Bipolar disorder is a lifelong condition that can affect both how you feel and how you act. It is a mood disorder thought to be caused by chemical imbalances in the brain that can result in extreme swings in mood – from manic highs to depressive lows.
AIDS/HIV
AIDS has become a global epidemic and more than 47 million people have been infected with HIV since the first reports of the disease more than twenty years ago. This center provides basic information on the difference between HIV infection and AIDS, details the signs and symptoms of disease, lists means of preventing transmission of the virus and outlines the complicationsassociated with AIDS/HIV as well as common drug treatments.
Allergies and Hayfever
Allergies and allergic disorders are among the most common of medical conditions, affecting more than 20 percent of all Americans. This center contains information relating to the most common allergies and outlines the types of drug treatments available, such as antihistamines, decongestants, nasal sprays, mast-cell stabilizing drugs and non-steroidal anti-inflammatory drugs.
Arthritis
Arthritis is a condition associated with swelling and inflammation of the joints, which often results in pain and restriction of movement. It is estimated that more than 40 million people in America have some form of arthritis. Consult this center if you wish to find more information on the types of arthritis (e.g. osteoarthritis and rheumatoid arthritis) and links to suitable drug treatments.
Cancer
"Cancer" is the term given to a large group of diseases that vary in type and location but have one thing in common: abnormal cells growing out of control. This center contains information on the various causes of cancer, methods of diagnosis and the variety of drugs and treatment options that are available. It also provides detailed information on breast, cervical, lung, prostateand skin cancers. Ask the Expert: Chemotherapy
Cholesterol
Cholesterol is a waxy, fat-like substance that occurs naturally in all parts of the body. Generally speaking, high levels of LDL (bad cholesterol) are associated with an increased risk of developing coronary heart disease, whereas high levels of HDL (good cholesterol) are associated with a decreased risk. Consult this center if you would like more information on the different types of cholesterol, details of how diet and exercise can help maintain desirable cholesterol levels and knowledge of drugs that can aid in achieving this goal.
Diabetes
Diabetes is a chronic metabolic disease characterized by high glucose (sugar) levels in the blood. Insulin, a hormone produced by the pancreas, regulates the amount of glucose in the blood. In patients with diabetes, the body either does not produce enough insulin, or does not adequately respond to the insulin it is producing, which causes blood sugar levels to be higher than normal. This center outlines the different types of diabetes, provides information on how diabetes is diagnosed and treated and lists complications that can occur in association with the disease. Sections include overview, risk factors & preventative measures, symptoms & complications and drug treatment.
Fibromyalgia
Fibromyalgia is a common condition characterized by long-term, body-wide pain and tender points in joints, muscles, tendons, and other soft tissues. It has also been linked to fatigue, morning stiffness, sleep problems, headaches, numbness in hands and feet, depression, and anxiety. Fibromyalgia can develop on its own or along with other musculoskeletal conditions such as rheumatoid arthritis or lupus.
Gastro
Gastroesophageal Reflux Disease (GERD) is a condition resulting from stomach acid moving backward from the stomach into the esophagus (the tube that connects the mouth to the stomach). The acid causes heartburn and can eventually damage the lining of the esophagus causing inflammation and pain. This center lists drugs available for the treatment of GERD and also describes treatment options for Crohn's disease and Peptic ulcers.
Hair Loss
Hair loss is related to the tendency of hair follicles to stop producing hair growth. This center describes the treatments available for reducing the rate of hair loss.
Menopause
Menopause is the transition period in a woman's life when her ovaries stop producing eggs, her body produces less estrogen and progesterone, and menstruation becomes less frequent, eventually stopping altogether. This center describes the causes, symptoms and treatments available for menopause.
Mental Health
Depression is the most common psychological problem in the US. This center contains information relating to the difference between Major and Minor Depression and provides links to common antidepressant drugs.
Sexual Health
Sexual Dysfunction, Erectile Dysfunction and Impotence are all terms for the consistent inability to sustain an erection sufficient for sexual intercourse. Consult this center if you wish to find general information relating to, and links to drugs commonly used for treating, these conditions.
