Fibro Fighters

Medications:

​

Gabapentine: 

Gabapentin (GPN) marketed under the brand name Neurontin among others, is a medication used to treat epilepsy, neuropathic pain, hot flashes, and restless leg syndrome.[4][5] In epilepsy it may be used for those withpartial seizures.[4] It is recommended as one of a number of first line medications for the treatment of neuropathic pain in diabetic neuropathy, post-herpetic neuralgia, and central neuropathic pain.[6] A 2014 review of its use for diabetic neuropathy and postherpetic neuralgia found about 14% of people have a meaningful benefit.[7]

Common side effects include sleepiness and dizziness. Serious side effects may include an increased risk of suicide, aggressive behaviour, and drug reaction with eosinophilia and systemic symptoms.[4] It is unclear if it is safe during pregnancy or breastfeeding.[8] Lower doses should be used in people with kidney problems. Gabapentin affects the inhibitory neurotransmitter γ-aminobutyric acid (GABA) but how it works is otherwise unclear.[4]

Gabapentin was first approved for use in 1993.[9] The wholesale price in the developing world is about US$40.50 per month.[10] In the United States it has been available as a generic medication since 2004.[4] As of 2015 the cost for a typical month of medication in the United States is US$100 to US$200.[11] During the 1990s Parke-Davis, a sub-company of Pfizer, used a number of techniques to encourage physicians in the United States to use gabapentin for unapproved uses

​

Pregabalin/Lyrica:

marketed under the brand name Lyrica among others, is a medication used to treat epilepsy, neuropathic pain, fibromyalgia, and generalized anxiety disorder.[8][9][10] Its use for epilepsy is as an add-on therapy for partial seizures with or without secondary generalization in adults.[11] Some off-label uses of pregabalin include restless leg syndrome,[12] prevention of migraines,[13] social anxiety disorder,[13] and alcohol withdrawal.[14] When used before surgery it does not appear to affect pain after surgery but may decrease the use of opioids.[15]

Common side effects include: sleepiness, confusion, trouble with memory, poor coordination, dry mouth, problem with vision, and weight gain.[9] Potentially serious side effects include angioedema, drug misuse, and an increased suicide risk.[9] When pregabalin is taken at high doses over a long period of time, addiction may occur, but if taken at usual doses the risk of addiction is low.[1] It is classified as a GABA analogue andgabapentinoid.[16]

Pregabalin is a GABAergic anticonvulsant and depressant of the central nervous system (CNS). It is a close analogue of the inhibitory neurotransmitter γ-aminobutyric acid (GABA).[17][18][19][20] Pregabalin binds with highaffinity to the α2δ subunit-containing voltage-gated calcium channels (VDCC). It increases extracellular GABA concentrations in the brain by producing a dose-dependent increase in L-Glutamic acid decarboxylase (GAD), the enzyme responsible for making GABA.[21][21][22][23]

Parke-Davis developed pregabalin as a successor to gabapentin and was brought to market by Pfizer after the company acquired Warner-Lambert.[20][24] There is to be no generic version available in the United States until 2018.[25] A generic version is available in Canada and the United Kingdom.[26][27] In the US it costs about 300-400 USD per month.[9] Pregabalin is a Schedule V controlled substance under the Controlled Substances Act of 1970 (CSA).

​

Morphine:

 is a pain medication of the opiate type which is found naturally in a number of plants and animals.[5][7] It acts directly on the central nervous system (CNS) to decrease the feeling of pain. It can be taken for bothacute pain and chronic pain. Morphine is frequently used for pain from myocardial infarction and during labour. It can be given by mouth, by injection into a muscle, by injecting under the skin, intravenously, into the space around the spinal cord, or rectally.[5] Maximum effect is around 20 min when given intravenously and 60 min when given by mouth while duration of effect is between three and seven hours.[5][6] Long-acting formulations also exist.[5]

Potentially serious side effects include a decreased respiratory effort and low blood pressure. Morphine has a high potential for addiction and abuse. If the dose is reduced after long-term use, withdrawal may occur. Common side effects include drowsiness, vomiting, and constipation. Caution is advised when used during pregnancy or breast feeding, as morphine will affect the baby.[5]

Morphine was first isolated between 1803 and 1805 by Friedrich Sertürner.[8] This is generally believed to be the first isolation of an active ingredient from a plant.[9] Merck began marketing it commercially in 1827.[8]Morphine was more widely used after the invention of the hypodermic syringe in 1853–1855.[8][10] Sertürner originally named the substance morphium after the Greek god of dreams, Morpheus, for its tendency to cause sleep.[10][11]

The primary source of morphine is isolation from poppy straw of the opium poppy.[12] In 2013, an estimated 523,000 kilograms of morphine were produced.[13] About 45,000 kilograms were used directly for pain, an increase over the last twenty years of four times.[13] Most use for this purpose was in the developed world.[13] About 70% of morphine is used to make other opioids such as hydromorphone, oxycodone andheroin.[13][14][15] It is a Schedule II drug in the United States,[14] Class A in the United Kingdom,[16] and Schedule I in Canada.[17] It is on the WHO Model List of Essential Medicines, the most important medications needed in a basic health system.[18] Morphine is sold under many trade names.

