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Fioricet contains a combination of acetaminophen, butalbital, and caffeine. Acetaminophen is a pain reliever and fever reducer. Butalbital is in a group of drugs called barbiturates.

It relaxes muscle contractions involved in a tension headache. Caffeine is a central nervous system stimulant. It relaxes muscle contractions in blood vessels to improve blood flow.

Fioricet is used to treat tension headaches that are caused by muscle contractions. Fioricet may also be used for purposes not listed in this medication guide.

Gabapentin order maybe delayed till Oct 6, 2020. If you are our returned customer, please go to our TX pharm to order. All new customer Gab orders maybe be delayed.

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Gabapentin is used to control the symptoms of seizures and works by reducing the abnormal electrical activity in the brain, but exactly how it does this is not fully understood. Gabapentin is also used to treat certain types of long-lasting pain caused by damage to nerves.

gabapentin-300Gabapentin belongs to a group of medicines known as anti-epileptic medicines, although it is prescribed for the treatment of several different conditions. You may have been prescribed it for the treatment of partial seizures, which are a type of epilepsy. A seizure is a short episode of symptoms which is caused by a burst of abnormal electrical activity in the brain. With a partial seizure, the burst of electrical activity stays in one part of the brain. Therefore, you tend to have localised or ‘focal’ symptoms. Gabapentin is used to control the symptoms of seizures and works by reducing the abnormal electrical activity in the brain. Exactly how it does this is not fully understood.

Gabapentin is also prescribed to treat certain types of long-lasting pain caused by damage to nerves. This type of pain, called neuropathic pain, can be caused by a number of different diseases. These include diabetes (where it is called diabetic neuropathy) and shingles (where it is called postherpetic neuralgia).

Although gabapentin is only licensed for use in epilepsy and neuropathic pain, it is also prescribed to help to prevent attacks of migraine. If you have been given it for this reason then you should speak with your doctor if you have any questions about your treatment.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking gabapentin it is important that your doctor knows:

  • If you are pregnant, trying for a baby or breast-feeding.
  • If you have any problems with the way your kidneys work.
  • If you have diabetes.
  • If you have ever had a mental health problem known as psychosis.
  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
  • If you have ever had an allergic reaction to a medicine.

Gabapentin Mechanism of action

The mechanism of the anticonvulsant action of gabapentin has not been fully described. Several possible mechanisms for pain improvement have been discussed.

gabapentin mechanism of actions
gabapentin mechanism of actions

Though similar in structure to the endogenous neurotransmitter GABA, gabapentin has not been shown to bind to GABA receptors at concentrations at or below 1 mM. Gabapentin modulates the action of glutamate decarboxylase (GAD) and branched chain aminotransferase (BCAT), two enzymes involved in GABA biosynthesis. In human and rat studies, gabapentin was found to increase GABA biosynthesis, and to increase non-synaptic GABA neurotransmission in vitro.

Gabapentin has been shown to bind to the α2δ-1 subunit of voltage gated calcium ion channels, which contributes to its pain attenuation effects in diabetic neuropathy and post-herpetic neuralgia. Other neurophysiological findings indicate that gabapentin also interacts with NMDA receptors, protein kinase C, and inflammatory cytokines.

What is gabapentin mostly used for?

Gabapentin is an antiepileptic or anticonvulsant treatment originally designed to prevent seizures, but which is now also used to manage certain types of pain and in a variety of other uses.

The medication is also used in veterinary medicine. Note that tablets, capsules or oral solutions designed for human consumption often contain sweeteners which may be poisonous to some species; be sure to buy Gabapentin in veterinary formulations for use in animals.

The medication comes in capsules, which may be opened and mixed into a beverage or soft foods that do not require chewing, though it is difficult to mask its bitter taste.

Preventing Seizures

Gabapentin is most commonly prescribed to prevent certain types of seizures:

    • Focal seizures
    • Mixed Seizures
    • Generalized Seizures

As a preventive treatment, Gabapentin may be used in children as young as 3, but is most often prescribed to people 12 years old and up.

The medication is typically taken 3 times per day, and treatment is usually long-term. Patients are usually started on smaller doses which are then increased if needed. The average dose for adults is 900 to 1800 mg per day.

