ADHD – Global Generics Shop

Get Modafinil

global — Fri, 16 Jun 2023 17:15:51 +0000

How should I take modafinil?

Follow all directions on your prescription label. Do not take modafinil in larger or smaller amounts or for longer than recommended.

Modafinil may be habit-forming. Never share modafinil with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it. Selling or giving away modafinil is against the law.

Modafinil is usually taken each morning to prevent daytime sleepiness, or 1 hour before the start of a work shift to treat work-time sleep disorders.

Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

You may take modafinil with or without food.

Modafinil is usually given for 12 weeks or less.

If you are taking modafinil to treat sleepiness caused by obstructive sleep apnea, you may also be treated with a continuous positive airway pressure (CPAP) machine. This machine is an air pump connected to a mask that gently blows pressurized air into your nose while you sleep. The pump does not breathe for you, but the gentle force of air helps keep your airway open to prevent obstruction.

Do not stop using your CPAP machine during sleep unless your doctor tells you to. The combination of treatment with CPAP and modafinil may be necessary to best treat your condition.

Modafinil will not cure obstructive sleep apnea or treat its underlying causes. Follow your doctor’s instructions about all your other treatments for this disorder.

Call your doctor if you continue to have excessive sleepiness even while taking modafinil.

Taking modafinil does not take the place of getting enough sleep.

Store at room temperature away from moisture and heat.

Keep track of the amount of medicine used from each new bottle. Modafinil is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

What happens if I miss a dose?

Talk with your doctor about what to do if you miss a dose of modafinil. Avoid taking the medicine if you do not plan to be awake for several hours. Skip the missed dose if it is almost bedtime. 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 should I avoid while taking modafinil?

modafinil may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Avoid other dangerous activities until you know how modafinil will affect your level of wakefulness.

Avoid drinking alcohol while taking modafinil.

Modafinil 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.

Modafinil can cause skin reactions that may be severe enough to need treatment in a hospital. Stop taking this medicine and get emergency medical help if you have:

skin rash or hives, blisters or peeling;
mouth sores, trouble swallowing;
fever, shortness of breath;
swelling in your legs;
dark urine, jaundice (yellowing of the skin or eyes); or
swelling in your face, eyes, lips, tongue, or throat.

Buy Modafinil online

global — Fri, 16 Jun 2023 17:12:19 +0000

What is modafinil?

Modafinil is a medication that promotes wakefulness.

Modafinil is used to treat excessive sleepiness caused by sleep apnea, narcolepsy, or shift work sleep disorder.

Modafinil may also be used for purposes not listed in this medication guide.

How should I take modafinil?

Follow all directions on your prescription label. Do not take modafinil in larger or smaller amounts or for longer than recommended.

Modafinil is usually taken each morning to prevent daytime sleepiness, or 1 hour before the start of a work shift to treat work-time sleep disorders.

Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

You may take modafinil with or without food.

Modafinil is usually given for 12 weeks or less.

Do not stop using your CPAP machine during sleep unless your doctor tells you to. The combination of treatment with CPAP and modafinil may be necessary to best treat your condition.

Modafinil will not cure obstructive sleep apnea or treat its underlying causes. Follow your doctor’s instructions about all your other treatments for this disorder.

Call your doctor if you continue to have excessive sleepiness even while taking modafinil.

Taking modafinil does not take the place of getting enough sleep.

Store at room temperature away from moisture and heat.

Keep track of the amount of medicine used from each new bottle. Modafinil is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

What happens if I 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 while taking modafinil?

modafinil may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Avoid other dangerous activities until you know how modafinil will affect your level of wakefulness.

Avoid drinking alcohol while taking modafinil.

Modafinil 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.

Modafinil can cause skin reactions that may be severe enough to need treatment in a hospital. Stop taking this medicine and get emergency medical help if you have:

skin rash or hives, blisters or peeling;
mouth sores, trouble swallowing;
fever, shortness of breath;
swelling in your legs;
dark urine, jaundice (yellowing of the skin or eyes); or
swelling in your face, eyes, lips, tongue, or throat.

Buy Farmapram online

global — Fri, 16 Jun 2023 16:46:55 +0000

Xanax (alprazolam) is a prescription medication that’s part of the benzodiazepine drug class. Also known as benzos, these drugs act as central nervous system (CNS) sedatives to promote relaxation. Benzos like Xanax are normally prescribed to treat anxiety disorders, alleviating symptoms like excessive worrying and nervousness. Because certain medications are expensive in the U.S., many people go to Mexico to buy as much Xanax as they want. But while buying Mexican Xanax bars can be easier on your wallet, it can end up costing you more if the drug is laced with impurities.