​

Butrans Patches:

A transdermal patch is a medicated adhesive patch that is placed on the skin to deliver a specific dose of medication through the skin and into the bloodstream. Often, this promotes healing to an injured area of the body. An advantage of a transdermal drug delivery route over other types of medication delivery such as oral, topical, intravenous, intramuscular, etc. is that the patch provides a controlled release of the medication into the patient, usually through either a porous membrane covering a reservoir of medication or through body heat melting thin layers of medication embedded in the adhesive. The main disadvantage to transdermal delivery systems stems from the fact that the skin is a very effective barrier; as a result, only medications whose molecules are small enough to penetrate the skin can be delivered by this method. A wide variety of pharmaceuticals are now available in transdermal patch form.

The first commercially available prescription patch was approved by the U.S. Food and Drug Administration in December 1979. These patches administered scopolamine for motion sickness.

Two opioid medications used to provide round-the-clock relief for severe pain are often prescribed in patch form, fentanyl CII (marketed as Duragesic) and buprenorphine CIII (marketed as BuTrans).​

​

Diazepam:

Diazepam, first marketed as Valium, is a medication of the benzodiazepine family that typically produces a calming effect. It is commonly used to treat a range of conditions including anxiety, alcohol withdrawal syndrome,benzodiazepine withdrawal syndrome, muscle spasms, seizures, trouble sleeping, and restless legs syndrome.[3] It may also be used to cause memory loss during certain medical procedures.[4][5] It can be taken by mouth, inserted into the rectum, injected into muscle, or injected into a vein.[5] When given into a vein, effects begin in one to five minutes and last up to an hour.[5] By mouth, effects may take 40 minutes to begin.[6]

Common side effects include sleepiness and trouble with coordination.[5] Serious side effects are rare.[3] They include suicide, decreased breathing, and an increased risk of seizures if used too frequently in those withepilepsy.[3][5] Occasionally excitement or agitation may occur.[7][8] Long term use can result in tolerance, dependence, and withdrawal symptoms on dose reduction. Abrupt stopping after long term use can be potentially dangerous.[3] After stopping, cognitive problems may persist for six months or longer.[7] It is not recommended during pregnancy or breastfeeding.[5] Its mechanism of action is by increasing the effect of the neurotransmitter gamma-Aminobutyric acid (GABA).[7]

Diazepam was first synthesized by Leo Sternbach, and was first manufactured by Hoffmann-La Roche. It has been one of the most frequently prescribed medications in the world since its launch in 1963. In the United States it was the highest selling medication between 1968 and 1982, selling more than two billion tablets in 1978 alone. In 1985 the patent ended, and there are now more than 500 brands available on the market.[3]Diazepam is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.[9] The wholesale cost in the developing world is about 0.01 USD per dose as of 2014.[10] In the United States it is about 0.40 USD per dose.[5]

​

Co-codamol:

Codeine/acetaminophen or co-codamol (BAN) is a compound analgesic consisting of a combination of codeine phosphate and paracetamol (acetaminophen). Co-codamol tablets are used for the relief of mild to moderate pain when paracetamol or NSAIDs such as ibuprofen, aspirin or naproxen alone do not sufficiently relieve a patient's symptoms, or where their use is ill-advised

Seven strengths are available:

• 8 mg of codeine phosphate per tablet (e.g. Tylenol 1 in US/Canada)

• 10 mg of codeine phosphate per tablet

• 12.8 mg of codeine phosphate per tablet

• 15 mg of codeine phosphate per tablet (e.g. brands Tylenol 2 in US/Canada, Norway, Australia (multiple brands), United Kingdom)

• 20 mg of codeine phosphate per tablet (Prontalgine in France, Empacod, South Africa and Zimbabwe)

• 30 mg of codeine phosphate per tablet (e.g. Tylenol 3 in US/Canada, ratio-Emtec-30 or "Emtec" in Canada, available elsewhere in capsules such as Tylex or in tablets/caplets e.g. Solpadol, Kapake, Panacod and Zapain).

