Raiyyan Tahsan

Raiyyan Tahsan
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Pulmonology Case No 5.Drug Induced Asthma.

ড্রাগ induced Asthma!!

Sometimes Asthma is Triggered By Some ড্রাগ, আর Drug ব্যবহার এর কারণে যদি Asthma এর symptom বা Teigger হয় তাকে Drug Induced Asthma বলা হয়!!

Triggering Drug গুলো হলো

•NSAID( Aspirin)

•Beta blockers( Mainly Non selective) even sometimes use of Topical Eye drop

এই ড্রাগ গুলো Bronchoconstriction করে Asthma কে বাড়িয়ে যায়⚠️

📍NSAID induced Asthma তে মূলত Middle age এর Female পেশেন্টরা বেশি Affected হয়__দেখা গেছে Asthama এর সাথে Nasap polyps & Rhinosinusitis থাকে।

এছাড়া Aspirin sensitive পেশেন্টরা Alcohol & salicylates যুক্ত খাবারের পরেও Asthma এর Symptoms গুলো হতে পারে____OCP & Betel nuts ও কখনো Asthma Aggravate করতে পারে

Betel nuts Contain Arecoline ,যা Asthma কে Aggravated করতে পারে

NSAID তে কেনো Asthma এর symptoms হতে পারে বাAggravated করতে পারে?

আমরা Pharmacology তে NSAID এর Mechanism এ পড়েছি( In short)

Arachidonic acid থেকে যখন COX & LOX(Lipoxygenase) তৈরী হয়। NSAID সেই cyclooxygenase(CoX) pathway কে inhibit করে দেয় ,,যার ফলে Prostaglandin (PG) তৈরী হবে না!!আর PG উৎপন্ন না হলে ব্যথা ও হবে না।কারণ Pain এর জন্য দায়ী এই PG___

তাহলে আমরা NSAID দিয়ে Arachidonic acid থেকে PG sysnthesis বন্ধ করে দিলাম Cox Pathway কে Inhibit করার মাধ্যমে🚫

But___lipoxygenase Pathway কে কিন্তু inhibit করে নাই, যার ফলে সব Arachidonic Acid এখন lipoxygenase pathway দিয়ে Leukotriens তৈরী করবে,, Cox Pathway দিয়ে যেতে পারবে না,coz Inhibit করা।

তাই Ultimately সব Arachidonic acid _ Leukotriens produce করবে

_____________________

Beta blocker (mainly Non Selective) কিভাবে Asthma কে Aggravated করে

Propanolol বহুল প্রচলিত Most Commonly prescribed non selective beta blocker…..কেনো Non selective এইটা আমরা জানি ;;Propanolol _Beta 1 &2 এই দুই রিসেপ্টর এর উপর ই কাজ করে,,আর Bronchial smooth muscle এ বিটা-2 receptor থাকে,যেখানে সে bronchoconstriction করে এবং Asthma কে Aggravated করে।

তাই Asthamic Pt কে Beta blockt Avoid করবো,Specially (Non selective গুলো)

♦Asthma with IHD তে Novel choice Of beta blocker হলো Nevibolol__যা বাজারে Nebicard নামে পাওয়া যায়

ড্রাগ Induced Asthma Treatment _

•Stop Triggering Drug❌

•Fr astmatic Pt Best choice fr pain relief __Paracetamol,Tramadol, (Napadol)!!!

Etoricoxib ও use করা যেতে পারে

•Brethlessness এর জন্য Inhaled Corticosteroid ব্যবহার করা যেতে পারে✅

Ref_Davidson+Longcase clinical medicine

Treatment Management:-

Nebivolol:-

Tablet 1:Nebicard 5mg (AS A Nebivolol Hydrochloride AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Indications of Tablet 1:Nebicard 5mg (AS A Nebivolol Hydrochloride AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Nebicard is indicated in-

  • Hypertension
  • Treatment of essential hypertension
  • Chronic heart failure (CHF)
  • Treatment of stable mild and moderate chronic heart failure in addition to standard therapies in elderly patients.

