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31
Официальный раздел / Buy Cheap Sinequan (Doxepin) No Prescription
« Последний ответ от MaioZird 18 июня 2011, 07:35:58 »
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Sinequan is antidepressant used to treat symptoms of depression and anxiety caused by alcoholism, manic-depressive or psychiatric conditions.

Product Description
Common use
Doxepin belongs to the class of tricyclic antidepressants (TCAs). This medication is used to treat major depression, anxiety disorder, insomnia and allergic rhinitis. Doxepin can be also applied for other purposes. 
 
Dosage and direction
Take Sinequan by mouth with a glass of water, with or without food. Take the drug only as prescribed because dosage and schedule may vary depending on your condition and other factors. Avoid cutting, crushing or chewing this medicine.
Do not take the medicine more often than it is prescribed. Do not give up taking it except on the advice of your doctor.
It may need time for the medicine to help.
Consult your doctor concerning proper dose for you.
 
Precautions
Before taking Doxepin tell your doctor or chemist if you are allergic to it; or if you have other allergies.
Inform your doctor or chemist if you have bipolar confusion, eye, liver or kidney problems.
Avoid drinking alcohol and smoking while being treated with this medication. 
Aged people can be more sensitive to side effects of the medicine.
During the pregnancy this treatment should be used only when strongly necessary. 
As this medicament can be absorbed by skin, women who are pregnant or may become pregnant should not manipulate this medicine. 
 
Contraindications
Sinequan should not be used by pregnant/nursing women or children as well as by the patients having demonstrated a reaction of hypersensitivity to Doxepin.
 
Possible side effect
The most common side effects are dizziness, drowsiness, lightheadedness, confusion, agitation, increased anxiety, etc.
A very serious allergic reaction rarely occurs. Many people using this medicine do not have serious side effects.
Turn to your doctor or pharmacist for more details.
In case you notice the effects not listed here, contact your doctor or pharmacist.
 
Drug interaction
Tell your doctor or pharmacist of all prescription and nonprescription/herbal products you used before using this medication.
Doxepin can interact with:
* MAO inhibitors: Furazolidone, Isocarboxazid, Linezolid, Moclobemide Tranylcypromine, etc.
* Anti-arrhythmic medication: Propafenone, Quinidine, etc.
* Selective Serotonin Reuptake Inhibitors (SSRIs): Citalopram, Dapoxetine, Fluoxetine, Fluvoxamine, Paroxetine, etc.
* Antipsychotics (also called neuroleptics): Fluphenazine, etc.
* H2-receptor antagonists: Cimetidine, Ranitidine, Famotidine, Nizatidine.
Turn to your doctor or pharmacist for more details.
 
Missed dose 
If you have missed your dose, take it as soon as you remember. If you see that it is near the time for the next dose, skip the missed dose and resume your usual dosing schedule. Do not take your dose twice.
 
Overdose
If you think you have used too much of this medicine seek emergency medical attention right away. The symptoms of overdose usually include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting.
 
Storage
Store your medicines at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store your drugs in the bathroom. Keep all drugs away from reach of children and pets.
 
Disclaimer
We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information at the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.



 
 
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« Последний ответ от MaioZird 18 июня 2011, 07:29:00 »
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Singulair sostanze blocchi nel corpo chiamati leucotrieni, che sono responsabili dello sviluppo di asma e rinite allergica.
 

Descrizione Del Prodotto
Uso commune
Singulair ГЁ uno dei leucotrieni , un inibitore che ha utilizzato per il trattamento di asma, la prevenzione di asma esercitazione-indotta, e la rinite allergica (starnuti, naso chiuso, rinorrea, prurito al naso, ed esterna e allergie indoor). blocchi di Singulair sostanze nel corpo chiamati leucotrieni, che causano asma e la rinite allergica.

