Pain Management: Neuropathic Pain Introduction Neuropathic pain is a complex, chronic pain state pain state that usually is accompanied by tissue injury. With With neuropathic pain, the nerve fibers themselves may be damaged, dysfunctional or injured. These damaged nerve fibers send incorrect signals to other pain centers. The impact of nerve fiber injury includes a change in n erve function both at the site of injury and areas around the injury. One example of neuropathic pain p ain is called phantom limb syndrome. This occurs when an arm or a leg has been removed because becau se of illness or injury, but the brain still gets pain messages from the nerves that originally carried impulses from the missing limb. These nerves now misfire and cause pain.
What causes neuropathic pain? Neuropathic pain often seems to have no obvious cause; but, some common causes of neuropathic pain include • • • • • • • • • •
!lcoholism !mputation "ac#, leg, and hip problems $hemotherapy %iabetes &acial nerve problems '() infection or !(%* +ultiple sclerosis *hingles *pine surgery
What are the symptoms of neuropathic pain? *ymptoms may include • •
*hooting and burning pain Tingling and numbness
How is neuropathic pain diagnosed? ! doctor will conduct an interview and physical exam. 'e or she may as# uestions about how you would describe your pain, when the pain occurs, or whether anything an ything specific triggers the pain.
How is neuropathic pain treated? *ome neuropathic pain studies suggest the use of non-steroidal anti-inflammatory drugs, drugs, such as !leve or +otrin +otrin,, may ease pain. *ome *o me people may reuire a stronger pain#iller, such as those containing morphine. !nticonvulsant and antidepressant drugs seem to wor# in some cases.
(f another condition, such as diabetes, is involved, better management of that disorder may alleviate the pain. (n cases that are difficult to treat, a pain specialist may use invasive or implantable device therapies to effectively manage the pain. lectrical stimulation of the nerves involved in neuropathic pain generation may significantly control the pain symptoms. /nfortunately, neuropathic pain often responds poorly to standard pain treatments and occasionally may get worse instead of better over time. &or some people, it can lead to serious disability.
Patient Discussions - Viewers share their comments Neuropathic Pain The MedicineNet physician editors as: What was the cause of your neuropathic pain0 ( have had 1 bac# operations. The 2st was due to a bulging disc and ( had to have it removed. ( ta#e 234mg of morphine per day and 54ml of oramorph medicine. (6ve been diagnosed as having $hronic Neuropathic pain and the specialists have said there is no more they can do for me. (6m unable to wal# and spend most of my days in bed unable to move due to tremendous pain. (s there any advice that anyone can give me as ( am very depressed and don7t #now what to do. !e"ated !eading: Neuropathic pain
$omment from )i#i+ason, 88-95 &emale :atient< ublished !pril 23 (7m two years out from chemotherapy for breast can cer. (7m enjoying a fine remission, however (7ve been told my sundry symptoms indicate neuropathic pain. +y fingers and toes bu== and tingle. ( also freuently have what behaves li#e gouty arthritis in my feet and hands. +y uric acid levels are generally good when this happens. ( get more and more confused about the nature of this condition. (7m also pretty discouraged. !e"ated !eading: chemotherapy > breast cancer > arthritis
$omment from &ate, 18-55 &emale :atient< ublished !pril 4? ( was caught in a crossfire and got shot @ times, 3 to the torso, 3 to the left arm and 1 to the right thigh. ( was also injured in the grenade blast, multiple fragments to my entire body. ( was inside a car then that crashed on a 14 feet cement wall causing concussion and abrasions. (7ve been diagnosed with Neuropathic A Nociceptive $hronic ain *yndrome. This was 31B years ago. !e"ated !eading: concussion > $hronic ain
$omment from Tewey, 58-85 +ale :atient< ublished &ebruary 2@ %iabetes :Type 2< was the cause of my neuropathic pain. &or a few years the pain in my calves :left more than right< was more of an irritation than a disability, but about three years ago, after a serious hypo which ( over-treated :too much orange juice< ( found ( could not wal# at all. &or almost a year (
was unable to wal# more than a few yards without crippling pain, but after a few months ( was able to ride a bicycle, and now ( can wal# a couple of miles :though not very fast< and ( can ride my bicycle for an hour or more. The pain is still there, and it is worse when ( wal#, bu t it is never as severe as three years ago. ( thin# the daily yoga is helping.
How Ner#e Pain $ee"s eople with nerve pain feel it different ways. &or some, it7s a stabbing pain in the middle of the night. &or others, it7s a chronic tingling or burning the y feel all day. /ncontrolled nerve pain can be hard to bear. "ut with treatment, it can often be controlled.
%nderstanding Ner#e Pain ain is supposed to be a warning. When your hand gets too close to a stove, the nerves send a pain signal to the brain -- and you pull bac# before you burn yourself. "ut if you have nerve pain, that system isn7t wor#ing. %amaged nerves may send false signals -- and you feel real pain without another cause. Or damaged nerves may stop you from feeling pain when you have an injury.
Ner#e Pain Triggers *ome find that certain body positions or activities -- li#e standing in line or wal#ing -- may become painful. Nerve damage may also ma#e your body overly sensitive. ven a gentle bree=e on your face may become excruciating.
&oss of $ee"ing Nerve damage may cause loss of sensation, ma#ing it harder to do things with your hands. Cnitting, typing, and tying your shoes may become difficult. +any people with nerve damage say that their sense of touch feels dulled, as if they are always wearing gloves.
