What is Tramadol

Tramadol hydrochloride (Ultram, Tramal) is a centrally acting synthetic opioid analgesic used in treating moderate to moderately-severe pain. The drug has a wide range of applications, including treatment of rheumatoid arthritis, restless legs syndrome and fibromyalgia. It was developed by the pharmaceutical company Grünenthal GmbH in the late 1970s.


Tramadol is a weak μ-opioid receptor agonist, releases serotonin, and inhibits the reuptake of norepinephrine. While its analgesic action is thus rather distinct from opioids per se, tramadol is a synthetic analog of the phenanthrene alkaloid codeine. Tramadol is converted to O-desmethyltramadol, a significantly more potent μ-opioid agonist. The euphoria and respiratory depression of opioids are mainly caused by the μ₁ and μ₂ receptors; the addictive nature of tramadol, as well as other opioids, is due to these effects, but tramadol's serotonergic and noradrenergic effects may also contribute to possible dependence. The opioid agonistic effect of tramadol and its major metabolite(s) is almost exclusively mediated by μ-opioid receptors. This further distinguishes tramadol from opioids in general (including morphine), which do not possess tramadol's degree of subtype selectivity and are much stronger opiate-receptor agonists.


Medical uses

Tramadol is used similarly to codeine, to treat moderate to moderately severe pain. Pharmacologically, Tramadol is similar to levorphanol (albeit with much lower μ-agonism), as both agents are also NMDA-antagonists with SNRI activity. 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)) also have similar activities. 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 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 Grünenthal GmbH, were 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.

Availability and usage

Tramadol is classified as a central nervous system drug usually marketed as the hydrochloride salt (tramadol hydrochloride); the tartrate is seen on rare occasions, and rarely (in the US at least) tramadol is available for both injection (intravenous and/or intramuscular) and oral administration. The most well known dosing unit is the 50 mg generic tablet made by several manufacturers. It is also commonly available in conjunction with APAP (paracetamol, acetaminophen) as Ultracet, in the form of a smaller dose of 37.5 mg tramadol and 325 mg of APAP. The solutions suitable for injection are used in patient-controlled analgesia pumps under some circumstances, either as the sole agent or along with another agent such as morphine.

Tramadol comes in many forms, including:

• capsules (regular and extended release)
• tablets (regular, extended release, chewable, low-residue and/or uncoated tablets that can be taken by the sublingual and buccal routes)
• suppositories
• effervescent tablets and powders
• ampules of sterile solution for SC, IM, and IV injection
• preservative-free solutions for injection by the various spinal routes (epidural, intrathecal, caudal, and others)
• powders for compounding
• liquids both with and without alcohol for oral and sub-lingual administration, available in regular phials and bottles, dropper bottles, bottles with a pump similar to those used with liquid soap and phials with droppers built into the cap
• tablets and capsules containing (acetaminophen/APAP), aspirin and other agents.  

Tramadol has been regularly used in the form of an ingredient in multi-agent topical gels, creams, and solutions for nerve pain, rectal foam, concentrated retention enema, and a skin plaster (transdermal patch) quite similar to those used with lidocaine.

Tramadol has a characteristic and unpleasant taste which is mildly bitter but much less so than morphine and codeine. Oral and sublingual drops and liquid preparations come with and without added flavoring. Also, 50 mg water-soluble tramadol tablets has strawberry-flavouring, no matter which company manufactured it, to distinguish every, same-looking and same sized Mirtazapine sublingual tablets, which has orange flavouring irrespective of the manufacturer. This different flavouring is considered to be a standard. Its relative effectiveness via transmucosal routes (i.e. sublingual, buccal, rectal) is similar to that of codeine, and, like codeine, it is also metabolized in the liver to stronger metabolites (see below).

The maximum dosage per day is 400 mg for oral use and 600 mg for parenteral use. Certain manufacturers or formulations have lower maximum doses. For example, Ultracet (37.5 mg/325 mg tramadol/APAP tablets) is capped at 8 tablets per day (300 mg/day) due to its acetaminophen content. Ultram ER is available in 100, 200, and 300 mg/day doses and is explicitly capped at 300 mg/day as well.

