What is diclofenac? Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). This medicine works by reducing substances in the body that cause pain and inflammation. Diclofenac is used to treat mild to moderate pain, or signs and symptoms of osteoarthritis or rheumatoid arthritis. Voltaren is also indicated for the treatment of ankylosing spondylitis. The Cataflam brand of this medicine is also used to treat menstrual cramps. Diclofenac powder (Cambia) is used to treat a migraine headache attack. Cambia will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks. Warnings You should not use diclofenac if you have a history of allergic reaction to aspirin or NSAIDs (non-steroidal anti-inflammatory drugs). Diclofenac can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG). Diclofenac may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using this medicine, especially in older adults. Before taking this medicine Diclofenac can increase your risk of fatal heart attack or stroke, even if you don't have any risk factors. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG). Diclofenac may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using this medicine, especially in older adults. You should not use diclofenac if you are allergic to it, or if you have ever had an asthma attack or severe allergic reaction after taking aspirin or an NSAID. Do not use Cambia to treat a cluster headache. Do not use Zipsor if you are allergic to beef or beef protein. To make sure this medicine is safe for you, tell your doctor if you have: heart disease, high blood pressure; ulcers or bleeding in your stomach; asthma; liver or kidney disease; or if you smoke. Diclofenac can affect ovulation and it may be harder to get pregnant while you are using this medicine. If you are pregnant, you should not take diclofenac unless your doctor tells you to. Taking a NSAID during the last 20 weeks of pregnancy can cause serious heart or kidney problems in the unborn baby and possible complications with your pregnancy. It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk. Diclofenac is not approved for use by anyone younger than 18 years old. How should I take diclofenac? Take diclofenac exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides. Your doctor may occasionally change your dose. Use the lowest dose that is effective in treating your condition. Different brands of diclofenac contain different amounts of diclofenac, and may have different uses. If you switch brands, your dose needs may change. Follow your doctor's instructions about how much medicine to take. Ask your pharmacist if you have any questions about the brand you receive at the pharmacy. Swallow the tablet whole and do not crush, chew, or break it. Take Zorvolex on an empty stomach, at least 1 hour before or 2 hours after a meal. Dissolve the powder form of this medicine (Cambia) with 1 to 2 ounces of water. Do not use any other type of liquid. Stir this mixture and drink all of it right away. Cambia works best if you take it on an empty stomach. Call your doctor if your headache does not completely go away after taking Cambia. If you use diclofenac long-term, you may need frequent medical tests. Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use. Dosing information Usual Adult Dose for Osteoarthritis: Diclofenac free acid capsules: 35 mg orally 3 times a day Diclofenac potassium immediate-release tablets: 50 mg orally 2 or 3 times a day Diclofenac sodium enteric-coated tablets: 50 mg orally 2 or 3 times a day or 75 mg orally 2 times a day Maximum dose: 150 mg daily Diclofenac sodium extended-release tablets: 100 mg orally once a day Use: For the relief of signs and symptoms of osteoarthritis. Usual Adult Dose for Ankylosing Spondylitis: Diclofenac sodium enteric-coated and delayed-release tablets: 25 mg orally 4 times a day. An additional 25 mg dose may be administered at bedtime, if necessary Maximum dose: 125 mg per day Use: For acute or long-term use in the relief of signs and symptoms of ankylosing spondylitis. Usual Adult Dose for Dysmenorrhea: Diclofenac potassium immediate-release tablets: 50 mg orally 3 times a day Comments: An initial dose of 100 mg orally followed by 50 mg oral doses may provide better relief for some patients; initiate treatment upon appearance of the first symptoms and continue for a few days. Use: For the relief of signs and symptoms of primary dysmenorrhea. Usual Adult Dose for Rheumatoid Arthritis: Diclofenac potassium immediate-release tablets: 50 mg orally 3 or 4 times a day Diclofenac sodium enteric-coated and delayed-release tablets: 50 mg orally 3 to 4 times a day or 75 mg orally twice a day Maximum dose: 225 mg daily Diclofenac sodium extended-release tablets: 100 mg orally once a day Maximum dose: 100 mg orally 2 times a day; this would be for the rare patient in whom the benefits outweigh the clinical risks. For the relief of signs and symptoms of rheumatoid arthritis Usual Adult Dose for Migraine: Diclofenac potassium for oral solution packets: 50 mg (1 packet) orally once Comments: This drug is not indicated for the prophylactic therapy of migraine or for use in cluster headaches; the