Pharmacology of Tablet 1:Nebicard 5mg (AS A Nebivolol Hydrochloride AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Nebivolol is a β adrenergic receptor blocking agent. Nebivolol inhibits both β1 and β1 adrenergic receptors. Nebivolol lacks intrinsic sympathomimetic and membrane stabilizing activity at therapeutically relevant concentrations. At clinically relevant doses, Nebivolol does not demonstrate β1-adrenergic receptor blockade activity. Various metabolites, including glucuronides, contribute to beta-blocking activity.

Mode of Action of Nebivolol involved include:

  • decreased heart rate
  • decreased myocardia contractility
  • diminution of tonic sympathetic outflow to the periphery from cerebral vasomotor centers
  • suppression of renin activity and
  • vasodilation and decreased peripheral vascular resistance

Pharmacokinetics: Nebivolol is metabolized by a number of routes, including glucuronidation and hydroxylation by CYP2D6. The active isomer (d-nebivolol) has an effective half-life of about 12 hours in CYP2D6 extensive metabolizers (most people), and 19 hours in poor metabolizers and exposure to d-nebivolol is substantially increased in poor metabolizers. This has less importance than usual, however, because the metabolites, including the hydroxyl metabolite and glucuronides (the predominant circulating metabolites), contribute to b blocking activity.

Absorption and Distribution: Absorption of Nebivolol is similar to an oral solution. Mean peak plasma nebivolol concentrations occur approximately 1.5 to 4 hours post-dosing in EMs and PMs. Food does not alter the pharmacokinetics of nebivolol. Nebivolol may be administered without regard to meals. The in vitro human plasma protein binding of nebivolol is approximately 98%, mostly to albumin, and is independent of nebivolol concentrations.

Metabolism and Excretion: Nebivolol is predominantly metabolized via direct glucuronidation of parent and to a lesser extent via N-dealkylation and oxidation via cytochrome P450 2D6. After a single oral administration of 14C-nebivolol, 38% of the dose was recovered in urine and 44% in feces for EMs and 67% in urine and 13% in feces for PMs.

Digoxin: Concomitant administration of Nebivolol (10 mg once daily) and digoxin (0.25 mg once daily) for 10 days in 14 healthy adult individuals resulted in no significant changes in the pharmacokinetics of digoxin or nebivolol.

Warfarin: Administration of Nebivolol (10 mg once daily for 10 days) led to no significant changes in the pharmacokinetics of nebivolol or R- or S-warfarin following a single 10 mg dose of warfarin. Similarly, nebivolol has no significant effects on the anticoagulant activity of warfarin, as assessed by Prothrombin time and INR profiles from 0 to 144 hours after a single 10 mg warfarin dose in 12 healthy adult volunteers. The starting dose should be reduced in patients with moderate hepatic impairment. No formal studies have been performed in patients with severe hepatic impairment and nebivolol should be contraindicated for these patients.

Dosage & Administration of Tablet 1:Nebicard 5mg (AS A Nebivolol Hydrochloride AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

The dose of Nebivolol should be individualized to the needs of the patient. For most patients, the recommended starting dose is 5 mg once daily, with or without food, as monotherapy or in combination with other agents. For patients requiring further reduction in blood pressure, the dose can be increased at 2-week intervals up to 40 mg. A more frequent dosing regimen is unlikely to be beneficial.

Interaction of Tablet 1:Nebicard 5mg (AS A Nebivolol Hydrochloride AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Nebicard should be used with care when myocardial depressants or inhibitors of AV conduction, such as certain calcium antagonists (particularly of the phenylalkylamine [verapamil] and benzothiazepine [diltiazem] classes), or antiarrhythmic agents, such as disopyramide, are used concurrently. Both digitalis glycosides and β-blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia.

Nebicard should not be combined with other β-blockers. Patients receiving catecholamine-depleting drugs, such as reserpine or guanethidine, should be closely monitored, because the added β-blocking action of Nebicard may produce excessive reduction of sympathetic activity. In patients who are receiving Nebicard and clonidine, Nebicard should be discontinued for several days before the gradual tapering of clonidine.

CYP2D6 Inhibitors: Use caution when Nebicard is co-administered with CYP2D6 inhibitors (quinidine, propafenone, fluoxetine, paroxetine, etc.)