Patients taking SSRIs, SNRIs, TCAs, MAOIs, or other strong opioids (oxycodone, methadone, fentanyl, morphine), as well as the elderly, pediatric, and those with severely reduced renal or hepatic function should consult their doctor regarding adjusted dosing or whether to use tramadol at all.

What is Propecia?

Propecia, or finasteride 1mg, is a medication that works to help with treating male pattern hair loss. It works to help with growing back hair that is on the top of one’s head that has been naturally lost due to a standard process of baldness.

How does Propecia work?

Propecia works by targeting DHT, a hormone in the male body that is known to cause male pattern baldness. The DHT that is in a man’s scalp will work to progressive cause hair follicles to shrink to the point where the amount of hair on the scalp will decrease. Propecia will help to block the production of DHT by working through the bloodstream to target DHT as it is being produced. This is to help with making it easier for follicles that have shrunken due to DHT to grow back in size so that hair can become visible again.

How long will it take for Propecia to work?

It can generally take an entire year for Propecia to work. The progress for how it works goes as follows:

• After the first day Propecia will start to block DHT in the scalp.
• After three to six months the user will be able to notice a substantial decline in the level of hair loss that one is dealing with.
• Hair can start growing back as early as the ninth month of use. However the twelfth month is generally the key time to see how well the treatment has worked.

How effective is Propecia?

Studies from the Food and Drug Administration have found that ninety percent of all men who use Propecia have been able to experience some results. Some men were able to grow back their hair while others did not grow back hair but were able to prevent future hair loss from occurring. These results have helped to make Propecia the first and only medication that is approved by the FDA with regards to treating male pattern hair loss.

How often should Propecia be taken?

Propecia should be taken every day. In order for it to be more effective the user should take it at the same time every day.

What if a user stops taking Propecia?

If a man stops taking Propecia he will end up losing the benefits of the drug. Sticking with Propecia if it is working properly can help to keep DHT from getting back into the scalp. Any hair that has grown back from using Propecia will more than likely be lost if a user stops handling it.

Who can take Propecia?

Men with mild or medium level hair loss can use Propecia. There are no other real limits primarily because of how Propecia comes in only one dosage level. This is the one milligram level.

Some people can divide their pills in half to where 0.5mg doses can work. However, it is strongly recommended to take the entire Propecia pill in order for it to be more effective and to work properly.

Who should not take Propecia?

Men who have severe hair loss should not take Propecia because it will be ineffective to them due to the substantial losses in follicles in one’s scalp. Also, men who are allergic to any of the ingredients that work in Propecia should not take it.

What side effects work with Propecia?

The side effects of Propecia include back pains, rashes, headaches, diarrhea and erectile dysfunction. Rare side effects that can occur after using this include breast enlargement and lip swelling. While these side effects are the most common among men who take Propecia they do not occur as often. FDA studies show that these side effects will occur in less than two percent of all men that use this drug.

Can people with liver damage use Propecia?

They could but the main ingredient in Propecia is something that will have to be broken down by the liver. Therefore anyone with liver damage should be very cautious when it comes to using Propecia. Talking with one’s doctor is the best thing to do.

How can a man get Propecia?

A man will need to talk with one’s doctor about Propecia. A variety of different factors will need to be considered when talking with a doctor about this drug. The concern that one has for one’s hair loss and the amount of hair loss that has been experienced will need to be discussed. The rate of the hair loss and the past treatments that one has used to help with taking care of hair should be discussed as well.

Are there any generic options available?

There are two different generic options for Propecia. In addition to the standard form that is manufactured by Merck there is also Finpecia, which is made by Cipla, and Finax, which is made by Dr. Reddy’s. It helps to talk with a doctor to help with figuring out if a generic option can work for one’s needs.

What is Fioricet?

Fioricet contains a combination of acetaminophen, butalbital, and caffeine. Acetaminophen is a pain reliever and fever reducer.

Butalbital is in a group of drugs called barbiturates. It relaxes muscle contractions involved in a tension headache. Caffeine is a central nervous system stimulant. It relaxes muscle contractions in blood vessels to improve blood flow.

Fioricet is used to treat tension headaches that are caused by muscle contractions.

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

Important information about Fioricet

Do not use Fioricet if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.