Dosaggio e indicazioni
Otterrete risultati migliori usando tutti i giorni. Inghiottire la compressa intera con un bicchiere d'acqua / latte. Se sei l'assunzione della compressa masticabile, la compressa deve essere masticata prima di ingestione.
La dose raccomandata per adulti e bambini dai 15 anni ГЁ di 10 mg al giorno. Per i bambini dai 6 ai 14 anni, la dose raccomandata ГЁ di 5 mg, una volta al giorno. Per i bambini piccoli 2 a 5 anni, la dose raccomandata ГЁ di 4 mg, una volta al giorno. Per l'etГ  bambini da 6 a 23 mesi di etГ , la dose raccomandata ГЁ di una bustina di granulato orale (4 mg), una volta al giorno. Questo farmaco deve essere assunto una volta al giorno alla sera. Anche noi desideriamo informarLa che la sicurezza e l'efficacia in pazienti pediatrici con meno di 12 mesi di etГ  non sono state stabilite.
Nota: questa istruzione presentato qui solo per la revisione. E 'molto necessario consultare il medico prima di utilizzare. Essa vi aiuterГ  ad avere migliori risultati.

Precauzioni
Singulair non deve essere utilizzato per il trattamento di attacchi acuti di asma. SINGULAIR non deve essere brusca sostituito per via inalatoria corticosteroidi per via inalatoria o per via orale. Gravidanza e allattamento. I bambini maggiori di / sopra i 6 anni. Attenzione che se hai l'asma e se l'asma ГЁ aggravata da aspirina, continuano ad evitare l'aspirina o altri farmaci chiamati farmaci anti-infiammatori durante l'assunzione di Singulair.

Controindicazioni
Non ammessi nei pazienti con ipersensibilitГ  nota ai componenti di questo prodotto.

Possibili effetti collaterali
Essi possono comprendere una reazione allergica: orticaria, difficoltГ  respiratorie, gonfiore del viso, delle labbra, della lingua o della gola. Anche gli effetti collaterali piГ№ possibili sono:
eruzione cutanea, ecchimosi, formicolio grave, intorpidimento, dolore, debolezza muscolare;
cambiamenti d'umore o di comportamento, ansia, depressione o pensieri di suicidio o di farti del male;
tremori o agitazione;
grave dolore del seno, gonfiore o irritazione, o
peggioramento dei sintomi dell'asma.

Meno gravi sono:
mal di testa;
mal di stomaco, bruciori di stomaco, disturbi di stomaco, nausea, diarrea;
dente del dolore;
sensazione di stanchezza;
febbre, naso chiuso, mal di gola, tosse, raucedine, o
rash di entitГ  lieve.

Se si verifica uno di loro smettere di usare Singulair e informi il medico il piГ№ presto possibile. Inoltre consultare il proprio medico di qualsiasi effetto indesiderato che sembra insolito.

Interazione tra farmaci
 Singulair interagire con i seguenti farmaci: cisapride; methscopolamine nitrati; nitrati come il nitrito di amile, isosorbide dinitrato, isosorbide mononitrato, nitroglicerina, nitroprussiato; altri prodotti sildenafil. Anche questo farmaco interagisce con: alcuni farmaci per la pressione alta, farmaci per il trattamento dell'infezione da HIV o l'AIDS, alcuni farmaci utilizzati per fungine o infezioni da lievito, come il fluconazolo, itraconazolo, ketoconazolo e voriconazolo, cimetidina, eritromicina, rifampicina. Si noti inoltre che una interazione tra due farmaci non sempre significa che si deve interrompere l'assunzione di uno di loro. Come al solito colpisce ГЁ l'effetto della droga, cosГ¬ consultare il proprio medico su come le interazioni sono gestite o dovrebbero essere gestiti.


Dose
Se hai dimenticato di prendere la dose nel tempo, si prega di farlo non appena si ricorda. Ma non prendete se ГЁ troppo tardi, o quasi ora per la dose successiva. Non aumentare la dose raccomandata. Prenda la dose di solito il giorno dopo nello stesso tempo regolarmente.

