effects, contact your health care provider. Call your doctor for medical advice about
side effects. To report side effects to the appropriate agency, please read the Guide to
Reporting Problems to FDA.

CITICOLINE
Citicoline is a brain chemical that occurs naturally in the body. As a medicine, it is taken by mouth as a supplement or
given by IV or as a shot.

Citicoline is used for Alzheimer's disease and other types of dementia, head trauma, cerebrovascular disease such
as stroke, age-related memory loss, Parkinson's disease, attention deficit-hyperactive disorder (ADHD),
and glaucoma.

Citicoline was originally developed in Japan for stroke. It was later introduced as a prescription drug in many
European countries. In these countries it is now frequently prescribed for thinking problems related to circulation
problems in the brain. In the US, citicoline is marketed as a dietary supplement.

How does it work?

Citicoline seems to increase a brain chemical called phosphatidylcholine. This brain chemical is important for brain
function. Citicoline might also decrease brain tissue damage when the brain is injured.

Possibly Effective for:
 Age-related memory problems. Taking citicoline seems to help memory loss in people aged 50 to 85
years.
 Long-term blood circulation problems in the brain (cerebrovascular diseases). There is some evidence that
taking citicoline by mouth or injecting citicoline into the vein or muscle might improve memory and behavior in
patients with long-term cerebrovascular diseases, such as stroke.
 Stroke recovery. Stroke patients who take citicoline by mouth within 24 hours of having the kind of stroke
that is caused by a clot (ischemic stroke) are more likely than other ischemic stroke patients to have a complete
recovery within 3 months. Stroke patients who receive intravenous (IV) citicoline within 12 hours of having an
ischemic stroke and daily thereafter for 7 days also have improved recovery.

Side effect
Citicoline is POSSIBLY SAFE when taken by mouth short-term (up to 90 days). The safety of long-term use is not
known. Most people who take citicoline don't experience problematic side effects. But some people can have side
effects such as trouble sleeping (insomnia), headache, diarrhea, low or high blood pressure, nausea, blurred vision,
chest pains, and others.

What is omeprazole?
Omeprazole (Prilosec, Zegerid) belongs to group of drugs called proton pump
inhibitors. It decreases the amount of acid produced in the stomach.

Omeprazole is used to treat symptoms of gastroesophageal reflux disease (GERD) and

other conditions caused by excess stomach acid. It is also used to promote healing of
erosive esophagitis (damage to your esophagus caused by stomach acid).

Omeprazole may also be given together with antibiotics to treat gastric ulcer caused by
infection with helicobacter pylori (H. pylori).
Omeprazole is not for immediate relief of heartburn symptoms.

Important information
Omeprazole is not for immediate relief of heartburn symptoms.

Heartburn is often confused with the first symptoms of a heart attack. Seek emergency
medical attention if you have chest pain or heavy feeling, pain spreading to the arm or
shoulder, nausea, sweating, and a general ill feeling.

You should not take this medication if you are allergic to omeprazole or to any other
benzimidazole medication such as albendazole or mebendazole.

Ask a doctor or pharmacist if it is safe for you to take omeprazole if you have liver
disease or heart disease, or low levels of magnesium in your blood.

Some conditions are treated with a combination of omeprazole and antibiotics. Use all
medications as directed by your doctor. Read the medication guide or patient
instructions provided with each medication. Do not change your doses or medication
schedule without your doctor's advice.

Take omeprazole for the full prescribed length of time. Your symptoms may improve
before the infection is completely cleared.

Prilosec OTC (over-the-counter) should be taken for no longer than 14 days in a row.
Allow at least 4 months to pass before you start another 14-day treatment.

Before taking this medicine

You should not use this medicine if you are allergic to omeprazole or to any
benzimidazole medicine such as albendazole or mebendazole.