Daily doses are usually divided into 3 smaller doses, taken morning, afternoon, and at bedtime. Doses should be taken at least 4 hours apart, but not more than 12 hours apart.

It may take several weeks for the medication to become noticeably effective. When working, seizures should occur with significantly less frequency or be eliminated entirely. It does not work on all seizures and is not effective for all patients; if effects are not significant after several weeks of use, speak with doctor about alternative options rather than continuing to buy Gabapentin.

Ending treatment abruptly may cause an increase in seizures; speak with a doctor about tapering off the medication.

Pain Relief

Patients planning to buy Gabapentin for pain relief should understand that it only works on very specific types of pain; namely neuropathic pain, or pain caused by damage to the somatosensory system, including:

    • Postherpetic neuralgia
    • Central neuropathic pain
    • Diabetic neuropathy
    • Fibromyalgia
    • Spinal injuries
    • Cancer

When given for pain, treatment may last just a few days for flare-ups or weeks or months in cases of chronic pain. Dosage rarely exceeds 1800 mg a day; greater amounts may be taken, but rarely produce additional relief.

Some individuals notice effects within the first day or two of treatment, but it may take several weeks to provide consistent pain relief in chronic conditions.

While some patients find Gabapentin tremendously helpful, others find it has little effect, even when treating the same condition. Speak with a doctor about other options if it is not providing significant relief.

Other Uses

Gabapentin is used in a wide range of other conditions, though it is not always the most effective option for certain ailments:

    • Menopausal symptoms
    • Uremic pruritus in liver failure
    • Restless leg syndrome
    • Insomnia
    • Anxiety disorders
    • Migraines

Many of this product’s off-label uses are somewhat controversial, as some claim there is no evidence the medication provides any benefit in some of the above conditions, while others claim it produces good results for some individuals.

In other cases the medication is recognized as being effective, but is not typically the preferred treatment; in these situations Gabapentin may be given when first-line treatments are ill-advised for some reason.

Patients are not advised to buy Gabapentin for off-label use without doctor collaboration, particularly if there are any preexisting major medical conditions.

Gabapentin Can be used for a lot of Nerve Pain related health conditions including Cough, Hot Flashes, Alcohol Withdrawal, Anxiety 161 reviews, Bipolar Disorder, Trigeminal Neuralgia, Postherpetic Neuralgia, Migraine, Insomnia, Occipital Neuralgia, Peripheral Neuropathy,Vulvodynia, Benign Essential Tremor, Epilepsy, Fibromyalgia, Pain Relief, Diabetic Peripheral Neuropathy , Neuropathic Pain,Reflex Sympathetic Dystrophy Syndrome,Periodic Limb Movement Disorder, Spondylolisthesis, Burning Mouth Syndrome,Pudendal Neuralgia, Small Fiber Neuropathy.

Use only the brand and form of gabapentin that your doctor has prescribed. Check your medicine each time you get a refill at the pharmacy, to make sure you have received the correct form of this medication. Do not stop taking Gabapentin unless your doctor tells you to. If your treatment is stopped it should be done gradually over a minimum of 1 week. If you stop taking gabapentin suddenly or before your doctor tells you, there is an increased risk of seizures.

What you should know before you buy gabapentin online ?

Patients should be aware of the therapeutic dosing for neuropathic pain to establish realistic expectations and improve compliance and likelihood of remaining on therapy.

The conversation may be as follows: “Gabapentin may reduce nerve pain at 600 mg 3 times a day but patients usually start on a low dose to make sure they tolerate it and is then increased slowly to give the body a chance to get used to it.

If dose increases along the titration cause intolerable side effects such as dizziness or drowsiness, this can often be overcome by reducing back to the previous dose and escalating more slowly over a longer period of time.” Patients should be encouraged to follow-up with their prescriber for continued titration.