Overdose
Se prende piГ№ della dose ГЁ necessario in lungo periodo di tempo puГІ portare a sintomi come sete, sonnolenza, pupille dilatate, aumento dei movimenti muscolari, mal di stomaco o grave. Se si verifica uno di loro chiamare immediatamente il medico.


Conservazioni
Conservare a temperatura ambiente tra i 59-77 gradi F (15-25 В° C) lontano dalla luce e dall'umiditГ , bambini e animali domestici. Non utilizzare dopo termine di scadenza.

Declinazione della responsabilita
Noi forniamo solo informazioni di carattere generale su farmaci che non copre tutte le direzioni, integrazioni farmacologiche, o precauzioni. Informazioni presso il sito non puГІ essere utilizzato per l'auto-trattamento e di auto-diagnosi. Eventuali istruzioni specifiche per un particolare paziente deve essere concordato con il proprio consulente sanitario o medico incaricato del caso. Decliniamo l'affidabilitГ  di queste informazioni e potrebbe contenere errori. Noi non siamo responsabili per qualsiasi danno diretto, indiretto, speciale o di altro indiretta, a seguito di qualsiasi uso delle informazioni su questo sito e anche per le conseguenze di auto-trattamento.
 


 
 
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« Последний ответ от MaioZird 18 июня 2011, 07:26:19 »



 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Product Description
Common use
Endep belongs to the tricyclic antidepressants. The drug is mostly used to treat depression  and obsessive compulsive disorder (OCD). The last is a nervous condition where a person has recurring thoughts or ideas, or does repetitive things because they are anxious.
Endep works on the central nervous system (CNS) and helps to relieve the symptoms of OCD. The medication helps to restore the balance of certain natural substances (serotonin, among others) in the brain. This medication is also used to treat panic attacks and ongoing pain.

Dosage and direction
Take the drug only as prescribed because dosage and schedule may vary on your condition and other factors.
It is advised to follow the doctor's instructions carefully and not to take more or less medication than prescribed.
It is advised not to eat grapefruit or drink grapefruit juice ( it influences the level of cyclosporin in your blood ). Also limit alcoholic beverages.
Do not suddenly stop taking this medication as your condition may become worse.
It may take 2 to 3 weeks or longer before you notice the effects of this medication. Inform your doctor about your condition.

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Contraindications
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Possible side effect
The most common side effects are dizziness, dry mouth, drowsiness, constipation, stomach upset, nausea, vomiting, sweating etc. Anxiety symptoms may temporarily worsen when you first start using Endep.
A serious allergic reaction to this drug is very rare, but seek immediate medical help if it occurs.
Many people using this medicine do not have serious side effects.
If you experience any side effects not listed above, notify your health care advisor or pharmacist.

Drug interaction
Tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use before using this medication.
Avoid taking Endep with:
* MAO inhibitors: Furazolidone, Isocarboxazid, Linezolid, Moclobemide Tranylcypromine, etc which cause high fever and convulsions if they are used together with Endep.
* anti-arrhythmic medication: Propafenone, Quinidine, etc.
* Epinephrine (stimulates alpha and beta receptors) concomitantly administered with Endep causes severe high blood pressure.
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* Antipsychotics (also called neuroleptics): Fluphenazine, etc.
* H2-receptor antagonists: Cimetidine, Ranitidine, Famotidine, Nizatidine, etc.
Nicotine decreases blood levels of this medication. Inform your doctor if you smoke or if you have recently stopped smoking.
Try not to eat grapefruit or drink grapefruit juice while being treated with this medication.
Consult your doctor or pharmacist for more details.

Missed dose
The missed dose should be taken as soon as you remember. If you see that it is near the time for the next intake, skip the missed dose and return to your usual dosing schedule. Do not take the dose twice.

Overdose
If you think you have used too much of this medicine seek emergency medical attention right away. The symptoms of overdose usually include nausea, chest pain, irregular heartbeat, and feeling light-headed or fainting.