Heartburn is often confused with the first symptoms of a heart attack. Seek emergency
medical attention if you have chest pain or heavy feeling, pain spreading to the arm or
shoulder, nausea, sweating, and a general ill feeling.

Ask a doctor or pharmacist if it is safe for you to use omeprazole if you have other
medical conditions, especially:

 liver disease;
 low levels of magnesium in your blood; or
 osteoporosis or low bone mineral density (osteopenia).
Do not use over-the-counter omeprazole (Prilosec OTC) without the advice of a doctor
if you have:

 trouble or pain with swallowing;

 bloody or black stools, vomit that looks like blood or coffee grounds;
 heartburn that has lasted for over 3 months;
 frequent chest pain, heartburn with wheezing;
 unexplained weight loss; or
 nausea or vomiting, stomach pain.
Taking a proton pump inhibitor such as omeprazole may increase your risk of
bone fracture in the hip, wrist, or spine. This effect has occurred mostly in people
who have taken the medication long term or at high doses, and in those who are age 50
and older. It is not clear whether omeprazole is the actual cause of an increased risk of
fracture.

Some conditions are treated with a combination of omeprazole and antibiotics. Use all
medications as directed by your doctor. Read the medication guide or patient
instructions provided with each medication. Do not change your doses or medication
schedule without your doctor's advice.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you
are pregnant or plan to become pregnant.

Omeprazole can pass into breast milk and may harm a nursing baby. Do not use this
medicine without a doctor's advice if you are breast-feeding.

Do not give omeprazole to a child younger than 1 year old without the advice of a
doctor.

How should I take omeprazole?

Omeprazole is usually taken before eating (at least 1 hour before a meal). Follow all
directions on your prescription label. Do not take this medicine in larger or smaller
amounts or for longer than recommended.

Prilosec OTC (over-the-counter) should be taken only once every 24 hours for 14 days.
Take the medicine in the morning before you eat breakfast. It may take up to 4 days for
full effect. Do not take more than one tablet every 24 hours.

Allow at least 4 months to pass before you start another 14-day treatment with Prilosec
OTC. Call your doctor if you have additional symptoms and need treatment before the 4
months has passed.

Do not crush, chew, or break an enteric coated pill, or a Prilosec OTC tablet. Swallow
the pill whole.

You may open the delayed-release capsule and sprinkle the medicine into a spoonful of
applesauce to make swallowing easier. Swallow the mixture right away without chewing.
Do not save for later use.

Dissolve the powder in a small amount of water. Use 1 teaspoon of water for the 2.5-
mg packet, or 1 Tablespoon of water for the 10-mg packet. Let the mixture stand for 2
or 3 minutes, then stir and drink right away. To make sure you get the entire dose, add a
little more water to the same glass, swirl gently and drink right away.

This mixture can also be given through a nasogastric (NG) feeding tube using only a
catheter-tipped syringe. Shake the syringe well, then attach it to the NG tube and push
the plunger down to empty the syringe into the tube. Refill the syringe with water and
flush the tube to wash the contents down.
Use this medicine for the full prescribed length of time. Your symptoms may improve
before your condition is completely cleared.

If you use omeprazole for longer than 3 years, you could develop a vitamin B-12
deficiency. Talk to your doctor about how to manage this condition if you develop it.

Call your doctor if your symptoms do not improve, or if they get worse while using
omeprazole.

Some conditions are treated with a combination of omeprazole and antibiotics. Use all
medications as directed by your doctor. Read the medication guide or patient
instructions provided with each medication. Do not change your doses or medication
schedule without your doctor's advice.

This medicine can cause unusual results with certain medical tests, and you may need to
stop using the medicine for a short time before a test. Tell any doctor who treats you
that you are using omeprazole.

Store at room temperature away from moisture and heat.

See also: Dosage Information (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time
for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking omeprazole?

This medicine can cause diarrhea, which may be a sign of a new infection. If you have
diarrhea that is watery or bloody, call your doctor. Do not use anti-diarrhea
medicine unless your doctor tells you to.