Contraindications of Tablet 1:Nebicard 5mg (AS A Nebivolol Hydrochloride AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Nebivolol is contraindicated in patients with severe bradycardia, heart block greater than first degree, cardiogenic shock, decompensated cardiac failure, sick sinus syndrome (unless a permanent pacemaker is in place), or severe hepatic impairment (Child-Pugh >B), and in patients who are hypersensitive to any component of this product.

Side Effects of Tablet 1:Nebicard 5mg (AS A Nebivolol Hydrochloride AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Headache, nausea and bradycardia.

Precautions & Warnings of Tablet 1:Nebicard 5mg (AS A Nebivolol Hydrochloride AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Abrupt Cessation of Therapy: Patients with coronary artery disease treated with Nebicard should be advised against abrupt discontinuation of therapy. Severe exacerbation of angina and the occurrence of myocardial infarction and ventricular arrhythmias have been reported in patients with coronary artery disease following the abrupt discontinuation of therapy with β-blockers. Myocardial infarction and ventricular arrhythmias may occur with or without preceding exacerbation of the angina pectoris. Even patients without overt coronary artery disease should be cautioned against interruption or abrupt discontinuation of therapy. As with other β-blockers, when discontinuation of Nebicard is planned, patients should be carefully observed and advised to minimize physical activity. Nebicard should be tapered over 1 to 2 weeks when possible. If the angina worsens or acute coronary insufficiency develops, it is recommended that Nebicard be promptly reinstituted, at least temporarily.

Cardiac Failure: Sympathetic stimulation is a vital component supporting circulatory function in the setting of congestive heart failure, and (β-blockade may result in further depression of myocardial contractility and precipitate more severe failure. In patients who have compensated congestive heart failure, Nebicard should be administered cautiously. If heart failure worsens, discontinuation of Nebicard should be considered.

Angina and Acute Myocardial Infarction: Nebicard was not studied in patients with angina pectoris or who had a recent Ml.

Bronchospastic Diseases: In general, patients with bronchospastic diseases should not receive (3-blockers.

Anesthesia and Major Surgery: If Nebicard is to be continued perioperatively, patients should be closely monitored when anesthetic agents which depress myocardial function, such as ether, cyclopropane, and trichloroethylene, are used. If β-blocking therapy is withdrawn prior to major surgery, the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures. The β-blocking effects of Nebicard can be reversed by β-agonists, e.g., dobutamine or isoproterenol. However, such patients may be subject to protracted severe hypotension. Additionally, difficulty in restarting and maintaining the heartbeat has been reported with (β-blockers).

Diabetes and Hypoglycemia: β-blockers may mask some of the manifestations of hypoglycemia, particularly tachycardia. Nonselective β-blockers may potentiate insulin-induced hypoglycemia and delay recovery of serum glucose levels. It is not known whether nebivolol has these effects. Patients subject to spontaneous hypoglycemia, or diabetic patients receiving insulin or oral hypoglycemic agents, should be advised about these possibilities and nebivolol should be used with caution.

Thyrotoxicosis: β-blockers may mask clinical signs of hyperthyroidism, such as tachycardia. Abrupt withdrawal of β-blockers may be followed by an exacerbation of the symptoms of hyperthyroidism or may precipitate a thyroid storm.

Peripheral Vascular Disease: β-blockers can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease. Caution should be exercised in these patients.

Non-dihydropyridine Calcium Channel Blockers: Because of significant negative inotropic and chronotropic effects in patients treated with β-blockers and calcium channel blockers of the verapamil and diltiazem type, caution should be used in patients treated concomitantly with these agents and ECG and blood pressure should be monitored.

Use in Special Populations of Tablet 1:Nebicard 5mg (AS A Nebivolol Hydrochloride AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Impaired Renal Function: Nebicard should be used with caution in patients with severe renal impairment because of decreased renal clearance. Nebicard has not been studied in patients receiving dialysis.

Impaired Hepatic Function: Nebicard should be used with caution in patients with moderate hepatic impairment because of decreased metabolism. Since Nebicard has not been studied in patients with severe hepatic impairment, Nebicard is contraindicated in this population. 

Risk of Anaphylactic Reactions: While taking β-blockers, patients with a history of severe anaphylactic reactions to a variety of allergens may be more reactive to repeated challenges either accidental, diagnostic, or therapeutic. Such patients may be unresponsive to the usual doses of epinephrine used to treat allergic reactions.