Storage
Store your medicines at room temperature between 68-77 F (20-25 C) away from light and moisture. Do not store the drugs in the bathroom. Keep all drugs away from reach of children and pets.

Disclaimer
We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information at the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.



 
 
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Propecia
Nom generique: le finasteride (FIH ride steh NAH)
Les noms de marque: Propecia, Proscar



Qu'est-ce que Propecia?
Propecia empeche la conversion de testosterone en dihydrotestosterone (DHT) dans le corps.
Propecia est utilise pour le traitement de la calvitie sur le sommet et le secteur anterieur de mi-cuir chevelu. Calvitie est une affection frequente dans laquelle les hommes d'experience amincissement des cheveux sur le cuir chevelu. Souvent, cela se traduit par un recul des cheveux et / ou la calvitie sur le dessus de la tete. Propecia est utilise par des hommes seulement et ne doit pas etre utilise par les femmes ou les enfants.
Propecia peut egalement etre utilise a d'autres fins qui ne figurent pas dans ce guide de medicament.

Informations importantes concernant Propecia
Propecia ne doit jamais etre pris par une femme ou un enfant. Le finasteride peut etre absorbe par la peau, et les femmes ou les enfants ne devraient pas etre autorises a manipuler les comprimes de Propecia.
Avant de prendre Propecia, parlez-en a votre medecin si vous avez deja eu une reaction allergique au finasteride, ou a un medicament appele dutasteride (Avodart).
Bien que Propecia n'est pas pour une utilisation par les femmes, ce medicament peut causer des malformations congenitales si une femme est exposee a elle pendant la grossesse. Propecia comprimes ne doit pas etre manipule par une femme qui est enceinte ou qui peuvent devenir enceintes. Propecia comprimes sont enduits et empecheront le contact avec la substance active pendant la manipulation normale, a condition que les comprimes ne sont pas brises ou ecrases. Si une femme vient accidentellement en contact avec ce medicament a partir d'un comprime ecrase ou casse, laver la zone avec du savon et de l'eau tout de suite. Appelez votre medecin immediatement si vous remarquez des morceaux de poitrine, la douleur, un ecoulement du mamelon, ou des changements de l'autre sein. Ceux-ci peuvent etre des signes de cancer du sein chez l'homme.



Avant de prendre Propecia
Propecia ne doit jamais etre pris par une femme ou un enfant. Le finasteride peut etre absorbe par la peau, et les femmes ou les enfants ne devraient pas etre autorises a manipuler un comprime de finasteride,
Pour vous assurer que vous pouvez sans risque prendre Propecia, parlez-en a votre medecin si vous avez un de ces autres conditions:
    une maladie du foie, ou anormale des enzymes hepatiques;
    cancer de la prostate;
    un trouble muscle de la vessie;
    retrecissement de l'uretre;
    si vous etes incapable d'uriner, ou
    si vous avez deja eu une reaction allergique a un medicament appele dutasteride (Avodart).
Bien que Propecia n'est pas pour une utilisation par les femmes, ce medicament peut causer des malformations congenitales si une femme est exposee a elle pendant la grossesse. Propecia comprimes ne doit pas etre manipule par une femme qui est enceinte ou qui peuvent devenir enceintes. Propecia comprimes sont enduits et empecheront le contact avec la substance active pendant la manipulation normale, a condition que les comprimes ne sont pas brises ou ecrases. Si une femme vient accidentellement en contact avec ce medicament a partir d'un comprime ecrase ou casse, laver la zone avec du savon et de l'eau tout de suite.