  • Before starting this treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about gabapentin and will provide you with a full list of the side-effects which you may experience from taking it.
  • Take gabapentin exactly as your doctor tells you to. There are several different strengths of gabapentin tablets and capsules available, and you could be prescribed more than one strength.
  • You will be advised to take a low dose when you first start taking gabapentin, and then to increase the dose over a few days. This is to allow your body to get used to it. Most people take three doses a day once they are on a regular maintenance dose. Your doctor will explain all this to you, and the dosing directions will be printed on the label of the pack. If you are still unsure about how to take your doses, ask your pharmacist to advise you.
  • You can take gabapentin before or after food. Swallow the tablets/capsules with a drink of water. If you have been supplied with oral liquid medicine, see the instructions below for using the oral dosing syringe.
  • Once you are taking a regular amount of gabapentin, try to take your doses at the same times each day. This will help you avoid missing doses.
  • If you do forget to take a dose, take one as soon as you remember. Try to take the correct number of doses each day, but do not take two doses at the same time.
  • If you need to take an antacid or indigestion remedy, do not take it during the two hours before or the two hours after you take gabapentin. This is because antacids reduce the amount of gabapentin that your body absorbs.

Instructions for using the dosing syringe with Gabapentin Rosemont Oral Solution

  1. Remove the bottle cap, and push the syringe adaptor into the top of the open bottle.
  2. Insert the syringe into the adapter.
  3. Turn the bottle (with the syringe connected to it) upside down.
  4. Gently pull out the plunger of the syringe so that the solution fills the syringe to the mark which corresponds to your dose.
  5. Turn the bottle the correct way up again, and remove the syringe from the bottle.
  6. Put the tip of the syringe into your mouth, and gently push the plunger so that the liquid is released into your mouth.
  7. Replace the bottle cap. Wash the syringe with water after each use.
  • Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.
  • When you first start a new treatment for epilepsy there may be a change in the number or type of seizures you experience. Your doctor will advise you about this. If you are a woman and want to have a family, make sure that you discuss this with your doctor before you become pregnant. This is so that you can be given advice about your treatment from a specialist.
  • People with epilepsy must stop driving. Your doctor will advise you about when it may be possible for you to start driving again. This will usually be after a year free of seizures.
  • A small number of people have developed mood changes or thoughts about suicide whilst being treated with anti-epileptics. If this happens to you, you must tell your doctor about it straightaway.
  • If you buy any medicines, always check with a pharmacist that they are suitable to take with your other medicines.
  • You must take gabapentin regularly every day. Stopping treatment suddenly can cause problems. If it becomes necessary for the treatment to stop, your doctor will want you to reduce your dose over a few days.
  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.
  • Once a bottle of Gabapentin Rosemont Oral Solution has been opened it will keep for one month. Do not use it after this time, and make sure you have a fresh supply.

Gabapentin Side Effects

gabapentinsideeffects

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, depression, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

    1. increased seizures;
    2. severe weakness or tiredness;
    3. upper stomach pain;
    4. chest pain, new or worsening cough with fever, trouble breathing;
    5. severe tingling or numbness;
    6. rapid back and forth movement of your eyes;
    7. kidney problems–little or no urination, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath; or
    8. severe skin reaction–fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with gabapentin. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Common gabapentin side-effects
What can I do if I experience this?
Feeling sleepy, tired, unsteady or dizzy; blurred vision and other eyesight problems Do not drive or use tools or machines
Headache Ask your pharmacist to recommend a suitable painkiller
Feeling or being sick, indigestion, stomach ache Stick to simple foods – avoid rich or spicy meals
Diarrhoea Drink plenty of water to replace the lost fluids
Constipation Try to eat a well-balanced diet and drink several glasses of water each day
Dry mouth Try chewing sugar-free gum or sucking sugar-free sweets
Infections, flu-like symptoms, increased appetite, flushing,
increased blood pressure, changes in weight, changes in emotions or mood, fits, movement difficulties, feeling shaky, difficulties sleeping, breathing difficulties, cough, gum changes, bruises, muscle or joint pains, impotence, and swollen feet or ankles
If any of these become troublesome, speak with your doctor for advice

Important: gabapentin has been associated with a number of unwanted effects which affect the blood, pancreas and liver. Although these occur less commonly than the side-effects listed above, you must let your doctor know straightaway if you notice any of the following as they could be serious:

  • Persistent stomach pain with sickness (these could be symptoms of an inflamed pancreas).
  • A skin rash, or any swelling of your mouth or face (these could be symptoms of an allergic reaction).
  • Any yellowing of your skin or of the whites of your eyes (these could be symptoms of jaundice).
  • Any unusual bruising or bleeding (these could be symptoms of a blood disorder).

