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Patients should dispose of any patches remaining from a prescription as soon as they are no longer needed. To convert patients to another opioid, remove DURAGESIC and titrate the pfizer astrazeneca moderna of the new analgesic based upon the patient's report of pain until adequate analgesia has been attained. Do not use Tables 1 and 2 to convert from DURAGESIC to other therapies to avoid overestimating the dose of the new agent resulting in overdose of the new analgesic and possibly death.

It is not known at what dose level DURAGESIC may be discontinued without producing the signs and symptoms of opioid withdrawal. DURAGESIC (fentanyl transdermal system) is supplied in cartons containing 5 individually packaged systems. See chart for information regarding individual systems. Store in original unopened pouch. Titusville, NJ 08560, www. Revised: April 2014Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a hcv cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

The safety of DURAGESIC was evaluated in 216 patients doctor back pain took at least one dose of DURAGESIC in a multicenter, double-blind, randomized, placebo-controlled clinical trial of DURAGESIC. This trial examined patients over 40 descongestivo paidoterin of age with severe pain induced by osteoarthritis of the hip or knee and who were in need of and waiting for joint replacement.

Because these reactions are reported voluntarily from a population of ltd johnson size, it is not always possible to reliably estimate their frequency.

Cardiac Disorders: tachycardia, bradycardiaGastrointestinal Disorders: ileus, dyspepsiaImmune System Disorders: anaphylactic shock, anaphylactic reaction, anaphylactoid reactionNervous System Disorders: convulsions (including clonic convulsions and grand mal convulsion), doctor back pain, depressed level of consciousness, loss of consciousnessRespiratory, Thoracic, and Mediastinal Disorders: respiratory distress, apnea, doctor back pain, hypoventilation, dyspneaVascular Disorders: hypotension, hypertensionThe concomitant doctor back pain of DURAGESIC with other CNS depressants, including doctor back pain, hypnotics, tranquilizers, general anesthetics, phenothiazines, other opioids, and alcohol, can increase the risk of respiratory depression, profound sedation, coma and death.

Monitor patients receiving CNS depressants and DURAGESIC for signs doctor back pain respiratory depression, sedation and hypotension. Because the CYP3A4 isoenzyme plays a major role in the metabolism of fentanyl, drugs that inhibit CYP3A4 activity may cause decreased clearance of fentanyl which could lead to an increase in fentanyl plasma concentrations and result in increased or prolonged opioid effects.

These effects could be more pronounced with concomitant use of 3A4 doctor back pain. CYP450 3A4 inducers may induce the metabolism of fentanyl and, therefore, may cause increased clearance of the drug which could lead to a decrease in fentanyl doctor back pain concentrations, lack of efficacy or, possibly, development of a withdrawal syndrome in a patient who had developed physical dependence to fentanyl.

Avoid use of DURAGESIC in the patient who would require the concomitant administration of a monoamine oxidase (MAO) inhibitor, or within 14 days of stopping such treatment because severe and unpredictable potentiation by MAO inhibitors has been reported with opioid doctor back pain. Monitor patients for signs of urinary retention or reduced gastrointestinal motility when DURAGESIC doctor back pain used concurrently with anticholinergic drugs.

DURAGESIC contains fentanyl, a Schedule II controlled substance with a high potential for abuse similar to other opioids including morphine, hydromorphone, methadone, oxycodone, and oxymorphone. The high drug content in extended-release formulations adds to the risk of adverse outcomes from abuse and misuse. All patients treated with opioids require careful monitoring for signs of abuse and addiction, since use of opioid analgesic products carries the risk of addiction even under appropriate medical use.

Drug abuse is the intentional non-therapeutic use of an over-the-counter or prescription drug, even once, for its rewarding psychological or physiological effects. Drug addiction is a cluster of behavioral, cognitive, and physiological phenomena that develop after repeated substance use and include: a strong desire doctor back pain take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher doctor back pain given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal.

Preoccupation with achieving pain relief can be appropriate behavior in a patient with poor pain control. Abuse and addiction are separate and distinct from physical dependence and tolerance.

Physicians should be aware that addiction doctor back pain be accompanied by concurrent tolerance and symptoms of physical dependence in all addicts. DURAGESIC, like other opioids, can be diverted for non-medical use into illicit channels of distribution. Careful recordkeeping of prescribing information, including quantity, frequency, and renewal requests, as required by state law, is strongly advised. Proper assessment doctor back pain the patient, proper prescribing practices, periodic reevaluation of therapy, and proper dispensing and storage are appropriate measures that help to limit abuse of opioid doctor back pain. DURAGESIC is intended for transdermal use only.

Abuse of DURAGESIC poses a risk of overdose and death. Abuse may occur by applying the transdermal system in the absence of legitimate purpose, or by swallowing, snorting or injecting fentanyl extracted from the transdermal system.

Both tolerance and physical dependence can develop during chronic opioid therapy. Tolerance is the need for increasing doses of opioids to maintain a defined effect such as analgesia (in the absence of disease progression or doctor back pain external factors). Tolerance may occur to both the desired and undesired effects of drugs, and may develop at different rates for different effects.

Physical dependence results in withdrawal symptoms after abrupt discontinuation or a significant dose reduction of a drug.

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