• 60 mg of codeine phosphate per tablet (e.g. Tylenol 4 in US/Canada, and generally contain from 300 mg to 1000 mg (1 gram) of paracetamol per tablet.[1]

Combination products containing codeine are available over the counter only in United Kingdom, France, Canada, Australia, New Zealand, Poland, Israel, Estonia and Costa Rica and Spain[2]

In the United Kingdom and Ireland the 15/500 and 30/500 tablets are available only with a prescription, although the 8/500 and 12.8/500 strengths are available over-the-counter. In Australia the 30/500 tablets are available only with a prescription, and the 10/500 and 15/500 tablets are Schedule 3 (Pharmacist Only Medicine). Manufacturer directions state not to exceed more than the recommended dosage of two tablets every four hours with a maximum of eight (8 × 500 mg) over a 24-hour period and no more than two (2 × 500 mg) at any one time. Other drugs containing paracetamol must be avoided unless otherwise directed by a physician or pharmacist, excessive amounts of paracetamol can lead to serious liver damage, see Paracetamol toxicity.

Co-codamol is marketed in Canada and the United States also under the generic name "Atasol Codeine". In the UK it is marketed as "Solpadeine Plus" and "Solpadeine Max", as well as "Solpadol". In Australia it is marketed as "Panadeine", "Panadeine Extra" and "Panadeine Forte". Co-codamol is sold as "Paralgin Minor" (15/200) (not available as of 2015), "Paralgin Forte" (30/400), "Paralgin Major" (60/800), "Pinex Forte" (30/500) and "Pinex Major" (60/1000) in Norway.

​

Topiramate:

Topiramate (brand name Topamax) is an anticonvulsant (antiepilepsy) drug. In late 2012, topiramate was approved by the United States Food and Drug Administration (FDA) in combination with phentermine for weight loss. The drug had previously been used off-label for this purpose. Topiramate was originally produced by Ortho-McNeil Neurologics and Noramco, Inc., both divisions of the Johnson & Johnson Corporation. This medication was discovered in 1979 by Bruce E. Maryanoff and Joseph F. Gardocki during their research work at McNeil Pharmaceutical.[1][2][3]

Topiramate came into commercial use in 1996.[4] Generic versions are available in Canada and these were approved by the FDA in September 2006. Mylan Pharmaceuticals was recently granted final approval for generic topiramate by the FDA for sale in the United States.[5] The last patent for topiramate in the U.S. was for use in children and expired on February 28, 2009.

Recent clinical reports indicate that it may have mood stabilizing properties.[22] Other off-label and investigational uses of topiramate include the treatment of essential tremor, bulimia nervosa,[23] obsessive-compulsive disorder, idiopathic intracranial hypertension[24] and cluster headache.[25] Topiramate has not been shown to work as a pain medicine in diabetic neuropathy, the only neuropathic condition in which it has been adequately tested.[26] Dispensing errors have been reported between Topamax (topiramate) tablets and Toprol-XL (metoprolol succinate) extended-release tablets thereby requiring extra care to ensure the correct medication is being taken.

​

Etoricoxib:

Etoricoxib (Arcoxia) is a selective COX-2 inhibitor from Merck & Co. Currently it is approved in more than 80 countries worldwide but not in the US, where the Food and Drug Administration (FDA) has required additional safety and efficacy data for etoricoxib before it will issue approval.

Etoricoxib is indicated for the treatment of rheumatoid arthritis, psoriatic arthritis, osteoarthritis, ankylosing spondylitis, chronic low back pain, acute pain, and gout. Approved indications differ by country.

A Cochrane systematic review assessed the benefits of single-dose etoricoxib in reduction of acute post-operative pain in adults.[1] Single-dose oral etoricoxib provides good quality pain relief post-operatively in adults and adverse events are similar to placebo in the studies included.[1] Etoricoxib given at a dose of 120 mg is as effective or even better than other analgesics that are commonly used.

​

Percocet:

The combination oxycodone/paracetamol (North American trade name Percocet, generic Endocet and Ratio-Oxycocet in Canada) is a combined opioid/non-opioid pain reliever used to treat moderate to severe acute(short-term) pain, marketed by Endo International plc, formerly Endo Pharmaceuticals  

As of August 2014, Endo Pharmaceuticals produces Percocet in the following dosages.[3] Percocet tablets are available in four combinations of oxycodone hydrochloride with 325 mg of paracetamol / acetaminophen, each having different appearances and usual maximum daily doses:[3][4]

Due to the liver toxicity of paracetamol the manufacturer and FDA dosage guidelines suggest no more than 4000mg total of paracetamol be taken per day, which would be 12 or fewer Percocet tablets per day as each one contains 325mg.

