Exalgo Drug Imprint
World Health Organ ;89 6: So at this rate you will go through a ounce in 24 minutes. Without any changes in whole body metabolic rate, it indirectly causes less glucose to be required to replenish ATP, due to a quota needing to be met during exercise and creatine phosphate taking up a relatively larger percentage of said quota. Postgrad Med J ; Mike wailed that it was "all my fault" just as they heard an explosion. Role of silicone derivative plus onion extract gel in presternal hypertrophic scar protection: However, some early research suggests that taking folic acid before getting pregnant might reduce the risk of having a baby that is too small even when born full term.
Indications and Usage for Morphine Sulfate
Get emergency medical help if you have signs of an allergic reaction: Like other narcotic medicines, hydromorphone can slow your breathing. Death may occur if breathing becomes too weak. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, pinpoint pupils, or if you are hard to wake up. Patients considered opioid tolerant are those who are taking for one week or longer,around-the-clock medicine consisting of at least 60 mg oral morphine per day, or at least 25 mcg transdermal fentanyl per hour, or at least 30 mg oral oxycodone per day, or at least 8 g oral hydromorphone per day, or at least 25 mg oral oxymorphone per day, or at least 60 mg oral hydrocodone per day, or an equianalgesic dose of another opioid for one week or longer.
Depending on the clinical situation, the initial starting dose may be lowered in patients who are opioid naive. The initial starting dose is 0. Intravenous administration should be given slowly, over at least 2 to 3 minutes, depending on the dose. The initial dose should be reduced in the elderly or debilitated and may be lowered to 0. There is inter-patient variability in the potency of opioid drugs and opioid formulations.
Divide the new total amount by the number of doses permitted based on dosing interval e. Titrate the dose according to the patient's response. If unacceptable opioid-related adverse reactions are observed, consider reducing the dosage. Adjust the dosage to obtain an appropriate balance between management of pain and opioid-related adverse reactions. If the patient develops these signs or symptoms, raise the dose to the previous level and taper more slowly, either by increasing the interval between decreases, decreasing the amount of change in dose, or both.
Each 1 mL pre-filled syringe of sterile, aqueous solution contains 0. Each 1 mL pre-filled syringe of sterile aqueous solution contains 10 mg of hydromorphone hydrochloride with 0. Protect from light until time of use. Routine procedures for handling controlled substances developed to protect the public may not be adequate to protect health care workers.
Implementation of more effective accounting procedures and measures to restrict access to drugs of this class appropriate to the practice setting may minimize the risk of self-administration by health care providers. The following serious adverse reactions are described, or described in greater detail, in other sections:.
The following adverse reactions associated with the use of hydromorphone were identified in clinical studies or postmarketing reports. Because some of these reactions were reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
The most common adverse effects are lightheadedness , dizziness, sedation, nausea, vomiting, sweating, flushing, dysphoria , euphoria , dry mouth , and pruritus.
These effects seem to be more prominent in ambulatory patients and in those not experiencing severe pain. General disorders and administration site conditions: Respiratory, thoracic, and mediastinal disorders: Skin and subcutaneous tissue disorders: Cases of serotonin syndrome, a potentially life-threatening condition, have been reported during concomitant use of opioids with serotonergic drugs.
Cases of adrenal insufficiency have been reported with opioid use, more often following greater than one month of use. Due to additive pharmacologic effect, the concomitant use of benzodiazepines and other CNS depressants, including alcohol, can increase the risk of hypotension, respiratory depression, profound sedation, coma, and death. Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate.
Limit dosages and durations to the minimum required. Serotonergic Drugs Clinical Impact: The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome Intervention: If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity e. If urgent use of an opioid is necessary, use test doses and frequent titration of small doses to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression. Hydromorphone may enhance the neuromuscular blocking action of skeletal muscle relaxants and produce an increased degree of respiratory depression. Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone.
Anticholinergic Drugs Clinical Impact: All patients treated with opioids require careful monitoring for signs of abuse and addiction, because use of opioid analgesic products carries the risk of addiction even under appropriate medical use. Prescription drug abuse is the intentional non-therapeutic use of a prescription drug, even once, for its rewarding psychological or physiological effects.
