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Tamiflu

Tamiflu

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Tamiflu 75mg 10 tablets $325.50 Click to Buy  

Online Pharmacy Next Day Overnight Delivery of tamiflu Prescription Medication You can now buy prescription Tamiflu online through a licensed US pharmacy located in your region using your credit card, including the one issued by your HSA. Oseltamivir is used to treat some types of influenza (flu) in patients who have had symptoms of the flu for 2 days or less. Oseltamivir is in a class of drugs called neuraminidase inhibitors. These drugs work by stopping the growth and spread of the flu virus in your body. Oseltamivir helps shorten the time you have flu symptoms such as nasal congestion, sore throat, cough, muscle aches, tiredness, headache, fever, and chills.



Urgent Pharmacy Prescriptions will process your Tamiflu order as soon as possible. In most cases, your prescription for Tamiflu will be processed within one business day and shipped via FedEx overnight delivery to you. Our network of physicians and pharmacists are based and licensed in the United States so you can be confident that you are receiving only US FDA approved medications in your order. Your prescription for Tamiflu will be handled with care and the utmost urgency. Please contact us at 1-888-738-3822 with any questions you may have regarding your order for Tamiflu.

TAMIFLU DRUG INFO


Why is this medication prescribed?

Oseltamivir is used to treat some types of influenza (flu) in patients who have had symptoms of the flu for 2 days or less. Oseltamivir is in a class of drugs called neuraminidase inhibitors. These drugs work by stopping the growth and spread of the flu virus in your body. Oseltamivir helps shorten the time you have flu symptoms such as nasal congestion, sore throat, cough, muscle aches, tiredness, headache, fever, and chills.

How should this medicine be used?

Oseltamivir comes as a capsule to take by mouth. It is usually taken twice daily for five days. Oseltamivir may be taken with or without food. Oseltamivir can cause an upset stomach; you can lessen this side effect by taking oseltamivir with food. Follow the directions on your prescription label carefully, and ask your doctor pharmacist to explain any part that you do not understand. Take oseltamamivir exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Continue to take oseltamivir even if you start to feel better. Do not stop taking oseltamivir without talking to your doctor.

What special precautions should I follow?

Before taking oseltamivir,

  • tell your doctor and pharmacist if you are allergic to oseltamivir or any other drugs.
  • tell your doctor what prescription and nonprescription medications you are taking, including vitamins and herbal products.
  • tell your doctor if you have or have ever had kidney disease.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking oseltamivir, call you doctor immediately.
What should I do if I forget a dose?

If you forget to take a dose, take it as soon as you remember it. If it is 2 hours or less until the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Although side effects from oseltamivir are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away:

  • upset stomach
  • vomiting
  • difficulty sleeping
  • bronchitis
  • dizziness
What storage conditions are needed for this medicine?

Keep this medicine in the container it came in and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

What other information should I know?

Oseltamivir will not stop you from giving the flu to others. You should maintain proper hygiene, wash your hands frequently, and avoid situations such as sharing cups and utensils that can spread the virus to others.

Oseltamivir does not replace the flu vaccine. You should continue to receive a flu shot each year if your doctor recommends it.

Do not let anyone else take your medication. Your prescription is probably not refillable. If you still have symptoms of the flu after you finish the oseltamivir, call your doctor.

Condylox

Condylox

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Condylox (Gel) .5% 1 tube $235.50 Click to Buy  
Condylox (Gel) .5% 2 tube $345.50 Click to Buy  
Condylox (Solution) .5% 1 bottle $219.95 Click to Buy  
Condylox (Solution) .5% 2 bottle $335.50 Click to Buy  
Condylox Generic Solution (Podofil) 5% 1 bottle $240.50 Click to Buy  
Condylox Generic Solution (Podofil) 5% 3 bottle $277.06 Click to Buy  

Online Next Day Overnight Delivery of condylox Prescription Medication You can now buy prescription Condylox online through a licensed US pharmacy located in your region using your credit card, including the one issued by your HSA. Podofilox (po-do-FIL-ox) is used to remove certain types of warts on the outside skin of the genital areas (penis or vulva). The gel is used also to treat warts between the genitals and the rectum, the solution is not. Neither the gel nor the solution is used to treat warts that occur inside the rectum, vagina, or urine passageways inside the penis (male) or the vulva (female). Podofilox works by destroying the skin of the wart.