Oxycodone Hydrochloride (mg)Paracetamol (Acetaminophen) (mg)Tablet ColorTablet Shape

2.5  325  pink  oval

5  325 blue  round

7.5   325  peach   oval

10.0   325   yellow  oblong

​

Amtriptyline:

​

Sold under the brand name Elavil among others, is a medicine used to treat a number of mental illnesses.[2] This includes major depressive disorder and anxiety disorder, and less commonly attention deficit hyperactivity disorder and bipolar disorder.[2][3] Other uses include prevention of migraines, treatment of neuropathic pain such as fibromyalgia and postherpetic neuralgia, and less commonly insomnia.[2][4] It is taken by mouth.[2]

Common side effects include a dry mouth, trouble seeing, low blood pressure on standing, sleepiness, and constipation. Serious side effects may include seizures, an increased risk of suicide in those less than 25 years of age, urinary retention, glaucoma, and a number of heart issues. It should not be taken with MAO inhibitors or the medication cisapride.[2] Amitriptyline may cause problems if taken during pregnancy.[2][5] Use duringbreastfeeding appears to be relatively safe.[6] Amitriptyline is in the tricyclic antidepressant (TCA) class of medications. Its exact mechanism of action is unclear.[2]

Amitriptyline was discovered in 1960[7] and approved by the US Food and Drug Administration (FDA) in 1961.[8] It is on the WHO Model List of Essential Medicines, the most important medications needed in a basic health system.[9] It is available as a generic medication.[2] The wholesale cost in the developing world as of 2014 is between 0.01 and 0.04 USD per dose.[10] In the United States it costs about 0.20 USD per dose

Amitriptyline is used for a number of medical conditions including major depressive disorder (MDD).[11][12][13] Some evidence suggests amitriptyline may be more effective than other antidepressants,[14] including selective serotonin reuptake inhibitors (SSRIs),[15] although it is rarely used as a first-line antidepressant due to its higher toxicity in overdose and generally poorer tolerability.[12]

It is TGA-labeled for migraine prevention, also in cases of neuropathic pain disorders,[12] fibromyalgia[4] and nocturnal enuresis.[12][16] Amitriptyline is a popular off-label treatment for irritable bowel syndrome (IBS),[17]although it is most frequently reserved for severe cases of abdominal pain in patients with IBS because it needs to be taken regularly to work and has a generally poor tolerability profile, although a firm evidence base supports its efficacy in this indication.[17] Amitriptyline can also be used as an anticholinergic drug in the treatment of early-stage Parkinson's disease if depression also needs to be treated.[18] Amitriptyline is the most widely researched agent for prevention of frequent tension headaches

​

Methocarbamol:

​

Methocarbamol is a central muscle relaxant used to treat skeletal muscle spasms. Under the trade name Robaxin, it is marketed by Actient Pharmaceuticals in the United States and Pfizer in Canada. The mechanism of action of methocarbamol is currently unknown, but may involve the inhibition of carbonic anhydrase.[2] The muscle relaxant effects of methocarbamol are largely attributed to central depressant effects;[3] however, peripheral effects of methocarbamol to prolong muscle refractory period have also been reported.[4] As with guaifenesin, inhibition of the NMDA receptor may be involved in the effects of methocarbamol. As of 2015 the cost for a typical month of medication in the United States is less than 25 USD

​

Duloxetine / Cymbalta:

​

Duloxetine, sold under the brand name Cymbalta among others,[1] is a serotonin–norepinephrine reuptake inhibitor (SNRI). It is mostly prescribed for major depressive disorder, generalized anxiety disorder, fibromyalgiaand neuropathic pain.[2]

Duloxetine failed to receive US approval for stress urinary incontinence amid concerns over liver toxicity and suicidal events; however, it was approved for this indication in the UK, where it is recommended as an add-on medication in stress urinary incontinence instead of surgery.[3] It was originally made by Eli Lilly.

The main uses of duloxetine are in major depressive disorder, generalized anxiety disorder, urinary incontinence, neuropathic pain, chronic musculoskeletal pain, and fibromyalgia.[2][4][5][6]

Duloxetine is recommended as a first line agent for the treatment of chemotherapy-induced neuropathy by the American Society of Clinical Oncology,[7] as a first-line therapy for fibromyalgia in the presence of mood disorders by the German Interdisciplinary Association for Pain Therapy,[8] as a Grade B recommendation for the treatment of diabetic neuropathy by the American Association for Neurology[9] and as a level A recommendation in certain neuropathic states by the European Federation of Neurological Societies.[10]

A 2014 Cochrane review concluded that duloxetine is beneficial in the treatment of diabetic neuropathy and fibromyalgia but that more comparative studies with other medicines are needed.[11] The French medical journalPrescrire concluded that duloxetine is no better than other available agents and has a greater risk of side effects.[12] Thus they recommend against its general use.

