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Encyclopedia > Tramadol
Tramadol
Systematic (IUPAC) name
rac-(1R,2R)-2-(dimethylaminomethyl)-1-
(3-methoxyphenyl)-cyclohexanol
Identifiers
CAS number 27203-92-5
ATC code N02AX02
PubChem 33741
DrugBank APRD00028
Chemical data
Formula C16H25NO2 
Mol. mass 263.4 g/mol
SMILES search in eMolecules, PubChem
Pharmacokinetic data
Bioavailability 68–72% Increases with repeated dosing.
Protein binding 20%
Metabolism Hepatic demethylation and glucuronidation
Half life 5–7 hours
Excretion Renal
Therapeutic considerations
Pregnancy cat.

C(AU) C(US) Image File history File links No higher resolution available. ... IUPAC nomenclature is a system of naming chemical compounds and of describing the science of chemistry in general. ... CAS registry numbers are unique numerical identifiers for chemical compounds, polymers, biological sequences, mixtures and alloys. ... The Anatomical Therapeutic Chemical Classification System is used for the classification of drugs. ... A section of the Anatomical Therapeutic Chemical Classification System. ... PubChem is a database of chemical molecules. ... The DrugBank database available at the University of Alberta is a unique bioinformatics and cheminformatics resource that combines detailed drug (i. ... A chemical formula is a concise way of expressing information about the atoms that constitute a particular chemical compound. ... For other uses, see Carbon (disambiguation). ... This article is about the chemistry of hydrogen. ... General Name, symbol, number nitrogen, N, 7 Chemical series nonmetals Group, period, block 15, 2, p Appearance colorless gas Standard atomic weight 14. ... General Name, symbol, number oxygen, O, 8 Chemical series nonmetals, chalcogens Group, period, block 16, 2, p Appearance colorless (gas) pale blue (liquid) Standard atomic weight 15. ... The molecular mass (abbreviated Mr) of a substance, formerly also called molecular weight and abbreviated as MW, is the mass of one molecule of that substance, relative to the unified atomic mass unit u (equal to 1/12 the mass of one atom of carbon-12). ... The simplified molecular input line entry specification or SMILES is a specification for unambiguously describing the structure of chemical molecules using short ASCII strings. ... In pharmacology, bioavailability is used to describe the fraction of an administered dose of unchanged drug that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs. ... A drugs efficacy may be affected by the degree to which it binds to the proteins within blood plasma. ... Drug metabolism is the metabolism of drugs, their biochemical modification or degradation, usually through specialized enzymatic systems. ... For the bird, see Liver bird. ... Demethylation is the chemical process resulting in the removal a methyl group (CH3) from a molecule. ... Example of glucuronidation Glucuronidation of alcohols and acids Glucuronidation is a major inactivating pathway for a huge variety of exogenous and endogenous molecules, including drugs, polluants, bilirubin, androgens, estrogens, mineralocorticoids, glucocorticoids, fatty acid derivatives, retinoids and bile acids. ... The biological half-life of a substance is the time required for half of that substance to be removed from an organism by either a physical or a chemical process. ... The kidneys are important excretory organs in vertebrates. ... The kidneys are the organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... The pregnancy category of a pharmaceutical agent is an assessment of the risk of fetal injury due to the pharmaceutical, if it is used as directed by the mother during pregnancy. ... For other uses, see Australia (disambiguation). ... For other uses of terms redirecting here, see US (disambiguation), USA (disambiguation), and United States (disambiguation) Motto In God We Trust(since 1956) (From Many, One; Latin, traditional) Anthem The Star-Spangled Banner Capital Washington, D.C. Largest city New York City National language English (de facto)1 Demonym American...

Legal status

Prescription Only (S4)(AU) POM(UK) The regulation of therapeutic goods, that is drugs and therapeutic devices, varies by jurisdiction. ... The Standard for the Uniform Scheduling of Drugs and Poisons, abbreviated SUSDP, is a document used in the regulation of drugs and poisons in Australia. ... For other uses, see Australia (disambiguation). ... Zoloft, an antidepressant and antianxiety medication A prescription drug is a licensed medicine that is regulated by legislation to require a prescription before it can be obtained. ...