Omeprazole side effects

Get emergency medical help if you have signs of an allergic reaction to
omeprazole: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

 severe stomach pain, diarrhea that is watery or bloody;

 seizure (convulsions);
 kidney problems--urinating more or less than usual, blood in your urine,
swelling, rapid weight gain; or
 symptoms of low magnesium--dizziness, confusion; fast or uneven heart rate;
tremors (shaking) or jerking muscle movements; feeling jittery; muscle
cramps, muscle spasms in your hands and feet; cough or choking feeling.
Common omeprazole side effects may include:

 stomach pain, gas;

 nausea, vomiting, diarrhea; or
 headache.

Stugeron (cinnarizine)
This antihistamine can be bought from
pharmacies to treat travel sickness - read on
for advice on its use, warnings and side effects

What is Stugeron used for?

 Preventing and treating travel sickness.

 Relieving nausea, vomiting, attacks of dizziness or
spinning sensations (vertigo) and sensations of ringing
or other noise in the ears (tinnitus) associated
with Meniere's disease and other middle ear
disorders.

How does Stugeron work?

Stugeron tablets contain 15mg cinnarizine as the active

ingredient. Cinnarizine is an antihistamine medicine
that works in the brain. It prevents an area of the brain
called the vomiting centre from receiving nerve
messages sent from the vestibular apparatus in the
inner ear.

The vestibular apparatus provides continual feedback

to the brain about our body position. When something
disturbs this, such as movement of the head when
travelling by boat or car, nerve signals are sent from
the vestibular apparatus to the vomiting centre in the
brain. This can cause sensations such as nausea,
dizziness or spinning sensations (vertigo) and the reflex
of vomiting.

Cinnarizine works by blocking histamine and

muscarinic receptors in the vomiting centre in the
brain. This prevents the vomiting centre from receiving
nerve messages from the vestibular apparatus. In turn,
 this prevents disturbances in the middle ear from
activating the vomiting centre and causing nausea,
vertigo and vomiting.

How do I take Stugeron?

 Stugeron tablets can be chewed, sucked or swallowed

whole.
 If you find this medicine upsets your stomach, taking it
with or after food may help.
 Do not take more than the recommended dose.

To prevent travel sickness:

 Adults and adolescents aged over 12 years should take

two tablets two hours before travel. You can then take
one tablet every eight hours during the journey if
needed.
 Children aged 5 to 12 years should take one tablet two
hours before travel. Children can then be given half a
tablet every eight hours during the journey if needed.

To treat the symptoms of inner ear disorders such as

Meniere's disease:

 Adults and adolescents aged over 12 years should take

two tablets three times a day.
 Children aged 5 to 12 years should take one tablet
three times day.

What should I know before taking Stugeron?

 Stugeron may cause drowsiness. If affected do not

drive or operate machinery.
 You should not drink alcohol while taking Stugeron, as
this is likely to make drowsiness worse.
 If you are due to have any skin prick tests to diagnose
allergies you should stop taking Stugeron at least 48
hours before the tests. This is because antihistamines
can prevent or lessen the skin reactions that indicate
an allergy, and so can make the test results unreliable.

Who should not take Stugeron?

 Children under five years of age.

  People with rare hereditary blood disorders called
porphyrias.
 Women who are pregnant or breastfeeding.
 People with rare hereditary problems of fructose or
galactose intolerance, Lapp lactase deficiency,
glucose-galactose malabsorption or sucrase-isomaltase
insufficiency (Stugeron tablets contain lactose and
sucrose).
 People who are allergic to any of the ingredients. If
you feel you have experienced an allergic reaction,
stop using Stugeron and inform your doctor or
pharmacist immediately.

Who should get medical advice before taking Stugeron? 

 People with kidney or liver problems.

 People with Parkinson's disease.

Can I take Stugeron while pregnant or breastfeeding?