If you experience any other symptoms which you think may be due to the medicine, speak with your doctor or pharmacist for further advice.

Gabapentin is an Addiction Treatment Medication

Gabapentin is used to treat cases of addiction in an off-label manner. Different companies, including Parke-Davis, Greenstone, and Teva, manufacture several varieties of the generic drug. Other drugs that have been used to treat the symptoms of addiction withdrawal, for specific substances, include:

      • Clondine
      • Other anticonvulsants, such as Tegretol and Depakote
      • Methadone and buprenorphine
      • Naltrexone

Typical Application

Available in capsules, tablets, and as an oral liquid, dosages range from 100 mg to 800 mg. The frequency with which a dose is repeated depends on the specific dose, which is usually based on the severity of withdrawal and the client’s weight. The drug’s half-life is around 5-7 hours.

Generally, it is used during medical detox and throughout subsequent treatment modalities to support relapse prevention while clients adjust to their new sober lifestyles.

Treating Substance Abuse

Despite its therapeutic role in neuropathic pain, gabapentin produces psychoactive effects and has an abuse liability. Gabapentin abuse typically involves taking higher doses in a single administration. The median single dose for gabapentin abuse is 3600 mg, which is 3 times the maximum recommended single dose of 1200 mg. Risk factors for gabapentin abuse include current or previous opioid abuse, previous cocaine use, and/or concurrent use of benzodiazepines or cannabis. Alcohol use disorder is not generally a predictor of gabapentin abuse.

According to Medscape, gabapentin can inflict users with suicidal thoughts and abrupt changes in behavior. For this reason, it should only be used under medical supervision. It can also cause elevated blood pressure, fever, sleep problems, appetite changes, and chest pain.

While it has been used to treat addictions to other substances, gabapentin is most often used to treat alcoholism — an addiction some 16.6 million adults suffered from in 2013, per the National Institute on Alcohol Abuse and Alcoholism.

During withdrawal from alcohol abuse or dependency, clients may experience anxiety, tremors, agitation, and irritability. In order to understand how gabapentin works, there must be a basic understanding of how the brain works first. Nervous system activity is partially controlled by GABA neurotransmitters. Gabapentin works by reducing activity among GABA. As a result, signals for pain, agitation, and anxiety are reduced, too.

An American Journal of Psychiatry study showed impressive results during the 16-week treatment of 150 people who were dependent on alcohol, noting better results among those who were treated with both gabapentin and naltrexone than the latter alone. The Journal of Clinical Psychiatry reported on another study in which individuals treated for alcoholism with gabapentin showed a significant reduction in how much they drank and a greater rate of abstinence than those in the placebo group.

Gabapentin has the same calming effect on individuals who are detoxing from marijuana and benzodiazepines. Despite claims from fans of the plant-based drug, marijuana is indeed addictive. In 2012, 305,560 people checked into rehab citing cannabis as their primary drug of abuse, per the Substance Abuse and Mental Health Services Administration. One Neuropsychopharmacology study that analyzed the use of gabapentin in the treatment of marijuana addiction and withdrawal noted individuals in the gabapentin treatment group used less marijuana, had fewer withdrawal symptoms, and experienced improvements in cognitive functioning, compared to the placebo group.

Gabapentin is used to treat Neuropathic pain

Painful neuropathy is a common and disabling problem in patients with longstanding diabetes mellitus. Tricyclic antidepressant drugs and other chronic analgesics have been beneficial in some patients, but no agent successfully relieves pain in most patients and adverse effects often preclude their use in high doses. Anecdotal reports suggest that gabapentin ameliorates pain associated with neuropathy and other neurological conditions with few side effects.

We conducted a randomized, double blind, placebo controlled trial to study the effect of low dose gabapentin in patients with painful diabetic neuropathy.

The results of this study suggest that gabapentin is probably ineffective or only minimally effective for the treatment of painful diabetic neuropathy at a dosage of 900 mg/day.