Ner#e Pain and '"eep Nerve pain is often worst at night. The touch of sheets or the pressure of lying down may be terribly uncomfortable. (f you can7t sleep because of your nerve pain, ma#e sure to mention it to your doctor. $hanging some habits or ta#ing medicine could help
&osing (a"ance (n addition to dulling your sense of touch, nerve damage may decrease muscle strength. These two effects may ma#e it harder to #eep your balance -- and that could lead to falls. !ssistive devices -- li#e braces, canes, or wal#ers -- may help.
%nseen In)uries Nerve damage doesn7t just cause pain. (t may also cause numbness that may prevent you from feeling pain when it matters. eople with nerve damage sometimes hurt themselves without reali=ing it. Dour doctor may recommend that you chec# yourself for injuries regularly -- especially your feet.
Ner#e Pain Progression Eeft untreated, nerve damage may worsen over time. (t usually starts in the nerves farthest from the brain and spinal cord -- li#e those in the feet and hands. Then it may move up into the legs and arms. 'owever, if you get control of your nerve pain promptly, you may be able to stop the damage -- and even reverse it.
*T+ Treatments for Ner#e Pain Over-the-counter pain#illers may be the first treatment your doctor recommends. These may include nonsteroidal anti-inflammatory drugs :N*!(%s< -- such as ibuprofen -- or analgesics, such as acetaminophen. Other options include pain#illing creams, ointments, oils, gels, or sprays that are used on the s#in.
Ner#e Pain: Prescription Treatments There are many prescription medicines that may h elp with nerve pain. *ome are powerful pain#illers. Other drug types might help too. *tudies have found that some medicines originally used for depression
and epilepsy may also help relieve nerve pain.
Natura" Treatments for Ner#e Pain $omplementary or alternative treatments may help. &or instance, studies have found that acupuncture may ease nerve pain. (n some cases, nerve pain is caused or aggravated by a deficiency of vitamin "23. Ta#ing supplements -- under your doctor7s care -- could help.
Taing +ontro" of ,our Hea"th (n addition to wor#ing with your doctor to find treatment that wor#s, you can ta#e other steps to fight chronic pain. Fetting regular exercise, #eeping a healthy weight, and improving your diet may help.
.N.!I+ N/M.: napro0en (!/ND N/M.: /napro01 Napre"an1 Naprosyn1 /"e#e D!% +&/'' /ND M.+H/NI'M: Naproxen belongs to a class of drugs called nonsteroidal antiinflammatory drugs :N*!(%s<. Other members of this class include ibuprofen :+otrin<, indomethacin :(ndocin<, nabumetone :Gelafen< and several others. These drugs are used for the management of mild to moderate pain, fever , and inflammation. They wor# by reducing the levels of prostaglandins, chemicals that are responsible for pain, fever, and inflammation. Naproxen bloc#s the en=yme that ma#es prostaglandins :cyclooxygenase<, resulting in lower conc entrations of prostaglandins. !s a conseuence, inflammation, pain and fever are reduced. Naproxen was approved by the &%! in %ecember 2HH2. P!.'+!IPTI*N: Des; :!leve, no<
.N.!I+ /V/I&/(&.: Des P!.P/!/TI*N': • • • • • •
!naprox :tablets< 3@8 and 884 mg; Naprosyn :tablets< 384, 1@8, and 844 mg; Naprosyn suspension 238 mgI8ml; $-Naprosyn 1@8 mg, !leve 334 mg; Naprelan :controlled-release tablets< 1@8 and 844mg.
'T*!/.: Naproxen should be stored at room temperature 28-14 $ :8H-?9 &<. P!.'+!I(.D $*!: Naproxen is used for the treatment of mild to moderate pain, inflammation, and fever. D*'IN: The usual adult dose is 384-844 mg twice daily using regular naproxen tablets. The usual dose for Naprelan controlled release tablets is @84 to 2444 mg given once daily. &or $-Naprosyn, the usual dose is 1@8-844 mg twice daily. Naproxen should be given with food to reduce upset stomach. D!% INT.!/+TI*N': Naproxen is associated with several suspected or probab le interactions that affect the action of other drugs. The following examples are the most common suspected interactions.
Naproxen may increase the blood levels of lithium :s#alith< by reducing the excretion of lithium by the #idneys. (ncreased levels of lithium may lead to lithium toxicity. Naproxen may reduce the blood pressure lowering effects of blood pressure medications. This may occur because prostaglandins play a role in the regulation of blood pressure. When naproxen is used in combination with methotrexate or aminoglycosides :for example, gentamicin< the blood levels of the methotrexate or aminoglycoside may increase, presumably because the eliminationfrom the body is reduced. This may lead to more methotrexate or aminoglycosiderelated side effects. (ndividuals ta#ing oral blood thinners or anticoagulants Jfor example, warfarin, :$oumadin
N*!(%s reduce the ability of blood to clot and therefore increase bleeding after an injury. Naproxen also may cause stomach and intestinal bleeding and ulcers. *ometimes, stomach ulceration and intestinal bleeding can occur without any abdominal pain. "lac# tarry stools, wea#ness, and di==iness upon standing may be the only signs of the bleeding. eople who are allergic to other N*!(%s should not use naproxen. N*!(%s reduce the flow of blood to
the #idneys and impair function of the #idneys. The impairment is most li#ely to occur in patients with preexisting impairment of #idney function or congestive heart failure, and use of N*!(%s in these patients should be done cautiously. (ndividuals with asthma are more li#ely to experience allergic reactions to naproxen and other N*!(%s. &luid retention, blood clots, heart attac#s, hypertension, and heart failure have also been associated with the use of N*!(%s. W/!NIN: This drug may infreuently cause serious :rarely fatal< bleeding from the stomach or intestines. This side effect can occur without warning at any time during treatment with naproxen. The elderly are at increased ris# for serious stomachIintestinal bleeding.
