Ultracet Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Warnings:

Tramadol/acetaminophen has a risk for abuse and addiction, which can lead to overdose and death. Tramadol/acetaminophen may also cause severe, possibly fatal, breathing problems. To lower your risk, your doctor should have you take the smallest dose of tramadol/acetaminophen that works, and take it for the shortest possible time. See also How to Use section for more information about addiction.

Ask your doctor or pharmacist if you should have naloxone available to treat opioid overdose. Teach your family or household members about the signs of an opioid overdose and how to treat it.

The risk for severe breathing problems is higher when you start this medication and after a dose increase, or if you take the wrong dose/strength. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems may cause very serious side effects, including death. Also, other medications can affect the removal of tramadol/acetaminophen from your body, which may affect how tramadol/acetaminophen works. Be sure you know how to take tramadol/acetaminophen and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.

Keep this medicine in a safe place to prevent theft, misuse, or abuse. If someone accidentally swallows this drug, get medical help right away.

One ingredient in this product is acetaminophen. Taking too much acetaminophen may cause serious (possibly fatal) liver disease. Adults should not take more than 4000 milligrams (4 grams) of acetaminophen a day. People with liver problems and children should take less acetaminophen. Ask your doctor or pharmacist how much acetaminophen is safe to take.

Do not use with any other drug containing acetaminophen without asking your doctor or pharmacist first. Acetaminophen is in many nonprescription and prescription medications (such as pain/fever drugs or cough-and-cold products). Check the labels on all your medicines to see if they contain acetaminophen, and ask your pharmacist if you are unsure.

Get medical help right away if you take too much acetaminophen (overdose), even if you feel well. Overdose symptoms may include nausea, vomiting, loss of appetite, sweating, stomach/abdominal pain, extreme tiredness, yellowing eyes/skin, and dark urine.

Daily alcohol use, especially when combined with acetaminophen, may damage your liver. Avoid alcohol.

Before using this medication, women of childbearing age should talk with their doctor(s) about the risks and benefits. Tell your doctor if you are pregnant or if you plan to become pregnant. During pregnancy, this medication should be used only when clearly needed. It may slightly increase the risk of birth defects if used during the first two months of pregnancy. Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. To lessen the risk, take the smallest effective dose for the shortest possible time. Babies born to mothers who use this drug for a long time may develop severe (possibly fatal) withdrawal symptoms. Tell the doctor right away if you notice any symptoms in your newborn baby such as crying that doesn’t stop, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or difficulty gaining weight.

Children younger than 12 years should not use products that contain tramadol. Children between 12 and 18 years old should not use tramadol after certain surgeries (including tonsil/adenoid removal). Also, tramadol use is not recommended for children between 12 and 18 years old who are obese or have breathing problems. Some children are more sensitive to tramadol and have had very serious (rarely fatal) breathing problems such as slow/shallow breathing (see also Side Effects section). Talk with your doctor or pharmacist about the risks and benefits of this medication.

Warnings:

Tramadol/acetaminophen has a risk for abuse and addiction, which can lead to overdose and death. Tramadol/acetaminophen may also cause severe, possibly fatal, breathing problems. To lower your risk, your doctor should have you take the smallest dose of tramadol/acetaminophen that works, and take it for the shortest possible time. See also How to Use section for more information about addiction.

Ask your doctor or pharmacist if you should have naloxone available to treat opioid overdose. Teach your family or household members about the signs of an opioid overdose and how to treat it.

The risk for severe breathing problems is higher when you start this medication and after a dose increase, or if you take the wrong dose/strength. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems may cause very serious side effects, including death. Also, other medications can affect the removal of tramadol/acetaminophen from your body, which may affect how tramadol/acetaminophen works. Be sure you know how to take tramadol/acetaminophen and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.

Keep this medicine in a safe place to prevent theft, misuse, or abuse. If someone accidentally swallows this drug, get medical help right away.

One ingredient in this product is acetaminophen. Taking too much acetaminophen may cause serious (possibly fatal) liver disease. Adults should not take more than 4000 milligrams (4 grams) of acetaminophen a day. People with liver problems and children should take less acetaminophen. Ask your doctor or pharmacist how much acetaminophen is safe to take.