Other items in this category include: Aldara

Click any link below to complete the health questionnaire and order form or call one of our helpful customer service representatives at 1 (888) 738-3822.



Urgent Pharmacy Prescriptions will process your Condylox order as soon as possible. In most cases, your prescription for Condylox will be processed within one business day and shipped via FedEx overnight delivery to you. Our network of physicians and pharmacists are based and licensed in the United States so you can be confident that you are receiving only US FDA approved medications in your order. Your prescription for Condylox will be handled with care and the utmost urgency. Please contact us at 1-888-738-3822 with any questions you may have regarding your order for Condylox.

CONDYLOX DRUG INFO


Brand Names

In the U.S.—

  • Condylox

Another commonly used name is podophyllotoxin.

Category
  • Antimitotic agent (topical)

Description

Podofilox (po-do-FIL-ox) is used to remove certain types of warts on the outside skin of the genital areas (penis or vulva). The gel is used also to treat warts between the genitals and the rectum, the solution is not. Neither the gel nor the solution is used to treat warts that occur inside the rectum, vagina, or urine passageways inside the penis (male) or the vulva (female). Podofilox works by destroying the skin of the wart.

This medicine is available only with your doctor's prescription, in the following dosage form(s):

    Topical
  • Gel (U.S.)
  • Solution (U.S.)


Before Using This Medicine

In deciding to use a medicine, the risks of using the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For podofilox, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to podofilox. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Podofilox has not been studied in pregnant women. However, studies in rats have shown that podofilox causes problems during pregnancy when injected at high doses. Topical podofilox may be absorbed into the skin at certain doses. Before using this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding—It is not known whether topical podofilox passes into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are using this medicine and who wish to breast-feed should discuss this with their doctor.

Children—Studies of this medicine have been done only in adult patients, and there is no specific information comparing use of podofilox in children with use in other age groups.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of podofilox in the elderly with use in other age groups.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your doctor and pharmacist if you are using any other prescription or nonprescription (over-the-counter [OTC]) medicine.



Proper Use of This Medicine

A paper with information for the patient will be given to you with your filled prescription and will provide many details concerning the use of podofilox. Read this paper carefully and ask your health care professional if you need additional information.

Also, keep podofilox away from the eyes and mucous membranes, such as the inside of the penis, rectum, or vagina. This medicine may cause severe irritation. If you get this medicine in your eyes or on one of these areas, immediately flush the area with water for 15 minutes.

Use podofilox only as directed, no more than 3 days a week and no more than 4 treatment cycles. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. To do so may increase the chances that this medicine is absorbed into the body and that side effects could occur.

Do not apply the medicine to any other wart until you discuss it with your doctor. The total dose of podofilox used on all warts should not exceed that which would cover an area measuring 1.6 square inches (10 square centimeters), about the size of a dollar coin.

To use:

  • To apply the solution, use the applicators that come with the solution or a cotton-tipped applicator. To apply the gel, use a cotton-tipped applicator or your finger. Never reuse an applicator or dip a used applicator into the bottle.
  • Apply podofilox only to the wart(s) discussed with your doctor.
  • Podofilox can cause severe irritation of normal skin. If you get medicine on normal skin, wash it off immediately.
  • Make sure the treated area is dry before allowing the treated skin to come in contact with normal, untreated skin.
  • Immediately after applying this medicine, wash your hands to remove any medicine. Properly discard used applicator(s).

Dosing—

The dose of podofilox will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of podofilox. If your dose is different, do not change it unless your doctor tells you to do so.

  • For topical dosage form (gel):
    • For warts on penis or vulva (genitals) or on skin between genitals and rectum:
      • Adults—Apply to the wart(s) two times a day for three days in a row using an applicator tip or finger. Skip four days by not applying any medicine for four days in a row. If the wart can still be seen, this application cycle may be repeated each week for up to four weeks, until the wart is gone. No more than 0.5 grams of gel should be used each day of treatment.
      • Children—Use and dose must be determined by the doctor.
  • For topical dosage form (solution):
    • For warts on penis or vulva (genitals) only:
      • Adults—Apply to the wart(s) two times a day (every twelve hours) for three days in a row using applicator tip. Skip four days by not applying any medicine for four days in a row. If the wart can still be seen, this application cycle may be repeated each week for up to four weeks, until the wart is gone. No more than 0.5 milliliters of solution should be used each day of treatment.
      • Children—Use and dose must be determined by the doctor.