Comment dois-je prendre Propecia?
Prenez Propecia exactement comme prescrit par votre medecin. Ne le prenez pas en grandes quantites ou pour plus longtemps que recommande. Suivez les instructions sur votre etiquette de prescription.
Prenez ce medicament avec un grand verre d'eau.
Propecia peut etre pris avec ou sans nourriture. Prendre ce medicament a la meme heure chaque jour.
Il est important d'utiliser le Propecia regulierement pour tirer le meilleur parti. Vous devrez peut-etre prendre tous les jours pendant trois mois ou plus avant de voir un avantage Propecia. Propecia ne peut fonctionner que sur le long terme si vous le prenez. Si le medicament n'a pas fonctionne pour vous dans douze mois, un traitement complementaire est peu probable que des avantages. Si vous arretez de prendre Propecia, vous perdrez probablement les cheveux que vous avez acquises dans les 12 mois a compter de l'arret du traitement. Vous devriez en discuter avec votre medecin.
Pour etre sur que ce medicament est d'aider votre etat, votre sang peut etre necessaire de tester souvent. Votre medecin pourra egalement tester votre antigene prostatique specifique (PSA) pour verifier le cancer de la prostate. Consultez votre medecin regulierement.
Store Propecia a temperature ambiante loin de l'humidite, la chaleur et la lumiere. Conserver le flacon hermetiquement ferme lorsqu'il n'est pas utilise.

Qu'arrive-t-il si je manque une dose?
Prenez la dose oubliee des que vous vous souvenez. Sautez la dose oubliee s'il est presque temps pour votre prochaine dose programmee. Ne pas prendre des medicaments supplementaires pour compenser la dose oubliee.

Ce qui se passe si je surdose?
Obtenir des soins medicaux d'urgence ou appelez la ligne d'aide de poison a 1-800-222-1222. Un surdosage de Propecia ne devrait pas produire des symptomes vie en danger.

Que dois-je eviter tout en prenant Propecia?
Eviter de se lever trop vite d'une position assise ou couchee, ou vous pouvez vous sentir etourdi. Levez-vous lentement et reguliere-vous pour eviter une chute.



Propecia effets secondaires
Obtenez de l'aide medicale d'urgence si vous avez un de ces signes d'une reaction allergique: urticaire, difficulte a respirer, gonflement de votre visage, levres, langue, ou de la gorge. Appelez votre medecin immediatement si vous remarquez des morceaux de poitrine, la douleur, un ecoulement du mamelon, ou des changements de l'autre sein. Ceux-ci peuvent etre des signes de cancer du sein chez l'homme.
Moins graves effets secondaires de Propecia peuvent inclure:
    impuissance, perte d'interet pour le sexe, ou des difficultes a avoir un orgasme;
    troubles de l'ejaculation;
    gonflement de vos mains ou des pieds;
    gonflement ou une sensibilite des seins;
    etourdissements, une faiblesse;
    se sentir comme vous evanouir;
    maux de tete;
    ecoulement nasal, ou
    une eruption cutanee.
Ce n'est pas une liste complete des effets secondaires et d'autres peuvent survenir. Appelez votre medecin pour un avis medical sur les effets secondaires. Vous pouvez signaler des effets indesirables a la FDA au 1-800-FDA-1088.



Quels sont les medicaments peuvent affecter Propecia?
Il peut y avoir d'autres medicaments qui peuvent interagir avec Propecia. Parlez a votre medecin tous les medicaments que vous utilisez. Cela inclut sur ordonnance, en vente libre, les vitamines, et a base de plantes. Ne commencez pas un nouveau medicament sans en parler a votre medecin.

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Tramadol
 

 
Tramadol hydrochloride (Ultram, Tramal others below) is a centrally acting opioid analgesic, used in treating moderate to severe pain. The drug has a wide range of applications, including treatment for restless leg syndrome and fibromyalgia. It was developed by the pharmaceutical company Grunenthal GmbH in the late 1970s.
 
Tramadol possesses weak agonist actions at the ?-opioid receptor, releases serotonin, and inhibits the reuptake of norepinephrine.
 