Smoking Cessation
About half of smokers die early of smoking-related illnesses and each year about 46% of them in the US try to quit smoking. This center compares the top drugs and provides useful information on smoking cessation.
For more information on diseases & conditions, please see the following resources:
Codeine is an opioid pain medication. An opioid is sometimes called a narcotic.
Codeine is used to treat mild to moderately severe pain.
Codeine may also be used for purposes not listed in this medication guide.
Important information
You should not use codeine if you are allergic to it, or if you have an uncontrolled breathing disorder, a bowel obstruction called paralytic ileus, or frequent asthma attacks or hyperventilation.
Codeine can slow or stop your breathing. Never use this medicine in larger amounts, or for longer than prescribed. Codeine may also be habit-forming, even at regular doses. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. Keep the medicine in a place where others cannot get to it.
MISUSE OF NARCOTIC MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription.
Medicines that contain codeine should not be given to a child just after surgery to remove the tonsils or adenoids.
Get emergency medical help if a child taking this medication has breathing problems, blue lips, or severe drowsiness, or if you cannot wake the child up from sleep.
Before taking this medicine
You should not use codeine if you are allergic to it, or if you have:
untreated or uncontrolled asthma or other breathing disorder;
a bowel obstruction called paralytic ileus; or
frequent asthma attacks or hyperventilation.
Medicines that contain codeine should not be given to a child just after surgery to remove the tonsils or adenoids.
In some people, codeine breaks down rapidly in the liver and reaches higher than normal levels in the body. This can cause dangerously slow breathing and may cause death, especially in a child.
To make sure this medicine is safe for you, tell your doctor if you have:
liver disease;
asthma, COPD, sleep apnea, or other breathing disorders;
curvature of the spine that affects breathing;
kidney disease;
a history of head injury or brain tumor;
low blood pressure;
blockage in your digestive tract (stomach or intestines);
a gallbladder or pancreas disorder;
underactive thyroid;
Addison's disease or other adrenal gland disorder;
enlarged prostate, urination problems;
mental illness; or
a history of drug or alcohol addiction.
FDA pregnancy category C. It is not known whether this medicine will harm an unborn baby.Codeine may cause breathing problems, behavior changes, or life-threatening addiction and withdrawal symptoms in your newborn if you use the medication during pregnancy. Tell your doctor if you are pregnant.
See also: Pregnancy and breastfeeding warnings (in more detail)
Codeine can pass into breast milk and may harm a nursing baby. The use of codeine by some nursing mothers may lead to life-threatening side effects in the baby. Do not breast-feed while taking this medicine.
Older adults may be more sensitive to the effects of this medicine.
How should I take codeine?
Follow all directions on your prescription label. Codeine can slow or stop your breathing. Never use this medicine in larger amounts, or for longer than prescribed. Tell your doctor if the medicine seems to stop working as well in relieving your pain.
Codeine may be habit-forming, even at regular doses. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. MISUSE OF NARCOTIC MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription. Selling or giving away codeine is against the law.
Take codeine with food or milk if it upsets your stomach.
Measure liquid medicine with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.
Drink 6 to 8 full glasses of water daily to help prevent constipation while you are taking codeine. Do not use a stool softener (laxative) without first asking your doctor.
Do not stop using codeine suddenly after long-term use, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using this medicine.
Store at room temperature away from moisture and heat.
Keep track of the amount of medicine used from each new bottle. Codeine is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.
After you have stopped using this medication, flush any unused pills down the toilet. Disposal of medicines by flushing is recommended to reduce the danger of accidental overdose causing death. This advice applies to a very small number of medicines only. The FDA, working with the manufacturer, has determined this method to be the most appropriate route of disposal and presents the least risk to human safety.
What happens if I miss a dose?
Since codeine is used for pain, you are not likely to miss a dose. Skip any missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. A codeine overdose can be fatal, especially in a child or other person using the medicine without a prescription. Overdose symptoms may include slow breathing and heart rate, severe drowsiness, muscle weakness, cold and clammy skin, pinpoint pupils, and fainting.
