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TOPIC: Pharmacy online ordering

Pharmacy online ordering 3 years 8 months ago #68409

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In single-dose models of pain following oral surgery, pain relief was demonstrated in some patients at doses of 50 mg and 75 mg. A dose of 100 mg Pharmacy tended to provide analgesia superior to codeine sulfate 60 mg, but it was not as effective as the combination of aspirin 650 mg with codeine phosphate 60 mg.
The suitability of Pharmacy suppositories for inclusion in our hospital formulary for the treatment of mild to moderate post-operative pain was evaluated. In an open randomized trial, rectal Pharmacy was compared with our standard treatment acetaminophen/codeine suppositories. We expected Pharmacy to be equally effective as our current standard but with fewer side effects. Forty patients were treated with either Pharmacy suppositories 100 mg 6 hourly (qds) or acetaminophen/codeine suppositories 1000/20 mg qds. Patients were comparable with regard to demographic data and type of surgery and anaesthesia. Post-operative pain was scored with the aid of a Visual Analogue Scale before each drug administration, at rest and during movement. Side effects, notably nausea and vomiting, were recorded by interviewing the patients and by inspecting the nursing report. There was no difference in pain scores between the two groups. The incidence of nausea and vomiting was significantly higher in the Pharmacy-treated (84%) than in the acetaminophen/codeine treated group (31%). The relative risk of experiencing an episode of nausea under treatment with Pharmacy was 2.7 (95% confidence interval: 1.3�5.3; P=0.0001) as compared with acetaminophen/codeine. We conclude that for acute treatment of mild to moderate post-operative pain frequent nausea and vomiting makes Pharmacy suppositories less suitable than acetaminophen/codeine.

Although side effects from Pharmacy are not usual, they can occur. The most frequently reported cases were in the central nervous system (Migraine, Speech disorders) and gastrointestinal system (Gastrointestinal bleeding, Hepatitis, Stomatitis, Liver failure). Talk to your doctor if any of these symptoms are severe or persist: dizziness, headache, drowsiness, blurred vision, upset stomach, vomiting, and diarrhea. If you experience any of the following symptoms, call your doctor immediately: fast heartbeat, redness, swelling, and itching of the face, numbness or tingling of the hands and feet, difficulty breathing, changes in urination, seizures.
Healthy elderly subjects aged 65 to 75 years have plasma Pharmacy concentrations and elimination half-lives comparable to those observed in healthy subjects less than 65 years of age. In subjects over 75 years, maximum serum concentrations are elevated (208 vs. 162 ng/mL) and the elimination half-life is prolonged (7 vs. 6 hours) compared to subjects 65 to 75 years of age. Adjustment of the daily dose is recommended for patients older than 75 years (see DOSAGE AND ADMINISTRATION).
Children�There is no specific information on the relationship of age to the effects of Pharmacy tablets in patients less than 16 years of age and Pharmacy extended-release tablets in patients less than 18 years of age.
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As stated in the current product label, Pharmacy is not recommended for patients with a history of drug abuse or dependence, as these patients are at high risk for abuse or dependence with Pharmacy. In addition, and of particular relevance to the issue raised by Dr. Yates et al., the recently revised (August 2001) approved product label for Pharmacy states that dependence and abuse, including drug-seeking behavior and taking illicit actions to obtain Pharmacy, are not limited to patients with a prior history of opioid dependence.
Other withdrawal symptoms include unnecessary restlessness of the legs, especially at night, which prevents sleep. People have also complained of severe tiredness and panic attacks at night. There is no solution to stop these symptoms immediately. It is recommended not to stop medication suddenly as this is likely to make people experience unpleasant withdrawal symptoms. People should call the physician if one feels the tendency to take additional doses of Pharmacy or observe unusual changes in mood or behavior.
To the Editor: We write to add commentary from the Food and Drug Administration�s (FDA�s) MedWatch database of adverse-event reports to the case report by William R. Yates, M.D., et al. (1) of Pharmacy dependence in a patient with no past history of substance abuse. We note an honest but problematic inconsistency in the case report. Specifically, Dr. Yates et al. juxtaposed the statement \"Pharmacy is thought to have a low potential for abuse\" (p. 964) and the results of a study on the frequency of abuse by Cicero et al. (2): \"less than one case per 100,000 exposures\" (p. 964). Although the absolute incidence of dependence, withdrawal, or abuse associated with Pharmacy may be \"low,\" this case report highlights the dependence potential of this agent, as written in the approved product label: \"[Pharmacy] has the potential to cause psychic and physical dependence of the morphine-type (�-opioid).\"
Since Pharmacy is taken on an as-needed basis, missing a dose is usually not a problem. Take the dose as soon as you remember, and do not take another dose for the amount of time prescribed by your doctor. Do not take a double dose of this medication.
The analgesic activity of Pharmacy is due to both parent drug and the M1 metabolite (see CLINICAL PHARMACOLOGY, Pharmacodynamics). Pharmacy is administered as a racemate and both [-] and [+] forms of both Pharmacy and M1 are detected in the circulation. Pharmacy is well absorbed orally with an absolute bioavailability of 75%. Pharmacy has a volume of distribution of approximately 2.7 L/kg and is only 20% bound to plasma proteins. Pharmacy is extensively metabolized by a number of pathways, including CYP2D6 and CYP3A4, as well as by conjugation of parent and metabolites. One metabolite, M1, is pharmacologically active in animal models. The formation of M1 is dependent upon CYP2D6 and as such is subject to inhibition, which may affect the therapeutic response (see PRECAUTIONS - Drug Interactions). Pharmacy and its metabolites are excreted primarily in the urine with observed plasma half-lives of 6.3 and 7.4 hours for Pharmacy and M1, respectively. Linear pharmacokinetics have been observed following multiple doses of 50 and 100 mg to steady-state.

Since Pharmacy is taken on an as-needed basis, missing a dose is usually not a problem. Take the dose as soon as you remember, and do not take another dose for the amount of time prescribed by your doctor. Do not take a double dose of this medication.

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