 Stugeron should not be taken by pregnant women

because the safety of cinnarizine for use  during
pregnancy has not been established. Seek further
medical advice from your doctor.
 Stugeron should not be taken by women who are
breastfeeding because it is not known if
cinnarizine passes into breast milk. Ask your doctor
for further advice.

What are the possible side effects of Stugeron?

Medicines and their possible side effects can affect

individual people in different ways. The following are
some of the side effects that are known to be
associated with cinnarizine. Just because a side effect
is stated here, it does not mean that all people taking
Stugeron will experience that or any side effect.

Common (affect between 1 in 10 and 1 in 100 people)

 Drowsiness.
 Weight gain (with long-term use).
 Indigestion.
 Nausea.
Uncommon (affect between 1 in 100 and 1 in 1000 people)

 Feeling lethargic.
 Fatigue.
 Abdominal pain.
 Vomiting.
 Sweating.

Frequency unknown

 Headache.
 Dry mouth.
 Skin reactions.
 Abnormal movements of the hands, legs, face, neck or
tongue, eg tremor, twitching, rigidity (stop taking
Stugeron and consult your doctor if you experience any
symptoms like this).
 Jaundice (stop taking Stugeron and consult your
doctor if you notice any yellowing of your eyes or skin
while taking it).

Side Effects
Easy bleeding/bruising, stomach upset/pain, diarrhea, and constipation may occur. If
any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has
judged that the benefit to you is greater than the risk of side effects. Many people using
this medication do not have serious side effects.

Although unlikely, serious bleeding in the stomach, gut, eyes, or brain may occur. Also,
clopidogrel can rarely cause a very serious blood disorder (thrombotic
thrombocytopenic purpura-TTP). Symptoms may appear any time after starting this
medication. Get medical help right away if any of these symptoms occur: severe
stomach/abdominal pain, uncontrolled bleeding from gums or nose, bloody/black stools,
confusion, fever, extreme skin paleness, purple skin patches, fainting, fast heartbeat,
sudden severe headache, unusual weakness/tiredness, vomit with blood or that looks
like coffee grounds, slurred speech, vision changes, seizures, yellowing eyes/skin,
bloody/red/pink/dark urine, signs of kidney problems (such as change in the amount of
urine).

A very serious allergic reaction to this drug is rare. However, get medical help right
away if you notice any symptoms of a serious allergic reaction, including: rash,
itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble
breathing.

This is not a complete list of possible side effects. If you notice other effects not listed
above, contact your doctor or pharmacist.
What is tramadol?
Tramadol is a narcotic-like pain reliever.

Tramadol is used to treat moderate to severe pain.

The extended-release form of tramadol is for around-the-clock treatment of pain. This

form of tramadol is not for use on an as-needed basis for pain.

Tramadol may also be used for purposes not listed in this medication guide.

Important information
You should not take tramadol if you have used alcohol, sedatives, tranquilizers, or
narcotic medications within the past few hours.

Tramadol can slow or stop your breathing, especially when you start using this medicine
or whenever your dose is changed. Never take tramadol in larger amounts, or for longer
than prescribed. Do not crush, break, or open an extended-release pill. Swallow it whole
to avoid exposure to a potentially fatal dose.

Seizures (convulsions) have occurred in some people taking this medicine. Tramadol
may be more likely to cause a seizure 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, narcotic, or medicine for nausea and vomiting

Tramadol may be habit-forming, even at regular doses. Take this medicine exactly as

prescribed by your doctor. Never share the medicine with another person. MISUSE
OF NARCOTIC PAIN MEDICATION CAN CAUSE ADDICTION, OVERDOSE, OR
DEATH, especially in a child or other person using the medicine without a
prescription.

Taking tramadol during pregnancy may cause life-threatening withdrawal

symptoms in the newborn.

Fatal side effects can occur if you use tramadol with alcohol, or with other drugs
that cause drowsiness or slow your breathing.