What Are Mexican Xanax Bars (Farmapram)?

Mexican Xanax bars refer to the benzodiazepine alprazolam, which is better known by its brand name: Xanax. Xanax is a short-acting tranquilizer of the benzo drug class that acts on the brain and CNS to produce side effects like sedation, relaxation, calm, and reduced anxiety.

The Food and Drug Administration (FDA) approved Xanax in October 1981, and it has since become one of the most popularly prescribed and abused drugs in the United States. Xanax is a Schedule IV drug because it has both a medical purpose and a potential for abuse and addiction.

However, while known in the U.S. as alprazolam, Mexican Xanax bars go by the name of Farmapram. Farmapram is a brand of alprazolam that’s produced in Mexico by Ifa Celtics with registration number 420M2001 SSA II.

Farmapram usually comes in a brown glass bottle with a white cap and contains 30 rectangular bars. Each Mexican Xanax bar usually contains 2 mg of the active ingredient alprazolam.

Mexican Xanax bars, including Farmapram, have no imprints. Other presentations of the drug include 0.25 mg boxes with 30 and 90 slotted tablets and 50 mg boxes with 30 and 90 tablets.

Farmapram for sale

global — Fri, 16 Jun 2023 16:46:10 +0000

WHAT IS FARMAPRAM?

Farmapram is Xanax from Mexico. Original non-adulterated preparations of Farmapram come in 1mg and 2mg and cause identical effects as Xanax, as the active ingredient for both medications is alprazolam. (To learn more about the various types of Xanax and their effects see our article on “Types of Xanax“.)

Alprazolam is a potent, short-acting anxiolytic of the benzodiazepine class. It is commonly used for the treatment of anxiety disorders, especially of panic disorder, but also sometimes for social anxiety disorder and generalized anxiety disorder. It was one of the first benzodiazepines to be synthesized and introduced for clinical use, and was soon followed by diazepam (Valium), chlordiazepoxide (Librium) and many others.

Alprazolam is sometimes used together with other recreational drugs, such as alcohol or MDMA, in so-called “party drug” mixtures. However, this can be extremely dangerous, as the combined effects of alprazolam and other drugs can lead to serious adverse reactions.

Alprazolam is also sometimes used as a date rape drug, as spiking someone with alprazolam can make it easier for someone to commit sexual assault by making the victim more compliant or unable to resist.

EFFECTS OF FARMAPRAM ABUSE

When you take Farmapram from an unknown source, you not only face all the risks that come with taking alprazolam, but there is also the additional risk of taking tablets that are adulterated with other psychoactive substances besides alprazolam. There is also a chance that the Farmapram that you take does not have any alprazolam in at all.

If you ingest a tablet that contains fentanyl, you are likely to feel highly intoxicated with opioid-like effects. Overdose frequently occurs from fentanyl ingestion.

People who take the authentic versions of Farmapram, which contain only alprazolam, are likely to experience wooziness, fatigue and feelings of being spaced out.

DANGERS OF FARMAPRAM

There are many dangers of Farmapram, which is why you should avoid abusing this drug. Here are just some of these dangers.

Adulteration with fentanyl and other substances

Perhaps the most significant danger of ingestion Farmapram from an unknown source is in unwittingly taking fentanyl. Fentanyl is a potent synthetic opioid that is similar to morphine, and is up to 100 times more powerful. It is a schedule II prescription drug, and is used to treat severe pain. However, because of its high potency and potential for abuse, fentanyl carries a very high risk for overdose and death.

In recent years, there has been a significant increase in the use of fentanyl, both legitimately and illegally. Fentanyl is often used as a cutting agent in other illicit drugs, such as heroin or cocaine. This can be deadly, as users may not know that their drug has been cut with fentanyl, and thus may take too high of a dose.

Due to its high potency, people may abuse fentanyl in order to get a stronger high. This is extremely dangerous, as a small mistake in dosage can easily lead to an overdose.

Symptoms of fentanyl overdose can include: slow or shallow breathing, cold and clammy skin, pinpoint pupils, and loss of consciousness. If you believe someone has overdosed on fentanyl, it is important to call 911 immediately, as time is of the essence.