Do not use with any other drug containing acetaminophen without asking your doctor or pharmacist first. Acetaminophen is in many nonprescription and prescription medications (such as pain/fever drugs or cough-and-cold products). Check the labels on all your medicines to see if they contain acetaminophen, and ask your pharmacist if you are unsure.

Get medical help right away if you take too much acetaminophen (overdose), even if you feel well. Overdose symptoms may include nausea, vomiting, loss of appetite, sweating, stomach/abdominal pain, extreme tiredness, yellowing eyes/skin, and dark urine.

Daily alcohol use, especially when combined with acetaminophen, may damage your liver. Avoid alcohol.

Before using this medication, women of childbearing age should talk with their doctor(s) about the risks and benefits. Tell your doctor if you are pregnant or if you plan to become pregnant. During pregnancy, this medication should be used only when clearly needed. It may slightly increase the risk of birth defects if used during the first two months of pregnancy. Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. To lessen the risk, take the smallest effective dose for the shortest possible time. Babies born to mothers who use this drug for a long time may develop severe (possibly fatal) withdrawal symptoms. Tell the doctor right away if you notice any symptoms in your newborn baby such as crying that doesn’t stop, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or difficulty gaining weight.

Children younger than 12 years should not use products that contain tramadol. Children between 12 and 18 years old should not use tramadol after certain surgeries (including tonsil/adenoid removal). Also, tramadol use is not recommended for children between 12 and 18 years old who are obese or have breathing problems. Some children are more sensitive to tramadol and have had very serious (rarely fatal) breathing problems such as slow/shallow breathing (see also Side Effects section). Talk with your doctor or pharmacist about the risks and benefits of this medication.

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Uses

See also Warning section.This product is used to treat moderate to moderately severe pain. It contains 2 medications: tramadol and acetaminophen. Tramadol belongs to a class of drugs known as opioid analgesics. It works in the brain to change how your body feels and responds to pain. Acetaminophen is used to relieve pain, and it can also reduce a fever.

How to use Ultracet

See also Warning section.

Read the Medication Guide provided by your pharmacist before you start taking tramadol/acetaminophen and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth as directed by your doctor, usually up to every 4 to 6 hours as needed for pain relief. You may take this drug with or without food. If you have nausea, it may help to take this drug with food. Ask your doctor or pharmacist about other ways to decrease nausea (such as lying down for 1 to 2 hours with as little head movement as possible).

The dosage is based on your medical condition and response to treatment. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor’s instructions carefully. The maximum recommended dose is 8 tablets per day. Do not increase your dose, take the medication more frequently, or take it for a longer time than prescribed. Properly stop the medication when so directed.

Pain medications work best if they are used as the first signs of pain occur. If you wait until the pain has worsened, the medication may not work as well.

If you have ongoing pain (such as due to arthritis), your doctor may direct you to also take long-acting opioid medications. In that case, this medication might be used for sudden (breakthrough) pain only as needed. Other pain relievers (such as naproxen, ibuprofen) may also be prescribed. Ask your doctor or pharmacist about using tramadol safely with other drugs.

Suddenly stopping this medication may cause withdrawal, especially if you have used it for a long time or in high doses. To prevent withdrawal, your doctor may lower your dose slowly. Tell your doctor or pharmacist right away if you have any withdrawal symptoms such as restlessness, mental/mood changes (including anxiety, trouble sleeping, thoughts of suicide), watering eyes, runny nose, nausea, diarrhea, sweating, muscle aches, or sudden changes in behavior.

When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.

Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.

Tell your doctor if your pain does not get better or if it gets worse.

Side Effects

See also Warning section.

Nausea, vomiting, constipation, lightheadedness, dizziness, drowsiness, or sweating may occur. Some of these side effects may decrease after you have been using this medication for a while. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

To prevent constipation, eat dietary fiber, drink enough water, and exercise. You may also need to take a laxative. Ask your pharmacist which type of laxative is right for you.

To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: interrupted breathing during sleep (sleep apnea), mental/mood changes (such as agitation, hallucinations), severe stomach/abdominal pain, difficulty urinating, signs of your adrenal glands not working well (such as loss of appetite, unusual tiredness, weight loss).

Get medical help right away if you have any very serious side effects, including: fast/irregular heartbeat, severe dizziness, fainting, seizure.

This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.