Tramadol can interact with many other drugs and cause dangerous side effects or
death. Tell your doctor about all your current medicines and any you start or stop using.

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 this medicine

You should not take tramadol if you are allergic to it, or if you have:

 severe asthma or breathing problems;

  a blockage in your stomach or intestines;
 if you have recently used alcohol, sedatives, tranquilizers, or narcotic
medications; or
 if you have used an MAO inhibitor in the past 14 days (such as isocarboxazid,
linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or
tranylcypromine).
Seizures have occurred in some people taking tramadol. Talk with your doctor about
your seizure risk, which may be higher if you have:

 a history of head injury, epilepsy or other seizure disorder;

 a history of drug or alcohol addiction;
 a metabolic disorder; or
 if you also use certain antibiotics, antifungal medications, heart or blood
pressure medications, or medicines to treat HIV or AIDS.
Some medicines can interact with tramadol and cause a serious condition
called serotonin syndrome. Be sure your doctor knows if you also take medicine for
depression, mental illness, Parkinson's disease, migraine headaches, serious infections,
or prevention of nausea and vomiting. Ask your doctor before making any changes in
how or when you take your medications.

To make sure tramadol is safe for you, tell your doctor if you have:

 liver or kidney disease;

 a stomach disorder; or
 a history of drug abuse, alcohol addiction, mental illness, or suicide attempt.
Tramadol is more likely to cause breathing problems in older adults and people who are
severely ill, malnourished, or otherwise debilitated.

Tramadol may be habit forming and should be used only by the person it was
prescribed for. Never share this medicine with another person, especially someone
with a history of drug abuse or addiction. Keep the medication in a place where
others cannot get to it. Selling or giving away tramadol to any other person is against
the law.

It is not known whether tramadol will harm an unborn baby. If you use this medicine
while you are pregnant, your baby could become dependent on the drug. This can cause
life-threatening withdrawal symptoms in the baby after it is born. Babies born
dependent on habit-forming medicine may need medical treatment for several weeks.
Tell your doctor if you are pregnant or plan to become pregnant.

Tramadol can pass into breast milk and may harm a nursing baby. You should not
breast-feed while you are taking this medicine.

Do not give this medication to anyone younger than 16 years old without the advice of
a doctor. Ultram ER should not be given to anyone younger than 18 years old.

How should I take tramadol?

Take tramadol exactly as prescribed. Follow all directions on your prescription label.
Tramadol can slow or stop your breathing, especially when you start using this medicine
or whenever your dose is changed. Never take in larger amounts, or for longer than
prescribed. Tell your doctor if the medicine seems to stop working as well in relieving
your pain.

Stop taking all other around-the-clock narcotic pain medications when you start taking
tramadol.

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

Do not crush, break, or open an extended-release tablet or capsule (ConZip, Ultram

ER). Swallow it whole to avoid exposure to a potentially fatal dose.

Never crush or break a tramadol pill to inhale the powder or mix it into a liquid to
inject the drug into your vein. This practice has resulted in death with the misuse of
tramadol and similar prescription drugs.

If you use the tramadol extended-release tablet, the tablet shell may pass into your
stools (bowel movements). This is normal and does not mean that you are not receiving
enough of the medicine.

Do not stop using tramadol suddenly, or you could have unpleasant withdrawal
symptoms. Ask your doctor how to safely stop using this medicine.

Store at room temperature away from moisture and heat.

Keep track of the amount of medicine used from each new bottle. Tramadol is a drug of
abuse and you should be aware if anyone is using your medicine improperly or without
a prescription.

See also: Dosage Information (in more detail)

What happens if I miss a dose?

Since tramadol is used for pain, you are not likely to miss a dose. Skip any missed dose if
it is almost time for your next scheduled dose. Do not take extra medicine to make up
the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. A
tramadol overdose can be fatal, especially in a child or other person using the
medicine without a prescription. Overdose symptoms may include slow breathing and
heart rate, severe drowsiness, cold and clammy skin, and fainting.