Fentanyl is a powerful and dangerous drug that should be used with caution. Anyone who uses fentanyl, whether legally or illegally, is at risk for overdose and death.

Anxiety

While Farmapram is most commonly used medically to reduce anxiety, using Farmapram in large doses or for long periods of time can actually cause a rebound effect, where increased anxiety is felt. This makes it incredibly difficult to stop taking Farmapram once someone is dependent on it, particularly if they are using it to reduce anxiety.

This is because when they stop taking the Farmapram, they must deal with the initial feelings of anxiety, plus any additional anxiety caused by reducing Farmapram use. Users who stop taking Xanax can sometimes feel this additional anxiety for periods up to two years. In rare cases, anxiety caused by Xanax may be permanent.

Depression

Chronic Farmapram abuse can lead to depression, particularly when users attempt to stop taking the drug. As mentioned, anxiety caused by Farmapram withdrawal can be extremely debilitating, and this can lead to feelings of hopelessness and helplessness.

These feelings can be amplified if someone has a history of depression, or if they are struggling with other issues in their life. Depression caused by Farmapram abuse can sometimes be so severe that it leads to suicidal thoughts or attempts.

Psychosis

In rare cases, long-term Farmapram abuse can lead to psychosis, which is a break from reality. Psychosis can cause delusions, hallucinations, and paranoia. It is important to seek medical help if someone you know is displaying these symptoms, as they could be a danger to themselves or others.

Memory loss

Prolonged use of Farmapram can lead to memory loss, both short-term and long-term. This effect is mostly caused by the way Farmapram affects the brain’s neurotransmitters.

Neurotransmitters are essential for sending messages between nerve cells and play a vital role in memory function. Farmapram alters the way these neurotransmitters work, which can lead to memory problems.

Dependence and addiction

Farmapram is a highly addictive drug, and dependence can develop very quickly, even when taking it as prescribed. In fact, many people who become addicted to Farmapram started out taking it as prescribed by their doctor.

Once someone is dependent on Farmapram, they will experience withdrawal symptoms if they try to stop taking the drug. These symptoms can be very unpleasant and can even be dangerous, so it’s important to get professional help if you or someone you know is struggling with a Xanax addiction.

HOW TO GET HELP FOR A XANAX ADDICTION IN OHIO & PA

If you are addicted to Xanax or another benzodiazepine like Farmapram, it may seem like your situation is hopeless. Fortunately, there are options available for you that will help you live a good life, free of addiction.

The first step is contacting a drug rehab and going through a drug detox. This process removes the drugs and their sedative effects from your system slowly, to eliminate the risk of seizures caused by stopping Xanax abuse suddenly. After this, you will be given the opportunity to work on the underlying causes of your addiction so that you can stay drug-free.

Buy Vyvanse 50mg online

global — Fri, 16 Jun 2023 13:56:00 +0000

Has a generic version of Vyvanse been approved?

No. There is currently no therapeutically equivalent version of Vyvanse available in the United States.

Note: Fraudulent online pharmacies may attempt to sell an illegal generic version of Vyvanse. These medications may be counterfeit and potentially unsafe. If you purchase medications online, be sure you are buying from a reputable and valid online pharmacy. Ask your health care provider for advice if you are unsure about the online purchase of any medication.

Related patents

Patents are granted by the U.S. Patent and Trademark Office at any time during a drug’s development and may include a wide range of claims.

Abuse-resistant amphetamine compounds
Patent 7,105,486
Issued: September 12, 2006
Inventor(s): Mickle; Travis & Krishnan; Suma & Bishop; Barney & Lauderback; Christopher & Moncrief; James Scott & Oberlender; Rob & Piccariello; Thomas
Assignee(s): New River Pharmaceuticals Inc.
The invention describes compounds, compositions and methods of using the same comprising a chemical moiety covalently attached to amphetamine. These compounds and compositions are useful for reducing or preventing abuse and overdose of amphetamine. These compounds and compositions find particular use in providing an abuse-resistant alternative treatment for certain disorders, such as attention deficit hyperactivity disorder (ADHD), ADD, narcolepsy, and obesity. Oral bioavailability of amphetamine is maintained at therapeutically useful doses. At higher doses bioavailability is substantially reduced, thereby providing a method of reducing oral abuse liability. Further, compounds and compositions of the invention decrease the bioavailability of amphetamine by parenteral routes, such as intravenous or intranasal administration, further limiting their abuse liability.