Tramadol is changed into a strong opioid drug in your body. In some people, this change happens faster and more completely than usual, which increases the risk of very serious side effects. Get medical help right away if you notice any of the following: slow/shallow breathing, severe drowsiness/difficulty waking up, confusion.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any of the following symptoms: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

See also Warning section.

Before taking this product, tell your doctor or pharmacist if you are allergic to tramadol or acetaminophen; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: brain disorders (such as head injury, tumor, seizures), breathing problems (such as asthma, sleep apnea, chronic obstructive pulmonary disease-COPD), kidney disease, liver disease, diabetes, mental/mood disorders (such as confusion, depression, suicidal thoughts), personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol), stomach/intestinal problems (such as blockage, constipation, diarrhea due to infection, paralytic ileus), difficulty urinating (such as due to enlarged prostate), gallbladder disease, disease of the pancreas (pancreatitis), obesity.

This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

Tramadol/acetaminophen may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.

The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using tramadol/acetaminophen, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).

Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/”water pills”) or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using tramadol/acetaminophen safely.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Some children may be more sensitive to very serious side effects of tramadol, such as extreme sleepiness, confusion, or slow/shallow/noisy breathing. (See also Warning section.)

Older adults may be more sensitive to the side effects of this drug, especially confusion, dizziness, drowsiness, slow/shallow breathing, and QT prolongation (see above). Older adults may also be more likely to develop a type of salt imbalance (hyponatremia) while using this drug.

During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Discuss the risks and benefits with your doctor. (See also Warning section.)

This medication passes into breast milk and may have undesirable effects on a nursing infant, such as unusual sleepiness, difficulty feeding, or trouble breathing. Breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

Interactions

See also Warning section.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some products that may interact with this drug include: certain pain medications (mixed opioid agonist-antagonists such as butorphanol, nalbuphine, pentazocine), naltrexone, samidorphan.

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/”ecstasy,” St. John’s wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

Other medications can affect the removal of tramadol from your body, which may affect how tramadol works. Examples include azole antifungals (such as itraconazole, ketoconazole), levoketoconazole, macrolide antibiotics (such as erythromycin), quinidine, rifamycins (such as rifampin), ritonavir, drugs used to treat seizures (such as carbamazepine), among others.

The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if this medication is taken with other products that may also cause drowsiness or breathing problems. Tell your doctor or pharmacist if you are taking other products such as other opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

This medication may interfere with certain laboratory tests (including amylase/lipase levels), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

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Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, give them naloxone if available, then call 911. If the person is awake and has no symptoms, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: slow/shallow breathing, nausea, vomiting, loss of appetite, sweating, slow/irregular heartbeat, stomach/abdominal pain, extreme tiredness, yellowing eyes/skin, dark urine, seizure, coma.

Do not share this medication with others. Sharing it is against the law.

This medication has been prescribed for your current condition only. Do not use it later for another condition unless told to do so by your doctor. A different medication may be necessary in that case.

Not applicable.

Store at room temperature away from light and moisture. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Images

Ultracet 37.5 mg-325 mg tablet

Color: light yellowShape: oblongImprint: O-M 650

This medicine is a light yellow, oblong, film-coated, tablet imprinted with “O-M” and “650”.

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Ultracet Dosage Guide – Drugs.com

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Generic name: TRAMADOL HYDROCHLORIDE 37.5mg, ACETAMINOPHEN 325mg
Dosage form: tablet, coated
Drug class: Narcotic analgesic combinations

Medically reviewed by Drugs. com. Last updated on Feb 23, 2023.

Important Dosage and Administration Instructions

• ULTRACET is not approved for use for more than 5 days.
• Do not exceed the recommended dose of ULTRACET. Do not co-administer ULTRACET with other tramadol or acetaminophen containing products [see Warnings and Precautions (5.19)] .
• Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals [see Warnings and Precautions (5.1)] .
• Initiate the dosing regimen for each patient individually, taking into account the patient’s severity of pain, patient response, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse [see Warnings and Precautions (5.1)] .
• Monitor patients closely for respiratory depression, especially within the first 24–72 hours of initiating therapy and following dosage increases with ULTRACET and adjust the dosage accordingly [see Warnings and Precautions (5. 3)] .