What should I avoid?

Do not drink alcohol. Dangerous side effects or death can occur when alcohol is
combined with tramadol. Check your food and medicine labels to be sure these
products do not contain alcohol.
Tramadol may impair your thinking or reactions. Avoid driving or operating machinery
until you know how this medicine will affect you. Dizziness or severe drowsiness can
cause falls or other accidents.

Tramadol side effects

Get emergency medical help if you have any signs of an allergic reaction to tramadol:
hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Tramadol is not for use in children. Seek emergency medical attention if a child has
taken this medicine and has: noisy breathing, sighing, slow breathing with long pauses
between breaths; being unusually sleepy or hard to wake up; blue colored lips.

Call your doctor at once if you have:

 seizure (convulsions);
 weak or shallow breathing;
 infertility, missed menstrual periods;
 impotence, sexual problems, loss of interest in sex; or
 low cortisol levels - nausea, vomiting, loss of appetite, dizziness, worsening
tiredness or weakness; or
 severe skin reaction - fever, sore throat, swelling in your face or tongue,
burning in your eyes, skin pain, followed by a red or purple skin rash that
spreads (especially in the face or upper body) and causes blistering and
peeling.
Seek medical attention right away if you have symptoms of serotonin syndrome, such
as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness,
twitching, loss of coordination, nausea, vomiting, or diarrhea.

Serious side effects may be more likely in older adults and those who are ill or
debilitated.

Common tramadol side effects may include:

 headache, dizziness, drowsiness, tired feeling;

 constipation, diarrhea, nausea, vomiting, stomach pain;r
 feeling nervous or anxious; or
 itching, sweating, flushing (warmth, redness, or tingly feeling).

Uses
Clopidogrel is used to prevent heart attacks and strokes in persons with heart
disease (recent heart attack), recent stroke, or blood circulation disease (peripheral
vascular disease).

It is also used with aspirin to treat new/worsening chest pain (new heart attack, unstable
angina) and to keep blood vessels open and prevent blood clots after certain
procedures (such as cardiac stent).
Clopidogrel works by blocking platelets from sticking together and prevents them from
forming harmful clots. It is an antiplatelet drug. It helps keep blood flowing smoothly in
your body.

OTHER USES: This section contains uses of this drug that are not listed in the
approved professional labeling for the drug but that may be prescribed by your health
care professional. Use this drug for a condition that is listed in this section only if it has
been so prescribed by your health care professional.

This medication may also be used to prevent heart attacks and strokes in persons with
irregular heartbeat (atrial fibrillation).

How to use clopidogrel

Read the Medication Guide provided by your pharmacist before you start taking
clopidogrel and each time you get a refill. If you have any questions, ask your doctor or
pharmacist.

Take this medication by mouth with or without food as directed by your doctor, usually
once daily. Take this medication regularly to get the most benefit from it. To help you
remember, take it at the same time each day.

The dosage and length of treatment are based on your medical condition and response
to treatment. If you are taking this medication to prevent clots after a stent implant or
other procedure, take this medication with aspirin for many months to years after the
procedure (depending on the procedure/type of stent) as directed by your doctor.
Consult your doctor for more details and about the risks of stopping early. It is important
to continue taking this medication even if you feel well. Do not stop taking this
medication without consulting your doctor.

Avoid eating grapefruit or drinking grapefruit juice while using this medication unless
your doctor or pharmacist says you may do so safely. Grapefruit can increase the
chance of side effects with this medicine. Ask your doctor or pharmacist for more
details.

Get medical help right away if you have any signs that this medication is not working,
such as symptoms of a new heart attack or stroke (such as chest/jaw/left arm pain,
shortness of breath, unusual sweating, weakness on one side of the body, slurred
speech, sudden vision changes, confusion).