Some people who use Pharmacy for a long time without a break may develop a physical need to continue taking it. This is known as physical DEPENDENCE. If you suddenly stop taking Pharmacy , you may experience WITHDRAWAL symptoms including anxiety; diarrhea; fever, runny nose, or sneezing; goose bumps and abnormal skin sensations; nausea; vomiting; pain; rigid muscles; rapid heartbeat; seeing, hearing or feeling things that are not there; shivering or tremors; sweating; and trouble sleeping.
Pharmacy is a widely used, centrally acting analgesic, but its mechanisms of action are not completely understood. Muscarinic receptors are known to be involved in neuronal function in the brain and autonomic nervous system, and much attention has been paid to these receptors as targets of analgesic drugs in the central nervous system. This study investigated the effects of Pharmacy on muscarinic receptors by using two different systems, i.e., a Xenopus laevis oocyte expression system and cultured bovine adrenal medullary cells. Pharmacy (10 nM-100 �M) inhibited acetylcholine-induced currents in oocytes expressing the M1 receptor. Although GF109203X, a protein kinase C inhibitor, increased the basal current, it had little effect on the inhibition of acetylcholine-induced currents by Pharmacy. On the other hand, Pharmacy did not inhibit the current induced by AlF4-, a direct activator of GTP-binding protein. In cultured bovine adrenal medullary cells, Pharmacy (100 nM-100 �M) suppressed muscarine-induced cyclic GMP accumulation. Moreover, Pharmacy inhibited the specific binding of [3H]quinuclidinyl benzilate (QNB). Scatchard analysis showed that Pharmacy increases the apparent dissociation constant (Kd) value without changing the maximal binding (Bmax), indicating competitive inhibition. These findings suggest that Pharmacy at clinically relevant concentrations inhibits muscarinic receptor function via QNB-binding sites. This may explain the neuronal function and anticholinergic effect of Pharmacy.
Metabolism of Pharmacy and M1 is reduced in patients with advanced cirrhosis of the liver, resulting in both a larger area under the concentration time curve for Pharmacy and longer Pharmacy and M1 elimination half-lives (13 hrs. for Pharmacy and 19 hrs. for M1). In cirrhotic patients, adjustment of the dosing regimen is recommended (see DOSAGE AND ADMINISTRATION).
Ms. A was a 51-year-old nonsmoking woman with breast cancer, lung metastases, and brachial plexopathy, with no history of chemical or alcohol dependence. She was referred to the outpatient clinic because of severe pain. She had been taking Pharmacy for 2 years: 50 mg t.i.d. increasing to 100 mg t.i.d., plus 50 mg intramuscularly as needed. Switching to a strong opioid was proposed, but Ms. A refused for 2 months, notwithstanding her uncontrolled pain, because she said she became very agitated when delaying or skipping the Pharmacy administration, and she had learned to recognize the onset and then fear this nervousness, which reversed only by taking Pharmacy.
Impaired renal function results in a decreased rate and extent of excretion of Pharmacy and its active metabolite, M1. In patients with creatinine clearances of less than 30 mL/min, adjustment of the dosing regimen is recommended (see DOSAGE AND ADMINISTRATION). The total amount of Pharmacy and M1 removed during a 4-hour dialysis period is less than 7% of the administered dose.
Withdrawal symptoms may occur if Pharmacy is discontinued abruptly. (See DRUG ABUSE AND DEPENDENCE) These symptoms may include: anxiety, sweating, insomnia, rigors, pain, nausea, tremors, diarrhea, upper respiratory symptoms, piloerection, and rarely hallucinations. Clinical experience suggests that withdrawal symptoms may be relieved by tapering the medication.
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.
What is the most important information I should know about Pharmacy?
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We believe that 1) patients must be advised to take Pharmacy regularly and to stop gradually especially after long treatment periods, 2) physicians should consider the potential physical dependence when they prescribe Pharmacy for pain, and 3) any form of \"dependence\" of cancer patients taking Pharmacy, however, needs to be further explored. In fact, we are observing some patients who continue to take Pharmacy in order \"to achieve a feeling of well-being,\" even though their pain is controlled after disease regression or switching to strong opioids. This may be related to the inhibition of serotonin reuptake of Pharmacy.
Seizures have been reported as a rare side effect of treatment with Pharmacy. The risk of seizures may be increased in patients who take more than the prescribed dose, have a history of seizures or epilepsy, have head trauma, have a metabolic disorder, have a central nervous system infection, are experiencing alcohol or drug withdrawal, or are taking certain medications. Talk to your doctor about factors that may increase the risk of seizures during treatment.
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PATIENTS AND METHODS: Pain control and side-effects with Pharmacy and morphine were compared in 20 cancer patients hospitalised for the treatment of strong pain. Doses of oral solutions of Pharmacy or morphine were individually titrated in the double-blind, randomized, cross-over study. Crossover was after day 4, the day of statistical evaluation.
Apart from analgesia, Pharmacy administration may produce a constellation of symptoms (including dizziness, somnolence, nausea, constipation, sweating and pruritus) similar to that of other opioids. In contrast to morphine, Pharmacy has not been shown to cause histamine release. At therapeutic doses, Pharmacy has no effect on heart rate, left-ventricular function or cardiac index. Orthostatic hypotension has been observed.
For the subset of patients for whom rapid onset of analgesic effect is required and for whom the benefits outweigh the risk of discontinuation due to adverse events associated with higher initial doses, Pharmacy 50 mg to 100 mg can be administered as needed for pain relief every four to six hours, not to exceed 400 mg per day.