The development of neuropathic pain involves several mechanisms including primary and secondary hyperalgesia, peripheral and central sensitisation and wind‐up phenomena. Neurotransmitters play a critical role in the process . Glutaminergic subtypes such as AMPA and neurokinin prime the NMDA receptor by triggering the release of intracellular calcium ions that unblock the magnesium ion plug in the NMDA receptor resulting in the influx of calcium ions into the cell. These calcium ions act as secondary messengers that initiate protein kinase C activation, proto‐oncogene expression (c‐fos, c‐jun) and nitric oxide production. NMDA receptor activation therefore increases the excitability of the nociceptive system.The rationale for the use of anticonvulsant drugs for the treatment of neuropathic pain is based on the similarities in the pathophysiological events observed in epilepsy and neuropathic pain models.

Gabapentin is used to treat Postherpetic Neuralgia

Gabapentin is reported to be efficacious in the treatment of neuropathic pain associated with postherpetic neuralgia. In a multicentre, randomised, double‐blind, placebo‐controlled, parallel design, 8‐week study involving 229 subjects with postherpetic neuralgia, Rowbotham et al.

demonstrated the efficacy of gabapentin in the treatment of postherpetic neuralgia. Patients were received gabapentin to a maximum of 3600 mg.day−1 of gabapentin or matching placebo. The study showed a statistically significant (p < 0.001) decrease in pain scores (using an 11‐point Likert scale) from 6.3 to 4.2 for the gabapentin group, compared with 6.5–6.0 in the placebo group.

Secondary measures of pain, as well as sleep interference, were improved with gabapentin (p < 0.001). The NNT for gabapentin was 3.2, compared with a combined analysis of three randomised controlled trials on carbemazepine in postherpetic neuralgia in which the NNT was 2.5 .

Gabapentin is also used to treat Alcohol Withdrawal

I am still on gabapentin. Dose is 600mg three times a day – total 1800mg in a 24 hour period. I had not had a drink “craving” since August 11, 2014 when I quit. (I did this within one week of starting gabapentin). I did have a glass of wine at Christmas, one beer on my birthday, and one glass of wine at Easter. That’s it. I use to have 10 beers a day, and three glasses of wine or gin for bad panic attacks and generalized anxiety. So for me (not everyone) I can have that occasional drink with friends, at party or any social event – then come home and not touch the stuff and WITHOUT ANY CRAVINGS AT ALL – as I had during my 40-year binge. Still, this drug is amazing. AA never worked for me.

“I went on gabapentin for alcoholism that troubled me for 10 years when nothing including Alcoholics Anonymous barely worked. I read anecdotal information that it helped with alcoholism, went on 600mg twice daily and it was the first thing that helped me. Now I take 1200mg twice daily and find it works great! Afterwards I read a study in the Journal of American Medicine, Gabapentin in Alcohol Dependance, 2014 that confirmed it works well in many people for cravings and binge drinking. This medicine should be further studied to confirm it works well. On this site it is obvious it helps a lot of people struggling with alcoholism which I have, along with Bipolar Disorder. I call Gabapentin my” happy pills” that also takes away my anxiety

I’ve detoxed several times. The last one was really bad. This time My Dr. put me gabapentin 300 mg. 3 times a day and Lithium. I usually suffer withdrawals for 5-7 days. I did have anxiety for two days, but I’m on day 3, no anxiety and no cravings

If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking. Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty, so the doctor knows what has been taken.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours. Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you. If you have any questions about this medicine ask your pharmacist.

Gabapentin for Migraine prevention

There are a number of second-line migraine treatments. The anti-seizure medication gabapentin has been demonstrated to be mildly useful in migraine and tension headache prophylaxis. In a large study on migraine, doses averaged approximately 2,400 mg per day, but lower doses are usually prescribed. Some patients do well with very low doses (200 or 300 mg per day). Sedation and dizziness may be a problem; however, gabapentin does not appear to cause end-organ damage, and weight gain is relatively minimal. Gabapentin can be used as an adjunct to other first-line preventive medications. Pregabalin (Lyrica) has a similar mechanism of action to gabapentin. Lyrica is fairly safe, but sedation and weight gain often occur.

A safe, non-addicting muscle relaxant, tizanidine is useful for migraine and chronic daily headache. Tizanidine may be used on an as-needed basis for milder headaches, or for neck or back pain. Cyclobenzaprine (10 mg) is helpful for sleeping, and helps some with migraine and chronic daily headache.