What should I avoid while taking codeine?
Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with codeine. Check your food and medicine labels to be sure these products do not contain alcohol.
Codeine may impair your thinking or reactions. Avoid driving or operating machinery until you know how this medicine will affect you. Dizziness or severe drowsiness can cause falls or other accidents.
Codeine side effects
Get emergency medical help if you have any of these signs of an allergic reaction to codeine: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Seek emergency medical attention if a child taking this medication has any of the following life-threatening side effects: noisy breathing, sighing, slow breathing with long pauses between breaths; being unusually sleepy or hard to wake up; blue colored lips.
In addition to its needed effects, some unwanted effects may be caused by codeine. In the event that any of these side effects do occur, they may require medical attention.
You should check with your doctor immediately if any of these side effects occur when taking codeine:
Incidence not known
Bloating
blurred vision
chills
cold, clammy skin
confusion
constipation
darkened urine
difficult or troubled breathing
dizziness
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fainting
fast, irregular, pounding, or racing heartbeat or pulse
fast, weak pulse
feeling of warmth
fever
indigestion
irregular, fast or slow, or shallow breathing
lightheadedness
loss of appetite
nausea
no blood pressure or pulse
no breathing
pains in the stomach, side, or abdomen, possibly radiating to the back
pale or blue lips, fingernails, or skin
redness of the face, neck, arms, and occasionally, upper chest
shortness of breath
stopping of the heart
sweating
unconsciousness
unusual tiredness or weakness
vomiting
wheezing
yellow eyes or skin
If any of the following symptoms of overdose occur while taking codeine, get emergency help immediately:
Symptoms of overdose
Bluish lips or skin
change in consciousness
chest pain or discomfort
constricted, pinpoint, or small pupils (black part of the eye)
decreased awareness or responsiveness
extreme sleepiness or unusual drowsiness
loss of consciousness
no blood pressure or pulse
severe sleepiness
slow or irregular heartbeat
Some of the side effects that can occur with codeine may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:
More common
Drowsiness
relaxed and calm
Incidence not known
Abdominal or stomach pain or cramps
blurred or loss of vision
diarrhea
disturbed color perception
double vision
dry mouth
false or unusual sense of well-being
fear or nervousness
feeling of constant movement of self or surroundings
The side effects have been more likely and more severe in patients with liver and/or renal disease.
Nervous system
Nervous system side effects have included mental and respiratory depression, stupor, delirium, somnolence, and dysphoria. An increased risk of falls and hip fractures has also been associated with codeine therapy, particularly in the elderly. A case of seizures has been reported with the use of intravenous codeine phosphate.
Opioids may result in psychotic symptoms in some patients.
One retrospective study of elderly patients who sustained a hip fracture suggested that the relative risk of hip fracture was 1.6 in patients using codeine compared to age matched nonusers.
Other
Other side effects including withdrawal symptoms after either abrupt cessation or fast tapering of narcotic analgesics have been reported. These withdrawal symptoms have included agitation, restlessness, anxiety, insomnia, tremor, abdominal cramps, blurred vision, vomiting, and sweating.
Cardiovascular
Hypotension is rare and has been reported most frequently with high doses.
Cardiovascular side effects have included hypotension and dizziness.
Gastrointestinal
Gastrointestinal side effects including nausea, vomiting, and constipation have been reported frequently. Severe constipation and ileus resulting in colonic perforation have also been reported. Four cases of acute pancreatitis have been reported.
Genitourinary
Genitourinary side effects including urinary retention have been reported.
Dermatologic
Dermatologic side effects including rashes, severe scarlatiniform eruptions, and generalized dermatitis have been reported rarely.
Codeine induced rashes may be related to direct stimulation of histamine release.
Renal
Renal side effects including acute renal failure (which may respond to naloxone therapy) have been reported in association with codeine therapy.
Immunologic
Immunologic side effects have included one study of a patient with exercise induced anaphylaxis and three control subjects which found a correlation between codeine wheal size and recent exercise.
Hypersensitivity
Hypersensitivity side effects including a case of codeine phosphate induced hypersensitivity syndrome have been reported.