Pediatric exclusivity
Abuse resistant lysine amphetamine compounds
Patent 7,223,735
Issued: May 29, 2007
Inventor(s): Mickle; Travis & Krishnan; Suma & Moncrief; James Scott & Lauderback; Christopher & Bishop; Barney & Oberlender; Rob & Piccariello; Thomas
Assignee(s): New River Pharmaceuticals Inc.
The present invention describes compounds, compositions and methods of using the same comprising lysine covalently attached to amphetamine. These compounds and compositions are useful for reducing or preventing abuse and overdose of amphetamine. These compounds and compositions find particular use in providing an abuse-resistant alternative treatment for certain disorders, such as attention deficit hyperactivity disorder (ADHD), ADD, narcolepsy, and obesity. Oral bioavailability of amphetamine is maintained at therapeutically useful doses. At higher doses bioavailability is substantially reduced, thereby providing a method of reducing oral abuse liability. Further, compounds and compositions of the invention decrease the bioavailability of amphetamine by parenteral routes, such as intravenous or intranasal administration, further limiting their abuse liability.

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global — Fri, 16 Jun 2023 11:29:20 +0000

Buy Stilnox at Dzen Pharmacy to bid farewell to insomnia

Sound sleep is one of the keys to the normal body and brain functioning. Being deprived of qualitative sleep, we put ourselves at risk of severe health problems’ development. If your sleeping issues are short-term, keeping to a diet, spending time in the fresh air, and sports would be enough. But if your insomnia becomes chronic, you won’t do without a proven sleeping medication, like Stilnox.

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How does our Stilnox for sale work?

Stilnox or Zolpidem reminds benzodiazepines, producing anxiolytic, sedative, hypnotic, amnesic, and anticonvulsant effects. It is prescribed to patients with situational and transient insomnia, including frequent awakening and trouble falling asleep.

Like other sedatives, Stilnox should be taken consciously. Do not use the drug if you:

drank alcohol
are pregnant
have mental disorders
suffer from severe liver, heart, lungs problems
have apnoea

Moreover, always keep to the dosage, treatment terms, and never give Zolpidem to kids.

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global — Fri, 16 Jun 2023 11:28:50 +0000

Stilnox is one of the brand names of Zolpidem without doctor rx, which is also marketed under the trade name Ambien. It is chemically different from benzodiazepines, although it has a similar hypnotic effect.

Doctors recommend Stilnox Zolpidem 10mg (Cheap shipping to USA) primarily for insomnia, but it also has important options for dependence. Sanofi-Aventis Produce STILNOX 10mg.

Stilnox Uses

STILNOX zolpidem 10mg is used to initiate and maintain sleep in people with insomnia, also called insomnia. Use is not recommend for more than 4 weeks.

STILNOX has a different chemical structure than other sleeping pills. STILNOX works by connecting special places to the brain that generate sleep.

However, your doctor may prescribe STILNOX for a different purpose.

Ask your doctor or pharmacist if you have questions about why it was prescribe.

Stilnox Side effects

According to the American Food and Drug Administration. UU. The following side results are relatively common when Stilnox is taken at therapeutic doses:

amnesty
euphoria
hallucinations
a headache
crisis modification
Increased appetite
Increase in libido
Loss of motor skills
nausea
Vomit

Some Stilnox users report rare side effects, such as: When performing routine tasks while sleeping. These unusual side effects are more likely to take place in the first few days after the first dose of Zolpidem without doctor rx and may involve complex debates for fear that in which the person can answer questions appropriately.

These episodes of illegality pose a significant risk to the user and his environment.

zolpidem Stilnox Overdose

The most common symptoms of Stilnox excess include taut pupils, extreme depression, and heavy breathing. to say nothing of These symptoms can also lead to coma and death in extreme cases.

Overdose with Stilnox is particularly fatal in combination with other medicines that suppress the central nervous system, such as alcohol and opioids.

The usual treatment for the symptoms of Stilnox overdose is Flumazenil, in the light of which is particularly effective in displacing Stilnox from its binding site.

Stilnox Treatment

Stencil Stilnox 10mg can cause withdrawal symptoms in people who depend on it. These symptoms are usually similar to those of benzodiazepines and can cause delirium and seizures.

Withdrawal symptoms are usually worse if the drug is taken at higher doses and over a longer period of time.

Stilnox overdose treatment usually involves to the end that a gradual dose reduction over several months to minimize withdrawal symptoms.