Tramadol is a synthetic analog of the phenanthrene alkaloid codeine and, as such, is an opioid and also a prodrug (codeine is metabolized to morphine, tramadol is converted to O-desmethyltramadol). Opioids are chemical compounds which act upon one or more of the human opiate receptors. The euphoria and respiratory depression are mainly caused by the ?1 and ?2 receptors; the addictive nature of the drug is due to these effects as well as its serotonergic/noradrenergic effects. The opioid agonistic effect of tramadol and its major metabolite(s) are almost exclusively mediated by the substance's action at the ?-opioid receptor. This characteristic distinguishes tramadol from many other substances (including morphine) of the opioid drug class, which generally do not possess tramadol's degree of subtype selectivity.
 

 
Medical uses
 
Tramadol is used similarly to codeine, to treat moderate to moderately severe pain. Tramadol is somewhat pharmacologically similar to levorphanol (albeit with much lower ?-agonism), as both opioids are also NMDA-antagonists which also have SNRI activity (other such opioids to do the same are dextropropoxyphene (Darvon) & M1-like molecule tapentadol (Nucynta, a new synthetic atypical opioid made to mimic the agonistic properties of tramadol's metabolite, M1(O-Desmethyltramadol). Tramadol is also molecularly similar to venlafaxine (Effexor) and has similar SNRI effects, with antinociceptive effects also observed. It has been suggested that tramadol could be effective for alleviating symptoms of depression, anxiety, and phobias[6] because of its action on the noradrenergic and serotonergic systems, such as its "atypical" opioid activity. However, health professionals have not endorsed its use for these disorders, claiming it may be used as a unique treatment (only when other treatments failed), and must be used under the control of a psychiatrist.
 
In May 2009, the United States Food and Drug Administration issued a Warning Letter to Johnson & Johnson, alleging that a promotional website commissioned by the manufacturer had "overstated the efficacy" of the drug, and "minimized the serious risks". The company which produced it, the German pharmaceutical company Grunenthal GmbH, were the ones alleged to be guilty of "minimizing" the addictive nature and proposed efficacy of the drug, although it showed little abuse liability in preliminary tests. The 2010 Physicians Desk Reference contains several warnings from the manufacturer, which were not present in prior years. The warnings include more compelling language regarding the addictive potential of tramadol, the possibility of difficulty breathing while on the medication, a new list of more serious side effects, and a notice that tramadol is not to be used in place of opiate medications for addicts. Tramadol is also not to be used in efforts to wean addict patients from opiate drugs, nor to be used to manage long-term opiate addiction.
 

 
 
Adverse effects
Main side effects of tramadol. Red color denotes more serious effects, requiring immediate contact with health provider.
 
The most commonly reported adverse drug reactions are nausea, vomiting, sweating, itching and constipation. Drowsiness is reported, although it is less of an issue than for non-synthetic opioids. Patients prescribed tramadol for general pain relief with or without other agents have reported withdrawal symptoms including uncontrollable nervous tremors, muscle contracture, and 'thrashing' in bed (similar to restless leg syndrome) if weaning off the medication happens too quickly. Anxiety, 'buzzing', 'electrical shock' and other sensations may also be present, similar to those noted in Effexor withdrawal. Respiratory depression, a common side-effect of most opioids, is not clinically significant in normal doses. By itself, it can decrease the seizure threshold. When combined with SSRIs, tricyclic antidepressants, or in patients with epilepsy, the seizure threshold is further decreased. Seizures have been reported in humans receiving excessive single oral doses (700 mg) or large intravenous doses (300 mg). However, there have been several rare cases of people having grand-mal seizures at doses as low as 100–400 mg orally. An Australian study found that of 97 confirmed new-onset seizures, eight were associated with tramadol, and that in the authors' First Seizure Clinic, "tramadol is the most frequently suspected cause of provoked seizures". There appears to be growing evidence that Tramadol use may have serious risks in some individuals and it is contra-indicated in patients with uncontrolled epilepsy (BNF 59). Seizures caused by tramadol are most often tonic-clonic seizures, more commonly known in the past as grand mal seizures. Also when taken with SSRIs, there is an increased risk of serotonin toxicity, which can be fatal. Fewer than 1% of users have a presumed incident seizure claim after their first tramadol prescription. Risk of seizure claim increases 2- to 6-fold among users adjusted for selected comorbidities and concomitant drugs. Risk of seizure is highest among those aged 25–54 years, those with more than four tramadol prescriptions, and those with a history of alcohol abuse, stroke, or head injury. Dosages of warfarin may need to be reduced for anticoagulated patients to avoid bleeding complications. Constipation can be severe especially in the elderly requiring manual evacuation of the bowel.[citation needed] Furthermore, there are suggestions that chronic opioid administration may induce a state of immune tolerance,[30] although tramadol, in contrast to typical opioids may enhance immune function.  Some have also stressed the negative effects of opioids on cognitive functioning and personality.
 