Ocular
Ocular side effects including a temporary 26% decrease in pupil diameter following the administration of intravenous codeine have been reported.
Respiratory
Respiratory side effects have included respiratory depression.
Methamphetamine may be sold illegally, either as pure dextromethamphetamine or in an equal parts mixture of the right and left handed molecules (i.e., 50% levomethamphetamine and 50% dextromethamphetamine). Both dextromethamphetamine and racemic methamphetamine are schedule II controlled substances in the United States. Similarly, the production, distribution, sale, and possession of methamphetamine is restricted or illegal in many other countries due to its placement in schedule II of the United Nations Convention on Psychotropic Substances treaty. In contrast, levomethamphetamine is an over-the-counter drug in the United States.
In low doses, methamphetamine can cause an elevated mood and increase alertness, concentration, and energy in fatigued individuals. At higher doses, it can induce psychosis, rhabdomyolysis and cerebral hemorrhage. Methamphetamine is known to have a high potential for abuse and addiction. Recreational use of methamphetamine may result in psychosis or lead to post-withdrawal syndrome, a withdrawal syndrome that can persist for months beyond the typical withdrawal period. Unlike amphetamine, methamphetamine is neurotoxic to humans, damaging both dopamine and serotonin neurons in the CNS. Contrary to the long-term use of amphetamine, there is evidence that methamphetamine causes brain damage from long-term use in humans; this damage includes adverse changes in brain structure and function, such as reductions in gray matter volume in several brain regions and adverse changes in markers of metabolic integrity.
Uses
Medical
In the United States, methamphetamine hydrochloride, under the trade name Desoxyn, has been approved by the USFDA for treatingADHD and exogenous obesity (obesity originating from factors outside of the patient's control) in both adults and children;however, the USFDA also indicates that the limited therapeutic usefulness of methamphetamine should be weighed against the inherent risks associated with its use. In the United States, methamphetamine's levorotary form is available in some over-the-counter nasal decongestant products, such as Vicks VapoInhaler.
As methamphetamine is associated with a high potential for misuse, the drug is regulated under the Controlled Substances Act and islisted under schedule II in the United States. Methamphetamine hydrochloride dispensed in the United States is required to include the following black box warning:
“
Methamphetamine has a high potential for abuse and should be tried only in weight reduction programs where alternative therapy has been ineffective. Administration of Methamphetamine for prolonged periods may lead to drug dependence. The drug should be prescribed or dispensed sparingly. Misuse may cause sudden death and serious cardiovascular adverse events.
Methamphetamine users and addicts may lose their teeth abnormally quickly, regardless of the route of administration, from a condition informally known as meth mouth. The condition is generally most severe in users who inject the drug, rather than those who smoke, ingest or inhale it. According to the American Dental Association, meth mouth "is probably caused by a combination of drug-induced psychological and physiological changes resulting in xerostomia (dry mouth), extended periods of poor oral hygiene, frequent consumption of high-calorie, carbonated beverages and bruxism (teeth grinding and clenching)". Many researchers suggest that meth-induced tooth decay is due to users' lifestyles, as dry mouth is also a side effect of prescription stimulants, which aren't known to cause serious tooth decay. They suggest that that the side effect has been exaggerated and stylized to deter potential users and stereotype current users.
This diagram depicts the signaling events in the brain's reward center that are induced by chronic high-dose exposure to psychostimulants that increase the concentration of synaptic dopamine, like amphetamine,methylphenidate, and phenethylamine, and cocaine. Following presynaptic dopamine and glutamateco-release by a drug, postsynaptic receptors for these neurotransmitters trigger internal signaling events through a cAMP pathway and calcium-dependent pathway that ultimately result in increased CREBphosphorylation. Phosphorylated CREB increases levels of ΔFosB, which in turn represses the c-fos gene with the help of corepressors. A highly stable (phosphorylated) form of ΔFosB, one that persists in neurons for one or two months, slowly accumulates following repeated exposure to stimulants through this process. ΔFosB functions as "one of the master control proteins" that produces addiction-relatedstructural changes in the brain, and upon sufficient accumulation, with the help of its downstream targets (e.g., nuclear factor kappa B), it induces an addictive state.