Patient Access to Naloxone for the Emergency Treatment of Opioid Overdose

Discuss the availability of naloxone for the emergency treatment of opioid overdose with the patient and caregiver and assess the potential need for access to naloxone, both when initiating and renewing treatment with ULTRACET [see Warnings and Precautions (5.3), Patient Counseling Information (17)] .

Inform patients and caregivers about the various ways to obtain naloxone as permitted by individual state naloxone dispensing and prescribing requirements or guidelines (e.g., by prescription, directly from a pharmacist, or as part of a community-based program).

Consider prescribing naloxone, based on the patient’s risk factors for overdose, such as concomitant use of CNS depressants, a history of opioid use disorder, or prior opioid overdose. However, the presence of risk factors for overdose should not prevent the proper management of pain in any given patient [see Warnings and Precautions (5. 1, 5.3, 5.8)] .

Consider prescribing naloxone if the patient has household members (including children) or other close contacts at risk for accidental exposure or overdose.

Initial Dosage

The initial dose of ULTRACET is 2 tablets every 4 to 6 hours as needed for pain relief up to a maximum of 8 tablets per day.

Dosage Modification in Patients with Renal Impairment

In patients with creatinine clearances of less than 30 mL/min, do not exceed 2 tablets every 12 hours.

Safe Reduction or Discontinuation of ULTRACET

Do not abruptly discontinue ULTRACET in patients who may be physically dependent on opioids. Rapid discontinuation of opioid analgesics in patients who are physically dependent on opioids has resulted in serious withdrawal symptoms, uncontrolled pain, and suicide. Rapid discontinuation has also been associated with attempts to find other sources of opioid analgesics, which may be confused with drug-seeking for abuse. Patients may also attempt to treat their pain or withdrawal symptoms with illicit opioids, such as heroin, and other substances.

When a decision has been made to decrease the dose or discontinue therapy in an opioid-dependent patient taking ULTRACET, there are a variety of factors that should be considered, including the dose of ULTRACET the patient has been taking, the duration of treatment, the type of pain being treated, and the physical and psychological attributes of the patient. It is important to ensure ongoing care of the patient and to agree on an appropriate tapering schedule and follow-up plan so that patient and provider goals and expectations are clear and realistic. When opioid analgesics are being discontinued due to a suspected substance use disorder, evaluate and treat the patient, or refer for evaluation and treatment of the substance use disorder. Treatment should include evidence-based approaches, such as medication assisted treatment of opioid use disorder. Complex patients with comorbid pain and substance use disorders may benefit from referral to a specialist.

There are no standard opioid tapering schedules that are suitable for all patients. Good clinical practice dictates a patient-specific plan to taper the dose of the opioid gradually. For patients on opioids who are physically opioid-dependent, initiate the taper by a small enough increment (e.g., no greater than 10% to 25% of the total daily dose) to avoid withdrawal symptoms, and use a gradual downward taper. Patients who have been taking opioids for briefer periods of time may tolerate a more rapid taper.

It may be necessary to provide the patient with lower dosage strengths to accomplish a successful taper. Reassess the patient frequently to manage pain and withdrawal symptoms, should they emerge. Common withdrawal symptoms include restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills, myalgia, and mydriasis. 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. If withdrawal symptoms arise, it may be necessary to pause the taper for a period of time or raise the dose of the opioid analgesic to the previous dose, and then proceed with a slower taper. In addition, monitor patients for any changes in mood, emergence of suicidal thoughts, or use of other substances.

When managing patients taking opioid analgesics, particularly those who have been treated for a long duration and/or with high doses for chronic pain, ensure that a multimodal approach to pain management, including mental health support (if needed), is in place prior to initiating an opioid analgesic taper. A multimodal approach to pain management may optimize the treatment of chronic pain, as well as assist with the successful tapering of the opioid analgesic [see Warnings and Precautions (5.20), Drug Abuse and Dependence (9.3)] .

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List of opioids: uses, common brands and safety information – Product Information

Home >> Product Information >> List of Opioids: Methods of Use, Common Brand Names, and Safety Information

Drug information. Opioids block signals from the brain that register pain. Learn more about the use and safety of opioids here.

List of opioids | What are opioids? | How do they work | Uses | Who can take opioids? | Security | Side effects | Expenses

Pain relief is a topic that receives a lot of attention in today’s healthcare industry. One of the most common reasons people go to the pharmacy is for painkillers. Medications that relieve pain are called analgesics. Analgesics are available without a prescription and by prescription. So how do you know which analgesic is right for your pain? This is an important issue for effective pain relief.