Missed dose—

If you miss a dose of this medicine, apply it as soon as possible. Then go back to your regular dosing schedule.

Storage—

To store this medicine:

  • Keep out of the reach of children.
  • Store away from heat and direct light.
  • Keep top tightly closed.
  • Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

Podofilox may not be able to prevent previously healed warts from reappearing or stop new warts from growing.

This medicine contains alcohol and therefore may be flammable. Do not use near heat, near open flame, or while smoking.


Side Effects of This Medicine
Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • More common
    • Bad odor (solution only);  bleeding of treated skin;  blistering, crusting, or scabbing of treated skin;  bloody urine (solution only);  burning feeling of treated skin;  dizziness (solution only);  headache (gel only);  itching of treated skin;  pain during sexual intercourse (solution only);  pain of treated skin;  problems with foreskin of penis (solution only) ;  redness or swelling of treated skin;  scarring of treated skin (solution only);  skin ulcers of treated skin;  vomiting (solution only)  

  • Symptoms of overdose--in order of occurrence
    • Nausea;  vomiting;  diarrhea ;  chills;  fever;  sore throat;  unusual bleeding or bruising ;  oral ulcers 

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

  • More common
    • Dryness of treated skin;  peeling of treated skin;  soreness or tenderness of treated skin ;  stinging or tingling of treated skin;  trouble in sleeping (solution only) 

  • Less common
    • Changes in color of treated skin (gel only);  skin rash (gel only) 

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Viagra

Viagra

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Online Next Day Overnight Delivery of viagra Prescription Medication You can now buy prescription Viagra online through a licensed US pharmacy located in your region using your credit card, including the one issued by your HSA. Viagra is taken by mouth as needed between four hours and one-half hour before sexual activity (about one hour before is most effective). Take only as directed, usually once daily as needed. Sildenafil works along with sexual stimulation to help achieve an erection.

Other items in this category include: Cialis, Levitra

Click any link below to complete the health questionnaire and order form or call one of our helpful customer service representatives at 1 (888) 738-3822.



Urgent Pharmacy Prescriptions will process your Viagra order as soon as possible. In most cases, your prescription for Viagra will be processed within one business day and shipped via FedEx overnight delivery to you. Our network of physicians and pharmacists are based and licensed in the United States so you can be confident that you are receiving only US FDA approved medications in your order. Your prescription for Viagra will be handled with care and the utmost urgency. Please contact us at 1-888-738-3822 with any questions you may have regarding your order for Viagra.

VIAGRA DRUG INFO


IMPORTANT NOTE: The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using this drug.

SILDENAFIL - ORAL (sill-DEN-uh-fil)

COMMON BRAND NAME(S): Viagra

USES: This medication is used to treat male sexual function problems (erection problems).

HOW TO USE: This drug is taken by mouth as needed between four hours and one-half hour before sexual activity (about one hour before is most effective). Take only as directed, usually once daily as needed. Sildenafil works along with sexual stimulation to help achieve an erection.

SIDE EFFECTS: Headache, flushing, stomach upset, nasal stuffiness, diarrhea and dizziness might occur. If these effects persist or worsen, notify your doctor promptly. Unlikely but report promptly: painful or other urination problems, vision problems, skin rash. Very unlikely but report promptly: chest pain, fainting, foot or ankle swelling. If you experience a painful or prolonged erection (lasting longer than 4 hours), stop using this drug and seek immediate medical attention. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: Before using this drug, tell your doctor your medical history, including: allergies (especially drug allergies), penis conditions such as fibrosis/scarring (e.g., Peyronie's disease), history of painful/prolonged erection (priapism), sickle cell anemia, blood system cancers (such as leukemia or myeloma), eye problems (retina diseases), kidney or liver disease, bleeding disorders, active stomach ulcers, heart disease, stroke, very high or low blood pressure. Limit alcohol intake, as it may aggravate side effects of this drug. Since this drug may cause dizziness, caution is advised when performing tasks requiring alertness (e.g., driving). To avoid dizziness and lightheadedness when rising from a seated or lying position, get up slowly. This drug is not to be used in women or children. The elderly may be more sensitive to the side effects of this drug; therefore caution is advised in this group.

