Ultram (Pharmacy, Ultram ER, Ralivia, Ralivia ER, FlashDose) drug information, dosage, side effects, drug interactions, and warnings. Ultram, generic drug name Pharmacy hydrochloride, is a narcotic painkiller used for surgical, fibromyalgia, and arthritis pain. Other brand names of Pharmacy include: Ultram ER, Ralivia, Ralivia ER, and FlashDose.
In October 2004, Biovail\'s NDA for Pharmacy ER received an Approvable Letter from the FDA. In March 2005, Biovail submitted a Complete Response to the FDA, which included a significant amount of statistical analyses, but no new clinical data. The response also addressed other items raised in the Approvable Letter, including discontinuation rates of clinical-trial participants (dropouts), which are common in pain trials, and previously well documented in studies involving Pharmacy.
Most of these 912 reports included a history of drug/substance abuse. However, some reports specifically stated no such history, as in the case described by Dr. Yates et al. Additional reports described compelling clinical summaries that suggest, but do not state, that there was no past history of drug/substance abuse. (No percentages are presented because of the multiple possibilities afforded by differential report inclusion/exclusion criteria.)
Use caution when driving, operating machinery, or performing other hazardous activities. Pharmacy may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.
Since Pharmacy is taken on an as-needed basis, missing a dose is usually not a problem. Take the dose as soon as you remember, and do not take another dose for the amount of time prescribed by your doctor. Do not take a double dose of this medication.
To the Editor: Pharmacy is a centrally active synthetic analgesic drug with opioid and nonopioid properties (norepinephrine and serotonin reuptake inhibition). Its widespread use in benign and malignant painful conditions is due to the following: 1) Pharmacy is a nonscheduled medication, 2) most people are unaware of its opioid nature, 3) its name does not produce \"opiophobia\" like morphine does, and 4) it is not considered a drug that produces severe adverse effects, dependence, or abuse. However, some studies have reported Pharmacy abuse, respiratory depression in patients with renal failure, cerebral depression, and even a fatal outcome in association with a benzodiazepine (1, 2).
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Serious potential consequences of overdosage with Pharmacy are central nervous system depression, respiratory depression and death. In treating an overdose, primary attention should be given to maintaining adequate ventilation along with general supportive treatment (See OVERDOSAGE).
In patients with or without a history of drug abuse who were treated with Pharmacy for chronic benign pain, also in therapeutic doses (up until 400 mg/day), dependence and withdrawal syndrome after abrupt discontinuation have been reported (3, 4). Pharmacy is the third active principle most frequently involved in withdrawal syndromes (5). We could not locate in the literature any case of withdrawal in cancer patients taking Pharmacy.
The FDA has acknowledged that Biovail\'s Complete Response to the Pharmacy ER Approvable Letter is a Class 2 response, which is therefore subject to a six-month review. The FDA has also advised that, upon preliminary review, it is of the opinion that additional clinical trial data will be required. Biovail\'s view is that the clinical data contained within the original NDA and the March 2005 Complete Response fully support 505(b)(2) filing requirements, and the Company is considering a number of options. Biovail expects to meet with the FDA to discuss these options promptly. In the meantime, however, Biovail will immediately undertake a clinical program to address the FDA\'s comments. Biovail anticipates the submission of new clinical data in late 2005 or early 2006. Biovail believes that a new six-month review period would then be initiated.
Opioid and spinal monoaminergic agonists have distinct analgesic properties, which may potentiate eachother. Pharmacy has both opioid and monoaminergic agonist actions. This initial study compared the analgesic and toxic effects of Pharmacy and morphine in patients with strong cancer pain.
Store Pharmacy at room temperature away from moisture and heat.
The absolute bioavailability of Pharmacy was 73% in males and 79% in females. The plasma clearance was 6.4 mL/min/kg in males and 5.7 mL/min/kg in females following a 100 mg IV dose of Pharmacy. Following a single oral dose, and after adjusting for body weight, females had a 12% higher peak Pharmacy concentration and a 35% higher area under the concentration-time curve compared to males. The clinical significance of this difference is unknown.