​

Savella/ Milnacipran:

​

Milnacipran (trade names Ixel, Savella, Dalcipran, Toledomin) is a serotonin–norepinephrine reuptake inhibitor (SNRI) used in the clinical treatment of fibromyalgia. It is not approved for the clinical treatment of major depressive disorder in the USA, but it is in other countries

Fibromyalgia

During its development for fibromyalgia, milnacipran was evaluated utilizing a composite responder approach. To be considered as a responder for the composite ‘treatment of fibromyalgia’ endpoint, each patient had to show concurrent and clinically meaningful improvements in pain, physical function and global impression of disease status. A systematic review in 2012 showed moderate relief for a minority of people with fibromyalgia. Milnacipran was associated with increased adverse events and discontinuing use of the drug

​

Venlafaxine:

​

Venlafaxine — brand names: Effexor, Effexor XR, Lanvexin, Viepax and Trevilor — is an antidepressant of the serotonin-norepinephrine reuptake inhibitor (SNRI) class.[3][4][5] This means it increases the concentrations of the neurotransmitters serotonin and norepinephrine in the body and the brain. First introduced by Wyeth in 1993, now marketed by Pfizer, it is licensed for the treatment of major depressive disorder(MDD), generalised anxiety disorder (GAD), panic disorder and social phobia.[6][7]

A comparative meta-analysis of 12 major antidepressants found that venlafaxine, mirtazapine, escitalopram, and sertraline were significantly more efficacious than duloxetine, fluoxetine, fluvoxamine, paroxetine, andreboxetine.[8] A combination of venlafaxine and mirtazapine achieved remission rates (defined as a HAM-D score of 7 or less) of 58% in one controlled trial.[9] In combination with an antipsychotic medicine aripiprazole, better results in treatment resistant depression in older adults have been demonstrated.[10]

The rate of life-threatening or lethal outcomes for suicidal overdoses of venlafaxine is lower than for the TCAs, MAOIs, and bupropion but higher than all of the SSRIs, and equal to citalopram.[11] It is metabolised in the body into another antidepressant drug called desvenlafaxine (O-desmethylvenlafaxine) which is also sold as an antidepressant, under the brand name Pristiq.[12]

In 2007, venlafaxine was the sixth most commonly prescribed antidepressant on the U.S. retail market, with 17.2 million prescriptions

​

Orphenadrine / Norflex:

​

Orphenadrine (sold under many brand names worldwide[1]) is an anticholinergic drug of the ethanolamine antihistamine class; it is closely related to diphenhydramine. It is used to treat muscle pain and to help with motor control in Parkinson's disease, but has largely been superseded by newer drugs. It was discovered and developed in the 1940s.

Orphenadrine is used to relieve pain caused by muscle injuries like strains and sprains in combination with rest and physical therapy.[4] A 2004 review found little clinical evidence for the safety or efficacy of orphenadrine for this use.[5]

Orphenadrine and other muscle relaxants are sometimes used to treat pain arising from rheumatoid arthritis but there is no evidence they are effective for that purpose.[6]

A 2003 Cochrane Review of the use of anticholinergic drugs to improve motor function in Parkinson's disease found that as a class, the drugs are useful for that purpose; it identified one single-site randomised, cross-over study of orphenadrine vs placebo.[7] Orphenadrine and other anticholinergics have largely been superseded by other drugs; they have a use in alleviating motor function symptoms, and appear to help about 20% of people with Parkinson's

​

​Lymecycline:

Lymecycline is a tetracycline broad-spectrum antibiotic marketed by the pharmaceutical company Galderma. It is approximately 5,000 times more soluble than tetracycline base and is unique amongst tetracyclines in that it is absorbed by an active transport process across the intestinal wall, making use of the same fast and efficient mechanism by which carbohydrates are absorbed.[1]

The greater absorption of lymecycline allows for lower dosages to be used; the standard dose of 408 mg is equivalent to 300 mg tetracycline base and, in its action, to 500 mg tetracycline hydrochloride. Lymecycline, unlike tetracycline hydrochloride, is soluble at all physiological pH values.