 

Fioricet Overdose and Overdose Treatment

Following an acute overdosage of butalbital, acetaminophen and caffeine, toxicity may result from the barbiturate or the acetaminophen. Toxicity due to caffeine is less likely, due to the relatively small amounts in this formulation.

Fioricet overdose Signs And Symptoms

Fioricet
Fioricet

Toxicity from barbiturate poisoning includes drowsiness, confusion, and coma; respiratory depression; hypotension; and hypovolemic shock.

In acetaminophen over dosage: dose-dependent, potentially fatal hepatic necrosis is the most serious adverse effect. Renal tubular necroses, hypoglycemic coma and coagulation defects may also occur. Early symptoms following a potentially hepatotoxic overdose may include: nausea, vomiting, diaphoresis and general malaise. Clinical and laboratory evidence of hepatic toxicity may not be apparent until 48 to 72 hours post-ingestion.

Acute caffeine poisoning may cause insomnia, restlessness, tremor, and delirium, tachycardia and extrasystoles.

Fioricet overdose Treatment

A single or multiple drug overdose with this combination product is a potentially lethal polydrug overdose, and consultation with a regional poison control center is recommended. Immediate treatment includes support of cardiorespiratory function and measures to reduce drug absorption.

Oxygen, intravenous fluids, vasopressors, and other supportive measures should be employed as indicated. Assisted or controlled ventilation should also be considered.

Gastric decontamination with activated charcoal should be administered just prior to N-acetylcysteine (NAC) to decrease systemic absorption if acetaminophen ingestion is known or suspected to have occurred within a few hours of presentation. Serum acetaminophen levels should be obtained immediately if the patient presents 4 hours or more after ingestion to assess potential risk of hepatotoxicity; acetaminophen levels drawn less than 4 hours post-ingestion may be misleading. To obtain the best possible outcome, NAC should be administered as soon as possible where impending or evolving liver injury is suspected. Intravenous NAC may be administered when circumstances preclude oral administration.

Vigorous supportive therapy is required in severe intoxication. Procedures to limit the continuing absorption of the drug must be readily performed since the hepatic injury is dose dependent and occurs early in the course of intoxication.

Addiction is a disease that impacts your behavior because your brain is pushing you toward continuing to use the drug that triggered the reward response again and again. Addiction to opioids is difficult to escape from, and it can lead to overdose and death. Another element of the use of opioids is tolerance and dependence. While these aren’t the same as addiction, these scenarios often go hand in hand with one another.

An opioid tolerance means that your body has become somewhat immune to the effects of these drugs so that you require higher doses to feel anything. A physical dependence means that in many ways the presence of opioids has become your new normal.

If you suddenly stop using opioids when you’re physically dependent on them, whether or not you’re addicted, you may experience very uncomfortable symptoms which are categorized as withdrawal.

Some of the symptoms of opiate withdrawal can include nausea, vomiting, goose bumps, cramping, diarrhea, agitation, anxiety, insomnia, and yawning. Withdrawal from opioids can range from annoying to very painful. During a medically-supervised opioid detox, doctors can prescribe certain medicines that can help keep the person more comfortable and help them be more successful at stopping their use of the drugs.

Some of the medicines that may be given to patients during opiate withdrawal include methadone, buprenorphine, clonidine, and naltrexone. These drugs do everything from providing a maintenance system for opioid addicts, to helping with the actual symptoms such as muscle aches and anxiety.

Some people may attempt to manage their own withdrawal from opioids, and not only can this be dangerous, but it is also often ineffective.

The Role of Gabapentin in Pain Management

Opioids, non‐steroidal anti‐inflammatory drugs (NSAIDs), antidepressants, and anticonvulsants are used as pharmacological agents to treat pain. However, no single class of drugs has been found to be effective in all types of pain, presumably because pain syndromes involve different mechanisms.

In addition, each of the currently available drugs is associated with adverse effects, some of which are potentially serious or life‐threatening such as idiosyncratic or toxic reactions.

