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 Chemical Pharmacology :. tramadol is an analgesic that has both novel opioid agonist and inhibition of monoamine reuptake leading to its analgesic efficacy. Natural action of opioids is due to the parent compound and metabolite O-desmethyl more active. tramadol acts in the system of monoamine reuptake resorption bottling nerve endings both norepinephrine and 5-hydroxytryptamine Apart from analgesia, tramadol may produce a variety of symptoms including dizziness, drowsiness, nausea, constipation and similar to other opioids. tramadol high curses Venus, often in combination monoamine oxidase (MAO) inhibitors or selective serotonin reuptake King (SSRIs), have been matched with serotonin syndrome is unrest, hyperthermia, muscle stiffness and pain.

Tramadol pain medication is one of the most popular on the market painkillers. You must have come across this name many times in your life. If you have not used yourself, then you must have known the family or friends who have used it for years. Or at some point, your doctor may have suggested this medication for the treatment of any type of physical pain in your body. Many people know that tramadol is a good medicine for pain, but many do not know the medical aspects of pain medication. Read on to find out what these facts.

 when you buy Tramadol  you know it is a pain medication that can be used to treat moderate to moderately severe pain. In the category of opioid agonists. Some people do not understand this medicine for an NSAID, but it is not. It facilitates the patient's pain by changing the way the body senses pain. buy Tramadol pain medication can be found in two formulations for immediate release and sustained release. One tablet of 50 mg is indicated for the immediate relief of pain, while greater than 100, 200 or 300 mg tablets are recommended for power prolonged pain relief.

 

One thing to keep in mind is that the pain medication tramadol tablets should be taken as a whole tablet. You should never try to divide it into pieces to make it easier to take. It should not be chewed or crushed or. There are some instructions for taking this drug, which will be provided by your doctor. Remember to follow anyone if you do not want to have side effects from pain medication. Another thing to consider is related to the dose. It is recommended not to increase the dose of tramadol pain medication without first consulting your doctor. The increased dosage requirements, could be addictive and dangerous for the body.

 

tramadol pain medication should be avoided by pregnant women and nursing mothers also. Not sure is these situations. Additionally, you may have certain drug interactions when combined with certain drugs. So if you are taking any other medicines, do not do well checked by a doctor. Your doctor can advise you whether it would be safe to take tramadol with other medicines you are taking. tramadol pain medication is a very popular pain relief medication, but you should know the medical facts to make the most of the medicine!

Tramadol is well absorbed orally. It can be done in less than 50-100 mg lozenges as needed for pain relief every 4 to 6 hours, not more than 400 mg per day.

Pharmacological Properties

Tramadol is an opioid analgesic that acts on the central nervous system. It is a nonselective pure agonist opioid receptors μ, d,? with a higher affinity for the μ receptor. In addition, in vitro inhibits the reuptake of norepinephrine and serotonin. These mechanisms contribute synergistically to the analgesic effect of tramadol. Unlike morphine, analgesic doses of tramadol not produce respiratory depressant effect. Similarly, gastrointestinal motility is not modified. Cardiovascular effects are usually mild. The precise mechanism of the analgesic properties of paracetamol is unknown and may involve central and peripheral effects.

Pharmacokinetics

Tramadol is administered in racemic form and the forms [-] and [+] of tramadol and its metabolite M1 are detected in the blood. [- Tramadol / (-) - (+) tramadol] After a single oral administration of a tablet ZALDIAR, maximum plasma concentrations of 64.3 / 55.5 ng / ml are reached and 4.2 ug / ml (paracetamol) after 1.8 h [(+) - tramadol / (-) - tramadol] and 0.9 h (paracetamol) respectively. Half-lives t1 / 2 are 5.1 / 4.7 h [(+) - tramadol / (-) - tramadol] and 2.5 h (paracetamol). We did not observe significant changes in the kinetic parameters of either active compared with the parameters of the active substances when these are used alone.