Routes oral, IV, IM

Tramadol (INN) (IPA: [ˈtræməˌdɒl]) is an atypical opioid which is a centrally acting analgesic, used for treating moderate to severe pain. It is a synthetic agent, as a 4-phenyl-piperidine analogue of codeine,[1][2] and appears to have actions on the GABAergic, noradrenergic and serotonergic systems. Tramadol was developed by the German pharmaceutical company Grünenthal GmbH and marketed under the trade name Tramal. Grünenthal has also cross licensed the drug to many other pharmaceutical companies that market it under various names. In pharmacology and toxicology, a route of administration is the path by which a drug, fluid, poison or other substance is brought into contact with the body. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... Intramuscular injection is an injection of a substance directly into a muscle. ... An International Nonproprietary Name (INN) is the official non-proprietary or generic name given to a pharmaceutical substance, as designated by the World Health Organization. ... Articles with similar titles include the NATO phonetic alphabet, which has also informally been called the “International Phonetic Alphabet”. For information on how to read IPA transcriptions of English words, see IPA chart for English. ... An opioid is a chemical substance that has a morphine-like action in the body. ... An analgesic (colloquially known as a painkiller) is any member of the diverse group of drugs used to relieve pain (achieve analgesia). ... Look up Pain in Wiktionary, the free dictionary. ... Codeine (INN) or methylmorphine is an opiate used for its analgesic, antitussive and antidiarrheal properties. ... Gaba may refer to: Gabâ or gabaa (Philippines), the concept of negative karma of the Cebuano people GABA, the gamma-amino-butyric acid neurotransmitter GABA receptor, in biology, receptors with GABA as their endogenous ligand Gaba 1 to 1, an English conversational school in Japan Marianne Gaba, a US model... Norepinephrine, known as noradrenaline outside the USA, is a catecholamine and a phenethylamine with chemical formula C8H11NO3. ... Serotonin (pronounced ) (5-hydroxytryptamine, or 5-HT) is a monoamine neurotransmitter synthesized in serotonergic neurons in the central nervous system (CNS) and enterochromaffin cells in the gastrointestinal tract of animals including humans. ... A pharmaceutical company, or drug company, is a commercial business whose focus is to research, develop, market and/or distribute drugs, most commonly in the context of healthcare. ... Grünenthal is a German pharmaceutical company. ...


Tramadol is usually marketed as the hydrochloride salt (tramadol hydrochloride) and is available in both injectable (intravenous and/or intramuscular) and oral preparations. It is also available in conjunction with paracetamol (acetaminophen). An injection is a method of putting liquid into the body with a hollow needle and a syringe which is pierced through the skin to a sufficient depth for the material to be forced into the body. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... Intramuscular injection is an injection of a substance directly into a muscle. ... Paracetamol (INN) (IPA: ) or acetaminophen (USAN), is the active metabolite of phenacetin, a so-called coal tar analgesic. ...


Tramadol is approximately 10% as potent as morphine, when given by the IV/IM route. Oral doses range from 50–400 mg daily, with up to 600 mg daily when given IV/IM. The 'combination' pills each contain 37.5 mg of tramadol and 325 mg of paracetamol, with the recommended dose being one or two pills every four to six hours. This article is about the drug. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... Paracetamol (INN) (IPA: ) or acetaminophen (USAN), is the active metabolite of phenacetin, a so-called coal tar analgesic. ...


Unlike most other opioids, Tramadol is not considered a controlled substance in many countries (the U.S. and Australia, among others), and is available with a normal prescription. Tramadol is also available over-the-counter without prescription in a few countries.[3] An opioid is a chemical substance that has a morphine-like action in the body. ... Wikipedia does not yet have an article with this exact name. ...

Contents

Uses

Tramadol is used to treat moderate and severe pain and most types of neuralgia, including trigeminal neuralgia.[citation needed] It has been suggested that tramadol could be effective for alleviating symptoms of depression and anxiety because of its action on GABAergic, noradrenergic and specifically serotonergic systems. However, health professionals have not yet endorsed its use on a large scale for disorders such as this.[4][5] Neuralgia is a painful disorder of the nerves. ... Trigeminal neuralgia, or Tic Douloureux, is a neuropathic disorder of the trigeminal nerve that causes episodes of intense pain in the eyes, lips, nose, scalp, forehead, and jaw. ...