Lymecycline, like other tetracyclines, is used to treat a range of infections. Its better absorption profile makes it preferable to tetracycline for moderately severe acne and typically prescribed for 8 weeks at a time, but alternatives should be sought if no improvement occurs by 3 months.[2]

 

Lymecycline capsules

Side effects

Lymecycline's side effects can include rash, headache, diarrhoea, ulcerative colitis, nausea, vomiting, dermatitis, dysphasia, inflammation of the liver, hypersensitive reactions, and visual disturbances. When taken for a long period of time, it can cause reflux oesophagitis.[3]

​​

Loratadine:

Loratadine is a second-generation peripheral histamine H1-receptor blocker used to treat allergies.[1][2] In structure, it is closely related to tricyclic antidepressants, such as imipramine, and is distantly related to the atypical antipsychotic quetiapine.[3]

Loratadine was discovered in 1981 and came to market in 1993.[4] It is on the World Health Organization's Model List of Essential Medicines, the most important medications needed in a basic health system.[5] It is available as a generic drug and is marketed for its nonsedating properties. There is a version combined with pseudoephedrine, a decongestant; known as pseudoephedrine/loratadine.

​

Dilantin / Phenytoin:

Phenytoin, sold under the brand name Dilantin among others, is an anti-seizure medication. It is useful for the prevention of tonic-clonic seizures, partial seizures, but not absence seizures. The intravenous form is used for status epilepticus that does not improve with benzodiazepines. It may also be used for certain heart arrhythmias or neuropathic pain. It can be taken intravenously or by mouth. The intravenous form generally begins working within 30 minutes and is effective for 24 hours. Blood levels can be measured to determine the proper dose.

Common side effects include nausea, stomach pain, loss of appetite, poor coordination, increased hair growth, and enlargement of the gums. Potentially serious side effects include sleepiness, self harm, liver problems, bone marrow suppression, low blood pressure, and toxic epidermal necrolysis. There is evidence that use during pregnancy results in abnormalities in the baby. It appears to be safe to use when breastfeeding. Alcohol may interfere with the medication's effects.

Phenytoin was first made in 1908 by the German chemist Heinrich Biltz and found useful for seizures in 1936. It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system. Phenytoin is available as a generic medication and usually not too expensive. The wholesale cost in the developing world is between US$0.003 and US$0.15 per dose. A month of treatment is about US$30 in the United states

​

Bactrim / Trimethroprim /Sulfamethoxazole:

Trimethoprim/sulfamethoxazole (TMP/SMX), also known as co-trimoxazole among other names, is an antibiotic used to treat a variety of bacterial infections.It consists of one part trimethoprim to five parts sulfamethoxazole. It is used for urinary tract infections, MRSA skin infections, travelers' diarrhea, respiratory tract infections, and cholera, among others. It may be used both to treat and prevent pneumocystis pneumonia in people with HIV/AIDS. It can be given by mouth or intravenously.

Common side effects include nausea, vomiting, rash, and diarrhea. Severe allergic reactions and Clostridium difficile diarrhea may occasionally occur. Its use near the end of pregnancy is not recommended. It appears to be okay during breastfeeding as long as the baby is healthy. TMP/SMX generally results in bacterial death. It works by blocking the making of folate by the bacteria.

TMP/SMX was first sold in 1974. It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system. It is available as a generic medication and is not very expensive. In the United States it is about 0.40 USD per dose.

Co-trimoxazole was claimed to be more effective than either of its components individually in treating bacterial infections, although this was later disputed.Because it has a higher incidence of adverse effects, including allergic responses, its use has been restricted in many countries to very specific circumstances where its improved efficacy has been demonstrated. It may be effective in a variety of upper and lower respiratory tract infections, renal and urinary tract infections, gastrointestinal tract infections, skin and wound infections, septicaemias, and other infections caused by sensitive organisms. Co-trimoxazole in retinochoroiditis shows a reduction in the risk of recurrent retinochoroiditis. The global problem of advancing antimicrobial resistance has led to a renewed interest in the use of co-trimoxazole more recently.

Susceptibility

Organisms against which co-trimoxazole can be effective include:

• Acinetobacter spp.

• Aeromonas hydrophila

• Alcaligenes xylosoxidans

• Bartonella henselae

• Bordetella pertussis (pertussis)

• Brucella spp.

• Burkholderia cepacia

• Burkholderia mallei (glanders)

• Burkholderia pseudomallei (melioidosis)

• Chlamydia trachomatis (chlamydia)

• Chryseobacterium meningosepticum

• Citrobacter spp.

• Enterobacter spp.

• Escherichia coli

• Haemophilus influenzae

• Hafnia alvei

• Kingella spp.

• Klebsiella granulomatis

• Klebsiella pneumoniae

• Legionella spp.