Racemic tramadol is absorbed rapidly and almost completely after oral administration .. The oral absorption of paracetamol is rapid and almost complete and occurs primarily in the small intestine. Peak plasma concentrations of paracetamol are reached in one hour and are not modified by the concomitant administration of tramadol. Oral administration of food ZALDIAR only changes the rate and speed of absorption slightly; consequently, it may be administered independently ZALDIAR meals.

Tramadol is extensively metabolized after oral administration. About 30% of the dose is excreted unchanged in the urine, while 60% is excreted as metabolites.

Tramadol and its metabolites are primarily eliminated by the kidneys. The half-life of paracetamol is approximately 2 to 3 hours in adults. It is shorter in children and slightly longer in the newborn and in cirrhotic patients. Paracetamol is mainly eliminated by proportional to the dose of glucurono derivatives and sulfoconjugates training. Less than 9% of paracetamol is excreted unchanged in the urine. In renal insufficiency, the half-life of both compounds is prolonged.

INDICATIONS

INDICATIONS: Symptomatic treatment of moderate to severe pain that does not respond to the use of peripherally acting analgesics used alone.

CONTRAINDICATIONS AND WARNINGS

Contraindications

• Known hypersensitivity to tramadol or paracetamol.

• Acute intoxication with alcohol, hypnotics, centrally acting analgesics, opioids or psychotropic drugs.

• prior or concomitant treatment in the last 15 days for inhibitors and non-selective MAO in the last 24 hours for selectively inhibit MAO A and MAO B.

• severe respiratory insufficiency,

• hepatocellular insufficiency.

• epilepsy not controlled by treatment

• Concomitant use of nalbuphine, buprenorphine, pentazocine

• Breast-feeding if long term treatment

WARNINGS

tramadol is not a suitable substitution treatment for opioid-dependent patients. Although tramadol is an opioid agonist, it can not suppress withdrawal symptoms by suppressing morphine treatment.

• convulsions have been observed mainly in predisposed or treated with drugs that can lower the seizure threshold patients. Epileptic patients controlled or predisposed to seizures should only be treated with tramadol when absolutely necessary.

• In adults should not exceed the limit dose of 4 grams per day.

• It is not recommended to drink alcohol during treatment.

• use in children under 16 is not recommended, use with caution in elderly, Use with caution in patients with a history of convulsiones.Tratamiento should be brief or intermittent, prolonged use can cause addiction.

Special Precautions

PRECAUTIONS

Preclinical data paracetamol have revealed no specific hazard for humans.

ZALDIAR should be used with caution in patients dependent or hypersensitivity to opioids or in patients with cranial trauma, in shock, in a state of altered consciousness for unknown reasons, with problems affecting the respiratory center or the respiratory function, or with high intracranial pressure.

tramadol has a low dependence potential.

Carcinogenicity / mutagenicity results of carcinogenicity tests do not suggest that tramadol pose a potential risk to humans. Results of standard mutagenicity tests did not reveal a potential genotoxic risk associated with the use of tramadol in man.

Pregnancy / Fertility:

• Data regarding paracetamol: The results of epidemiological studies in humans have shown that paracetamol has no teratogenic or fetotoxic effects.

• Data regarding tramadol: Animal studies have shown no evidence that there is a teratogenic or on fertility. In humans, there are currently insufficient data to assess the teratogenic potential of tramadols effect when administered during the first trimester of pregnancy. Therefore, it is not advisable to use tramadol during the first trimester of pregnancy.

From the 2nd trimester, you can consider using carefully (preferably short).

Lactation: Approximately 0.1% of the maternal dose of tramadol is excreted in breast milk:

Pediatrics: The safety and efficacy of tramadol has not been established in children under 15 years of age. Therefore, treatment is not recommended in this population.