Off-label and investigational uses

Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. ... Postherpetic neuralgia (PHN) is a painful condition caused by the varicella zoster virus in a dermatomal distribution (the area governed by a particular sensory nerve) after an attack of herpes zoster (HZ) (commonly known as shingles), usually manifesting after the vesicles have crusted over and begun to heal. ... Fibromyalgia (FM or FMS) is a chronic syndrome (constellation of signs and symptoms) characterized by diffuse or specific muscle, joint, or bone pain, fatigue, and a wide range of other symptoms. ... Restless legs syndrome (RLS, or Wittmaack-Ekboms syndrome) is a condition that is characterised by an irresistible urge to move ones legs. ... For other uses see Opiate (disambiguation), or for the class of drugs see Opioid. ... Premature ejaculation (PE), also known as rapid ejaculation, premature climax or early ejaculation, is the most common sexual problem in men, affecting 25%-40% of men. ...

Veterinary

Tramadol is used to treat post-operative and/or chronic (e.g. cancer-related) pain in dogs and cats.[1]


Mechanism of action

The mode of action of tramadol has yet to be fully understood, but it is believed to work through modulation of the GABAergic, noradrenergic and serotonergic systems, in addition to its mild agonism of the μ-opioid receptor. The contribution of non-opioid activity is demonstrated by the analgesic effects of tramadol not being fully antagonised by the μ-opioid receptor antagonist naloxone. Naloxone is a drug used to counter the effects of opioid overdose, for example heroin and morphine overdose. ...


Tramadol is marketed as a racemic mixture with a weak affinity for the μ-opioid receptor (approximately 1/6th that of morphine). The (+)-enantiomer is approximately four times more potent than the (-)-enantiomer in terms of μ-opioid receptor affinity and 5-HT reuptake, whereas the (-)-enantiomer is responsible for noradrenaline reuptake effects (Shipton, 2000). These actions appear to produce a synergistic analgesic effect, with (+)-tramadol exhibiting 10-fold higher analgesic activity than (-)-tramadol (Goeringer et al., 1997). In chemistry, a racemate is a mixture of equal amounts of left- and right-handed stereoisomers of a chiral molecule. ... This article is about the drug. ... In chemistry, enantiomers (from the Greek ἐνάντιος, opposite, and μέρος, part or portion) are stereoisomers that are nonsuperimposable complete mirror images of each other, much as ones left and right hands are the same but opposite. ... To meet Wikipedias quality standards, this article may require cleanup. ... Serotonin (5_hydroxytryptamine, or 5_HT) is a monoamine neurotransmitter synthesised in serotonergic neurons in the central nervous system and enterochromaffin cells in the gastrointestinal tract. ...


The serotonergic modulating properties of tramadol mean that it has the potential to interact with other serotonergic agents. There is an increased risk of serotonin syndrome when tramadol is taken in combination with serotonin reuptake inhibitors (e.g. SSRIs), since these agents not only potentiate the effect of 5-HT but also inhibit tramadol metabolism. Tramadol is also thought to have some NMDA-type antagonist effects which has given it a potential application in neuropathic pain states. Serotonergic means related to, capable of producing, altering, or releasing serotonin, a neurotransmitter, and can refer to the following classes of chemicals: Selective serotonin reuptake inhibitor - A common class of serotonergic antidepressants Noradrenergic and specific serotonergic antidepressant - Another class of serotonergic antidepressants serotonergic psychedelics - The serotonergic hallucinogenic drugs This is... Serotonin syndrome is a rare, but potentially life-threatening adverse drug reaction that results from intentional self-poisoning, therapeutic drug use, or inadvertent interactions between drugs. ... SSRI redirects here; for other uses, see SSRI (disambiguation). ...


Metabolism

Tramadol undergoes hepatic metabolism via the cytochrome P450 isozyme CYP2D6, being O- and N-demethylated to five different metabolites. Of these, M1 is the most significant since it has 200 times the μ-affinity of (+)-tramadol, and furthermore has an elimination half-life of nine hours, compared with six hours for tramadol itself. In the 6% of the population who have slow CYP2D6 activity, there is therefore a slightly reduced analgesic effect. Phase II hepatic metabolism renders the metabolites water-soluble and they are excreted by the kidneys. Thus reduced doses may be used in renal and hepatic impairment. The liver is an organ in vertebrates including humans. ... Cytochrome P450 Oxidase (CYP2E1) Cytochrome P450 oxidase (commonly abbreviated CYP) is a generic term for a large number of related, but distinct, oxidative enzymes (EC 1. ... Isozymes, (or isoenzymes) are isoforms (closely related variants) of enzymes. ... Cytochrome P450 2D6 (CYP2D6), a member of the cytochrome P450 mixed-function oxidase system, is one of the most important enzymes involved in the metabolism of xenobiotics in the body. ... O-Desmethyltramadol (M1) is an opioid analgesic which is made in the body from tramadol. ... Kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ... The liver is an organ in vertebrates including humans. ...


