Knowing More on Stress Headache

Plenty of health problems are blamed on stress. Headache episodes for instance are the most often associated with the tension we have to encounter at job and in your own home. In the 21st century, people’s life has improved a lot technologically, yet its quality has reduced a lot. We are usually around the run, coping with busy schedules, tense job situations, debt, kids’ problems, health problems and every day life decisions. A stress headache represents the normal reaction of the body system to a situation that one has difficulties coping with.

Migraine treatment
Migraine treatment

Tension headaches will also be known as stress headaches because they outcomes as a shrinkage of the back, neck and head muscles. Many people suffer from a stress headache once or twice a month; the signs and symptoms are not severe or debilitating. You might really feel a firmness across the head or at the back of the neck. The strength of the ache varies from individual to individual and situation to situation, but the condition is generally explained as manageable.

You could study how to prevent a stress headache, by learning a couple of stress management techniques. Rest, correct (stomach) breathing, aromatherapy, neuro-linguistic programming, repetition of positive assertions, yoga exercise, normal bodily exercise and lots of rest could show effective ways to deal with the extremely stressful life style that modern-day guy discovers so difficult to adjust to. In the event you work in an office environment and you spend lots of time seated, you need to remember to stand up every so often and do some body moves to be able to eliminate the tension from the spine, the back and the neck muscles.

Massage of head, shoulders and neck also eliminates the tension and reduces the intensity of the stress headache. Point out should be made that this indicator is usually associated with higher blood pressure. In the event you suffer from regular stress-induced headaches, you need to talk to a doctor right away to be able to get an appropriate therapy.

Psychological and mental stress interferes with the entire body system, even if you experience the issue like a problematic stress headache. The liver for instance is recognized to suffer alterations in its performance during extremely stressful periods. Acupuncture and herbal remedies could be combined with standard medicine to cut back tension, stabilize blood pressure and stimulate a general state of well being. The ache decreases when the mind-body unit enters a balanced state. Therefore , within the attempt to attain much better stress management, you ought to follow a much more complicated and therapeutic method to therapy so as to improve your entire lifestyle and reduce the unfavorable impact of stress.

Gabapentin Breastfeeding Warnings

Benefit should outweigh risk.

Excreted into human milk: Yes

Gabapentin and breastfeeding

If your doctor or health visitor says your baby is healthy, you can take gabapentin while breastfeeding. It’s important to keep taking gabapentin to keep you well.

Gabapentin passes into breast milk in small amounts. It has not been known to cause any side effects in breastfed babies.

If your baby is not feeding as well as usual, seems unusually sleepy, has a stomach upset, or if you have any other concerns about your baby, talk to your doctor, pharmacist, health visitor or midwife.

Gabapentin and fertility

There’s no evidence to suggest that taking gabapentin reduces fertility in either men or women. However, discuss your pregnancy plans with a doctor. They may wish to review your medicine and prescribe a higher dose of folic acid for you to take (5mg a day) before you become pregnant.

Speak to a pharmacist or your doctor before taking gabapentin if you’re trying to get pregnant.

Comments:
-The effects in the nursing infant are unknown.
-Limited information indicates that maternal doses up to 2.1 g daily produce relatively low levels in infant serum.
-Breastfed infants should be monitored for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsant or psychotropic drugs.

You can not take Prescription for a long time, you need find a way to treat your pain without prescription. Exercising is the best way to relieve your pain. because exercising can enhance your immune system and increase your muscle strength and make your nerve strong.

 

Fioricet Tolerance and Addiction

Fioricet with Codeine is supplied in capsule form for oral administration.

Each capsule contains:

Butalbital, USP ………………. 50 mg
Acetaminophen, USP ……………….300 mg
Caffeine, USP ……………….40 mg
Codeine Phosphate, USP ……………….30 mg

Tolerance and addiction may also occur with butalbital. Tolerance means that a person needs more of the medication to achieve headache relief. Addiction to butalbital is characterized by persistent behaviors, like compulsions, to take a butalbital-containing medication.