Geriatrics: In patients over 75 years of age is recommended that the interval between dose increases to 9 hours

Renal impairment: Tramadol use in patients with severe renal impairment (creatinine clearance <10 mL / min) is not recommended. In cases of moderate renal insufficiency (creatinine clearance 10 to 30 mL / min) the dosage should be increased at intervals of 12 hours.

Effects on ability to drive and use machines

The potential effect on care can make driving and using machines is dangerous, particularly after the concomitant intake of alcohol or antidepressants of the central nervous system.

ADVERSE EFFECTS

ADVERSE REACTIONS

The adverse reactions most commonly reported during clinical trials with the combination of paracetamol / tramadol include nausea, dizziness and somnolence, observed in 10% of patients.

Cardiovascular system disorders:

• Uncommon (0.1% -1%): hypertension, palpitations, tachycardia, arrhythmia.

Disorders of the central and peripheral nervous system:

• Very common (> 10%): Dizziness, drowsiness.

• Regular (1% -10%): Headache, tremors.

• Uncommon (0.1% -1%): involuntary muscle contractions, paresthesia, tinnitus.

• Rare (<0.1%): ataxia, seizures.

Respiratory system disorders:

• Uncommon (0.1% -1%): dyspnea.

Gastrointestinal disorders:

• Very common (> 10%): nausea.

• Regular (1% -10%): vomiting, constipation, dry mouth, diarrhea, abdominal pain, dyspepsia, flatulence.

• Uncommon (0.1% -1%): Dysphagia mane.

Disorders of the liver and biliary system:

• Uncommon (0.1% -1%): elevated liver transaminases.

Disorders of the skin and appendages:

• Regular 1% -10%): sweating, pruritus.

• Uncommon (0.1% -1%): dermal reactions (eg rash, urticaria).

Interactions

INTERACTION WITH OTHER DRUGS

Concomitant use with:

• MAO inhibitors: In case of recent treatment with non-selective inhibitors of monoamine oxidase, should be delayed 15 days starting treatment with tramadol . In case of recent treatment with MAO inhibitors or selective B should be delayed 24 hours of treatment with tramadol.

• opioid agonists-antagonists (buprenorphine, nalbuphine, pentazocine): Due to the decline of the analgesic effect by competitive blocking effect at the receptors.

Concomitant use is not recommended:

Alcohol. Alcohol increases the sedative effect of opioid analgesics. Decreased alertness can make driving dangerous and use of machines. Avoid drinking alcoholic beverages and medications containing alcohol.

Carbamazepine: Risk of decreased plasma concentrations of tramadol.

Precautions to be taken into account in case of concomitant use:

Other opioid derivatives (including antitussive drugs and substitutive treatments), benzodiazepines and barbiturates. Increased risk of respiratory depression, which can be fatal in overdose.

Other central nervous system depressants, other opioid derivatives (including antitussive drugs and substitutive treatments), barbiturates, benzodiazepines, other anxiolytics, hypnotics, sedative antidepressants, sedative antihistamines, neuroleptics, centrally-acting antihypertensive drugs, thalidomide and baclofen.

These drugs can cause increased central depression. The effect on care can make dangerous driving and using machines.

Drugs that reduce the seizure threshold, such as bupropion, antidepressants reuptake inhibitors of serotonin, tricyclic antidepressants and neuroleptics. Concomitant use of tramadol with these drugs may increase the risk of seizures.

OVERDOSE

OVERDOSE AND TREATMENT

Symptoms of overdose due to tramadol: miosis, vomiting, cardiovascular collapse, somnolence including coma, convulsions and respiratory depression, which could lead to respiratory arrest.

Overdose symptoms due to paracetamol: An overdose is a particular concern in elderly patients, especially in young children, which can be fatal.

Emergency Treatment

Move immediately to a specialized unit, Keep respiratory and circulatory functions, before starting treatment, take a blood sample as soon as possible to measure the plasma concentration of paracetamol and tramadol and in order to perform tests hepáticas.Realizar tests liver at the start (of overdose) and repeated every 24 hours. Usually an increase in liver enzymes (AST, ALT), which normalizes after one or two weeks is observed.