Therapeutic Class of Tablet 1:Nebicard 5mg (AS A Nebivolol Hydrochloride AS A Beta-adrenoceptor blocking drugs, Beta-blockers)

Beta-adrenoceptor blocking drugs, Beta-blockers

For pain Reliver used Paracetamol,Tramadol,Napadol,Etoricoxib

We described about Etoricoxib:-

Tablet 2:-Tory 120 mg (AS A Etoricoxib AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Indications of Tablet 2:-Tory 120 mg (AS A Etoricoxib AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Tory tablet is indicated for the symptomatic relief of-

  • Osteoarthritis (OA)
  • Rheumatoid arthritis (RA)
  • Ankylosing spondylitis, and
  • The pain and signs of inflammation associated with acute gouty arthritis.
  • For the short-term treatment of moderate pain associated with dental surgery.

Pharmacology Tablet 2:-Tory 120 mg (AS A Etoricoxib AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Etoricoxib is a potent, orally active cyclooxygenase-2 (COX-2) specific inhibitor within, and significantly above, the clinical dose range. Two isoforms of cyclooxygenase have been identified: cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). COX-1 is responsible for prostaglandin-mediated normal physiologic functions such as gastric cytoprotection and platelet aggregation. Inhibition of COX-1 by nonselective NSAIDs has been associated with gastric damage and inhibition of platelet aggregation. COX-2 has been shown to be primarily responsible for the synthesis of prostanoid mediators of pain, inflammation, and fever. Selective inhibition of COX-2 by etoricoxib (within the clinical dose range) decreases these clinical signs and symptoms with decreased potential for Gl toxicity and effects on platelet aggregation. Etoricoxib produced dose-dependent inhibition of COX-2 without inhibition of COX-1 at doses up to 150 mg daily. Etoricoxib did not inhibit gastric prostaglandin synthesis.

Dosage & Administration Tablet 2:-Tory 120 mg (AS A Etoricoxib AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Adult and adolescent over 16 years:

  • Osteoarthritis: The recommended dose is 30 mg once daily. In some patients with insufficient relief from symptoms, an increased dose of 60 mg once daily may increase efficacy.
  • Rheumatoid arthritis: The recommended dose is 90 mg once daily.
  • Ankylosing spondylitis: The recommended dose is 90 mg once daily.
  • Acute gouty arthritis: The recommended dose is 120 mg once daily. In clinical trials for acute gouty arthritis, Etoricoxib was given for 8 days.
  • Postoperative dental surgery pain: The recommended dose is 90 mg once daily, limited to a maximum of 3 days.

Some patients may require additional postoperative analgesia. As the cardiovascular risks of Etoricoxib may increase with dose and duration of exposure, the shortest duration possible and the lowest effective daily dose should be used. The patient’s need for symptomatic relief and response to therapy should be re-evaluated periodically, especially in patients with osteoarthritis.

Interaction Tablet 2:-Tory 120 mg (AS A Etoricoxib AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

With medicine:

  • Oral anticoagulants: In subjects stabilized on chronic warfarin therapy, the administration of Tory was associated with an increase in prothrombin time.
  • Diuretics, ACE inhibitors and Angiotensin II Antagonists: NSAIDs may reduce the effect of diuretics and other antihypertensive drugs.
  • Acetylsalicylic Acid: Tory can be used concomitantly with acetylsalicylic acid at doses used for cardiovascular prophylaxis (low-dose acetylsalicylic acid).
  • Ciclosporin and tacrolimus: Although this interaction has not been studied with Tory, coadministration of ciclosporin or tacrolimus with any NSAID may increase the nephrotoxic effect of ciclosporin or tacrolimus.
  • Lithium: NSAIDs decrease lithium renal excretion and therefore increase lithium plasma levels.

With food & others: Take without regards to meals.