Some treatment not to mention programs for Stilnox 10mg overdose symptoms involve altering the patient to an equivalent dose of the benzodiazepine, which has a greater impact than Stilnox. Common options for this type of treatment include chlordiazepoxide and diazepam.

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global — Fri, 16 Jun 2023 11:17:57 +0000

Uses

Carisoprodol is used short-term to treat muscle pain and discomfort. It is usually used along with rest, physical therapy, and other treatments. It works by helping to relax the muscles.

How to use Soma

Take this medication by mouth with or without food as directed by your doctor. Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.

The dosage is based on your medical condition and response to treatment. This medication should only be used short-term (for 3 weeks or less) unless directed by your doctor.

If you suddenly stop using this medication, you may have withdrawal symptoms (such as stomach cramps, trouble sleeping, headache, nausea). To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used carisoprodol for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal.

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

Precautions

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

Before using this medication, tell your doctor or pharmacist your medical history, especially of: a certain blood disorder (acute intermittent porphyria), kidney disease, liver disease, seizure, personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol).

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

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

Older adults may be more sensitive to the side effects of this drug, especially drowsiness, or confusion. These side effects can increase the risk of falling.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

This medication passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

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global — Fri, 16 Jun 2023 11:17:16 +0000

What is Soma?

Soma is a muscle relaxer that blocks pain sensations between the nerves and the brain.

Soma is used together with rest and physical therapy to treat skeletal muscle conditions such as pain or injury.

Soma should only be used for short periods (up to two or three weeks) because there is no evidence of its effectiveness in long term use and most skeletal muscle injuries are generally of short duration.

Warnings

You should not take Soma if you have porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system) or are allergic to carisoprodol or meprobamate.

Carisoprodol may be habit-forming. Never share this medicine with another person. Misuse of habit-forming medicine can cause addiction, overdose, or death.

Carisoprodol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol. It can increase drowsiness and dizziness caused by this medicine.

You may have withdrawal symptoms when you stop using Soma after using it over a long period of time. Do not stop using this medication suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

Before taking this medicine

You should not use Soma if you are allergic to carisoprodol or meprobamate, or if you have:

porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system).

Tell your doctor if you have ever had:

liver disease;
kidney disease; or
a seizure.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant.

Carisoprodol can pass into breast milk and may cause drowsiness in a nursing baby. Tell your doctor if you are breast-feeding.

Soma is not approved for use by anyone younger than 16 years old.

Older adults may be more sensitive to the effects of this medicine.

Buy Rivotril 2mg

global — Fri, 16 Jun 2023 10:45:04 +0000

PRODUCT DETAILS

Clonazepam

Action
Indications
Contraindications
Route/Dosage
Interactions
Lab Test Interferences
Adverse Reactions
Precautions Patient Care Considerations
Administration/Storage
Assessment/Interventions
Patient/Family Education

(kloe-NAY-ze-pam) Klonopin, Rivotril Class: Anticonvulsant/Benzodiazepine

Action Potentiates action of GABA, inhibitory neurotransmitter, resulting in increased neuronal inhibition and CNS depression, especially in limbic system and reticular formation.

Indications Treatment of Lennox-Gestalt syndrome; management of akinetic and myoclonic seizures and absence seizures unresponsive to succinimides. Unlabeled use(s): Treatment of restless legs syndrome, parkinsonian dysarthria, acute manic episodes of bipolar affective disorder, multifocal tic disorders and neuralgias; adjunctive therapy for schizophrenia.

Contraindications Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; significant liver disease; shock; coma; acute alcohol intoxication.

Route/Dosage

ADULTS: Initial dose: PO 1.5 mg/day in 3 divided doses. Increase by 0.5–1 mg q 3 days until seizures are adequately controlled (maximum 20 mg/day). INFANTS & CHILDREN (£ 10 yr Or 30 Kg): Initial dose: PO 0.01–0.03 mg/kg/day in 2–3 divided doses. Increase by 0.25–0.5 mg q 3 days until maintenance dose of 0.1–0.2 mg/kg has been reached.

Interactions

Alcohol and CNS depressants: May cause additive CNS depressant effects. Cimetidine, oral contraceptives, disulfiram: May cause effects of clonazepam to increase, with excessive sedation and impaired psychomotor function. Digoxin: May increase serum digoxin concentrations. Omeprazole: May increase Theophylline’s: May antagonize sedative effects.

Lab Test Interferences None well documented.

