Previous US studies suggest a relatively low risk of seizures with Pharmacy, unless it is taken by people with epilepsy or taken with other drugs that reduce the seizure threshold.2-4
We believe that 1) patients must be advised to take Pharmacy regularly and to stop gradually especially after long treatment periods, 2) physicians should consider the potential physical dependence when they prescribe Pharmacy for pain, and 3) any form of \"dependence\" of cancer patients taking Pharmacy, however, needs to be further explored. In fact, we are observing some patients who continue to take Pharmacy in order \"to achieve a feeling of well-being,\" even though their pain is controlled after disease regression or switching to strong opioids. This may be related to the inhibition of serotonin reuptake of Pharmacy.
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Pharmacy has been shown to inhibit reuptake of norepinephrine and serotonin in vitro, as have some other opioid analgesics. These mechanisms may contribute independently to the overall analgesic profile of Pharmacy. Analgesia in humans begins approximately within one hour after administration and reaches a peak in approximately two to three hours.
Pharmacy is used to relieve moderate to moderately severe pain.
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Pharmacy is a synthetic, centrally acting analgesic that was approved for use in Australia in 1998. Seizures have been reported in patients receiving the drug in overdose and, rarely, at the recommended dose.1-4 Over a one-year period, we observed a number of Pharmacy-associated seizures in the First Seizure Clinic at Austin Health, an outpatient service for rapid evaluation and diagnosis of patients with new-onset seizures.5
Pharmacy (TRA-ma-dole) is used to relieve pain, including pain after surgery. The long-acting tablets are used for chronic ongoing pain. The effects of Pharmacy are similar to those of narcotic analgesics. Although Pharmacy is not classified as a narcotic, it may become habit-forming, causing mental or physical dependence.
For patients with moderate to moderately severe chronic pain not requiring rapid onset of analgesic effect, the tolerability of Pharmacy can be improved by initiating therapy with a titration regimen: The total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg/day (50 mg q.i.d.). After titration, Pharmacy 50 to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg/day.
Pharmacy should not be used in CHILDREN younger than 16 years old; safety and effectiveness in these children have not been confirmed.
Serious potential consequences of overdosage with Pharmacy are central nervous system depression, respiratory depression and death. In treating an overdose, primary attention should be given to maintaining adequate ventilation along with general supportive treatment (See OVERDOSAGE).
Since Pharmacy�s initial marketing, from March 1995 through June 2001, the FDA has received 912 domestic adverse-event reports classified under the coding terms \"drug dependence,\" \"drug withdrawal,\" or \"drug abuse\" in association with Pharmacy. (The use of these terms is not based on DSM-IV criteria but taken from the reports themselves and so will vary by reporting clinician.) The distribution by adverse-event term is as follows: dependence: N=426, withdrawal: N=407, abuse: N=241 (the sum exceeds 912 since a report may have included more than one adverse-event term).
In our First Seizure Clinic, Pharmacy is the most frequently suspected cause of provoked seizures. We cannot calculate the exposure risk in our population, but the frequency of Pharmacy-related seizures suggests that they may be under-reported. It is important to consider Pharmacy as a possible cause of seizures � even when used at recommended doses. This may avoid inappropriate use of anti-epileptic drugs and unnecessary restrictions on driving and choice of vocation that might apply in cases of new-onset epilepsy.