DRUG INTERACTIONS: Tell your doctor of all nonprescription and prescription medication you may use, especially of: nitrate medications (e.g., nitroglycerin, isosorbide dinitrate), nitroprusside (any "nitric oxide donor" medicines), cimetidine, erythromycin, azole antifungals (e.g., itraconazole, ketoconazole), mibefradil, rifamycins (e.g., rifampin), high blood pressure medicines, certain HIV protease inhibitors (such as saquinavir, ritonavir, amprenavir), delavirdine. Do not start or stop any medicine without doctor or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include severe dizziness, fainting, or prolonged erection.

NOTES: Do not share this medication with others, since they may have a problem that is not effectively treated by this drug. Use of this drug does not protect against sexually transmitted diseases (e.g., HIV, Hepatitis B, gonorrhea, syphilis)

MISSED DOSE: Not applicable.

STORAGE: Store at room temperature between 59 and 86 degrees F (15-30 degrees C) away from light and moisture.

Rozerem

Rozerem

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Rozerem 8mg 30 Tablets $155.50 Click to Buy  
Rozerem 8mg 60 Tablets $255.50 Click to Buy  
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You can now buy prescription Rozerem online through a licensed US pharmacy located in your region using your credit card, including the one issued by your HSA. Rozerem is a sedative, also called a hypnotic. It affects chemicals in your brain that may become unbalanced and cause sleep problems (insomnia). Rozerem is used to treat insomnia. This medication causes relaxation to help you fall asleep and stay asleep. Rozerem may also be used for purposes other than those listed in this medication guide.



Urgent Pharmacy Prescriptions will process your Rozerem order as soon as possible. In most cases, your prescription for Rozerem will be processed within one business day and shipped via FedEx overnight delivery to you. Our network of physicians and pharmacists are based and licensed in the United States so you can be confident that you are receiving only US FDA approved medications in your order. Your prescription for Rozerem will be handled with care and the utmost urgency. Please contact us at 1-888-738-3822 with any questions you may have regarding your order for Rozerem.

Tramadol

Tramadol

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Tramadol 50mg (Generic for Ultram) 180 Tablets $125.50 Click to Buy  
Tramadol 50mg (Generic for Ultram) 30 Tablets $75.50 Click to Buy  
Tramadol 50mg (Generic for Ultram) 90 Tablets $95.50 Click to Buy  

Online Next Day Overnight Delivery of tramadol Prescription Medication You can now buy prescription Tramadol online through a licensed US pharmacy located in your region using your credit card, including the one issued by your HSA. Tramadol is used to relieve moderate to moderately severe pain. It also may be used to treat pain caused by surgery and chronic conditions such as cancer or joint pain. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

Other items in this category include: Butalbital, Ultracet, Ultram

Click any link below to complete the health questionnaire and order form or call one of our helpful customer service representatives at 1 (888) 738-3822.



Urgent Pharmacy Prescriptions will process your Tramadol order as soon as possible. In most cases, your prescription for Tramadol will be processed within one business day and shipped via FedEx overnight delivery to you. Our network of physicians and pharmacists are based and licensed in the United States so you can be confident that you are receiving only US FDA approved medications in your order. Your prescription for Tramadol will be handled with care and the utmost urgency. Please contact us at 1-888-738-3822 with any questions you may have regarding your order for Tramadol.

TRAMADOL DRUG INFO


IMPORTANT NOTE: The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using this drug.

TRAMADOL - ORAL (TRAH-muh-dall)

COMMON BRAND NAME(S): Ultram

USES: Tramadol is used to relieve moderate to moderately severe pain. It also may be used to treat pain caused by surgery and chronic conditions such as cancer or joint pain. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

HOW TO USE: Take this medication by mouth as prescribed. It is usually taken every 4 to 6 hours as needed. Use this medication exactly as prescribed. Do not increase your dose, use it more frequently or use it for a longer period of time than prescribed because this drug can be habit-forming. Also, if used for an extended period of time, do not suddenly stop using this drug without your doctor's approval. When used for extended periods, this medication may not work as well and may require different dosing. Consult your doctor if the medication stops working well.