 
 
Chemistry
Characteristics

 
Structurally, tramadol closely resembles a stripped down version of codeine. Both codeine and tramadol share the 3-methyl ether group, and both compounds are metabolized along the same hepatic pathway and mechanism to the stronger opioid, phenol agonist analogs. For codeine, this is morphine, and for tramadol, it is the O-desmethyltramadol.
Comparison with related substances
 
Structurally, tapentadol is the closest chemical relative of tramadol in clinical use. Tapentadol is also an opioid, but unlike both tramadol and venlafaxine, tapentadol represents only one stereoisomer and is the weaker of the two, in terms of opioid effect. Both tramadol and venlafaxine are racemic mixtures. Structurally, tapentadol also differs from tramadol in being a phenol, and not an ether. Also, both tramadol and venlafaxine incorporate a cyclohexyl moiety, attached directly to the aromatic, while tapentadol lacks this feature. In reality, the closest structural chemical entity to tapentadol in clinical use is the over-the-counter drug phenylephrine. Both share a meta phenol, attached to a straight chain hydrocarbon. In both cases, the hydrocarbon terminates in an amine.
[edit] Synthesis and stereoisomerism
 
(1R,2R)-Tramadol   (1S,2S)-Tramadol
(1R,2R)-Tramadol     (1S,2S)-Tramadol
(1R,2S)-Tramadol   (1S,2R)-Tramadol
(1R,2S)-Tramadol     (1S,2R)-Tramadol

 
The chemical synthesis of tramadol is described in the literature.[36] Tramadol [2-(dimethylaminomethyl)-1-(3-methoxyphenyl)cyclohexanol] has two stereogenic centers at the cyclohexane ring. Thus, 2-(dimethylaminomethyl)-1-(3-methoxyphenyl)cyclohexanol may exist in four different configurational forms:
 
    (1R,2R)-isomer
    (1S,2S)-isomer
    (1R,2S)-isomer
    (1S,2R)-isomer

 
The synthetic pathway leads to the racemate (1:1 mixture) of (1R,2R)-isomer and the (1S,2S)-isomer as the main products. Minor amounts of the racemic mixture of the (1R,2S)-isomer and the (1S,2R)-isomer are formed as well. The isolation of the (1R,2R)-isomer and the (1S,2S)-isomer from the diastereomeric minor racemate [(1R,2S)-isomer and (1S,2R)-isomer] is realized by the recrystallization of the hydrochlorides. The drug tramadol is a racemate of the hydrochlorides of the (1R,2R)-(+)- and the (1S,2S)-(–)-enantiomers. The resolution of the racemate [(1R,2R)-(+)-isomer / (1S,2S)-(–)-isomer] was described[37] employing (R)-(–)- or (S)-(+)-mandelic acid. This process does not find industrial application, since tramadol is used as a racemate, despite known different physiological effects [38] of the (1R,2R)- and (1S,2S)-isomers, because the racemate showed higher analgesic activity than either enantiomer in animals[39] and in humans.[40]
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