Empty stomach causing vomiting (when the patient is conscious) by irritation or washing gástrico.El antidote in case of respiratory depression due to overdose of tramadol is naloxone.

Regardless of the amount of paracetamol ingested communicated should administer the antidote to acetaminophen, acetylcysteine, orally or intravenously, as soon as possible. If possible, in the 10 hours following the overdose.

DOSAGE AND DOSAGE

DOSAGE AND ADMINISTRATION

One or two tablets every 4 to 6 hours and a maximum of 8 tablets per day. The dose should preferably be taken at intervals of 6 hours with a minimum interval of four hours. tramadol should not be given longer than is strictly necessary. If a long-term treatment of pain precise tramadol only be possible by prescription and close medical supervision. The tablets should be swallowed whole with a sufficient amount of liquid. They must not break or chew.

STORAGE

PRESERVATION AND STORAGE

Store in cool, dry place

Keep out of the reach and sight of children

Shopping online can be a convenient way to search and compare prices. But when it comes to buying prescription drugs, beware: you might end up buying fake medicines or hazardous ingredients. Or, you could fall into legitimate-looking Web sites with the intention to deceive but to get your personal information and use it to steal your identity, take your money and send you defective, or just disappear and not send anything medications.

How can you tell if you are dealing with a reputable pharmacy? The FDA recommends using only Web sites based in the US pharmacies licensed by a state board of pharmacy. The association called the English National Association of Boards of Pharmacy (NABP) has information on the state board in your area and a list of pharmacies accredited through its Verified Internet Pharmacy Practices program Sites (VIPPS). These pharmacies are licensed and meet other criteria NABP. You can also find a link to a list of non-recommended sites.

Avoid sites that:

Do not ask for a recipe or prescription.

Do not have a registered pharmacist available to answer your questions.

Do not give the address and phone number of the business.

You are located outside the United States or that have not been licensed by the state board of pharmacy appropriate.

A dishonest seller may send fake drugs, expired, mislabeled, or the wrong dose. Or they could contain dangerous ingredients, or may not have been stored or shipped correctly. And if you rip a site located outside the United States, it is very little that the government can do. For more information visit the FDA Web site. And remember that as drug prices vary, it is best to shop and compare.

To find other ways to save money with generic medicines, see the Generic Drugs section.

Internet Recommendation:

Compare the prices of medicines in different pharmacies on the Internet and remember to calculate shipping costs.

Health and welfare are central components to live a life free of stress rounded. When the need for medication or health care advice arises and can rely on a good pharmacy it is a way to relieve the added pressure of being ill or injured. Find a nearby pharmacy that accepts your insurance, stock a lot of inventory to fill prescriptions quickly, offers spacious over-the-counter medicines, and provides reliable additional recommendations and suggestions that help in the recovery process.

Instructions

1 Locate the nearest pharmacy typing its address in the Google search engine and click enter. Click on "Maps" in the upper left corner of the resulting page.

2 Click "Search nearby" column of information to the left of the map. Type "Pharmacy" in the search box that appears. Note pharmacies on the map found in the most convenient locations.

3 Contact your nearest pharmacies to ensure store hours stick to your scheduling needs and accept your insurance plan.

4 Once you have narrowed your search to nearby pharmacies with appropriate hours and acceptance of insurance each pay a visit to assess the cleanliness, professionalism and courtesy offered to customers. Look for private consultation room where guests can have conversations with pharmacists about medications and prescriptions.

5 Consider the size of the pharmacy to determine whether the action is large enough to ensure that prescriptions can be filled quickly and effectively. Inventory is also important when considering the cost. Make sure the pharmacy is stocked with both brand name and generic prescription and over-the-counter (OTC) options give variable costs.