Adverse effects

The most commonly reported adverse drug reactions are nausea, vomiting and sweating. Drowsiness is reported, although it is less of an issue than for other opioids. Respiratory depression, a common side effect of most opioids, is not clinically significant in normal doses. By itself, it can decrease the seizure threshold. When combined with SSRIs, tricyclic antidepressants, or in patients with epilepsy, the seizure threshold is further decreased. Seizures have been reported in humans receiving excessive single oral doses (700 mg) or large intravenous doses (300 mg). An Australian study found that of 97 confirmed new-onset seizures, eight were associated with Tramadol, and that in the authors' First Seizure Clinic, "Tramadol is the most frequently suspected cause of provoked seizures" (Labate 2005). Dosages of coumadin/warfarin may need to be reduced for anticoagulated patients to avoid bleeding complications. An adverse drug reaction (abbreviated ADR) is a term to describe the unwanted, negative consequences sometimes associated with the use of medications. ... This article is about epileptic seizures. ... Chemical structure of the tricyclic antidepressant amitriptyline. ... Warfarin (also known under the brand names of Coumadin, Jantoven, Marevan, and Waran) is an anticoagulant medication that is administered orally or, very rarely, by injection. ...


Dependence

Some controversy exists regarding the dependence liability of tramadol. Grünenthal has promoted it as an opioid with a lower risk of opioid dependence than that of traditional opioids, claiming little evidence of such dependence in clinical trials. They offer the theory that since the M1 metabolite is the principal agonist at μ-opioid receptors, the delayed agonist activity reduces dependence liability. The noradrenaline reuptake effects may also play a role in reducing dependence. Opioid dependence is a medical diagnosis characterized by an individuals inability to stop using opioids even when objectively in his or her best interest to do so. ...


Despite these claims, it is apparent in community practice, that dependence to this agent does occur.[17] However, this dependence liability is considered relatively low by health authorities, such that tramadol is classified as a Schedule 4 Prescription Only Medicine in Australia, rather than as a Schedule 8 Controlled Drug like other opioids (Rossi, 2004). Similarly, tramadol is not currently scheduled by the U.S. DEA, unlike other opioid analgesics. Nevertheless, the prescribing information for Ultram warns that tramadol "may induce psychological and physical dependence of the morphine-type". In addition, there are widespread reports by consumers of extremely difficult withdrawal experiences. [18] The Standard for the Uniform Scheduling of Drugs and Poisons, abbreviated SUSDP, is a document used in the regulation of drugs and poisons in Australia. ... An opioid is any agent that binds to opioid receptors found principally in the central nervous system and gastrointestinal tract. ... Since 1973, the DEA has enforced the drug laws in the United States. ...


A controlled study that compared different medications found "the percent of subjects who scored positive for abuse at least once during the 12-month follow-up were 2.5% for NSAIDs, 2.7% for tramadol, and 4.9% for hydrocodone. When more than one hit on the dependency algorithm was used as a measure of persistence, abuse rates were 0.5% for NSAIDs, 0.7% for tramadol, and 1.2% for hydrocodone. Thus, the results of this study suggest that the prevalence of abuse/dependence over a 12-month period in a CNP population that was primarily female was equivalent for tramadol and NSAIDs, with both significantly less than the rate for hydrocodone".[18] Dependency has a number of meanings: In project management, a dependency is a link amongst a projects terminal elements. ...