Tell your doctor if you have ever had alcoholic liver disease (cirrhosis) or if you drink more than 3 alcoholic beverages per day. You may not be able to take medicine that contains acetaminophen. Do not take more Fioricet than is recommended. An overdose of acetaminophen can damage your liver or cause death. Ask a doctor or pharmacist before using any other cold, allergy, pain, or sleep medication. Acetaminophen (sometimes abbreviated as APAP) is contained in many combination medicines. Taking certain products together can cause you to get too much acetaminophen which can lead to a fatal overdose. Check the label to see if a medicine contains acetaminophen or APAP.

Avoid drinking alcohol. It may increase your risk of liver damage while taking Fioricet due to the acetaminophen component.

Before taking Fioricet

Do not use Fioricet if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects. Tell your doctor if you have ever had alcoholic liver disease (cirrhosis) or if you drink more than 3 alcoholic beverages per day. You may not be able to take medicine that contains acetaminophen. You should not take Fioricet if you are allergic to acetaminophen, butalbital, or caffeine, or if you have porphyria.

To make sure you can safely take Fioricet, tell your doctor if you have any of these other conditions:

• kidney disease,
• liver disease; or
• a history of mental illness or suicidal thoughts.

Butalbital may be habit forming and should be used only by the person it was prescribed for. Never share Fioricet 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.

FDA pregnancy category C. It is not known whether Fioricet will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Acetaminophen, butalbital, and caffeine can pass into breast milk and may harm a nursing baby. Do not use Fioricet without telling your doctor if you are breast-feeding a baby.

How should I take Fioricet?

Take Fioricet exactly as prescribed. Never take Fioricet in larger amounts, or for longer than recommended by your doctor. An overdose of this medication can damage your liver or cause death.Follow the directions on your prescription label. Tell your doctor if the medicine seems to stop working as well in relieving your pain. Take the medicine with food or milk if it upsets your stomach.

Store Fioricet at room temperature away from moisture and heat.

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

See also: Fioricet dosage (in more detail)

What happens if I miss a dose?

Since Fioricet is usually taken as needed, you may not be on a dosing schedule. If you are taking the medication regularly, 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.

The first signs of an acetaminophen overdose include loss of appetite, nausea, vomiting, stomach pain, sweating, and confusion or weakness. Later symptoms may include pain in your upper stomach, dark urine, and yellowing of your skin or the whites of your eyes.

Overdose symptoms may also include insomnia, restlessness, tremor, dizziness, drowsiness, diarrhea, increased sweating, shallow breathing, confusion, uneven heartbeats, seizure (convulsions), or coma.

What should I avoid while taking Fioricet?

Fioricet can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol. It may increase your risk of liver damage while taking acetaminophen. Ask a doctor or pharmacist before using any other cold, allergy, pain, or sleep medication. Acetaminophen (sometimes abbreviated as APAP) is contained in many combination medicines. Taking certain products together can cause you to get too much acetaminophen which can lead to a fatal overdose. Check the label to see if a medicine contains acetaminophen or APAP.

While you are taking Fioricet, avoid taking diet pills, caffeine pills, or other stimulants (such as ADHD medications) without your doctor's advice.

What Is Viagra?

Viagra is an oral drug developed by Pfizer to treat one of the most widespread sexual disorders - erectile dysfunction.
The active ingredient in this drug, which got the approval from the US Food and Drug Administration (FDA) in 1998, is sildenafil citrate.
It works by dilating blood vessels and blocking the phosphodiesterase type 5 enzyme. This helps to improve blood flow to the penis and, thus, achieve and maintain an erection.
Viagra is great for men who are diagnosed with erectile dysfunction, simply experience inconsistent ability to achieve an erection or cannot sustain a prolonged erection.
The dosage of Viagra depends on the nature of the sexual disorder, health conditions, age and other factors. The dosage can only be prescribed by a physician upon a careful medical examination. Usually, men are prescribed 50 mg of Viagra daily. The drug is also available in 25 mg and 100 mg pills. 
Viagra should be taken 30-60 minutes prior to the sexual ativity for it to take effect. The Viagra effect usually lasts up to 4 hours or less if taken with fat foods or alcohol.
Pfizer proved that Viagra can be used to treat conditions other than erectile dysfunction. As such, research showed that the drug is ideal for treatment of high-altitude pulmonary edema, pulmonary arterial hypertension and sexual function in women taking antidepressant drugs.