Contraindications Tablet 2:-Tory 120 mg (AS A Etoricoxib AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

  • Hypersensitivity to the active substance or to any of the excipients.
  • Active peptic ulceration or active gastro-intestinai (Gl) bleeding.
  • Patients who have experienced bronchospasm, acute rhinitis, nasal polyps, angioneurotic oedema, urticaria, or allergic-type reactions after taking acetylsalicylic acid or NSAIDs including COX-2 (cyclooxygenase-2) inhibitors.
  • Pregnancy and lactation.
  • Severe hepatic dysfunction (serum albumin <25 g/l or Child-Pugh score 10).
  • Estimated renal creatinine clearance <30 ml/min.
  • Children and adolescents under 16 years of age.
  • Inflammatory bowel disease.
  • Congestive heart failure (NYHA ll-IV).
  • Patients with hypertension whose blood pressure is persistently elevated above 140/90 mmHg and has not been adequately controlled.
  • Established ischaemic heart disease, peripheral arterial disease, and/or cerebrovascular disease.

Side Effects Tablet 2:-Tory 120 mg (AS A Etoricoxib AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Side-effects may include palpitation, fatigue, influenza-like symptoms, ecchymosis; less commonly dry mouth, taste disturbance, mouth ulcer, appetite and weight change, atrial fibrillation, transient ischaemic attack, chest pain, flushing, cough, dyspnoea, epistaxis, anxiety, mental acuity impaired, paraesthesia, electrolyte disturbance, myalgia and arthralgia; very rarely confusion and hallucinations.

Pregnancy & Lactation

The use of Etoricoxib, as with any drug substance known to inhibit COX-2, is not recommended in women attempting to conceive. It is not known whether Etoricoxib is excreted in human milk. Etoricoxib is excreted in the milk of lactating rats. Women who use Etoricoxib must not breastfeed.

Precautions & Warnings

  • Caution is advised with treatment of patients most at risk of developing a gastrointestinal complication with NSAIDs; the elderly, patients using any other NSAID or acetylsalicylic acid concomitantly or patients with a prior history of gastrointestinal disease, such as ulceration and Gl bleeding.
  • Patients with significant risk factors for cardiovascular events (e.g. hypertension, hyperlipidaemia, diabetes mellitus, smoking) should only be treated with Tory after careful consideration.
  • Administration of Tory may cause a reduction in prostaglandin formation and, secondarily, in renal blood flow, and thereby impair renal function. Monitoring of renal function in such patients should be considered.
  • Caution should be exercised in patients with a history of cardiac failure, left ventricular dysfunction, or hypertension and in patients with pre-existing edema from any other reason.
  • Any patients with symptoms and/or signs suggesting liver dysfunction, or in whom an abnormalliver function test has occurred, should be monitored. If signs of hepatic insufficiency occur, or if persistently abnormal liver function tests (three times the upper limit of normal) are detected, Tory should be discontinued.
  • Tory should be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity.
  • Tory may mask fever and other signs of inflammation. Caution should be exercised when co-administering Tory with warfarin or other oral anticoagulants.

Overdose Effects Tablet 2:-Tory 120 mg (AS A Etoricoxib AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Administration of single doses of Tory up to 500 mg and multiple doses up to 150 mg/day for 21 days did not result in significant toxicity. In the event of overdose, it is reasonable to employ the usual supportive measures, e.g., remove unabsorbed material from the Gl tract, employ clinical monitoring, and institute supportive therapy, if required.

Therapeutic Class Tablet 2:-Tory 120 mg (AS A Etoricoxib AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Non-steroidal Anti-inflammatory Drugs (NSAIDs)

OR Tramadol:-

Capsule 3:- Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

Indications of Capsule 3:- Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

Anadol SR is used for the treatment of moderate to severe painful conditions. These include:

  • Postoperative pain
  • Colic and spastic pain
  • Cancer pain
  • Joint pain
  • Neck and back pain
  • Pain associated with osteoporosis.

Pharmacology of Capsule 3:- Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

Tramadol is a centrally acting synthetic analgesic compound. It inhibits the re uptake of neurotransmitters- serotonin and noradrenaline. Thus it modifies the transmission of pain impulses by activating both descending serotonergic pathways and noradrenergic pathways involved in analgesia. The analgesic effects of Tramadol are mediated via stimulation of mu-opioid receptors and indirect modulation of central monoaminergic inhibitory pathways.