SIDE EFFECTS: This medication may cause dizziness, weakness, incoordination, nausea or vomiting, stomach upset, constipation, headache, drowsiness, anxiety, irritability, dry mouth, or increased sweating. If any of these effects persist or worsen, inform your doctor. Notify your doctor if you develop any of these serious effects while taking this medication: chest pain, rapid heart rate, skin rash or itching, mental confusion, disorientation, seizures, tingling of the hands or feet, trouble breathing. In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, breathing trouble. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: Tell your doctor your medical history, especially of: kidney disease, liver disease, seizure disorder, lung disease, history of drug or alcohol dependency, any allergies you may have. Limit alcohol as it may add to the dizziness or drowsiness effects caused by the medication. Because this drug may make you dizzy/drowsy, use caution performing tasks requiring alertness such as driving. This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. Tramadol is excreted into breast milk. Because the effects on a nursing infant are not known, consult your doctor before breast- feeding.

DRUG INTERACTIONS: Tell your doctor of all prescription and nonprescription medications you may use, especially of: carbamazepine, narcotic pain relievers (e.g., codeine), drugs used to aid sleep, antidepressants (e.g., SSRI-types such as fluoxetine or fluvoxamine), MAO inhibitors (e.g., furazolidone, linezolid, phenelzine, procarbazine, selegiline, tranylcypromine), psychiatric medicine (e.g., nefazodone), "triptan"-type drugs, anti-anxiety drugs (e.g., diazepam), sibutramine. Also, report use of certain antihistamines (e.g., diphenhydramine) which are also present in many cough-and-cold products. Do not start or stop any medicine without doctor or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include cold and clammy skin, low body temperature, slowed breathing, slowed heartbeat, drowsiness, dizziness, lightheadedness, deep sleep, loss of consciousness, or seizures.

NOTES: Do not share this medication with others.

MISSED DOSE: If you miss a dose, take it as soon as remembered; do not take it if it is near the time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store this medication at room temperature between 59 and 86 degrees F (15 to 30 degrees C) away from heat and light. Do not store in the bathroom. Keep this and all medications out of the reach of children.

Tramadol

From Wikipedia, the free encyclopedia

Chemical structure of 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)

Legal status

Prescription Only (S4)(AU) POM(UK)

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, some of which are listed below.

Tramadol is usually marketed as the hydrochloride salt (tramadol hydrochloride) and is available in both injectable (intravenous and/or intramuscular) and oral preparations (e.g. Zydol in UK and Australia, Ultram in U.S., Zytrim in Spain and Canada, and Calmador in Argentina). It is also available in conjunction with paracetamol (acetaminophen) as Ultracet or Tramacet.

Dosages vary depending on the degree of pain experienced by the patient. 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.

Unlike most other opioids, Tramadol is not considered a controlled substance in many countries (U.S. and Canada, among others), and is available with a normal prescription. Tramadol is available over-the-counter without prescription in a few countries.[3]

Contents

Uses

Tramadol is often used to treat moderate and severe pain and most types of neuralgia, including trigeminal neuralgia.[citation needed]

It is 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.

Off-label and investigational uses

Veterinary

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

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. 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 1/6th 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).

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.

Metabolism

Tramadol undergoes hepatic metabolism via the cytochrome P450 isozyme CYP2D6, being O- and N-demethylated to 5 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 9 hours compared to 6 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.

Adverse effects

The most commonly reported adverse drug reactions are nausea, vomiting and sweating. Drowsiness is reported, although it is less of an issue compared to 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 finds that of 97 confirmed new-onset seizures, 8 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.

Dependence

Some controversy exists regarding the dependence liability of tramadol. Grünenthal has promoted it as an opioid with a low risk of opioid dependence compared to 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.

Despite these claims it is apparent, in community practice, that dependence to this agent does occur. This would be expected since analgesic and dependence effects are mediated by the same μ-opioid receptor. 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. [citation needed]

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."