Traditionally, the treatment of neuropathic pain has involved anticonvulsants, such as carbemazepine, valproic acid and phenytoin, and tricyclic antidepressants, such as amitriptyline and nortriptyline and doxepin. The main disadvantages of the anticonvulsants are their potential for drug interactions via the induction of hepatic enzymes, or resulting from inhibition of hepatic enzymes by other drugs. Minor side‐effects such as sedation, ataxia, vertigo and diplopia are associated with carbemazepine and phenytoin, whereas, anorexia, nausea, vomiting and tremor are associated with valproic acid. Chronic phenytoin use may cause peripheral neuropathy (30%) and gingival hyperplasia (20%), and fetal hydantoin syndrome if administered during pregnancy. Carbemazepine can cause chronic diarrhoea or the syndrome of inappropriate ADH secretion, and rarely aplastic anaemia, thrombocytopaenia, hepatocellular jaundice and cardiac arrhythmias.

Tricyclic antidepressants also cause side‐effects that can be troublesome or potentially dangerous, such as anticholinergic effects (dry mouth, blurred vision, urinary retention, ileus), sedation, orthostatic hypotension, tachycardia and atrio‐ventricular conduction disturbances. Such adverse effects are likely to reduce the tolerance of this group of drugs in elderly or unwell patients. Some subgroups of patients with painful neuropathy such as diabetes may also have autonomic neuropathy and may not tolerate the orthostatic hypotension associated with tricyclic antidepressants.

With increasing evidence of the efficacy of gabapentin in a wide variety of pain syndromes, especially neuropathic pain, gabapentin may be potentially useful because of its relative freedom from serious adverse effects, its lack of interactions with other drugs and its lack of potential for causing drug dependence.

A comparison of the evidence available of efficacy and toxicity for anticonvulsants (gabapentin, phenytoin and carbemazepine) and antidepressants (tricyclic antidepressants and SSRIs) in patients with diabetic neuropathy and postherpetic neuralgia has recently been made by Collins et al. [129] These two neuropathic pain conditions were chosen according to strict diagnostic criteria. Although two previous systematic reviews of anticonvulsants and antidepressants in diabetic neuropathy showed no significant difference in efficacy or adverse effects between the two drug classes [130, 131], Collins et al. found that when data from randomised controlled trials for both diabetic neuropathy and postherpetic neuralgia were pooled, the NNT for at least 50% pain relief was identical for both classes of drugs. When gabapentin was compared with other anticonvulsants, there was no significant difference in efficacy.

The NNT for gabapentin was 3.4 compared with 2.2 for phenytoin/carbemazepine. The number needed to harm (NNH, defined as the number needed to harm one patient from the therapy) for minor adverse effects was 2.7 for both antidepressants and anticonvulsants. Collins et al. used two trials to provide data on minor adverse effects for gabapentin and two trials for phenytoin. The NNH (minor adverse effects) was 2.6 similar to that of gabapentin and 3.2 for phenytoin. The NNH (major adverse effects) for the tricyclic antidepressants was 17, and no significant difference in the incidence of major adverse effects was found between anticonvulsants and placebo.

Collins et al. suggested that the difference in the incidence of major adverse effects can be compared by using the ratio between treatment specific benefit and treatment specific harm (defined as the number of patients needed to experience at least 50% benefit for one to experience a major adverse effect that warranted discontinuation of treatment). The ratio for gabapentin was 6 compared with an average of 8 for all anticonvulsants, and 6 for all antidepressants. As adverse data were pooled from both diabetic and postherpetic neuralgia studies, methodological factors and heterogenicity in these data may limit the validity and robustness of these ratios. The spectrum of the pain and short study duration tend to underestimate the treatment effect, whereas the small sample size of the studies overestimate the treatment effect.

The above evidence suggests that gabapentin is as efficacious at treating neuropathic pain with no significant difference in minor adverse effects and a low propensity for serious adverse effects compared with other anticonvulsants and antidepressants. Therefore, gabapentin is a useful agent in the multimodal approach in the management of neuropathic pain.

Adverse Reactions in Pooled Placebo-Controlled Trials in Postherpetic Neuralgia

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Postherpetic Neuralgia

The most common adverse reactions associated with the use of NEURONTIN in adults, not seen at an equivalent frequency among placebo-treated patients, were dizziness, somnolence, and peripheral edema.