safety and efficacy of a second dose has not been established. Use: For acute treatment of migraine with or without aura. Usual Adult Dose for Pain: Oral: Diclofenac potassium liquid-filled capsules: 25 mg orally 4 times a day Diclofenac free acid capsules: 18 mg or 35 mg orally 3 times a day Diclofenac potassium immediate-release tablets: 50 mg orally 3 times a day; an initial dose of 100 mg orally followed by 50 mg oral doses may provide better relief in some patients. Parenteral: 37.5 mg IV bolus over 15 seconds every 6 hours as needed for pain Maximum Dose: 150 mg per day Comment: Patients should be well hydrated prior to IV administration of this drug in order to reduce the risk of adverse renal reactions. Uses: For the management of mild to moderate acute pain (oral, IV) and moderate to severe pain alone or in combination with opioid analgesics (IV). What happens if I miss a dose? 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. What to avoid Avoid drinking alcohol. It may increase your risk of stomach bleeding. Avoid taking aspirin or other NSAIDs unless your doctor tells you to. Ask a doctor or pharmacist before using other medicines for pain, fever, swelling, or cold/flu symptoms. They may contain ingredients similar to diclofenac (such as aspirin, ibuprofen, ketoprofen, or naproxen). Diclofenac side effects Get emergency medical help if you have signs of an allergic reaction to diclofenac (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling). Get emergency medical help if you have signs of a heart attack or stroke: chest pain spreading to your jaw or shoulder, sudden numbness or weakness on one side of the body, slurred speech, feeling short of breath. Stop using this medicine and call your doctor at once if you have: the first sign of any skin rash, no matter how mild; flu-like symptoms; heart problems - swelling, rapid weight gain, feeling short of breath; kidney problems - little or no urinating, painful or difficult urination, swelling in your arms or legs, feeling tired or short of breath; liver problems - nausea, diarrhea, stomach pain (upper right side), tiredness, itching, dark urine, jaundice (yellowing of the skin or eyes); or signs of stomach bleeding - bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds. Common diclofenac side effects may include: indigestion, gas, nausea, vomiting, stomach pain; diarrhea, constipation; headache, dizziness, drowsiness; abnormal lab tests; itching, sweating; stuffy nose; increased blood pressure; or swelling or pain in your arms or legs. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.   What other drugs will affect diclofenac? Ask your doctor before using diclofenac if you take an antidepressant. Taking certain antidepressants with an NSAID may cause you to bruise or bleed easily. Tell your doctor about all your other medicines, especially: heart or blood pressure medication, including a diuretic or "water pill"; other forms of diclofenac (Arthrotec, Flector, Pennsaid, Solaraze, Voltaren Gel); a blood thinner - warfarin, Coumadin, Jantoven; or other NSAIDs - aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), indomethacin, meloxicam, and others. This list is not complete. Other drugs may interact with diclofenac, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

What is lidocaine injection? Lidocaine is a local anesthetic (numbing medication) that is used to numb an area of your body to help reduce pain or discomfort caused by invasive medical procedures such as surgery, needle punctures, or insertion of a catheter or breathing tube. Lidocaine injection is sometimes used to treat irregular heart rhythms that may signal a possible heart attack. Lidocaine injection is also given in an epidural (spinal block) to reduce the discomfort of contractions during labor. Lidocaine injection may also be used for purposes not listed in this medication guide. Warnings You should not receive lidocaine injection if you have severe heart block, or a heart rhythm disorder called Stokes-Adams syndrome or Wolff-Parkinson-White Syndrome. Before taking this medicine You should not receive this medicine if you are allergic to lidocaine injection or any other type of numbing medicine, or if you have: severe heart block; a heart rhythm disorder called Stokes-Adams syndrome (sudden slow heart beats that can cause you to faint); or a heart rhythm disorder called Wolff-Parkinson-White Syndrome (sudden fast heartbeats that can cause you to faint or become easily tired). Tell your doctor if you have ever had: an allergy to corn products; liver disease; kidney disease; heart disease (unless you are being treated with lidocaine injection for a heart condition); coronary artery disease, circulation problems; or malignant hyperthermia. Tell your doctor if you are pregnant or breastfeeding. How is lidocaine injection given? A healthcare provider will give you this injection. When used to treat heart rhythm problems, lidocaine is given as an infusion into a vein. When used as a local anesthetic, lidocaine is injected through the skin directly into the body area to be numbed. Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while you are receiving lidocaine injection in a hospital setting. If you are being treated for irregular heart rhythm, your heart rate will be constantly monitored using an electrocardiograph or ECG (sometimes called an EKG). This will help your doctor determine how long to treat you with lidocaine injection.   What happens if I miss a dose? Since lidocaine injection is used only when needed in a clinical setting, you are not likely to miss a dose. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What should I avoid after receiving lidocaine injection? Lidocaine injection can cause side effects that may impair your thinking or reactions. Unless absolutely necessary, do not drive after receiving lidocaine injection. Avoid eating or chewing within 1 hour after lidocaine injection is used to numb your mouth or throat. You may have trouble swallowing which could lead to choking. You may also accidentally bite the inside of your mouth if you are still numb an hour after treatment with lidocaine injection. Lidocaine injection side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Tell your caregiver right away if you have: twitching, tremors, seizure (convulsions); a light-headed feeling, like you might pass out; slow heart rate, weak pulse, weak or shallow breathing; sudden feeling of heat, cold, or numbness; muscle stiffness and pain; weak or shallow breathing; blue appearance of the skin; or severe anxiety, unusual fear or uneasy feeling. Common side effects may include: drowsiness, dizziness; nausea, vomiting; feeling hot or cold; confusion, ringing in your ears, blurred vision, double vision; or numbness in places where the medicine is accidentally applied. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.   What other drugs will affect lidocaine injection? Tell your doctor about all your other medicines, especially: cimetidine, fluvoxamine, nefazodone, St John's wort; antibiotic or antifungal medicine; antiviral medicine to treat hepatitis or HIV/AIDS; heart or blood pressure medicine--amiodarone, digoxin, nicardipine, procainamide, propranolol; seizure medicine--carbamazepine, phenytoin; or tuberculosis medicine--isoniazid, rifampin. This list is not complete. Other drugs may affect lidocaine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

What is tramadol? Tramadol is a pain medicine similar to an opioid and is classified as a synthetic opioid. It acts in the central nervous system (CNS) to relieve pain. Tramadol is used to treat moderate to severe pain in adults. The extended-release form of tramadol is for around-the-clock treatment of pain. This form of tramadol is not for use on an as-needed basis for pain. Warnings Seizures have been reported in patients taking tramadol. Your risk of seizures is higher if you are taking higher doses than recommended. Seizure risk is also higher in those with a seizure disorder or those taking certain antidepressants or opioid medications. Tramadol should not be used if you are suicidal or prone to addiction. You should not take tramadol if you have severe breathing problems, a blockage in your stomach or intestines, or if you have recently used alcohol, sedatives, tranquilizers, narcotic medication, or an MAO inhibitor (isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others). Tramadol can slow or stop your breathing, and may be habit-forming. MISUSE OF THIS MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription. Keep this medicine where others cannot get to it. Tramadol should not be given to a child younger than 12 years old, or anyone younger than 18 years old who recently had surgery to remove the tonsils or adenoids. Ultram ER should not be given to anyone younger than 18 years old. Taking tramadol during pregnancy may cause life-threatening withdrawal symptoms in the newborn. Fatal side effects can occur if you use this medicine with alcohol, or with other drugs that cause drowsiness or slow your breathing. Before taking this medicine You should not take tramadol if you are allergic to it, or if you have: severe asthma or breathing problems; a stomach or bowel obstruction (including paralytic ileus); if you have recently used alcohol, sedatives, tranquilizers, or narcotic medications; or if you have used an MAO inhibitor in the past 14 days (such as isocarboxazid, linezolid, methylene blue injection, phenelzine, or tranylcypromine). Tramadol should not be given to a child younger than 12 years old. Ultram ER should not be given to anyone younger than 18 years old. Do not give this medicine to anyone younger than 18 years old who recently had surgery to remove the tonsils or adenoids. Seizures have occurred in some people taking tramadol. Your seizure risk may be higher if you have ever had: a head injury, epilepsy or other seizure disorder; drug or alcohol addiction; or a metabolic disorder. To make sure tramadol is safe for you, tell your doctor if you have ever had: breathing problems, sleep apnea; liver or kidney disease; urination problems; problems with your gallbladder, pancreas, or thyroid; a stomach disorder; or mental illness, or suicide attempt. If you use tramadol during pregnancy, your baby could be born