Proprietary preparations

Grünenthal, which still owns the patent to tramadol, has cross-licensed the agent to various pharmaceutical companies internationally. Thus tramadol is marketed under many trade names including: Adolan, Adolonta, Anadol, Calmador, Contramal, Crispin, Lumidol, Mandolgine, Mosepan, Nobligan, Poltram, Sintradon, Siverol, Tiparol, Toplagic, Tradol, Tradolan, Tralgit, Tramacet, Tramacip, Tramadin, Tramal, Tramahexal, Tramazac, Trama-Klosidol, Tramedo, Trodon, Ultracet, Ultram, Zaldiar, Zamadol, Zydol and Zytram.

Trivia

Footnotes

  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. ^ 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): 1842-6. PMID 9633738. 
  5. ^ 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. 
  6. ^ 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: 34-9. PMID 9190323. 
  7. ^ 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. 
  8. ^ 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. 
  9. ^ Lauerma H, Markkula J (1999). "Treatment of restless legs syndrome with tramadol: an open study". The Journal of clinical psychiatry 60 (4): 241-4. PMID 10221285. 
  10. ^ 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. 
  11. ^ 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. 
  12. ^ 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): 143-8. DOI:10.1007/s10194-005-0169-y. PMID 16355295. 
  13. ^ Goldsmith TB, Shapira NA, Keck PE (1999). "Rapid remission of OCD with tramadol hydrochloride". The American journal of psychiatry 156 (4): 660-1. PMID 10200754. 
  14. ^ 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. 
  15. ^ King, Steven A. (2007-06-01). "NSAIDs and Cardiovascular Disease". Psychiatric Times 24 (7). Retrieved on 2007-08-01. 
  16. ^ 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): 465-476. Retrieved on 2007-01-13. 
  17. ^ Zahlaway, Jon. "Autopsy shows ODB died of accidental drug overdose", LiveDaily, December 15, 2004. Retrieved on 2007-01-13. 

References

  • Goeringer K, Logan B, Christian G. "Identification of tramadol and its metabolites in blood from drug-related deaths and drug-impaired drivers.". J Anal Toxicol 21 (7): 529-37. PMID 9399121. 
  • Labate A, Newton M, Vernon G, Berkovic S (2005). "Tramadol and new-onset seizures.". emja: The Medical Journal of Australia 182 (1): 42-43. 
  • (2004) in Ed. Rossi S: Australian Medicines Handbook. Adelaide: Australian Medicines Handbook. ISBN 0-9578521-4-2. 
  • Shipton E (2000). "Tramadol--present and future.". Anaesth Intensive Care 28 (4): 363-74. PMID 10969362. 
  • Ultram (PDF). Ortho-McNeil. – U.S. Prescribing Information
  • McDiarmid T, Mackler L, Schneider D (January 2005). "Clinical inquiries. What is the addiction risk associated with tramadol?". J Fam Pract 54 (1): 72-3. PMID 15623411. 

External links

Yasmin

Yasmin

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Online Next Day Overnight Delivery of yasmin Prescription Medication You can now buy prescription Yasmin online through a licensed US pharmacy located in your region using your credit card, including the one issued by your HSA. Traditionally, oral contraceptives (OCs) have had very similar progestins. Even recently developed progestins have all had structures resembling androgens — until now.

YASMIN is the only OC with the novel, dual-property progestin, drospirenone — the only progestin that has AntiMineralocorticoid and AntiAndrogenic* properties. Drospirenone represents a unique class of progestins with an entirely different molecular structure and activity profile than the currently available progestins. Drospirenone is an analogue of spironolactone.

Other items in this category include: Alesse, Diflucan, Estradiol, Fluconazole, Mircette, Ortho Evra Patch, Ortho Tri-Cyclen, Plan B, Seasonale, Vaniqa

Click any link below to complete the health questionnaire and order form or call one of our helpful customer service representatives at 1 (888) 738-3822.



Urgent Pharmacy Prescriptions will process your Yasmin order as soon as possible. In most cases, your prescription for Yasmin will be processed within one business day and shipped via FedEx overnight delivery to you. Our network of physicians and pharmacists are based and licensed in the United States so you can be confident that you are receiving only US FDA approved medications in your order. Your prescription for Yasmin will be handled with care and the utmost urgency. Please contact us at 1-888-738-3822 with any questions you may have regarding your order for Yasmin.