Drug addiction is a cluster of behavioral, cognitive , and physiological phenomena that develop after repeated substance use and includes a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal. Preoccupation with achieving adequate pain relief can be appropriate behavior in a patient with poor pain control.
Abuse and addiction are separate and distinct from physical dependence and tolerance. Healthcare providers should be aware that addiction may not be accompanied by concurrent tolerance and symptoms of physical dependence in all addicts. In addition, abuse of opioids can occur in the absence of true addiction. Careful record-keeping of prescribing information, including quantity, frequency, and renewal requests as required by state and federal law, is strongly advised.
Proper assessment of the patient, proper prescribing practices, periodic re-evaluation of therapy and proper dispensing and storage are appropriate measures that help to limit abuse of opioid drugs. Parenteral drug abuse is commonly associated with transmission of infectious diseases such as hepatitis and HIV. Both tolerance and physical dependence can develop during chronic opioid therapy. Tolerance is the need for increasing doses of opioids to maintain a defined effect such as analgesia in the absence of disease progression or other external factors.
Tolerance may occur to both the desired and undesired effects of drugs, and may develop at different rates for different effects. Physical dependence results in withdrawal symptoms after abrupt discontinuation of a significant dosage reduction of a drug. Withdrawal also may be precipitated through the administration of drugs with opioid antagonist activity e. Physical dependence may not occur to a clinically significant degree until after several days to weeks of continued opioid usage.
Some or all of the following can characterize this syndrome: Other signs and symptoms also may develop, including irritability, anxiety, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia , vomiting, diarrhea, or increased blood pressure, respiratory rate , or heart rate.
Infants born to mothers physically dependent on opioids will also be physically dependent and may exhibit respiratory difficulties and withdrawal signs [see Use In Specific Populations ]. Addiction can occur at recommended dosages and if the drug is misused or abused.
Risks are increased in patients with a personal or family history of substance abuse including drug or alcohol abuse or addiction or mental illness e. The potential for these risks should not, however, prevent the proper management of pain in any given patient. Opioids are sought by drug abusers and people with addiction disorders and are subject to criminal diversion. Strategies to reduce these risks include prescribing the drug in the smallest appropriate quantity.
Contact local state professional licensing board or state controlled substances authority for information on how to prevent and detect abuse or diversion of this product.
Serious, life-threatening, or fatal respiratory depression has been reported with the use of opioids, even when used as recommended. Respiratory depression , if not immediately recognized and treated, may lead to respiratory arrest and death. Carbon dioxide CO2 retention from opioid-induced respiratory depression can exacerbate the sedating effects of opioids. Administration of this formulation may cause fatal respiratory depression when administered to patients who are not tolerant to the respiratory depressant effects of opioids.
Neonatal opioid withdrawal syndrome, unlike opioid withdrawal syndrome in adults, may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts. Observe newborns for signs of neonatal opioid withdrawal syndrome and manage accordingly. Advise pregnant women using opioids for a prolonged period of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available [see Use In Specific Populations , Patient Counseling Information ].
Because of these risks, reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioid analgesics alone.
If the decision is made to prescribe a benzodiazepine or other CNS depressant concomitantly with an opioid analgesic , prescribe the lowest effective dosages and minimum durations of concomitant use. In patients already receiving an opioid analgesic, prescribe a lower initial dose of the benzodiazepine or other CNS depressant than indicated in the absence of an opioid, and titrate based on clinical response.
If an opioid analgesic is initiated in a patient already taking a benzodiazepine or other CNS depressant, prescribe a lower initial dose of the opioid analgesic, and titrate based on clinical response. Follow patients closely for signs and symptoms of respiratory depression and sedation.
Advise patients not to drive or operate heavy machinery until the effects of concomitant use of the benzodiazepine or other CNS depressant have been determined.
Life-threatening respiratory depression is more likely to occur in elderly, cachectic , or debilitated patients because they may have altered pharmacokinetics or altered clearance compared to younger, healthier patients [see Life-Threatening Respiratory Depression ]. Alternatively, consider the use of non-opioid analgesics in these patients.
Presentation of adrenal insufficiency may include non-specific symptoms and signs including nausea, vomiting, anorexia , fatigue, weakness, dizziness, and low blood pressure. If adrenal insufficiency is suspected, confirm the diagnosis with diagnostic testing as soon as possible. If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. Wean the patient off of the opioid to allow adrenal function to recover and continue corticosteroid treatment until adrenal function recovers.