For severe pain – such as after surgery or injury – opioids are the most effective analgesics for pain relief. If you’ve ever broken a bone or had your wisdom teeth removed, you may be familiar with some branded prescription opioids such as Percocet, Lortab, or Tylenol #3. In this article, we’ll look at important facts about opioid drugs, including their properties, common trademarks and safe use.

900 28 Learn more

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List of opioids
Generic name		Average Cash Price	SingleCare Savings	Learn More
Acetaminophen-Codeine #3	Tylenol #3	$13.92 for 20 300-30mg Tablets	Get 9 Coupons0031	Learn more
Buprenorphine	Buprenex, Subutex, Butrans, Belbuca	$52.48 for 10 8 mg tablets	Get coupons
Fentanyl	Actiq, Abstral, Duragesic , Fentora, Subsys	$149 for 10 25mcg/hour patches	Get Coupons	Learn More
Hydrocodone Acetaminophen	Norco, Lortab, Lorse, Xodol, Hycet	$14. 73 for 12 tablets of 5-325mg	Get Coupons	Learn More
Hydrocodone Bitartrate	Zohydro ER, Hisingla ER	$283 US for 30 10mg Capsules	Get Coupons	Learn More
Hydrocodone-Homatropine	Hykodan, Hydromet	$37.52 for 30 Tablets 5-1.5 mg	Get coupons ( tablet) Get coupons (liquid)	Learn more
Hydromorphone	Dilaudid, Exalgo	$21.15 for 30 2mg tablets	Learn more
Meperidine	Demerol	$3.90 for 1ml 50mg/ml	Get Coupons	Learn More
Methadone	Dolophine Methadose Floppy	$42.84 for 90 10mg Tablets	Get Coupons	Learn More
Morphine (Extended Edition) Contin, Morfabond	$74.26 for 60 x 15 mg tablets	Get coupons	Learn more
Morphine sulfate (immediate release)	Roxanol (discontinued)	$41. 37 for 60 tablets 15 mg	Get coupons (tablet) Get coupons (liquid)	Learn more
Oxycodone-acetaminophen	Percocet, Endocet, Roxicet, Xartemis XR	14.10 US$ for 12 5-325 mg tablets	Get Coupons	Learn more
Oxycodone-Aspirin	Percodan, Endodan	$264 for 120 tablets, 4.83-325mg	Get coupons	Learn more
Oxycodone (immediate release)	Oxido, Roxycodone	$118 for 120 10 mg tablets	Get coupons	Learn more
Oxycodone Extended	OxyContin, Xtampza ER	316 USD for 60 10mg Tablets	Get Coupons	Learn More
Tapentadol	Nucynta, Nucynta ER	$274.57 for 30 50mg tablets	Get coupons	Learn more
Tramadol	Ultram	$47.14 for 60 tablets of 50 mg	Get coupons	Learn more

Other opioids

• Codeine sulfate
• Duramorph (morphine for injection)
• Hydrocodone-ibuprofen
• Oxymorphone
• Oxycodone and naloxone ( Targiniq ER)
• Tramadol-acetaminophen (Ultracet)

The following are several opioid drugs used to treat conditions other than pain:

• Opium tincture for diarrhea
• Loperamide (Imodium) for diarrhea

90 263 Diphenoxylate-atropine (lomotil) from diarrhea

• Hydrocodone-chlorpheniramine (Vituz) for cough
• Buprenorphine-naloxone (Suboxone, Zubsolv) for opioid use disorder

What are opioids?

Opioids are a class of drugs used to relieve moderate to severe pain. Opioids are also called narcotics. The term “narcotic” is used by some people to refer to illicit drugs, but it technically refers to opioids. Opioids are legal when purchased with a prescription under federal and state laws.

Opioids occur naturally; opium, morphine and codeine are obtained from the opium poppy in Asia. Synthetic opioids are modified in the laboratory. These include oxycodone, hydrocodone, fentanyl, and many others.

How do opioids work?

Our body contains naturally occurring opioids called endorphins. Endorphins bind and activate certain receptors in the nervous system. Collectively, the various receptors are referred to as opioid receptors. When activated, the receptors block signals from the brain that register pain. This not only dulls the pain, but also creates a feeling of calm and happiness.