%rugs related to naproxen have rarely caused blood clots to form, resulting in serious :possibly fatal< heart attac#s and stro#es. This medication might also rarely cause similar problems. The ris# of these serious side effects may increase if you have heart disease and with longer use of this medication. Tal# to your doctor or pharmacist about the benefits and ris#s of treatment, as well as other possible medication choices. *top ta#ing naproxen and see# immediate medical attention if you notice any of the following rare but very serious side effects blac# stools, persistent stomachIabdominal pain, vomit that loo#s li#e coffee grounds, chest pain, shortness of breath, wea#ness on one side of the body, sudden vision changes, slurred speech. This medication should not be used right before or after heart bypass surgery. %'.': Naproxen is used to relieve pain and swelling :inflammation< from various conditions. (t is used to treat headaches, muscle aches, bac#aches, tendonitis, dental pain, and menstrual cramps. (t also reduces pain, swelling, and joint stiffness caused by arthritis, bursitis, and gout attac#s. Geducing these symptoms helps you do more of your normal daily activities. This medication is #nown as a nonsteroidal anti-inflammatory drug :N*!(%<.
napro0en - ora"1 /napro01 Naprosyn 2cont34 H*W T* %'.: Gead the +edication Fuide provided by your pharmacist before you start using naproxen and each time you get a refill. (f you have any uestions regarding the information, consult your doctor or pharmacist.Ta#e this medication by mouth with a full glass of water :? ounces or 354 milliliters< unless your doctor directs you otherwise. %o not lie down for at least 14 minutes after ta#ing this drug. To prevent stomach upset, ta#e this medication with food, mil#, or an antacid.%osage is based on your medical condition and response to therapy. %o not ta#e more than 2,844 milligrams of naproxen :eual to 2,984 milligrams of naproxen sodium< per day. To minimi=e side effect ris#s :e.g., stomach bleeding<, use this medication at the lowest effective dose for the shortest possible length of time. %o not increase your dose or ta#e it more often than prescribed. &or ongoing conditions such as arthritis, continue ta#ing it as directed by your do ctor. %iscuss the ris#s and benefits with your doctor or pharmacist.(n certain conditions :e.g., arthritis<, it may ta#e up to 3 wee#s of regular use before the full benefits of this drug ta#e effect.(f you are ta#ing this drug on an Las neededL basis :not on a regular schedule<, remember that pain medications wor# best if the y are used as the first signs of pain occur. (f you wait until the pain has significantly worsened, the medicine may not wor# as well.(f you use this medication for migraine headache, and the pain is not relieved or worsens after the first dose, tell your doctor immediately.(nform your doctor if your condition worsens. 'ID. .$$.+T': *ee also Warning section./pset stomach, nausea, heartburn, diarrhea, constipation,
headache, tiredness, drowsiness, and di==iness may occur. (f any of these effects persist or worsen, notify your doctor or pharmacist promptly.Gemember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the ris# of side effects. +any people using this medication do not have serious side effects.Tell your doctor immediately if any of these unli#ely but serious side effects occur stomach pain, difficultIpainful swallowing, swelling of the handsIfeet, suddenIunexplained weight gain, vision changes, hearing changes :e.g., ringing in the ears<, mentalImood changes :e.g., depression<, fastIpounding heartbeat, persistentIsevere headache, fainting.Tell your doctor immediately if any of these rare bu t very serious side effects occur change in the amount of urine, easy bruisingIbleeding, signs of infection :e.g., fever , persistent sore throat<, unexplained stiff nec#.This drug may rarely cause serious :possibly fatal< liver disease. (f you notice any of the following rare but very serious side effects, stop ta#ing naproxen and tell your d octor immediately yellowing eyesIs#in, dar# urine, unusualIextreme tiredness, severe stomachIabdominal pain, persistent nauseaIvomiting.! very serious allergic reaction to this drug is unli#ely, but see# immediate medical attention if it occurs. *ymptoms of a serious allergic reaction may include rash, itchingIswelling :especially of the faceItongueIthroat<, severe di==iness, trouble breathing.This is not a complete list of possible side effects. (f you notice other effects not listed above, contact you r doctor or pharmacist.(n the /* -$all your doctor for medical advice about side effects. Dou may report side effects to &%! at 2-?44-&%!-24??.(n $anada - $all your doctor for medical advice about side effects. Dou may report side effects to 'ealth $anada at 2-?99-315-3158. P!.+/%TI*N': "efore ta#ing naproxen, tell your doctor or pharmacist if you are allergic to it; or to aspirin or other N*!(%s :e.g., ibuprofen, celecoxib<; or if you have any other allergies.This medication should not be used if you have certain medical conditions. "efore using this medicine, consult your doctor or pharmacist if you have aspirin-sensitive asthma :a history of worsening breathing with runnyIstuffy nose after ta#ing aspirin or other N*!