with life-threatening withdrawal symptoms, and may need medical treatment for several weeks. Ask a doctor before using tramadol if you are breastfeeding. Tell your doctor if you notice severe drowsiness or slow breathing in the nursing baby. How should I take tramadol? Take tramadol exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides. Never use tramadol in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to take more of this medicine. Never share tramadol with another person, especially someone with a history of drug addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medicine where others cannot get to it. Selling or giving away this medicine is against the law. Stop taking all opioid medications when you start taking tramadol. Tramadol can be taken with or without food, but take it the same way each time. Swallow the capsule or tablet whole to avoid exposure to a potentially fatal overdose. Do not crush, chew, break, open, or dissolve. Measure liquid medicine with the supplied syringe or a dose-measuring device (not a kitchen spoon). Never crush or break a tramadol tablet to inhale the powder or mix it into a liquid to inject the drug into your vein. This practice has resulted in death. You may have withdrawal symptoms if you stop using tramadol suddenly. Ask your doctor before stopping the medicine. Store at room temperature away from moisture and heat. Keep track of your medicine. You should be aware if anyone is using it improperly or without a prescription. Do not keep leftover tramadol. Just one dose can cause death in someone using it accidentally or improperly. Ask your pharmacist where to locate a drug take-back disposal program. If there is no take-back program, mix the leftover medicine with cat litter or coffee grounds in a sealed plastic bag throw the bag in the trash. Dosing information Usual Adult Dose for Pain: Adults (17 years or older): 50 to 100 mg orally every 4 to 6 hours as needed for pain -For patients not requiring rapid onset of analgesic effect: Initial dose: 25 mg orally once a day; titrate in 25 mg increments every 3 days to reach a dose of 25 mg four times a day; thereafter increase by 50 mg as tolerated every 3 days Maximum dose: 400 mg per day. Usual Adult Dose for Chronic Pain: Extended-Release (ER): 18 years or older (tramadol-naive): 100 mg orally once a day -Individually titrate in 100 mg increments every 5 days to an effective dose that minimizes adverse reactions -Maximum Dose: 300 mg/day For patients CURRENTLY receiving Immediate-Release (IR) Tramadol: Initial Dose: Calculate 24-hour IR requirement and initiate with a total daily ER dose rounded down to the next lowest 100 mg increment orally once a day Conversion from other Opioids: Discontinue all other around the clock opioid drugs prior to initiating therapy -Initial dose: 100 mg ER orally once a day -Individually titrate in 100 mg increments every 5 days to an effective dose that minimizes adverse reactions -Maximum Dose: 300 mg/day. Usual Geriatric Dose for Pain: Dose selection should be cautious generally starting at the low end of the dose range Over 75 years: Maximum dose of Immediate-release: 300 mg per day. Usual Geriatric Dose for Chronic Pain: Dose selection should be cautious generally starting at the low end of the dose range Over 75 years: Maximum dose of Immediate-release: 300 mg per day. Usual Pediatric Dose for Pain: Tramadol is not recommended for use in pediatric patients 17 years or older: See Adult Dose.   What happens if I miss a dose? Since tramadol is used for pain, you are not likely to miss a dose. Skip any missed dose if it is almost time for your next dose. Do not use two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose can be fatal, especially in a child or other person using the medicine without a prescription. Overdose symptoms may include severe drowsiness, pinpoint pupils, slow breathing, or no breathing. Your doctor may recommend you get naloxone (a medicine to reverse an opioid overdose) and keep it with you at all times. A person caring for you can give the naloxone if you stop breathing or don't wake up. Your caregiver must still get emergency medical help and may need to perform CPR (cardiopulmonary resuscitation) on you while waiting for help to arrive. Anyone can buy naloxone from a pharmacy or local health department. Make sure any person caring for you knows where you keep naloxone and how to use it. What should I avoid while taking tramadol? Do not drink alcohol. Dangerous side effects or death could occur. Avoid driving or hazardous activity until you know how tramadol will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries. Tramadol side effects Get emergency medical help if you have signs of an allergic reaction to tramadol (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling). Tramadol can slow or stop your breathing, and death may occur. A person caring for you should give naloxone and/or seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up. Call your doctor at once if you have: noisy breathing, sighing, shallow breathing, breathing that stops during sleep; a slow heart rate or weak pulse; a light-headed feeling, like you might pass out; seizure (convulsions); or low cortisol levels - nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness. Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea. Serious breathing problems may be more likely in older adults and people who are debilitated or have wasting syndrome or chronic breathing disorders. Common tramadol side effects may include: constipation, nausea, vomiting, stomach pain; dizziness, drowsiness, tiredness; headache; or itching. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.   What other drugs will affect tramadol? You may have breathing problems or withdrawal symptoms if you start or stop taking certain other medicines. Tell your doctor if you also use an antibiotic, antifungal medication, heart or blood pressure medication, seizure medication, or medicine to treat HIV or hepatitis C. Many other drugs can be dangerous when used with tramadol. Tell your doctor if you also use: medicine for allergies, asthma, blood pressure, motion sickness, irritable bowel, or overactive bladder; other opioid medicines; a benzodiazepine sedative like Valium, Klonopin, or Xanax; sleep medicine, muscle relaxers, or other drugs that make you drowsy; or drugs that affect serotonin, such as antidepressants, stimulants, or medicine for migraines or Parkinson's disease. This list is not complete. Other drugs may interact with tramadol, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Many other drugs can be dangerous when used with tramadol. Tell your doctor if you also use: medicine for allergies, asthma, blood pressure, motion sickness, irritable bowel, or overactive bladder; other opioid medicines; a benzodiazepine sedative like Valium, Klonopin, or Xanax; sleep medicine, muscle relaxers, or other drugs that make you drowsy; drugs that affect serotonin, such as antidepressants, stimulants, or medicine for migraines or Parkinson's disease. drugs that affect serotonin levels in your body - a stimulant, or medicine for depression, Parkinson's disease, migraine headaches, serious infections, or nausea and vomiting. This list is not complete. Many other drugs may affect tramadol. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

What is tramadol? Tramadol is a pain medicine similar to an opioid and is classified as a synthetic opioid. It acts in the central nervous system (CNS) to relieve pain. Tramadol is used to treat moderate to severe pain in adults. The extended-release form of tramadol is for around-the-clock treatment of pain. This form of tramadol is not for use on an as-needed basis for pain. Warnings Seizures have been reported in patients taking tramadol. Your risk of seizures is higher if you are taking higher doses than recommended. Seizure risk is also higher in those with a seizure disorder or those taking certain antidepressants or opioid medications. Tramadol should not be used if you are suicidal or prone to addiction. You should not take tramadol if you have severe breathing problems, a blockage in your stomach or intestines, or if you have recently used alcohol, sedatives, tranquilizers, narcotic medication, or an MAO inhibitor (isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others). Tramadol can slow or stop your breathing, and may be habit-forming. MISUSE OF THIS MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription. Keep this medicine where others cannot get to it. Tramadol should not be given to a child younger than 12 years old, or anyone younger than 18 years old who recently had surgery to remove the tonsils or adenoids. Ultram ER should not be given to anyone younger than 18 years old. Taking tramadol during pregnancy may cause life-threatening withdrawal symptoms in the newborn. Fatal side effects can occur if you use this medicine with alcohol, or with other drugs that cause drowsiness or slow your breathing. Before taking this medicine You should not take tramadol if you are allergic to it, or if you have: severe asthma or breathing problems; a stomach or bowel obstruction (including paralytic ileus); if you have recently used alcohol, sedatives, tranquilizers, or narcotic medications; or if you have used an MAO inhibitor in the past 14 days (such as isocarboxazid, linezolid, methylene blue injection, phenelzine, or tranylcypromine). Tramadol should not be given to a child younger than 12 years old. Ultram ER should not be given to anyone younger than 18 years old. Do not give this medicine to anyone younger than 18 years old who recently had surgery to remove the tonsils or adenoids. Seizures have occurred in some people taking tramadol. Your seizure risk may be higher if you have ever had: a head injury, epilepsy or other seizure disorder; drug or alcohol addiction; or a metabolic disorder. To make sure tramadol is safe for you, tell your doctor if you have ever had: breathing problems, sleep apnea; liver or kidney disease; urination problems; problems with your gallbladder, pancreas, or thyroid; a stomach disorder; or mental illness, or suicide attempt. If you use tramadol during pregnancy, your baby could be born with life-threatening withdrawal symptoms, and may need medical treatment