Adverse Reactions

CV: Cardiovascular collapse; hypotension; phlebitis or thrombosis at intravenous sites. CNS: Drowsiness; confusion; ataxia; dizziness; lethargy; fatigue; apathy; memory impairment; disorientation; anterograde amnesia; restlessness; headache; slurred speech; aphonia; stupor; coma; euphoria; irritability; vivid dreams; psychomotor retardation; paradoxid reactions (eg, anger, hostility, mania, insomnia, muscle spasms). DERM: Rash. EENT: Visual and auditory disturbances; depressed hearing. GI: Constipation; diarrhea; dry mouth; coated tongue; excessive salivation; nausea; anorexia; vomiting. GU: Dysuria; enuresis; nocturia; urinary retention. HEMA: Blood dyscrasias including agranulocytosis; anemia; thrombocytopenia; leukopenia; neutropenia. HEPA: Hepatic dysfunction, including hepatitis and jaundice; elevated LDH, ALT, AST and alkaline phosphatase. OTHER: Dependence/withdrawal syndrome (eg, confusion, abnormal perception of movement, depersonalization, muscle twitching, psychosis, paranoid delusions, seizures).

Precautions

Pregnancy: Safety not established. Avoid drug, especially during first trimester, because of possible increased risk of congenital malformation. Not recommended during labor and delivery. Lactation: Excreted in breast milk. Children: Initial dose should be small and gradually increased. Long-term use may cause adverse effects such as possibly delayed mental or physical development. Elderly or debilitated patients: Initial dose should be small and gradually increased. Give drug with extreme care to elderly or very ill patients with limited respiratory reserve. Psychiatric disorders: Not intended for use in patients with primary depressive disorder, psychosis or disorders in which anxiety is not prominent. Renal or hepatic impairment: Use drug with caution to avoid accumulation. Seizure: In patients with multiple seizure types, drug may increase incidence or precipitate onset of grand mal seizures. Suicide: Use drug with caution in patients with suicidal tendencies; do not allow patient access to large quantities.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Give with food or milk to decrease GI upset.
Do not administer with antacid; give at least 1 hr. apart.
If possible, divide daily dose into three equal doses. If doses are unequal, give largest dose at bedtime.
Parenteral administration should be reserved primarily for acute states.
Observe patient for up to 3 hr. after parenteral administration.
Do not inject drug intra-arterially; intra-arterial injection may produce arteriospasm that can lead to gangrene.
Store at room temperature.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies.
Assess renal studies: urinalysis, BUN, urine creatinine.
Assess blood studies (CBC and platelets) prior to and regularly throughout therapy.
Evaluate hepatic studies: ALT, AST, bilirubin, creatinine, alkaline phosphatase.
Patient should undergo ophthalmic examination before, during and after therapy.
Observe for drowsiness, ataxia, confusion, especially in elderly or debilitated patient.
Drowsiness and dizziness may occur early in therapy; assist with ambulation, use side rails.
Provide gum, hard candy and frequent sips of water to relieve dry mouth.
Because of risk of apnea and cardiac arrest, resuscitative facilities should be available.
Monitor drug levels during therapy. Therapeutic level is 20–80 mg/ml.
Monitor for blood dyscrasias: observe for fever, sore throat, bruising, rash, jaundice.
Monitor mental status: mood, sensorium, affect, over sedation, sleep pattern, drowsiness, behavioral changes (especially in children; eg, inattention in school). Report changes to physician.
Monitor seizure activity and record. Take seizure precautions as needed.
Abrupt withdrawal, particularly in long-term, high-dose therapy, may cause status epilepticus, vomiting, diarrhea, and sweating; monitor patient carefully.

OVERDOSAGE: SIGNS & SYMPTOMS Somnolence, confusion, diminished reflexes, coma

Patient/Family Education

Instruct patient to take drug with food or milk to decrease GI upset.
Tell patient not to take drug within 1 hr. of antacid.
Instruct patient to keep record of seizure activity and report to physician.
Encourage patient to carry identification card or Medi-Alert bracelet that indicates diagnosis and drug dosage.
If patient is child, advise parents to supervise child’s play and watch for inattention.
Caution patient not to stop taking medication abruptly.
Advise patient to contact physician immediately if serious side effects (eg, changes in mental status) occur.
Instruct patient to rise slowly or fainting may occur, especially in elderly patients.
Advise patient to avoid intake of alcoholic beverages or other CNS depressants.
Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.