Recreational use

As an opioid analgesic, tramadol can be used recreationally. It can, via agonism of μ opiate receptors, produce effects similar to those of other opioids (e.g., morphine or hydrocodone), although not nearly as intense due to tramadol's much lower affinity for the receptor. In addition to acting as an opioid, tramadol is also a very weak but rapidly acting serotonin-norepinephrine reuptake inhibitor[19]. When taken in amounts larger than normal therapeutic doses, tramadol can cause seizures (typically tonic-clonic) and severe nausea, which could deter abuse to some extent. Tramadol has been known to produce severe withdrawal symptoms with abrupt cessation after prolonged use.[18] The μ opioid receptors (MOR) are a class of opioid receptors with high affinity for enkephalins and beta-endorphin but low affinity for dynorphins. ... Serotonin Norepinephrine Serotonin-norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant used in the treatment of clinical depression and other affective disorders. ... Tonic-clonic seizures (also known as Grand Mal Seizures, though this term is now discouraged and rarely used in a clinical setting) are a type of generalised seizure affecting the whole brain. ... For other uses, see Nausea (disambiguation). ... Withdrawal, also known as withdrawal syndrome, refers to the characteristic signs and symptoms that appear when a drug that causes physical dependence is regularly used for a long time and then suddenly discontinued or decreased in dosage. ...


Proprietary preparations

Grünenthal, which still owns the patent to tramadol, has cross-licensed the agent to pharmaceutical companies internationally. Thus, tramadol is marketed under many trade names around the world, including:

  • Adolan
  • Adolonta
  • Anadol
  • Boldol (in Bosnia and Herzegovina)
  • Calmador (in Argentina)
  • Contramal
  • Crispin
  • Dolol (in Denmark)
  • Lumidol
  • Mandolgin (in Denmark)
  • Mandolgine
  • Mosepan
  • Nobligan
  • Poltram
  • Sintradon
  • Siverol
  • Tiparol
  • Toplagic
  • Tradol
  • Tradolan
  • Tradolan (in Sweden)
  • Tralgit
  • Tramacet
  • Tramacip
  • Tramadin
  • Tramadolor
  • Tramal (in Slovenia)
  • Tramalgic (in Hungary)
  • Tramahexal
  • Tramacet (combined with paracetamol)
  • Tramazac (in India)
  • Trama-Klosidol
  • Tramedo
  • Trodon (in Serbia)
  • Ultracet (combined with paracetamol)
  • Ultram and Ultram ER (in the US)
  • Zaldiar
  • Zamudol
  • Zydol (in the UK and Australia)
  • Zytram
  • Zytrim (in Spain)

Paracetamol (INN) (IPA: ) or acetaminophen (USAN), is the active metabolite of phenacetin, a so-called coal tar analgesic. ... Not to be confused with Republika Srpska. ... United States may refer to: Places: United States of America SS United States, the fastest ocean liner ever built. ...

Notable related deaths

Rapping is one of the elements of hip hop and the distinguishing feature of hip hop music; it is a form of rhyming lyrics spoken rhythmically over musical instruments, with a musical backdrop of sampling, scratching and mixing by DJs. ... Ol Dirty Bastard (November 15, 1968 - November 13, 2004) was an American rapper and one of the founding members of the hip hop group Wu-Tang Clan. ... Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. ... is the 317th day of the year (318th in leap years) in the Gregorian calendar. ... Year 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ...