• Listeria monocytogenes (listeriosis)

• Moraxella catarrhalis

• Morganella morganii

• Mycobacterium tuberculosis (tuberculosis)

• Neisseria gonorrhoeae (gonorrhoea)

• Neisseria meningitidis (meningococcal disease)

• Nocardia spp.

• Plesiomonas shigelloides

• Pneumocystis jirovecii

• Proteus mirabilis

• Proteus vulgaris

• Providencia rettgeri

• Providencia stuartii

• Salmonella typhi (typhoid fever)

• Non-typhi Salmonella

• Serratia spp.

• Shigella spp.

• Staphylococcus aureus

• Staphylococcus epidermidis

• Staphylococcus saprophyticus

• Stenotrophomonas maltophilia

• Streptococcus agalactiae

• Streptococcus faecalis

• Streptococcus pneumoniae

• Streptococcus pyogenes

• Streptococcus viridans

• Toxoplasma gondii (toxoplasmosis)

• Tropheryma whippelii (Whipple's disease)

• Vibrio cholerae (cholera)

• Yersinia enterocolitica

• Yersinia pestis (bubonic plague)

• Yersinia pseudotuberculosis

The only notable nonsusceptible organisms are the mycoplasmae and Francisella tularensis (the causative organism of tularaemia).

​

Tramadol:

Tramadol, sold under the brandname Ultram among others,is an opioid pain medication used to treat moderate to moderately severe pain. When taken as an immediate-release oral formulation, the onset of pain relief usually occurs within about an hour.It has two different mechanisms. First, it binds to the μ-opioid receptor. Second, it inhibits the reuptake of serotonin and norepinephrine.

Serious side effects may include seizures, increased risk of serotonin syndrome, decreased alertness, and drug addiction although the risk of serotonin syndrome appears to be low. Common side effects include: constipation, itchiness and nausea, among others. A change in dosage may be recommended in those with kidney or liver problems. It is not recommended in those who are at risk of suicide. While not recommended in women who are breastfeeding, those who take it should not stop breastfeeding.

Tramadol is marketed as a racemic mixture of both R- and S-stereoisomers.This is because the two isomers complement each other's analgesic activity.It is often combined with paracetamol (acetaminophen) as this is known to improve the efficacy of tramadol in relieving pain.Tramadol is metabolized to O-desmethyltramadol, which is a more potent opioid. It is of the benzenoid class.

Tramadol was launched and marketed as "Tramal" by the German pharmaceutical company Grünenthal GmbH in 1977 in West Germany, and 20 years later it was launched in countries such as the UK, US, and Australia. It is marketed under many brand names worldwide.

 

​

Methocarbamol / Robaxin:

methocarbamol are largely attributed to central depressant effects;[3] however, peripheral effects of methocarbamol to prolong muscle refractory period have also been reported.[4] As with guaifenesin, inhibition of the NMDA receptor may be involved in the effects of methocarbamol. As of 2015 the cost for a typical month of medication in the United States is less than 25 USD

Potential side-effects include: drowsiness, dizziness, clumsiness (ataxia), upset stomach, flushing, blurred vision, and fever. Both tachycardia (fast heart rate) and bradycardia (slow heart rate) have been reported;[6][7] these can be serious. Other serious side-effects include the development of a severe skin rash or itching, fainting, jaundice, persistent nausea/vomiting, stomach/abdominal pain, mental/mood changes, trouble urinating, and signs of infection. If taken in large amounts at once or more than directed or as prescribed, dysphoria or suicidal thoughts may occur.[8] In addition, methocarbamol may cause urine to turn black, blue, or green. However, this effect is harmless.[9]

Methocarbamol has a high therapeutic index, i.e., a wide range of safe and effective dosages. Consumer (OTC) doses are in the range 3–6 g per day,[10] while clinical doses can be as high as 24 g per day for severe conditions such as tetanus.[11]

Because of the potential for side-effects, this drug is considered to be a high-risk medication for the elderly.

​

Magnesium Oil Spray / Fibroflex

(Users definition:The benefits get from the spray is as follows, 
In the morning when I wake I am unable to bend my fingers or make a fist. The feel fat swollen and painful. 
I can honestly say,, hand on heart that after 1_2 mind after applying I can make a fist and pain is greatly reduced. I also put on other soft tissue areas such as feet, elbows, arms and shoulder joint with the same effect. 
About two weeks after using it I bumped into a colleague who has neuropathy from diabetes. 
She told me she had Ben using the spray for over a year with good results. 
I know it's available in the states under the name FibroFlex and it's around $36 per 100ML. 
I buy in a health food store for €15/$17, under the name of Magnesium Oil Spray. 
Hope this is helpful. 
Yvonne B.)