(%s<, severe #idney disease, recent heart b ypass surgery :$!"F<."efore using this medication, tell your doctor or pharmacist your medical history, especially of #idney disease, liver disease, poorly controlled diabetes, stomachIintestineIesophagus problems :e.g., bleeding, ulcers<, heart disease :e.g., congestive heart failure, history of heart attac# <, high blood pressure, stro#e, swelling :edema, fluid retention<, a severe loss of body water :dehydration<, blood disorders :e.g., anemia<, bleeding or clotting problems, asthma, growths in the nose :nasal polyps<.*ome naproxen products contain salt :sodium<. Tell your doctor if you are on a saltrestricted diet."efore having surgery, tell your doctor or den tist that you are using this medication.This drug may ma#e you di==y or drowsy. %o not drive, use machinery, or do any activity that reuires alertness until you are sure you can perform such activities safely.This medicine may cause stomach bleeding. %aily use of alcohol and tobacco may increase your ris# for stomach bleeding, especially when combined with this medicine. Eimit alcohol an d stop smo#ing. $onsult your doctor or pharmacist for more information.This medication may ma#e you more sensitive to the sun. !void prolonged sun exposure, tanning booths, and sunlamps. /se a sunscreen and wear protective clothing when outdoors.The elderly may be more sensitive to the side effects of this drug, especially stomachIintestinal bleeding and #idney effects.This medication should be used onl y when clearly needed during the first 9 months of pregnancy. (t is not recommended for use during the last 1 months of pregnancy due to possible harm to the unborn baby and interference with normal laborIdelivery. %iscuss the ris#s and benefits with your doctor.This drug passes into breast mil#. While there have been no reports of harm to nursing infants, consult your doctor before breast-feeding. D!% INT.!/+TI*N': Dour healthcare professionals :e.g., doctor or pharmacist< may already be aware of any possible drug interactions and may be monitoring you for it. %o not start, stop or change the dosage of any medicine before chec#ing with them first.This drug should not be used with the
following medications because very serious interactions may occur high doses of aspirin and related drugs :salicylates<, cidofovir, other N*!(%s :e.g., #etorolac<.(f you are currently using any of these medications listed above, tell your doctor or pharmacist before starting naproxen."efore using this medication, tell your doctor or pharmacist of all prescription and nonprescriptionIherbal products you may use, especially of anti-platelet drugs :e.g., cilosta=ol, clopidogrel<, oral bisphosphonates :e.g., alendronate<, Lblood thinnersL :e.g., enoxaparin, heparin, warfarin<, corticosteroids :e.g., prednisone<, cyclosporine, desmopressin, digoxin, high blood pressure drugs :including !$ inhibitors such as captopril, angiotensin receptor bloc#ers such as losartan, and beta-bloc#ers such as metoprolol<, lithium, methotrexate, pemetrexed, probenecid, **G( antidepressants :e.g., fluoxetine, sertraline<, Lwater pillsL :diuretics such as furosemide, hydrochlorothia=ide, triamterene<.$hec# all prescription and nonprescription medicine labels carefully for other painIfever drugs :N*!(%s such as aspirin, celecoxib, ibuprofen<. These drugs are similar to this medication, so ta#ing one of these drugs while also ta#ing this medication may increase your ris# of side effects. 'owever, if your doctor has prescribed low doses of aspirin to prevent heart attac# or stro#e :usually at dosages of ?2-138 milligrams a day<, you should continue to ta#e the aspirin. %aily use of N*!(%s :e.g., ibuprofen< may decrease aspirin7s ability to prevent heart attac#Istro#e. $onsult your doctor or pharmacist for more details and to discuss other possible treatments :e.g., acetaminophen< for your painIfever.This medication can affect the results of certain lab tests. +a#e sure laboratory p ersonnel and your doctors #now you use this drug.This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Ceep a list of all your medications with you, and share the list with your doctor and pharmacist. *V.!D*'.: (f overdose is suspected, contact your local p oison control center or emergency room immediately. /* residents can call the /* national poison hotline at 2-?44-333-2333. $anadian residents should call their local poison control center directly. *ymptoms of overdose may include severe stomach pain, vomit that loo#s li#e coffee grounds, extreme drowsiness, slow or shallow breathing, sei=ures. N*T.': %o not share this medication with others.Eaboratory andIor medical tests :e.g., complete blood count, liver and #idney function tests< may be performed periodically to monitor your progress or chec# for side effects. $onsult your doctor for more details.Non-drug treatment for arthritis that is approved by your doctor :e.g., weight loss if needed, strengthening and conditioning exercises< may help improve your flexibility, range of motion, and joint function. $onsult your doctor for specific instructions. MI''.D D*'.: (f you are prescribed this drug on a regular schedule :not just Las neededL< and you miss a dose, ta#e it as soon as you remember. (f it is near the time of the next dose, s#ip the missed dose and resume your usual dosing schedule. %o not double the dose to catch up. 'T*!/.: *tore at room temperature between 8H-?9 degrees & :28-14 degrees $< away from light and moisture. %o not store in the bathroom. Ceep all medicines away from children an d pets.%o not flush medications down the toilet or pour them into a drain unless instructed to do so. roperly discard this product when it is expired or no longer needed. $onsult your pharmacist or local waste disposal company for more details about how to safely discard your product.