In the 2 controlled trials in postherpetic neuralgia, 16% of the 336 patients who received NEURONTIN and 9% of the 227 patients who received placebo discontinued treatment because of an adverse reaction. The adverse reactions that most frequently led to withdrawal in NEURONTIN-treated patients were dizziness, somnolence, and nausea.

Following table lists adverse reactions that occurred in at least 1% of NEURONTIN-treated patients with postherpetic neuralgia participating in placebo-controlled trials and that were numerically more frequent in the NEURONTIN group than in the placebo group.

TABLE 3. Adverse Reactions in Pooled Placebo-Controlled Trials in Postherpetic Neuralgia
NEURONTIN
N=336
%
Placebo
N=227
%
Reported as blurred vision
Body as a Whole
  Asthenia 6 5
  Infection 5 4
  Accidental injury 3 1
Digestive System
  Diarrhea 6 3
  Dry mouth 5 1
  Constipation 4 2
  Nausea 4 3
  Vomiting 3 2
Metabolic and Nutritional Disorders
  Peripheral edema 8 2
  Weight gain 2 0
  Hyperglycemia 1 0
Nervous System
  Dizziness 28 8
  Somnolence 21 5
  Ataxia 3 0
  Abnormal thinking 3 0
  Abnormal gait 2 0
  Incoordination 2 0
Respiratory System
  Pharyngitis 1 0
Special Senses
  Amblyopia 3 1
  Conjunctivitis 1 0
  Diplopia 1 0
  Otitis media 1 0

Other reactions in more than 1% of patients but equally or more frequent in the placebo group included pain, tremor, neuralgia, back pain, dyspepsia, dyspnea, and flu syndrome.

There were no clinically important differences between men and women in the types and incidence of adverse reactions. Because there were few patients whose race was reported as other than white, there are insufficient data to support a statement regarding the distribution of adverse reactions by race.

 

Migraine Headache and Tension Headache Symptoms

A migraine is a severe headache usually followed by symptoms including nausea and vomiting. This would disable you in a few hours or maybe even days. The level at which this happens or even just its frequency varies.

Migraine
Migraine

A recent study shows that women have problems with migraines much more than men. Although its exact cause is unknown, birth control devices happen to be one of many culprits.

A good example ofsuch a birth control device is the oral contraceptives. It is because its ingredients alter the woman’s hormonal level and causes the migraine. The causecertainly is too much estrogen which is certainly put into what is already naturally produced by the body.

Besides migraine, oral contraceptives may cause medical abnormalities from uterine fibroids to breast cancer.

Sometimes, the migraine attack may occur before or after taking the oral contraceptive. If this happens regularly, you are advised to try another method of birth control. This could be avoided though if you take it with food or milk. You should take this at the same time daily and stick with the prescribed dosage that was given to you.

Women over the age of 35 and experience migraines as a result of using birth control tablets and other devices are at risk of getting a stroke. This is another reason why some institutions strongly advice females to use another thing if they don’t want to get pregnant.

Those who are diabetic, have high cholesterol levels and blood pressure are advised not to take oral contraceptives.

But there is hope. One of the newest oral contraceptives to date is Seasonal. This tablet was introduced into the market in 2003 and since it makes females only experience a period four times in one year, this means fewer headaches for migraine sufferers.

But this oral contraceptive may not work for everyone.

In case you suffer migraines due to neurological problems, this won’t do any good and you will have to find another birth control device.

Women may still choose to use oral contraceptives.This really is only after they are examined by the doctor and if everything looks good, he or she will prescribe a lower dose of oral contraceptives. Talking to your physician may even prevent a full blown migraine from happening since there’s really no permanent solution to stop this from happening.

But you’ll find some women who experience migraines even before they start using oral contraceptives. In fact, the frequency didn’t increase or decrease once they were around the tablet but complained that the severity of the migraine got worse.

The severity of the migraine will also not go away overnight after you quit using oral contraceptives. Studies show that it will have a few months to your hormonal levels to normalize and only then will you have the ability to see an improvement.

Despite that, migraines will still happen and you will not blame it only on the tablet but due to other factors such as the food you eat, stress at home or in the office, other medications that you may be taking, physical factors and changes in the environment.

So although there is a direct link between oral contraceptives and migraine, you cannot say that it is the only reason why women suffer from it more than men.