​

Magnesium oil (also referred to as transdermal magnesium)[1] is a mixture of Magnesium chloride in water. In reality it is not an oil. It is applied to the skin.[2] The magnesium is absorbed through the skin and is claimed to have health benefits, such as for the treatment of magnesium deficiency, to relieve muscle pains and aches (especially headaches), and enhance to relaxation.

​

Hydrocortisone / Cortef

Hydrocortisone, sold under the brandname Cortef among others, is the name for the hormone cortisol when supplied as a medication. Uses includes conditions such as adrenocortical insufficiency, adrenogenital syndrome, high blood calcium, thyroiditis, rheumatoid arthritis, dermatitis, asthma, and COPD. It is the treatment of choice for adrenocortical insufficiency. It can be given by mouth or by injection. After long term use, if stopped this should be done slowly.

Side effects may include mood changes, increased risk of infection, and swelling. With long term use common side effects include osteoporosis, upset stomach, physical weakness, easy bruising, and yeast infections. While used, it is unclear if it is safe during pregnancy.

It works as an antiinflammatory and by immune suppression.

Hydrocortisone was discovered in 1955. It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system. It is avaliable as a generic medication. The wholesale cost in the developing world is about 0.27 USD per day as of 2014 for the form taken by mouth.In the United States it costs less than 25 USD for a typical month of treatment.

Pharmacology

 

Cortisol for injection

Hydrocortisone is the pharmaceutical term for cortisol used in oral administration, intravenous injection, or topical application. It is used as an immunosuppressive drug, given by injection in the treatment of severe allergic reactions such as anaphylaxis and angioedema, in place of prednisolone in patients needing steroid treatment but unable take oral medication, and perioperatively in patients on long-term steroid treatment to prevent Addisonian crisis. It may also be injected into inflamed joints resulting from diseases such as gout.

Compared to hydrocortisone, prednisolone is about four times as strong and dexamethasone about forty times as strong, in their anti-inflammatory effect.Prednisolone can also be used as cortisol replacement, and at replacement dose levels (rather than anti-inflammatory levels), prednisolone is about eight times more potent than cortisol.[9] For side effects, see corticosteroid and prednisolone.

It may be used topically for allergic rashes, eczema, psoriasis, pruritus (itchyness) and other inflammatory skin conditions. Topical hydrocortisone creams and ointments are available in most countries without prescription in strengths ranging from 0.05% to 2.5% (depending on local regulations) with stronger forms available by prescription only. Covering the skin after application increases the absorption and effect. Such enhancement is sometimes prescribed, but otherwise should be avoided to prevent overdose and systemic impact.

​

Escitalpram / Lexapro / Cipralex

Escitalopram, also known by the brand names Lexapro and Cipralex among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It is approved by the U.S. Food and Drug Administration (FDA) for the treatment of adults and children over 12 years of age with major depressive disorder(MDD) or generalized anxiety disorder (GAD). Escitalopram is the (S)-stereoisomer (Left-enantiomer) of the earlier Lundbeck drug citalopram, hence the name escitalopram. Whether escitalopram exhibits superior therapeutic properties to citalopram or merely represents an example of "evergreening" is controversial.

The utility of antidepressant drugs in the treatment of mild-to-moderate depression is itself controversial. In those with very severe depression there is a large benefit

​

Lidocaine, also known as xylocaine and lignocaine,

A medication used to numb tissue in a specific area and to treat ventricular tachycardia. It can also be used for nerve blocks. Lidocaine mixed with a small amount of epinephrine is available to allow larger doses for numbing, and to make it last longer. When used as an injectable, it typically begins working within four minutes and lasts for half an hour to three hours. Lidocaine may also be applied directly to the skin for numbing.

Common side effects with intravenous use include sleepiness, muscle twitching, confusion, changes in vision, numbness, tingling, and vomiting. It can cause low blood pressure and an irregular heart rate. There are concerns that injecting it into a joint can cause problems with the cartilage.[4] It appears to be generally safe for use in pregnancy. A lower dose may be required in those with liver problems. It is generally safe to use in those allergic to tetracaine or benzocaine. Lidocaine is an antiarrhythmic medication of the class Ib type. Lidocaine works by blocking sodium channels and thus decreasing the rate of contractions of the heart. When used locally as a numbing agent, local neurons cannot signal the brain.[4]

Lidocaine was discovered in 1946 and went on sale in 1948. It is on the WHO Model List of Essential Medicines, the most important medications needed in a basic healthcare system.It is available as a generic medication and is not very expensive. The wholesale cost in the developing world in 2014 was US$0.45to $1.05 wholesale per 20ml vial of medication.

​