for several weeks. Ask a doctor before using tramadol if you are breastfeeding. Tell your doctor if you notice severe drowsiness or slow breathing in the nursing baby. How should I take tramadol? Take tramadol exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides. Never use tramadol in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to take more of this medicine. Never share tramadol with another person, especially someone with a history of drug addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medicine where others cannot get to it. Selling or giving away this medicine is against the law. Stop taking all opioid medications when you start taking tramadol. Tramadol can be taken with or without food, but take it the same way each time. Swallow the capsule or tablet whole to avoid exposure to a potentially fatal overdose. Do not crush, chew, break, open, or dissolve. Measure liquid medicine with the supplied syringe or a dose-measuring device (not a kitchen spoon). Never crush or break a tramadol tablet to inhale the powder or mix it into a liquid to inject the drug into your vein. This practice has resulted in death. You may have withdrawal symptoms if you stop using tramadol suddenly. Ask your doctor before stopping the medicine. Store at room temperature away from moisture and heat. Keep track of your medicine. You should be aware if anyone is using it improperly or without a prescription. Do not keep leftover tramadol. Just one dose can cause death in someone using it accidentally or improperly. Ask your pharmacist where to locate a drug take-back disposal program. If there is no take-back program, mix the leftover medicine with cat litter or coffee grounds in a sealed plastic bag throw the bag in the trash. Dosing information Usual Adult Dose for Pain: Adults (17 years or older): 50 to 100 mg orally every 4 to 6 hours as needed for pain -For patients not requiring rapid onset of analgesic effect: Initial dose: 25 mg orally once a day; titrate in 25 mg increments every 3 days to reach a dose of 25 mg four times a day; thereafter increase by 50 mg as tolerated every 3 days Maximum dose: 400 mg per day. Usual Adult Dose for Chronic Pain: Extended-Release (ER): 18 years or older (tramadol-naive): 100 mg orally once a day -Individually titrate in 100 mg increments every 5 days to an effective dose that minimizes adverse reactions -Maximum Dose: 300 mg/day For patients CURRENTLY receiving Immediate-Release (IR) Tramadol: Initial Dose: Calculate 24-hour IR requirement and initiate with a total daily ER dose rounded down to the next lowest 100 mg increment orally once a day Conversion from other Opioids: Discontinue all other around the clock opioid drugs prior to initiating therapy -Initial dose: 100 mg ER orally once a day -Individually titrate in 100 mg increments every 5 days to an effective dose that minimizes adverse reactions -Maximum Dose: 300 mg/day. Usual Geriatric Dose for Pain: Dose selection should be cautious generally starting at the low end of the dose range Over 75 years: Maximum dose of Immediate-release: 300 mg per day. Usual Geriatric Dose for Chronic Pain: Dose selection should be cautious generally starting at the low end of the dose range Over 75 years: Maximum dose of Immediate-release: 300 mg per day. Usual Pediatric Dose for Pain: Tramadol is not recommended for use in pediatric patients 17 years or older: See Adult Dose.   What happens if I miss a dose? Since tramadol is used for pain, you are not likely to miss a dose. Skip any missed dose if it is almost time for your next dose. Do not use two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose can be fatal, especially in a child or other person using the medicine without a prescription. Overdose symptoms may include severe drowsiness, pinpoint pupils, slow breathing, or no breathing. Your doctor may recommend you get naloxone (a medicine to reverse an opioid overdose) and keep it with you at all times. A person caring for you can give the naloxone if you stop breathing or don't wake up. Your caregiver must still get emergency medical help and may need to perform CPR (cardiopulmonary resuscitation) on you while waiting for help to arrive. Anyone can buy naloxone from a pharmacy or local health department. Make sure any person caring for you knows where you keep naloxone and how to use it. What should I avoid while taking tramadol? Do not drink alcohol. Dangerous side effects or death could occur. Avoid driving or hazardous activity until you know how tramadol will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries. Tramadol side effects Get emergency medical help if you have signs of an allergic reaction to tramadol (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling). Tramadol can slow or stop your breathing, and death may occur. A person caring for you should give naloxone and/or seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up. Call your doctor at once if you have: noisy breathing, sighing, shallow breathing, breathing that stops during sleep; a slow heart rate or weak pulse; a light-headed feeling, like you might pass out; seizure (convulsions); or low cortisol levels - nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness. Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea. Serious breathing problems may be more likely in older adults and people who are debilitated or have wasting syndrome or chronic breathing disorders. Common tramadol side effects may include: constipation, nausea, vomiting, stomach pain; dizziness, drowsiness, tiredness; headache; or itching. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.   What other drugs will affect tramadol? You may have breathing problems or withdrawal symptoms if you start or stop taking certain other medicines. Tell your doctor if you also use an antibiotic, antifungal medication, heart or blood pressure medication, seizure medication, or medicine to treat HIV or hepatitis C. Many other drugs can be dangerous when used with tramadol. Tell your doctor if you also use: medicine for allergies, asthma, blood pressure, motion sickness, irritable bowel, or overactive bladder; other opioid medicines; a benzodiazepine sedative like Valium, Klonopin, or Xanax; sleep medicine, muscle relaxers, or other drugs that make you drowsy; or drugs that affect serotonin, such as antidepressants, stimulants, or medicine for migraines or Parkinson's disease. This list is not complete. Other drugs may interact with tramadol, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Many other drugs can be dangerous when used with tramadol. Tell your doctor if you also use: medicine for allergies, asthma, blood pressure, motion sickness, irritable bowel, or overactive bladder; other opioid medicines; a benzodiazepine sedative like Valium, Klonopin, or Xanax; sleep medicine, muscle relaxers, or other drugs that make you drowsy; drugs that affect serotonin, such as antidepressants, stimulants, or medicine for migraines or Parkinson's disease. drugs that affect serotonin levels in your body - a stimulant, or medicine for depression, Parkinson's disease, migraine headaches, serious infections, or nausea and vomiting. This list is not complete. Many other drugs may affect tramadol. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

What is acetaminophen and tramadol? Acetaminophen and tramadol is a combination medicine used to treat moderate to severe pain. Acetaminophen and tramadol contains an opioid-like medicine, and may be habit-forming. Acetaminophen and tramadol may also be used for purposes not listed in this medication guide. Warnings MISUSE OF acetaminophen and tramadol CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medicine where others cannot get to it. Do not give this medicine to anyone younger than 12 years old, or anyone under 18 who recently had surgery to remove the tonsils or adenoids. Taking this medicine during pregnancy may cause life-threatening withdrawal symptoms in the newborn. Fatal side effects can occur if you use this medicine with alcohol, or with other drugs that cause drowsiness or slow your breathing. Before taking this medicine You should not use this medicine if you are allergic to acetaminophen (Tylenol) or tramadol (Ultram), or if you have: severe asthma or breathing problems; a blockage in your stomach or intestines; or if you have used an MAO inhibitor (such as isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, tranylcypromine) in the past 14 days. Acetaminophen and tramadol is not approved for use by anyone younger than 12 years old. Do not give this medicine to anyone younger than 18 years old who recently had surgery to remove the tonsils or adenoids. Seizures have occurred in some people taking tramadol. Your risk of a seizure may be higher if you have ever had: alcoholism or drug addiction; breathing problems, sleep apnea; a metabolic disorder; a head injury, brain tumor, or seizures; or if you have recently used sedatives, tranquilizers, or narcotic medications. Tell your doctor if you have ever had: liver disease, or if you drink alcohol; kidney disease, urination problems; problems with your pancreas, gallbladder, or thyroid; or depression, mental illness, or a suicide attempt. If you use this medicine during pregnancy, your baby could be born with life-threatening withdrawal symptoms, and may need medical treatment for several weeks. Ask a doctor before using this medicine if you are breastfeeding. Tell your doctor if you notice severe drowsiness or slow breathing in the nursing baby. How should I take acetaminophen and tramadol? Follow the directions on your prescription label and read all medication guides. Never use acetaminophen and tramadol in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to take more of this medicine. Never share acetaminophen and tramadol with another person, especially someone with a history of drug addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medicine where others cannot get to it. Selling or giving away this medicine is against the law. The maximum amount of acetaminophen and tramadol is 2 tablets per dose, or 8 tablets per day. Do not take this medicine for longer than 5 days in a row. You may take this medicine with or without food, but take it the same way each time. You should not stop using this medicine