These behaviors impair their life in some way, negatively impacting relationships and/or everyday functioning.

Is Fioricet Addictive?

Although it’s only a prescription headache medication, Fioricet has the potential to cause addiction.

If a person follows their prescription guidelines and uses the medication correctly, the risks of addiction are low. However, if someone takes too much Fioricet, they may develop tolerance to its effects.

A person with tolerance to a certain dose of Fioricet will require higher doses of the medication to alleviate their headaches.

When a person with tolerance starts to take more Fioricet, possibly by obtaining more prescriptions, they may eventually become dependent on it. In other words, they may feel unable to get through the day without taking Fioricet, and if they stop, they will experience symptoms of withdrawal. These symptoms arise because their body has grown accustomed to Fioricet in high doses.

If a Fioricet-dependent person attempts to weather withdrawal alone, it’s likely they will take Fioricet again just to relieve the symptoms. This is a hallmark characteristic of addiction. Anyone who compulsively abuses Fioricet to avoid withdrawal likely has an addiction to Fioricet. Additionally, people with an addiction to Fioricet will experience cravings for the medication which further compel them to keeping using it.

Moreover, the ingredient butalbital is an addictive substance in its own right. Butalbital can cause someone to “get high” because it’s a central nervous system depressant. Since butalbital is part of Fioricet, it is possible for someone to abuse Fioricet as a recreational drug. At high doses, Fioricet can intoxicate a person in a manner similar to alcohol. People who abuse Fioricet for this purpose have as much of a risk of developing an addiction as they would have if they repeatedly use an illegal drug.

You can not take Prescription for a long time, you need find a way to treat your pain without prescription. Exercising is the best way to relieve your pain. because exercising can enhance your immune system and increase your muscle strength and make your nerve strong.

Returned customer questions and answers

Some returned customers may ask our questions here.

Why you use so many websites ?

Only one website is good enough for you. Our websites are normally hosted by different web hosting providers. Sometimes they may down for no reasons. But as our returned customer, you need read our newsletter and following our newsletter’s websites and emails.

Please do not order in two different websites.

What is your current pharms’s DNS and Refill Days ?

Our current pharms are located in . They all follow US law of refill days and doctor’s licenses.  They all have DNS limitation.

Please check the website for their DNS.  If you are in the DNS state, I am sure the pharm will not ship to you.

Please also check your refill days. If you refill too soon, the pharm will not send you orders either.

I cannot check every order’s refill days. You need check yourself for your refill days.

Because all our customer data are not stored online, so we cannot send you and reminder for refills.

We really do not have time to find the reasons why the pharm didnot send you orders. Normally they have four reasons:

      1. you have sent bounced check;
      2. you did not pick up your last order;
      3. you are in the pharm’s DNS state
      4. you refill too soon.

If you have not recieived your COD orders after four business days, please email me  to find the reasons.

Do you need new customers ?

New customers need strict verification and doctor reviews.  If you are our returned customer, please go to our returned customer only websites. You will get it from our newsletter.

New customer must verify their address themselves by go to USPS website https://tools.usps.com/go/ZipLookupAction_input

AK customers are all recommended to use P.O. Box to send them orders.

We send each new customer a welcome email. You need reply with “yes ” and we will send you COD order.

The Welcome email :

This is first time you order from us. Just want to confirm whether you really want to pick up this COD order. You are familliar with this prescription and have used this prescription before. All our pharms and doctors are us licensed. The doctors have license in your state too. The State will be a DNS state if the Doctors have no license in that state.

The postman normally deliver the order to your home. Your Address should be OK for postman. You can check your address OK or not in USPS system by clicking: https://tools.usps.com/go/ZipLookupAction_input

We will send you tracking ID within two business days after your confirmation. You can also go to USPS to pick it up if you are not in home. Orders must be picked up and pay the postman USPS money Order not Personnel Check.