6 Look around each location to a large supply of various counter medications which can be useful either when there is no recipe to fill or to complement a prescribed medication.

7 Talk to your pharmacist to determine if he or she has a friendly attitude, but professional. Ask if the pharmacy keeps electronic medical records to ensure that careful attention is paid to accurate records of patients to fill prescriptions.

What is difficult to price a pharmacy?

The difficulties always come from how to value the right to open the pharmacy and, therefore, the right to transfer. Not surprisingly, it must be remembered that, given the pharmaceutical planning, only those who go to an administrative authorization process with sufficient merit may agree to open a new pharmacy, so in many cases the only option is to access a purchase by transfer.

Therefore, normally, there is more demand than supply, which favors the concern of the buyer who, when he knows that there is a pharmacy for sale, is willing to almost everything and, on the other hand, the preferred position of the seller who thinks he can ask almost any price for their pharmacy. The market is boss, but it's still good to have clear parameters to be certain that what is offered or what is called for is in line with reality.

What must be taken into account when setting the price of a pharmacy?

Depending on who you ask the answers may vary greatly, however there is a widespread misconception that you have to apply a consistent formula to multiply the annual sales of a corrective index (usually range from 1.25 to 2) Thus a pharmacy a year selling 1 million could cost from € 1,250,000 to € 2,000,000. These rates are constantly changing depending on the demand, but also of the parties.

This calculation formula, by itself, is ancient: responding to a situation that is now clearly overtaken (by law), which was a fixed margin for all drug sales (29.9% before), so He knew exactly what would be the real benefit of the buyer. Also what is sold in the pharmacy was basically medicine. At present while the price of the drug is fixed and the margin is fixed by law there are many settings, so that the pharmacist to take home is not as easy as multiplied by a percentage sales. Therefore only the multiplier applied to all sales is a mistake because it differs considerably sell a growth hormone, a cancer treatment, a bronchodilator, an antibiotic, cough syrup or aspirin (to be thought in the drug price and margin)

Therefore the price of a drug should not be obtained with a simple but after taking into account various topics formula.

Well, what is taken into account to date for calculating the price a pharmacy.

There is no single solution, but I do believe that there are different parameters that have to be combined and assessed, they are not limited to the following, but can also read another entry of this blog on this topic.

1. Location: the location of the pharmacy in the area in the neighborhood, if you are near a health center or hospital, school, market; the population is in the range of influence; greater number are young people or children, purchasing power; if only pharmacy in town; if you have kits.

2. Local Pharmacy: local legal situation: if the property or otherwise if a lease and its conditions; if it is amended or updated; if you have meters according to the current demands of both the regulations and the market; access thereto; security measures; automation.

3. Personnel: Number of employees according to real need sales, contract types, categories, seniority, wages, cost of hypothetical dismissal or subrogation.

4. Revenue: sales type (counter, social security or other insurance, drugstore, other sales) Determination of benefits, by type of sale.

5. Specific Clientele: Residences, mutual societies, schools and valuation in proportion to sales

6. Pharmacy Services: schedule, guards, sections, nutrition, number of daily wholesale deals.

7. Future: New pharmacies that will be open in the area or draft new regulations and other issues that can change the billing future.

With these data one can make a fairly complete analysis, but certainly the end price of a drug depends on the ability of the parties to negotiate, of the urgency of the operation and, ultimately, of the opportunity.

In my career I have seen that all pharmacies, sooner or later will end up transferring because he always comes to an agreement on price. But beyond this, I will not finish this post without saying that both buyer and seller should be aware of the real situation of the pharmacy at the time of sale, taking into account also the national economic context. Both must be honest and must be transparency to prevent either considered ultimately deceived. And in this exchange of positions and valuations is essential that the intermediary, there is almost always (either a company or a professional), competent, trustworthy and honest.

Need help selling or buying? Want a second opinion? Do not hesitate to contact us and we get a budget. Trust us and you will not regret

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