References

  1. ^ Dayer P, Desmeules J, Collart L (1997). "[Pharmacology of tramadol]". Drugs 53 Suppl 2: 18–24. PMID 9190321. 
  2. ^ Opioids.com
  3. ^ Erowid
  4. ^ Opioids.com
  5. ^ Opioids.com
  6. ^ Harati Y, Gooch C, Swenson M, et al (1998). "Double-blind randomized trial of tramadol for the treatment of the pain of diabetic neuropathy". Neurology 50 (6): 1842–46. PMID 9633738. 
  7. ^ Harati Y, Gooch C, Swenson M, et al (2000). "Maintenance of the long-term effectiveness of tramadol in treatment of the pain of diabetic neuropathy". J. Diabetes Complicat. 14 (2): 65–70. PMID 10959067. 
  8. ^ Göbel H, Stadler T (1997). "[Treatment of post-herpes zoster pain with tramadol. Results of an open pilot study versus clomipramine with or without levomepromazine]" (in French). Drugs 53 Suppl 2: 34–39. PMID 9190323. 
  9. ^ Boureau F, Legallicier P, Kabir-Ahmadi M (2003). "Tramadol in post-herpetic neuralgia: a randomized, double-blind, placebo-controlled trial". Pain 104 (1–2): 323–31. PMID 12855342. 
  10. ^ Bennett RM, Kamin M, Karim R, Rosenthal N (2003). "Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain: a double-blind, randomized, placebo-controlled study". Am. J. Med. 114 (7): 537–45. PMID 12753877. 
  11. ^ Lauerma H, Markkula J (1999). "Treatment of restless legs syndrome with tramadol: an open study". The Journal of clinical psychiatry 60 (4): 241–44. PMID 10221285. 
  12. ^ Sobey PW, Parran TV, Grey SF, Adelman CL, Yu J (2003). "The use of tramadol for acute heroin withdrawal: a comparison to clonidine". J Addict Dis 22 (4): 13–25. PMID 14723475. 
  13. ^ Threlkeld M, Parran TV, Adelman CA, Grey SF, Yu J (2006). "Tramadol versus buprenorphine for the management of acute heroin withdrawal: a retrospective matched cohort controlled study". Am J Addict 15 (2): 186–91. doi:10.1080/10550490500528712. PMID 16595358. 
  14. ^ Engindeniz Z, Demircan C, Karli N, et al (Jun 2005). "Intramuscular tramadol vs. diclofenac sodium for the treatment of acute migraine attacks in emergency department: a prospective, randomised, double-blind study". J Headache Pain 6 (3): 143–48. doi:10.1007/s10194-005-0169-y. PMID 16355295. 
  15. ^ Goldsmith TB, Shapira NA, Keck PE (1999). "Rapid remission of OCD with tramadol hydrochloride". The American journal of psychiatry 156 (4): 660–61. PMID 10200754. 
  16. ^ Salem EA, Wilson SK, Bissada NK, Delk JR, Hellstrom WJ, Cleves MA (2007). "Tramadol HCL has Promise in On-Demand Use to Treat Premature Ejaculation". The Journal of Sexual Medicine (OnlineEarly Articles). PMID 17362279. 
  17. ^ McDiarmid, Todd; Mackler, Leslie (2005-01-01). "What is the addiction risk associated with tramadol". Journal of Family Practice 54 (1). Retrieved on 2007-09-17. 
  18. ^ a b c Adams, Edgar; Breiner, Scott; Cicero, Theodore; Geller, Anne; Inciardi, James; Schnoll, Sidney; Senay, Edward; Woody, George (May 2006). "A Comparison of the Abuse Liability of Tramadol, NSAIDs, and Hydrocodone in Patients with Chronic Pain". Journal of Pain and Symptom Management 31 (5): 465–76. Retrieved on 2007-01-13. 
  19. ^ King, Steven A. (2007-06-01). "NSAIDs and Cardiovascular Disease". Psychiatric Times 24 (7). Retrieved on 2007-08-01. 
  20. ^ Zahlaway, Jon. "Autopsy shows ODB died of accidental drug overdose", LiveDaily, December 15, 2004. Retrieved on 2007-01-13. 

A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... is the 1st day of the year in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 260th day of the year (261st in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... January 13 is the 13th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 152nd day of the year (153rd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 213th day of the year (214th in leap years) in the Gregorian calendar. ... is the 349th day of the year (350th in leap years) in the Gregorian calendar. ... Year 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... January 13 is the 13th day of the year in the Gregorian calendar. ...

External links


  Results from FactBites:
 
Tramadol Information from Drugs.com (1827 words)
While you are taking tramadol, do not drink alcohol or use drugs that make you sleepy (such as cold medicine, other pain medications, muscle relaxants, and medicine for seizures, depression or anxiety).
Tramadol may also cause serious or fatal side effects in a newborn if the mother uses the medication during pregnancy or labor.
Tramadol can be taken with or without food, but take it the same way each time.
Tramadol - Wikipedia, the free encyclopedia (908 words)
Tramadol is available in both injectable (intravenous and/or intramuscular) and oral preparations including the extended-release tablet Ultram ER (100,200,300).
The contribution of non-opioid activity is demonstrated by the analgesic effects of tramadol not being fully antagonised by the μ-opioid receptor antagonist naloxone.
Tramadol is marketed as a racemic mixture with a weak affinity for the μ-opioid receptor (approximately 1/6000th that of morphine).
  More results at FactBites »

 
 

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