.N.!I+ N/M.: i5uprofen (!/ND N/M.: /d#i"1 +hi"dren6s /d#i"7Motrin1 Medipren1 Motrin1 Nuprin1 Pedia+are $e#er etc3 D!% +&/'' /ND M.+H/NI'M: (buprofen belongs to a class of drugs called non-steroidal antiinflammatory drugs :N*!(%s<. Other members of this class include aspirin, naproxen :!leve<, indomethacin :(ndocin<, nabumetone :Gelafen< and several others. These drugs are used for the management of mild to moderate pain, fever , and inflammation. ain, fever, and inflammation are promoted by the release in the body of chemicals called prostaglandins. (buprofen bloc#s the en=yme that ma#es prostaglandins :cyclooxygenase<, resulting in lower levels of prostaglandins. !s a conseuence, inflammation, pain and fever are reduced. The &%! approved ibuprofen in 2H@5. P!.'+!IPTI*N: Des .N.!I+ /V/I&/(&.: Des P!.P/!/TI*N': Tablets of 344, 544, 944, and ?44 mg; $hewable tablets of 84 and 244 mg; $apsules of 344 mg; *uspension of 244 mgI3.8 ml and 244 mgI8 ml; Oral drops of 54 mgIml. 'T*!/.: (buprofen should be stored at room temperature, between 28-14M$ :8H-?9M&<. P!.'+!I(.D $*!: (buprofen is used for the treatment of mild to moderate p ain, inflammation and fever caused by many and diverse diseases. D*'IN: &or minor aches, mild to moderate pain, menstrual cramps, and fever, the usual adult dose is 344 or 544 mg every 5 to 9 hours.
!rthritis is treated with 144 to ?44 mg 1 or 5 times daily. When under the care of a physician, the maximum dose of ibuprofen is 1.3 g daily. Otherwise, the maximum dose is 2.3 g daily. (ndividuals should not use ibuprofen for more than 24 days for the treatment of pain or more than 1 days for the treatment of a fever unless directed by a physician. $hildren 9 months to 23 years of age usually are given 8-24 mgI#g of ibuprofen every 9-? hours for the treatment of fever and pain. The maximum dose is 54 mgI#g daily. uvenile arthritis is treated with 34 to 54 mgI#gIday in 1-5 divided doses. (buprofen should be ta#en with meals to prevent stomach upset. D!% INT.!/+TI*N': (buprofen is associated with several suspected or probable interactions that can affect the action of other drugs. (buprofen may increase the blood levels of lithium :s#alith< by reducing the excretion of lithium by the #idneys. (ncreased levels of lithium may lead to lithium toxicity. (buprofen may reduce the blood pressure-lowering effects of drugs that are given to reduce blood pressure. This may occur because prostaglandins play a role in the regulation of blood pressure. When ibuprofen is used in combination with aminoglycosides Jfor example, gentamicin :Faramycin
N%!'IN M*TH.!': (buprofen is not excreted in breast mil#. /se of ibuprofen while breastfeeding, poses little ris# to the infant. 'ID. .$$.+T': The most common side effects from ibuprofen are rash, ringing in the ears, headaches, di==iness, drowsiness, abdominal pain, nausea, diarrhea, constipation and heartburn. N*!(%s reduce the ability of blood to clot and therefore increase bleeding after an injury. (buprofen may cause ulceration of the stomach or intestine, and the ulcers may bleed. *ometimes, ulceration can occur without abdominal pain, and blac#, tarry stools, wea#ness, and di==iness upon standing :orthostatic hypotension< due to bleeding may be the only signs of an ulcer. N*!(%s reduce the flow of blood to the #idneys and impair function of the #idneys. The impairment is most li#ely to occur in patients who already have impaired function of the #idney or congestive heart failure, and use of N*!(%s in these patients should be cautious. eople who are allergic to other N*!(%s, including aspirin, should not use ibuprofen. (ndividuals with asthma are more li#ely to experience allergic reactions to ibuprofen and other N*!(%s. &luid retention :edema<, blood clots, heart attac#s, hypertension and heart failure have also been associated with the use of N*!(%s. W/!NIN: This drug may infreuently cause serious :rarely fatal< bleeding from the stomach or intestines. !lso, related drugs rarely have caused blood clots to form, resulting in heart attac#s and stro#es. This medication might also rarely cause similar problems. Tal# to your doctor or p harmacist about the benefits and ris#s of treatment, as well as other possible medication choices.
(f you notice any of the following rare but very serious side effects, stop ta#ing ibuprofen and see# immediate medical attention blac# stools, persistent stomachIabdominal pain, vomit that loo#s li#e coffee grounds, chest pain, wea#ness on one side of the body, sudden vision changes, slurred speech. %'.': (buprofen is a nonsteroidal anti-inflammatory drug :N*!(%<, which relieves pain and swelling :inflammation<. (t is used to treat headaches, muscle aches, bac #aches, dental pain, menstrual cramps, arthritis, or athletic injuries. This medication is also used to reduce fever and to relieve minor aches and pains due to the common cold or flu.This drug wor#s by bloc#ing the en=yme in your body that ma#es prostaglandins. %ecreasing prostaglandins helps to reduce pain, swelling, and fever. H*W T* %'.: Gead the +edication Fuide provided by your pharmacist before you start using ibuprofen and each time you get a refill. (f you have any uestions regarding the information, consult your doctor or pharmacist.Ta#e this medication by mouth with a full glass :? ounces or 354 milliliters< of water unless your doctor directs you otherwise. %o not lie down for at least 14 minutes after ta#ing this drug.(f stomach upset occurs while ta#ing this medication, ta#e it with food, mil#, or an antacid. The dosage is based on your medical condition and response to therapy. (f repeat doses are needed, they are usually given 9 or ? hours apart; or as directed by your doctor.When ibuprofen is used in children, the dose is based on your child7s weight. Gead the product instructions to find the appropriate dose for your child7s weight. $onsult the pharmacist or do ctor if you have uestions or if you need help in choosing the appropriate dosage form.