Please tell us whether you are OK to pick it up. I will place your order into pharm as soon as I get your reply. New customers need to verify so it may take a longer time. If new customer can not pick up his first order successfully, we will not send him order any more.

Please reply “yes” or “no”

“yes” will begin to process your order.

Thanks
Steve

AK Customers for Gabapentin

AK USPS returned a lot of orders. Please use your P.O Box if you live in AK.

 

 

Gabapentin, impotence and other problems?

I was just hoping that you might have the answer I am hoping for?

I started taking gabapentin 300mg twice a day, then 3 times a day, then 600mg twice a day then 3 times a day, now after 2 to 3 years later 800mg 3 times a day.

My doctor says it won’t cause erectile dysfunction but it started very soon after the 300mg 3 times a day. I tried Viagra and Cialis very little help. My wife is very displeased and sometimes thinks it is something to do with her. I know it has nothing to do with her as she is my bride of 24 years and my soul mate spirit. I have very bad pain that the gabapentin used to help with but it now seems it helps no more.

I would rather have my manhood back and my bride be happy and me than be in pain that just won’t go away. To get to the real question, how slowly should I get off the gabapentin and will I ever be able to get back to normal?

I will have to just have to tolerate the pain now that I have my diabetes under control. I rarely have to take my diabetes medicine but a few times a week because it makes my numbers to low and I black out when they get to low.

Usually 82 morning, 92 lunch, and 98 dinner. Any help will be greatly appreciated.

Answers:

Unfortunately gabapentin can cause impotence.

Side effects of the Urogenital System:

Infrequent: urinary tract infection, dysuria, impotence, urinary incontinence, vaginal moniliasis, breast pain, menstrual disorder, polyuria, urinary retention

Rare: cystitis, ejaculation abnormal, swollen penis, gynecomastia, nocturia, pyelonephritis, swollen scrotum, urinary frequency, urinary urgency, urine abnormality.

Talk to your doctor about coming off gabapentin and he/she could put you on some other medicine to help the pain. You don’t have to ween off gabapentin but please get your doctor to monitor you once you are off.

Cautions with other medicines

Some medicines may affect how gabapentin works or increase the chance of you having side effects.

Antacids can reduce the amount of gabapentin that the body takes in so it does not work as well. To stop this happening, if you need to take an antacid, take it at least 2 hours before or after your dose of gabapentin.

Tell your doctor if you’re taking any of these medicines before you start gabapentin treatment:

  • strong painkillers, such as morphine – these can make you very tired and dizzy when you start taking gabapentin
  • antidepressants, such as amitriptyline or fluoxetine
  • antipsychotic medicines for mental health problems like schizophrenia or bipolar disorder
  • a medicine to prevent malaria called mefloquine

Gabapentin Drug Interaction

Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Monitor therapy


Alizapride: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Aluminum Hydroxide: May decrease the serum concentration of Gabapentin. Management: Administer gabapentin at least 2 hours after administration of antacids containing aluminum hydroxide or magnesium hydroxide. Consider therapy modification

Azelastine (Nasal): CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). Avoid combination

Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Consider therapy modification

Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Monitor therapy

Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Bromopride: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Bromperidol: May enhance the CNS depressant effect of CNS Depressants. Avoid combination

Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Consider therapy modification

Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Cannabis: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Consider therapy modification

Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy

CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Monitor therapy

Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Doxylamine: May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended. Monitor therapy

Dronabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Droperidol: May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs. Consider therapy modification

Esketamine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Consider therapy modification

HYDROcodone: CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Kava Kava: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy

Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs. Monitor therapy

Magnesium Salts: May enhance the CNS depressant effect of Gabapentin. Specifically, high dose intravenous/epidural magnesium sulfate may enhance the CNS depressant effects of gabapentin. Magnesium Salts may decrease the serum concentration of Gabapentin. Management: Administer gabapentin at least 2 hours after use of a magnesium-containing antacid. Monitor patients closely for evidence of reduced response to gabapentin therapy. Monitor for CNS depression if high dose IV/epidural magnesium sulfate is used. Consider therapy modification