A common situation where endorphins create this effect is during exercise. Opioid drugs mimic the body’s endorphins by activating opioid receptors to an even greater extent. Some opioids act very quickly. They are used to treat breakthrough pain (severe pain that lasts for a relatively short time).

Extended release opioids act more slowly but for longer periods. They are often used to help reduce pain levels during the day or night while reducing the use of immediate-release opioids, which are more likely to be addictive.

What are opioids used for?

Opioids are used to treat moderate to severe pain. The following medical scenarios are commonly associated with opioid use:

• Cancer such as leukemia, prostate cancer, colon cancer, breast cancer, and others
• Palliative care
• Sickle cell crisis
• Arthritis (including psoriatic arthritis, rheumatoid arthritis and osteoarthritis)
• Use disorder opioids
• Sciatica
• Postoperative pain
• Kidney stones
• Migraines
• Musculoskeletal pain (eg, back pain)
• Low dose opioids combined with other ingredients to treat cough or diarrhea.

Who can take opioids?

Infants, children and adolescents

Opioids are prescribed for children and adolescents to relieve pain after surgery. Not all opioids are suitable for this age group. Fentanyl, morphine and methadone are used at any age. Oxycodone and hydromorphone are not indicated for children under 6 months of age. Hydrocodone is not indicated for use in patients younger than 2 years of age.

In 2017, the FDA restricted the use of codeine and tramadol in children due to severe breathing difficulties. In particular, codeine should not be used in children under 12 years of age, and tramadol should not be used in children under 18 years of age. Meperidine is not recommended for use in pediatric patients due to the accumulation of a toxic metabolite that can cause toxic seizures, especially in patients with poor renal function.

Adults

Opioids are safe for adults when taken for a short period and as directed by a doctor. The most common side effects are the result of central nervous system (CNS) depression, including drowsiness, sedation, and psychomotor disturbances. Some patients may experience memory impairment or confusion. All people who use opioids should be aware of the inherent risk of opioid dependence, dependency and overdose. These risks increase with opioid abuse.

Elderly

The use of opioids in the geriatric population should be avoided whenever possible. The use of opioids in the elderly significantly increases the risk of falls because they can cause ataxia, psychomotor impairment, and syncope. If there are no safe alternatives, opioids may be prescribed at the lowest effective dose – usually 25% to 50% of the adult dose – and then adjusted according to tolerability.

Pets

Two opioids are FDA approved for use in animals; buprenorphine is approved for use in cats and butorphanol is approved for use in cats, dogs and horses. Veterinarians typically prescribe off-label opioids for use in pets. For example, hydrocodone is used to treat pain and cough in dogs. Tramadol is often prescribed to relieve pain in dogs and cats.

Are opioids safe?

All opioids carry some risk of opioid dependence, abuse and abuse. The National Institute on Drug Abuse reports that over 2 million Americans abuse opioids and that more than 90 deaths from opioid overdose. The widespread misuse and overprescribing of opioids is a major public health crisis, commonly referred to as the opioid epidemic. To minimize the risk of opioid abuse, the U.S. Food and Drug Administration (FDA) has taken many steps to help patients and prescribers use drugs safely.

In 2016, the FDA announced a new requirement that immediate release opioids include a black box warning on the label detailing the risk of abuse and abuse that can lead to addiction, overdose and death.

In the same year, the FDA required a black box warning for opioids indicating the risk of using opioids with other central nervous system depressants, including benzodiazepines. These two separate classes of drugs, if taken together, can lead to severe sedation, respiratory depression, coma, and death.

In 2020, the FDA required that opioid labeling include advice to talk to your healthcare provider about using naloxone, an antidote for opioid overdose.

Long-term use of opioids is no longer recommended for chronic pain other than pain associated with cancer. In fact, long-term use of opioids can exacerbate some types of chronic pain and put patients at greater risk of opioid dependence.

When used correctly, short-term medical use of opioids can be safe and rarely leads to dependence. To avoid overdosing, always administer opioids according to package directions.

Opioid recalls

Any drug sold may be subject to recall if the manufacturer or regulatory authorities become aware that it may be defective or potentially harmful. The following are recent opioid recalls:

Hospira, Inc. recalled their hydromorphone injection on April 13, 2020 due to glass vials being empty or cracked. All affected products have expired.