(n certain conditions :e.g., arthritis<, it may ta#e up to two wee#s, ta#en regularly, before the full benefits of this drug ta#e effect.(f you are ta#ing this drug on an Las neededL basis :not on a regular schedule<, remember that pain medications wor# best if the y are used as the first signs of pain occur. (f you wait until the pain has significantly worsened, the medicine may not wor# as well.(f you use this medication for migraine headache, and the pain is not relieved or worsens after the first dose, tell your doctor immediately.&or nonprescription ibuprofen products (f you are treating yourself or giving this medication to a child for undiagnosed fever or pain, consult the doctor immediately if symptoms do not improve within 35 ho urs, worsen or last for more than 1 days, or if new symptoms appear.To reduce your ris# of stomach bleeding and other side effects, ta#e this medication at the lowest effective dose for the shortest possible time. %o not increase your dose, ta#e it
more freuently, or ta#e it for a longer time than prescribed. %o not ta#e the over-the-counter product for more than 24 days unless otherwise directed. 'ID. .$$.+T': /pset stomach, nausea, vomiting, heartburn, headache, diarrhea, constipation, drowsiness, and di==iness may occur. (f any of these effects persist or worsen, notify your doctor or pharmacist promptly.(f your doctor has directed you to use this medication, remember that he or she has judged that the benefit to you is greater than the ris# of side effects. +any peo ple using this medication do not have serious side effects.Tell your doctor immediately if any of these serious side effects occur stomach pain, swelling of the hands or feet, sudden or unexplained weight gain, ringing in the ears :tinnitus<.Tell your doctor immediately if any of these unli#ely but serious side effects occur vision changes, rapid or pounding heartbeat, easy bruising or bleeding, difficultIpainful swallowing.Tell your doctor immediately if any of these highly unli#ely but very serious side effects occur change in amount of urine, severe headache, very stiff nec#, mentalImood changes, persistent sore throat or fever.This drug may rarely cause serious :possibly fatal< liver disease. (f you notice any of the following highly unli#ely but very serious side effects, stop ta#ing ibuprofen and consult your doctor or pharmacist immediately yellowing eyes and s#in, dar# urine, unusualIextreme tiredness.!n allergic reaction to this drug is unli#ely, but see# immediate medical attention if it occurs. *ymptoms of an allergic reaction include rash, itchingIswelling :especially of the faceItongueIthroat<, severe di==iness, trouble breathing.This is not a complete list of possible side effects. (f you notice other effects not listed above, contact your doctor or pharmacist.(n the /* -$all your doctor for medical ad vice about side effects. Dou may report side effects to &%! at 2-?44-&%!-24??.(n $anada - $all your doctor for medical advice about side effects. Dou may report side effects to 'ealth $anada at 2-?99-315-3158. P!.+/%TI*N': "efore ta#ing ibuprofen, tell your doctor or p harmacist if you are allergic to it; or to aspirin or other N*!(%s :e.g., naproxen, celecoxib<; or if you have any other allergies.This medication should not be used if you have certain medical conditions. "efore using this medicine, consult your doctor or pharmacist if you have severe #idney disease, aspirin-sensitive asthma :a history of worsening breathing with runnyIstuffy nose after ta#ing aspirin or other N*!(%s<, recent heart bypass surgery :$!"F<."efore using this medication, tell your doctor or pharmacist your medical history, especially of #idney disease, liver disease, poorly controlled diabetes, stomachIintestineIesophagus problems :e.g., bleeding, ulcers, recurring heartburn<, heart disease :e.g., congestive heart failure, history of heart attac# <, high blood pressure, stro#e, swelling :edema, fluid retention<, dehydration, blood disorders :e.g., anemia<, bleeding or clotting problems, asthma, growths in the n ose :nasal polyps<, history of an allergic reaction with symptoms of lipItongueIthroat swelling :angioedema<, any allergies in addition to those listed above.This drug may ma#e you di==y or drowsy. %o not drive, use machinery, or do any activity that reuires alertness until you are sure you can perform such activities safely. Eimit alcoholic beverages.This medicine may cause stomach bleeding. %aily use of alcohol and tobacco, especially when combined with this medicine, may increase your ris# for stomach bleeding. Eimit alcohol and stop smo#ing. $onsult your doctor or pharmacist for more information.This medication may ma#e you more sensitive to the sun. !void prolonged sun exposure, tanning booths or sunlamps. /se a sunscreen and wear protective clothing when outdoors.$aution is advised when u sing this drug in the elderly because they may be more sensitive to the side effects of the drug, especially stomach bleeding and #idney effects.This medication should be used only when clearly needed during the first 9 months of pregnancy. (t is not recommended for use during the last 1 months of pregnancy due to the potential for harm to an unborn baby and interference with normal laborIdelivery. %iscuss the ris#s and benefits with your doctor.This medication passes into breast mil#. While there have been no reports of harm to nursing infants, consult your doctor before breast-feeding.