Mefloquine: May diminish the therapeutic effect of Anticonvulsants. Mefloquine may decrease the serum concentration of Anticonvulsants. Management: Mefloquine is contraindicated for malaria prophylaxis in persons with a history of convulsions. Monitor anticonvulsant concentrations and treatment response closely with concurrent use. Consider therapy modification

Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established. Consider therapy modification

MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Monitor therapy

Mianserin: May diminish the therapeutic effect of Anticonvulsants. Monitor therapy

Minocycline: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Morphine (Systemic): Gabapentin may enhance the CNS depressant effect of Morphine (Systemic). Morphine (Systemic) may increase the serum concentration of Gabapentin. Monitor therapy

Nabilone: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Opioid Agonists: CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Orlistat: May decrease the serum concentration of Anticonvulsants. Monitor therapy

Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Avoid combination

Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Avoid combination

OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Avoid combination

Perampanel: May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. Consider therapy modification

Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Monitor therapy

ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Monitor therapy

Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Monitor therapy

Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Monitor therapy

Selective Serotonin Reuptake Inhibitors: CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. Monitor therapy

Sodium Oxybate: May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated. Consider therapy modification

Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Consider therapy modification

Tapentadol: May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Tetrahydrocannabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Tetrahydrocannabinol and Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Avoid combination

Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Consider therapy modification

Gabapentin is used for Restless legs syndrome

Gabapentin in the management of restless legs syndrome (RLS) has been evaluated in small controlled trials, demonstrating benefits compared with placebo.

Restless legs syndrome (RLS) is a condition that causes an uncontrollable urge to move the legs, usually because of an uncomfortable sensation. It typically happens in the evening or nighttime hours when you’re sitting or lying down. Moving eases the unpleasant feeling temporarily.

Restless legs syndrome, also known as Willis-Ekbom disease, can begin at any age and generally worsens as you age. It can disrupt sleep, which interferes with daily activities.

Simple self-care steps and lifestyle changes may help relieve symptoms. Medications also help many people with RLS.

Gabapentin enacarbil is FDA-approved for the treatment of RLS .

The American Academy of Sleep Medicine (AASM) guidelines regarding RLS management consider gabapentin effective based on low-level evidence and note that patients with pain symptoms appeared to benefit most.

The benefit-risk ratio is unclear. The European Federation of Neurological Societies/European Neurological Society/European Sleep Research Society (EFNS/ENS/ESRS) Task Force guidelines consider gabapentin effective for short-term management and possibly effective for long-term management of RLS.

Additional study is needed to establish optimal dosing. Based on the International Restless Legs Syndrome Study Group, European Restless Legs Syndrome Study Group, and RLS Foundation (IRLSSG/EURLSSG/RLS-F) guidelines for the prevention and treatment of dopaminergic augmentation in restless legs syndrome, α2δ ligands (eg, gabapentin) are effective and should be considered for the initial treatment of patients with RLS due to their minimal risk of augmentation.

Additionally, patients who experience augmentation on dopaminergic agents may benefit from a switch to α2δ ligands (eg, gabapentin). However, the guidelines note that long-term studies are needed.

 

Gabapentin is used for Neuropathic pain (other than postherpetic neuralgia)

In a meta-analysis of trials evaluating the treatment of neuropathic pain, including painful polyneuropathy and spinal cord injury pain, gabapentin was shown to be safe and effective . Data from meta-analyses support the use of immediate-release gabapentin for reducing pain by more than 50% in diabetic neuropathy.

What is neuropathic pain?

Neuropathic pain can happen if your nervous system is damaged or not working correctly. You can feel pain from any of the various levels of the nervous system—the peripheral nerves, the spinal cord and the brain. Together, the spinal cord and the brain are known as the central nervous system. Peripheral nerves are the ones that are spread throughout the rest of your body to places likes organs, arms, legs, fingers and toes.