Alvogen recalled their fentanyl transdermal patch due to product mislabelling in July 2019of the year. A small number of cartons contained fentanyl patches of the wrong strength. All affected products have expired.

PharmMedium Services, Ltd. recalled their injection of hydromorphone due to the presence of sulfite – in the information on the label of the claimed product, the product did not contain sulfite. Sulfite exposure can lead to serious adverse reactions in patients allergic to sulfite. All affected products have expired.

Opioid restrictions

Opioids should be avoided in patients with a history of substance use or prescription drug use as they may be addictive.

Use extreme caution when taking any opioid medication if you have ever had a severe hypersensitivity reaction to an opioid. Opioids often cause the release of histamine, resulting in itching. This is not a real allergy. True allergy to opioids includes anaphylaxis or angioedema. Due to the similarity in their chemical structure, cross-sensitivity with opioids other than the original pathogen is possible.

Opioids should not be used in patients with respiratory disease because opioids may aggravate respiratory depression.

Opioids should not be used in patients with known or suspected gastrointestinal obstruction, including paralytic ileus, as opioids may significantly reduce gastrointestinal motility.

Patients with liver or kidney disease should be closely monitored when taking opioids. Their dosages probably need to be adjusted to avoid dangerous levels of CNS depression.

Can opioids be taken while pregnant or breastfeeding?

The Centers for Disease Control and Prevention (CDC) does not recommend the use of opioids during pregnancy or breastfeeding if safer alternatives are available. In addition to the risk of misuse (which can harm the mother), long-term use of opioids during pregnancy or breastfeeding can harm the baby. Opioids cross the placenta, so newborns are exposed to them. According to the CDC, this can lead to preterm birth, poor fetal growth, and birth defects (including neural tube defects, glaucoma, stomach defects, and congenital heart defects). Infants exposed to opioids during pregnancy often develop neonatal dependence and withdrawal.

Opioid withdrawal symptoms include vomiting, diarrhea, inability to gain weight, high-pitched screaming, abnormal sleep patterns, irritability, hyperactivity, and tremors. This condition can be life-threatening without early treatment. The severity depends on the dose and the frequency of the maternal dose.

Are opioids controlled?

Because of the potential for abuse and misuse, opioids are classified as controlled substances by the US Drug Enforcement Agency (DEA). Almost all opioids are listed as controlled substances. Drugs in this category are the most heavily regulated of all prescription drugs. There are a few exceptions, such as buprenorphine, tramadol, and acetaminophen-codeine. These are still controlled substances, but there are fewer restrictions on their use. The schedule system and the specific drugs assigned to each schedule may vary from state to state due to controlled substance laws.

Common side effects of opioids

All opioids have many side effects. Many of these side effects are the result of CNS depression. These side effects may be exacerbated by other CNS depressants such as benzodiazepines, alcohol, and barbiturates. This includes:

• Drowsiness
• Confusion
• Sleep disturbance
• Psychomotor disturbances
• Shortness of breath (difficulty breathing)

Opioids also slow down the digestive tract. This causes side effects such as:

• Nausea/vomiting
• Constipation

Opioids cause the release of histamine which can lead to:

• Itching (itching)
• Rash 9 0264
• Flushing

If you have taken opioids drugs for a long period, you should not stop taking them suddenly as you may experience withdrawal symptoms. Your doctor should prescribe a slow titration to safely stop the drug.

How much do opioids cost?

Many opioids are available in generic form at an affordable price, usually less than US$20. Coupon SingleCare. Some common opioids in this price range include tramadol, oxycodone, buprenorphine tablets, and the generic Percocet, Lortab, and Tylenol #3. Some opioids are much more expensive.

For example, oxymorphone typically costs over $500 for a generic (or $111.81 with a SingleCare coupon). Some opioids, such as Nucynta, are only branded, making them more expensive (Nucynta costs about $274 for a 30-day supply at most retail pharmacies).

In insurance plans, most generic opioids are usually listed in Tier 1, which is the cheapest prescription drug tier.

Insurance plans often limit how many opioids they will cover over a given period. Doctors may send a prior authorization form to the insurance company if a patient requires a higher dose than the plan normally allows. For example, many insurance plans only cover a 7-day supply of drugs the first time a beneficiary receives a prescription for opioids while using their health plan.