suddenly after long-term use. Follow your doctor's instructions about tapering your dose. Store at room temperature away from moisture and heat. Keep your medicine in a place where no one can use it improperly. Do not keep leftover medication. Just one dose can cause death in someone using this medicine accidentally or improperly. Ask your pharmacist where to locate a drug take-back disposal program. If there is no take-back program, mix the leftover medicine with cat litter or coffee grounds in a sealed plastic bag throw the bag in the trash. What happens if I miss a dose? Since this medicine is used for pain, you are not likely to miss a dose. Skip any missed dose if it's almost time for your next dose. Do not use two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose can be fatal, especially in a child or person using acetaminophen and tramadol without a prescription. Overdose symptoms may include severe drowsiness, pinpoint pupils, slow breathing, or no breathing. Your doctor may recommend you get naloxone (a medicine to reverse an opioid overdose) and keep it with you at all times. A person caring for you can give the naloxone if you stop breathing or don't wake up. Your caregiver must still get emergency medical help and may need to perform CPR (cardiopulmonary resuscitation) on you while waiting for help to arrive. Anyone can buy naloxone from a pharmacy or local health department. Make sure any person caring for you knows where you keep naloxone and how to use it. What should I avoid while taking acetaminophen and tramadol? Do not drink alcohol. Dangerous side effects or death could occur. Avoid driving or operating machinery until you know how this medicine will affect you. Dizziness or severe drowsiness can cause falls or other accidents. Ask a doctor or pharmacist before using any other medicine that may contain acetaminophen (sometimes abbreviated as APAP). Taking certain medications together can lead to a fatal overdose. Acetaminophen and tramadol side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. In rare cases, acetaminophen may cause a severe skin reaction that can be fatal. This could occur even if you have taken acetaminophen in the past and had no reaction. Stop taking acetaminophen and tramadol and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling. This medicine can slow or stop your breathing, and death may occur. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up. Stop using this medicine and call your doctor at once if you have: noisy breathing, sighing, shallow breathing, breathing that stops during sleep; a slow heart rate or weak pulse; a light-headed feeling, like you might pass out; seizure (convulsions); chest pain; liver problems--upper stomach pain, loss of appetite, dark urine, jaundice (yellowing of the skin or eyes); low cortisol levels-- nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness; or high levels of serotonin in the body--agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, diarrhea. Serious breathing problems may be more likely in older adults and in those who are debilitated or have wasting syndrome or chronic breathing disorders. Common side effects may include: dizziness, drowsiness; stomach pain, nausea, loss of appetite, diarrhea, constipation; or sweating. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Acetaminophen / tramadol side effects (more detail) Acetaminophen and tramadol dosing information Usual Adult Dose for Pain: Usual dose: 2 tablets orally every 4 to 6 hours as needed for pain Maximum dose: 8 tablets per day Maximum duration: 5 days Comments: -Each tablet contains Tramadol 37.5 mg and Acetaminophen 325 mg. Maximum daily doses are Tramadol: 300 mg per day and Acetaminophen 2600 mg per day. -Use of more than 1 product at time containing acetaminophen is not recommended. -Due to the risks of addiction, abuse, and misuse, this drug is reserved for patients who have not been or are not expected to tolerate non-opioid pain medications or who have not obtained or are not expected to obtain analgesia with other pain management treatments. Use: For the short-term (use should be limited to 5 days or less) management of acute pain, severe enough to require an opioid analgesic and for whom alternative treatments are inadequate. Detailed Acetaminophen / tramadol dosage information What other drugs will affect acetaminophen and tramadol? You may have a fatal acetaminophen and tramadol overdose if you start or stop using certain other medicines. Tell your doctor about all your medications. Many other drugs can be dangerous when used with acetaminophen and tramadol. Tell your doctor if you also use: medicine for allergies, asthma, blood pressure, motion sickness, irritable bowel, or overactive bladder; opioid medicines; a benzodiazepine sedative like Valium, Klonopin, or Xanax; sleep medicine, muscle relaxers, or other drugs that make you drowsy; or drugs that affect serotonin, such as antidepressants, stimulants, or medicine for migraines or Parkinson's disease. This list is not complete. Many drugs may affect acetaminophen and tramadol, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here.