Dosage & Administration of Capsule 3:- Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

Capsule or Tablet: Usual doses are 50 to 100 mg every four to six hours. For acute pain an initial dose of 100 mg is required. For chronic painful conditions an initial dose of 50 mg is recommended. Subsequent doses should be 50 to 100 mg administered 4-6 hourly. The dose level and frequency of dosing will depend on the severity of the pain.The total daily dosage by mouth should not exceed 400 mg.

Sustained Release Capsule or Tablet: One SR capsule or tablet every 12 hours, for example first one in the morning and then at the same time in the evening. The number of capsules taken at a time will depend upon severity of pain, but it should not be taken more frequently than every 12 hours.The total daily dosage by mouth should not exceed 400 mg.

Injection: A dose of 50-100 mg may be given every 4 to 6 hours by intramuscular or by intravenous infusion. For the treatment of postoperative pain,the initial dose is 100 mg followed by 50 mg every 10 to 20 minutes if necessary to a maximum of 250 mg in the first hour. Thereafter, doses are 50 to 100 mg every 4 to 6 hours up to a total daily dose of 600 mg.

Suppository: Tramadol suppository should be administered rectally. For adults usual dose is 100 mg Tramadol Hydrochloride 6 hourly. In general, 400 mg Tramadol Hydrochloride (4 Tramadol suppository) per day sufficient. However, for the treatment of Cancer pain and severe pain after operations much higher daily doses can be used.

Interaction of Capsule 3:- Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

In general, physician need not be concerned about drugs interacting with Anadol SR. The monoamine oxidase (MAO) inhibitors represent the only drug class not recommended for combination with Anadol SR. Concomitant administration of carbamazepine with Anadol SR causes a significant increase in Anadol SR metabolism and it requires to increase the dose of Anadol SR.

Contraindications

Tramadol is contraindicated in persons having hypersensitivity to this drug. It is also contraindicated in acute intoxication with alcohol, hypnotics, centrally acting analgesics, opioids or psychotropic drugs.

Side Effects of Capsule 3:- Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

Commonly occurring side-effects are dizziness/vertigo, nausea, constipation, headache, somnolence, vomiting, pruritus, CNS stimulation, asthenia, sweating, dyspepsia, dry mouth, diarrhoea. Less commonly occurring side-effects include malaise, allergic reaction, weight loss, vasodilatation, palpitations, abdominal pain, anorexia, flatulence, GI bleeding, hepatitis, stomatitis etc.

Pregnancy & Lactation

Safe use of Tramadol in pregnancy has not been established. Tramadol has been shown to cross the placenta. There are no adequate and well-controlled studies in pregnant women. Therefore, Tramadol should be used during pregnancy only if the potential benefit justifies the risk to the foetus. Tramadol Hydrochloride should not be administered during breast feeding as Tramadol and its metabolites have been detected in breast milk.

Precautions & Warnings of Capsule 3:- Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

Respiratory depression: When large doses of tramadol are administered with anaesthetic with anaesthetic medications or alcohol, respiratory depression may result. Therefore, tramadol should be administered cautiously in patients at risk for respiratory depression.

Opioid dependence: Anadol SR is not recommended for patients who are dependent on opioids.

Concomitant CNS depressants: Anadol SR should be used with caution and in reduced dosages when administering to patients receiving CNS depressants such as alcohol, opioids, anesthetic agents, phenothiazines, tranquilizers or sedative hypnotics.

Concomitant MAO inhibitors: Anadol SR should be used with great caution in patients taking MAO inhibitors, since tramadol inhibits the uptake of norepinephrine and serotonin.

Anadol SR should be used with caution in patients with increased intracranial pressure or head injury and patients with acute abdominal conditions.

Use in Special Populations of Capsule 3:- Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

In children from the age of 1 year Anadol SR can be given in a dose of 1-2 mg/kg body weight. However,suppository (100 mg Anadol SR) should not be administered in children and adolescents below the age of 14 years. Anadol SR 100 mg SR Capsules have not been studied in children. Therefore, safety and efficacy have not been established and the product should not be used in children.

Therapeutic Class of Capsule 3:- Anadol SR 100mg (AS A Tramadol Hydrochloride AS A Opioid analgesics).

Opioid analgesics

Raiyyan Tahsan Date:27-01-2025 Monday Time:11-26-55 AM

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