D!% INT.!/+TI*N': Dour healthcare professionals :e.g., doctor or pharmacist< may already be aware of any possible drug interactions and may be monitoring you for it. %o not start, stop or change the dosage of any medicine before chec#ing with them first.This drug should not be used with the following medications because very serious interactions may occur cidofovir, #etorolac.(f you are currently using any of these medications listed above, tell your doctor or pharmacist before starting ibuprofen."efore using this medication, tell your doctor or ph armacist of all prescription and nonprescriptionIherbal products you may use, especially of anti-platelet drugs :e.g., cilosta=ol, clopidogrel<, oral bisphosphonates :e.g., alendronate<, other medications for arthritis :e.g., aspirin, methotrexate<, Lblood thinnersL :e.g., enoxaparin, heparin, warfarin<, corticosteroids :e.g., prednisone<, cyclosporine, desmopressin, high blood pressure drugs :including !$ inhibitors such as captopril, angiotensin (( receptor antagonists such as losartan, and beta-bloc#ers such as metoprolol<, lithium, pemetrexed, Lwater pillsL :diuretics such as furosemide, hydrochlorothia=ide, triamterene<.$hec# all prescription and nonprescription medicine labels carefully for other painIfever drugs :N*!(%s such as aspirin, celecoxib, naproxen<. These drugs are similar to ibuprofen, so ta# ing one of these drugs while also ta#ing ibuprofen may increase your ris# of side effects. $onsult your doctor or pharmacist for more details.'owever, if your doctor has prescribed low doses of aspirin to prevent heart attac# or stro#e :usually at dosages of ?2-138 milligrams a day<, you should continue to ta#e the aspirin. %aily use of ibuprofen may decrease aspirin7s ability to prevent heart attac#Istro#e. Tal# to your doctor about using a different medication :e.g., acetaminophen< to treat painIfever. (f you must ta#e ibuprofen, tal# to your doctor about possibly ta#ing immediate-release aspirin :not enteric-coated< while also ta#ing the ibuprofen dose apart from your aspirin dose. %o not increase your daily dose of aspirin or change the way you ta#e aspirinIother medications without your doctor7s approval.This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or p harmacist of all the products you use. Ceep a list of all your medications with you, and share the list with your doctor and pharmacist. *V.!D*'.: (f overdose is suspected, contact your local p oison control center or emergency room immediately. /* residents can call the /* national poison hotline at 2-?44-333-2333. $anadian residents should call their local poison control center directly. *ymptoms of overdose may include severe stomach pain, coffee ground-li#e vomit, unusually fast or slow heartbeat, trouble breathing, extreme drowsiness, loss of consciousness, or sei=ures. N*T.': %o not share this medication with others.Eaboratory andIor medical tests may be performed periodically to monitor your progress or chec# for side effects. $onsult your doctor for more details. MI''.D D*'.: (f you are prescribed this drug on a regular schedule :not just Las neededL< and you miss a dose, use it as soon as you remember. (f it is near the time of the next dose, s#ip the missed dose and resume your usual dosing schedule. %o not double the dose to catch up. 'T*!/.: *tore at room temperature between 8H and ?9 degrees & :28-14 degrees $< away from light and moisture. %o not store in the bathroom. Ceep all medicines away from children and pets.%o not flush medications down the toilet or pour the m into a drain unless instructed to do so. roperly discard this product when it is expired or no longer needed. $onsult your pharmacist or local waste disposal company for more details about how to safely discard your product.
.N.!I+ N/M.: ga5apentin (!/ND N/M.: Neurontin1 a5arone D!% +&/'' /ND M.+H/NI'M: Fabapentin is an anticonvulsant that is used for preventing sei=ures and for treating postherpetic neuralgia. The mechanism of action of gabapentin is not #nown. Fabapentin structurally resembles the neurotransmitter gamma aminobutyric acid :F!"!<. (t is possible that this similarity is related to gabapentin7s mechanism of action. (n animal models used for testing the anticonvulsant and analgesic activity of d rugs, gabapentin prevents sei=ures and reduces pain-related responses. The &%! approved gabapentin in %ecember 2HH1. P!.'+!IPTI*N: Des .N.!I+ /V/I&/(&.: Des P!.P/!/TI*N': • • •
$apsules 244, 144, and 544 mg. Tablets 244, 144, 544, 944, and ?44 mg. *olution 384 mgI8 ml
'T*!/.: Tablets and capsules should be stored between 28-14 $ :8H-?9 &<. Fabapentin solution should be refrigerated between 3-? $ :19-59 &<. P!.'+!I(.D $*!: Fabapentin is approved for treating sei=ure disorders and nerve damage from herpes =oster :shingles, postherpetic neuralgia<. There are many non-approved uses for gabapentin. These include alcohol withdrawal, cocaine withdrawal, hiccups, restless leg syndrome, hyperhidrosis, headaches, diabetic neuropathy, hot flashes, and fibromyalgia. D*'IN: Fabapentin may be ta#en with or without food. The recommended dose for postherpetic neuralgia is 2?44 mg daily in 1 divided doses. The initial dose of 144 mg daily is increased over several days to the recommended daily dose. *ei=ures are treated with H44-2?44 mgIdaily in 1 divided doses. Withdrawal of treatment should occur slowly over a wee#. D!% INT.!/+TI*N': !ntacids reduce the concentration of gabapentin in blood. Therefore, gabapentin should be administered 3 hours or more after ta#ing antacids. +orphine significantly increases blood concentrations of gabapentin and may increase central nervous system-related adverse events associated with gabapentin. P!.N/N+,: *afety in pregnancy has not been established. N%!'IN M*TH.!': Fabapentin is secreted in human breast mil# . Nursing mothers should only use gabapentin if the benefits outweigh the un#nown ris# to the fetus. 'ID. .$$.+T': $ommon side effects of gabapentin are di==iness, somnolence, ataxia, fatigue, fluid retention, hostility, nausea and vomiting. Other adverse events associated with gabapentin include hypertension, anorexia, bruising, joint pain, motion sic#ness, and pneumonia.