Damaged nerve fibers send the wrong signals to pain centers. Nerve function may change at the site of the nerve damage, as well as areas in the central nervous system (central sensitization).

Neuropathy is a disturbance of function or a change in one or several nerves. Diabetes is responsible for about 30% of neuropathy cases. It is not always easy to tell the source of the neuropathic pain. There are hundreds of diseases that are linked to this kind of pain.

Data from a limited number of clinical trials support the use of extended-release gabapentin in reducing pain by more than 50% and improving sleep in diabetic neuropathy.

Based on guidelines from the International Association for the Study of Pain (IASP), European Federation of Neurological Societies (EFNS), and Society of Critical Care Medicine (SCCM), gabapentin is effective and recommended for the management of peripheral neuropathy .

Based on guidelines from the EFNS, IASP, and National Institute for Health and Care Excellence (NICE), gabapentin is effective and recommended as first-line therapy, supported by strong evidence, in the management of diabetic neuropathy.

The IASP guidelines recommend both immediate- and extended-release gabapentin . In contrast, a guideline from the American Academy of Neurology (AAN), American Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation states that gabapentin is probably effective and should be considered an alternative treatment for painful diabetic neuropathy based on limited benefit in 2 controlled trials.

Similarly, a position statement from the American Diabetes Association (ADA) recommends gabapentin as a second-line option .

Gabapentin Usage for Alcohol disorder and Alcohol withdrawal

Alcohol use disorder, moderate to severe (alternative agent)

Data from randomized, double-blind, placebo-controlled studies support the use of gabapentin in the maintenance of abstinence in patients with alcohol use disorder.

Based on the American Psychiatric Association (APA) guidelines for the pharmacological treatment of patients with alcohol use disorder, gabapentin is suggested for patients with alcohol use disorder (moderate to severe) who want to decrease or abstain from use of alcohol and either prefer gabapentin or are unable to tolerate or are unresponsive to naltrexone and acamprosate .

Based on the VA/DoD clinical practice guideline for the management of substance use disorders, gabapentin given for moderate to severe alcohol use disorder is effective and suggested when first-line pharmacotherapy is contraindicated or ineffective.

Alcohol withdrawal, mild (alternative agent)

Data from a randomized, double-blind, active-controlled study support the use of gabapentin in the treatment of alcohol withdrawal.

Based on the VA/DoD clinical practice guideline for the management of substance use disorders, gabapentin given for mild alcohol withdrawal is effective and suggested when the risk of benzodiazepines outweigh the benefits (eg, inadequate monitoring available, abuse liability, contraindication, adverse reaction).

Gabapentin Pharmacology

Gabapentin is structurally related to GABA. However, it does not bind to GABAA or GABAB receptors, and it does not appear to influence synthesis or uptake of GABA.

High affinity gabapentin binding sites have been located throughout the brain; these sites correspond to the presence of voltage-gated calcium channels specifically possessing the alpha-2-delta-1 subunit.

Gabapentin 800mg
Gabapentin 800mg

This channel appears to be located presynaptically, and may modulate the release of excitatory neurotransmitters which participate in epileptogenesis and nociception.

Absorption

Variable, from proximal small bowel by L-amino transport system; saturable process; dose-dependent

Vd: 58 ± 6 L; CSF concentrations are ~20% of plasma concentrations

Metabolism

Not metabolized

Excretion

Proportional to renal function; urine (as unchanged drug)

Clearance: Apparent oral clearance is directly proportional to CrCl: Clearance in infants is highly variable; oral clearance (per kg) in children <5 years of age is higher than in children ≥5 years of age

Time to Peak

Immediate release: Infants 1 month to Children 12 years: 2 to 3 hours; Adults: 2 to 4 hours; Extended release: 8 hours

Half-Life Elimination

Infants 1 month to Children 12 years: 4.7 hours

Adults, normal: 5 to 7 hours; increased half-life with decreased renal function; anuric adult patients: 132 hours; adults during hemodialysis: 3.8 hours

Protein Binding

<3%