Tolerance is expected to develop with regular methamphetamine use and, when abused, this tolerance develops rapidly.
The evidence on effective treatments for amphetamine and methamphetamine dependence and abuse is limited. In light of this, fluoxetine andimipramineappear to have some limited benefits in treating abuse and addiction, "no treatment has been demonstrated to be effective for the treatment of [methamphetamine] dependence and abuse".
In highly dependent amphetamine and methamphetamine abusers, "when chronic heavy users abruptly discontinue [methamphetamine] use, many report a time-limited withdrawal syndrome that occurs within 24 hours of their last dose". Withdrawal symptoms in chronic, high-dose users are frequent, occurring in up to 87.6% of cases, and persist for three to four weeks with a marked "crash" phase occurring during the first week. Methamphetamine withdrawal symptoms can include anxiety, drug craving, dysphoric mood,fatigue, increased appetite, increased movement or decreased movement,lack of motivation, sleeplessness or sleepiness, and vivid or lucid dreams.Withdrawal symptoms are associated with the degree of dependence (i.e., the extent of abuse). The mental depression associated with methamphetamine withdrawal lasts longer and is more severe than that of cocaine withdrawal.
Current models of addiction from chronic drug use involve alterations in gene expression in certain parts of the brain. The most important transcription factors that produce these alterations are ΔFosB, cyclic adenosine monophosphate (cAMP) response element binding protein (CREB), and nuclear factor kappa B (NFκB). ΔFosB is the most significant, since its overexpression in the nucleus accumbens is necessary and sufficient for many of the neural adaptations seen in drug addiction; it has been implicated in addictions to alcohol, cannabinoids, cocaine, nicotine, phenylcyclidine, andsubstituted amphetamines. ΔJunD is the transcription factor which directly opposes ΔFosB. Increases in nucleus accumbens ΔJunD expression can reduce or, with a large increase, even block most of the neural alterations seen in chronic drug abuse (i.e., the alterations mediated by ΔFosB). ΔFosB also plays an important role in regulating behavioral responses to natural rewards, such as palatable food, sex, and exercise. Since natural rewards, like drugs of abuse, induce ΔFosB, chronic acquisition of these rewards can result in a similar pathological addictive state. Consequently, ΔFosB is the key transcription factor involved in amphetamine addiction, especially amphetamine-induced sex addictions. ΔFosB inhibitors (drugs that oppose its action) may be an effective treatment for addiction and addictive disorders.
Neurotoxicity
Unlike amphetamine, methamphetamine is directly neurotoxic to dopamine neurons. Moreover, methamphetamine abuse is associated with an increased risk of Parkinson's disease due to excessive pre-synaptic dopamine autoxidation, a mechanism of neurotoxicity. Similar to the neurotoxic effects on the dopamine system, methamphetamine can also result in neurotoxicity to serotonin neurons. It has been demonstrated that a high core temperature is correlated with an increase in the neurotoxic effects of methamphetamine. As a result of methamphetamine-induced neurotoxicity to dopamineneurons, chronic use may also lead to post acute withdrawals which persist beyond the withdrawal period for months, and even up to a year.
Sexually transmitted infection
Methamphetamine use was found to be related to higher frequencies of unprotected sexual intercourse in both HIV-positive and unknown casual partners, an association more pronounced in HIV-positive participants.These findings suggest that methamphetamine use and engagement in unprotected anal intercourse are co-occurring risk behaviors, behaviors that potentially heighten the risk of HIV transmission among gay and bisexual men. Methamphetamine use allows users of both sexes to engage in prolonged sexual activity, which may cause genital sores and abrasions as well as priapism in men. Methamphetamine may also cause sores and abrasions in the mouth via bruxism, increasing the risk of sexually transmitted infection.
Besides the sexual transmission of HIV, it may also be transmitted between users who share a common needle. The level of needle sharing among methamphetamine users is similar to that among other drug injection users.