!ntiepileptic medications have been associated with increased ris# of suicidal thin#ing and behavior. !nyone considering the use of antiepileptic drugs must balance this ris# of suicide with the clinical need. atients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior. %'.': Fabapentin is used with other medications to help control sei=ures in adults and children :1 years of age and older<. (t is also used to relieve nerve pain associated with shingles :herpes =oster<
infection in adults.OT'G This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. /se this drug for a condition that is listed in this section on ly if it has been so prescribed by your health care professional.Fabapentin may also be used to treat other nerve pain conditions :e.g., diabetic neuropathy, peripheral neuropathy, trigeminal neuralgia<. H*W T* %'.: Ta#e this medication by mouth, with or without food, as directed by your doctor. The dosage is based on your medical condition and response to therapy. %uring the first few days, your doctor may gradually increase your dose so your body can adjust to the medication. To minimi=e side effects, ta#e the very first dose at bedtime./se this medication regularly in order to get the most benefit from it. This drug wor#s best when the amount of medicine in your body is #ept at a constant level. Therefore it is best to ta#e gabapentin at evenly spaced intervals throughout the day and night.%o not ta#e this medication more often or increase your dose without consulting your doctor. Dour condition will not improve any faster and the ris# of serious side effects may be increased.%o not stop ta#ing this medication without consulting your doctor. *ome conditions such as sei=ures may become wo rse when the drug is abruptly stopped. Dour dose may need to be gradually decreased.!ntacids containing aluminum or magnesium may interfere with the absorption of this medication. Therefore it is best to ta#e gabapentin at least 3 hours after ta#ing an antacid.(nform your doctor if you r condition does not improve or worsens. 'ID. .$$.+T': %rowsiness, di==iness, unsteadiness, fatigue, vision changes, weight gain, nausea, dry mouth, or constipation may occur. (f any of these effects persist or worsen, notify your doctor or pharmacist promptly.Gemember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the ris# of side effects. +any people using this medication do not have serious side effects.Tell your doctor immediately if any of these serious side effects occur tremor or sha#ing, swollen armsIlegs.Tell your doctor immediately if any of these unli#ely but serious side effects occur loss of coordination.! small number of people who ta#e anticonvulsants for any condition :such as sei=ure, bipolar disorder , pain< may experience depression, suicidal thoughtsIattempts, or other mentalImood problems. Tell your doctor immediately if you or your familyIcaregiver notice any unusualIsudden changes in your mood, thoughts, or behavior including signs of depression, suicidal thoughtsIattempts, thoughts about harming yourself.Tell your doctor immediately if any of these highly unli#ely but very serious side effects occur persistent sore throatIfeverIcough, unusual bleedingIbruising, painIredness of arms or legs, trouble breathing, fastIslowIirregular heartbeat, hearing loss, stomachIabdominal pain.! very serious allergic reaction to this drug is unli#ely, but see# immediate medical attention if it occurs. *ymptoms of a serious allergic reaction may include rash, itchingIswelling :especially of the faceItongueIthroat<, severe di==iness, trouble breathing.This is not a complete list of possible side effects. (f you notice other effects not listed above, contact your doctor or pharmacist.(n the /* -$all your doctor for medical ad vice about side effects. Dou may report side effects to &%! at 2-?44-&%!-24??.(n $anada - $all your doctor for medical advice about side effects. Dou may report side effects to 'ealth $anada at 2-?99-315-3158. P!.+/%TI*N': "efore ta#ing gabapentin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies."efore using this medication, tell your doctor or pharmacist your medical history, especially of #idney disease.This drug may ma#e you di==y or drowsy. %o not drive, use machinery, or do any activity that reuires alertness until you are sure you can perform such activities safely. Eimit alcoholic beverages.$aution is advised when using this drug in the elderly because they may be more sensitive to its effects, especially swollen armsIlegs or loss of coordination.$aution is advised when using this drug in children because they may be more sensitive to its effects, especially the mentalImood changes :e.g., hostility<.This medication should be used onl y when clearly needed during pregnancy. %iscuss the ris#s and benefits with your doctor.Fabapentin
passes into breast mil#. "ecause the effects of this drug on the nursing infant are un#nown, consult your doctor before breast-feeding. D!% INT.!/+TI*N': Dour doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. %o not start, stop, or change the dosage of any medicine before chec#ing with them first.*ee also 'ow to /se section."efore using this medication, tell your doctor or pharmacist of all prescription and no nprescriptionIherbal products you may use, especially of antacids containing aluminum or magnesium, morphine.This product can affect the results of certain lab tests for urine protein. +a#e sure laboratory personnel and your doctors #now you use this drug.This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Ceep a list of all your medications with you, and share the list with your doctor and pharmacist. *V.!D*'.: (f overdose is suspected, contact your local p oison control center or emergency room immediately. /* residents can call the /* national poison hotline at 2-?44-333-2333. $anadian residents should call their local poison control center directly. *ymptoms of overdose may include severe drowsiness, slurred speech, or extreme lethargy. N*T.': %o not share this medication with others. MI''.D D*'.: (f you miss a dose, use it as soon as you remember. (f it is near the time of the next dose, s#ip the missed dose and resume your usual dosing schedule. %o not double the dose to catch up. 'T*!/.: *tore at room temperature :@@ degrees & or 38 degrees $< away from light and moisture. "rief storage between 8H-?9 degrees & :28-14 degrees $< is permitted. %o not store in the bathroom. Ceep all medicines away from children and pets.%o not flush medications down the toilet or pour them into a drain unless instructed to do so. roperly discard this product when it is expired or n o longer needed. $onsult your pharmacist or local waste disposal company for more details about how to safely discard your product.+%($!E !EGT Dour condition can cause complications in a medical emergency. &or enrollment information call +edic!lert at 2-?44-?85-2299 :/*!<, or 2-?44-99?-284 @ :$anada<.
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