Other opioids may be tried as some cases reported use of a different opioid without recurrence of adrenal insufficiency. The information available does not identify any particular opioids as being more likely to be associated with adrenal insufficiency. There is increased risk in patients whose ability to maintain blood pressure has already been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs e.
In patients who may be susceptible to the intracranial effects of CO2 retention e. Opioids may also obscure the clinical course in a patient with a head injury. Opioids may cause increases in serum amylase. Monitor patients with biliary tract disease, including acute pancreatitis , for worsening symptoms. The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than in nonasthmatic people.
Long term studies in animals to evaluate the carcinogenic potential of hydromorphone have not been conducted. Hydromorphone was positive in the mouse lymphoma assay in the presence of metabolic activation, but was negative in the mouse lymphoma assay in the absence of metabolic activation. Hydromorphone was not mutagenic in the in vitro bacterial reverse mutation assay Ames assay.
Hydromorphone was not clastogenic in either the in vitro human lymphocyte chromosome aberration assay or the in vivo mouse micronucleus assay. Reduced implantation sites and viable fetuses were noted at 2. In animal reproduction studies, reduced postnatal survival of pups, and decreased were noted following oral treatment of pregnant rats with hydromorphone during gestation and through lactation at doses 0.
In published studies, neural tube defects were noted following subcutaneous injection of hydromorphone to pregnant hamsters at doses 6. No malformations were noted at 4 or Based on animal data, advise pregnant women of the potential risk to a fetus. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect , loss, or other adverse outcomes.
Prolonged use of opioid analgesics during pregnancy for medical or nonmedical purposes can result in physical dependence in the neonate and neonatal opioid withdrawal syndrome shortly after birth. Neonatal opioid withdrawal syndrome presents as irritability, hyperactivity and abnormal sleep pattern, high pitched cry, tremor , vomiting, diarrhea, and failure to gain weight. The onset, duration, and severity of neonatal opioid withdrawal syndrome vary based on the specific opioid used, duration of use, timing and amount of last maternal use, and rate of elimination of the drug by the newborn.
Opioids cross the placenta and may produce respiratory depression and psycho-physiologic effects in neonates. An opioid antagonist, such as naloxone , must be available for reversal of opioid-induced respiratory depression in the neonate.
However, this effect is not consistent and may be offset by an increased rate of cervical dilation , which tends to shorten labor. Monitor neonates exposed to opioid analgesics during labor for signs of excess sedation and respiratory depression. Maternal toxicity was noted in all treatment groups reduced food consumption and body weights in the two highest dose groups. There was no evidence of malformations or embryotoxicity reported.
Maternal toxicity was noted in the two highest dose groups reduced food consumption and body weights. The findings cannot be clearly attributed to maternal toxicity.
In a published study, CF -1 mice were treated subcutaneously with continuous infusion of 7. Increased pup mortality and decreased pup body weights were noted at 0.
Maternal toxicity decreased food consumption and body weight gain was also noted at the two highest doses tested. Low levels of opioid analgesics have been detected in human milk. Withdrawal symptoms can occur in breastfed infants when maternal administration of hydromorphone is stopped, or when breast-feeding is stopped.
In animal studies, Beta-Ecdysterone was found to stimulate the biosynthesis of contractile proteins in the skeletal muscles. Compared to the anabolic steroid Methandrosternolone, Beta-Ecdysterone was found to have caused statistically larger increases in added muscle mass and muscle protein. For a complete summary of the study, read more about Beta-Ecdysterone Hydroxyecdysone here: Calcium beta-hydroxy beta-methylbutyrate, as a dietary supplement, may affect protein synthesis. During resistance training, calcium beta-HMB has been reported to reduce muscle catabolism, promote fat loss, increase strength and fat-free mass in athletic and nonathletic populations.
We cannot stress how great this formula is and how much time was put into making this just right. This product is not intended to diagnose, treat, cure or prevent any disease. All products are intended for adults over the age of 18 and are not to be used by children under the age of We do not have any clinical studies backing up our claims. Individual results will vary. Do not use more than the daily dose recommended on the label. Please speak with your primary care physician before purchasing or starting the use of any supplement.
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