Other coverage limits may apply depending on the condition being treated. For example, methadone is covered by a medical plan and not pharmacy insurance if it is used to treat addiction and not treat pain.

Before you get an opioid prescription, check with SingleCare to make sure you’re paying the lowest price.

Resources:

• Opioid Dependence, HelpGuide
• About Opioid Use During Pregnancy, CDC
• Maternal Opioid Analgesic Treatment and Risk of Birth Defects, CDC
• AGS Beers Criteria, Journal of the American Geriatric Society
• Opioid Abuse, American Society of Anesthesiologists
• Opioid Use ov in children, Journal of Pediatric Pharmacology and Therapy

TRAMOL – effective centrally acting analgesic

TRAMOL

is a tramadol preparation manufactured by Brahma Drug (India), which has been used in clinical practice for a long time to relieve pain of moderate and severe intensity.

Tramadol is an opiate receptor agonist, interacting mainly with the m-subtype, and also inhibits the reuptake of certain monoamines (norepinephrine, serotonin), which contributes to the development of an analgesic effect. The active metabolite of tramadol, o-demethyltramadol, significantly exceeds the parent substance in affinity for m-opioid receptors, and 2–4 times in analgesic activity. The antinociceptive effect of tramadol is partially eliminated by the opiate receptor antagonist naloxone.

Tramadol is not an opium derivative or a semi-synthetic derivative of morphine or thebaine, although its analgesic effect is due to opioid receptor agonism.

Tramadol treatment may develop dependence and withdrawal symptoms, but the latter is less pronounced than with other opiate receptor agonists, as well as side effects – nausea, lethargy, constipation, dry mouth, excessive sweating and pruritus. Respiratory depression compared to morphine is usually not pronounced, but may occur when the drug is used in high doses. In this regard, tramadol is prescribed with caution to patients with a threat of developing respiratory depression. Side effects are usually rare; from the side of the cardiovascular system, the development of arterial hypotension, syncope and sinus tachycardia is possible.

TRAMOL

is widely used to relieve acute and chronic pain syndrome of moderate to severe intensity of various etiologies in patients after various surgical interventions, including orthopedic, gynecological operations, caesarean section, dental surgical procedures (for example, extraction of molars).

When administered parenterally at a daily dose of 100-250 mg (lumbago, neuropathy, diseases of the musculoskeletal system, as well as when used in maxillofacial surgery), the drug is not inferior in effectiveness to repeated use of combined oral analgesics, including those containing codeine.

The use of TRAMOLA is indicated for pain in patients with cancer with insufficient effectiveness of non-narcotic analgesics. The drug is inferior in effectiveness to morphine derivatives, however, it causes the development of serious side effects much less frequently.

TRAMOL

is also used to eliminate severe myalgia in leptospirosis, pain syndrome in enterovirus infections, colitis of infectious etiology.

TRAMOL

is administered at a dose of 50-100 mg subcutaneously, intramuscularly or intravenously (slowly). The maximum analgesic effect develops approximately within 1 hour after the administration of the drug, its duration is 3-6 hours. If necessary, it is administered again at a dose of 50 mg after 30-60 minutes.

The most common side effects that develop during treatment with tramadol are dose-dependent: dizziness or nausea, headache, lethargy; from the digestive tract – constipation. Vomiting is less common, especially after rapid intravenous administration, as well as a feeling of dry mouth, dyspepsia, very rarely – skin rash, decreased blood pressure, syncope, tachycardia, urination disorders.

With caution, the drug should be used simultaneously with carbamazepine, opiate analgesics – it is possible to potentiate the side effects characteristic of these drugs.

The drug may have an adverse effect on the ability to drive vehicles and potentially dangerous machinery. Alcohol should be avoided while using the drug.

Use during pregnancy only if the expected benefit to the expectant mother outweighs the potential risk to the fetus.

Tramadol is excreted in breast milk. Data on the safety of its use during breastfeeding are not available.

Clinical manifestations of tramadol overdose are similar to those of opiate poisoning – miosis, vomiting, respiratory depression, convulsions, collapse.

In such cases, supportive treatment is carried out, aimed primarily at ensuring adequate respiratory function (ALV). Naloxone (an opiate antagonist) reverses some of the effects of tramadol.