YASMIN DRUG INFO


IMPORTANT WARNING:

Cigarette smoking increases the risk of serious side effects from oral contraceptives, including heart attacks, blood clots, and strokes. This risk is higher for women over 35 years old and heavy smokers (15 or more cigarettes per day). If you take oral contraceptives, you should not smoke.


Why is this medication prescribed?

Oral contraceptives (birth-control pills) are used to prevent pregnancy. Estrogen and progestin are two female sex hormones. Combinations of estrogen and progestin work by preventing the release of eggs from the ovaries (ovulation) and changing the cervical mucus and the lining of the uterus. Oral contraceptives are a very effective method of birth control, but they do not prevent the spread of AIDS and other sexually transmitted diseases.

How should this medicine be used?

Oral contraceptives come in packets of 21 or 28 tablets to take by mouth once a day. To avoid upset stomach, take oral contraceptives with food or milk. Take the tablet routinely at the same time every day (e.g., after dinner or at bedtime) to help you remember to take the tablet regularly. Missing doses increases your risk of becoming pregnant.

When first starting on this medicine, use an additional method of birth control until you have correctly taken 7 days' worth of medicine.

If you have a 21-tablet packet, take one tablet daily for 21 days and then none for seven days. Then start a new packet.

If you have a 28-tablet packet, take one tablet daily for 28 days. The last seven tablets are a different color. These tablets are not birth-control pills; they contain iron (ferrous fumarate) or an inactive ingredient. You should take one tablet daily continuously for 28 days in the order specified in your packet, starting a new packet the day after taking your 28th tablet.

Follow the directions on your prescription label carefully concerning when to take your first tablet (on the first or fifth day of your menstrual period or on the first Sunday after or on which bleeding begins). Take the oral contraceptive exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Do not stop taking this medicine without talking to your doctor.

If you have recently given birth, wait until 4 weeks after giving birth to begin taking oral contraceptives.

Before taking oral contraceptives, ask your pharmacist or doctor for a copy of the manufacturer's information for the patient and read it carefully.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking oral contraceptives,

  • tell your doctor and pharmacist if you are allergic to estrogen, progestin, or any other medications.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking. Be sure to mention any of the following: acetaminophen (APAP, Tylenol); antibiotics; anticoagulants ('blood thinners') such as warfarin (Coumadin); atorvastatin (Lipitor); clofibrate (Atromid-S); cyclosporine (Neoral, Sandimmune); griseofulvin (Fulvicin, Grifulvin, Grisactin); HIV protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir); medications for seizures such as carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), phenytoin (Dilantin), and topiramate (Topamax); morphine (Kadian, MS Contin, MSIR, others); oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), prednisone (Deltasone), and prednisolone (Prelone); phenylbutazone; rifabutin (Mycobutin); rifampin (Rifadin, Rimactane); temazepam (Restoril); theophylline (Theobid, Theo-Dur); and thyroid medication such as levothyroxine (Levothroid, Levoxyl, Synthroid). Before taking Yasmin, tell your doctor and pharmacist if you are taking angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin), enalapril (Vasotec), and lisinopril (Prinivil, Zestril); angiotensin II antagonists such as irbesartan (Avapro), losartan (Cozaar), and valsartan (Diovan); aspirin and other nonsteroidal anti-inflammatory medications (NSAIDS) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); diuretics ('water pills') such as amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium); or heparin. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor what herbal products you are taking, especially St. John's wort.
  • tell your doctor if you have or have ever had breast lumps or cancer; endometrial cancer; high blood pressure; high blood cholesterol and fats; diabetes (high blood sugar); asthma; stroke; blood clots; toxemia (high blood pressure during pregnancy); heart attack; epilepsy (seizures); migraine headaches; depression; liver, heart, gallbladder, or kidney disease; adrenal insufficiency (for Yasmin); jaundice (yellowing of the skin or eyes); vaginal bleeding between menstrual periods; and excessive weight gain and fluid retention (bloating) during the menstrual cycle.
  • do not take oral contraceptives if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking oral contraceptives, call your doctor immediately.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking oral contraceptives.
  • tell your doctor and pharmacist if you wear contact lenses. If you notice changes in vision or ability to wear your lenses while taking hormone replacement therapy, see an eye doctor.
What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

If you miss doses of your oral contraceptive, you may be at risk for becoming pregnant. Instructions about missed doses are different for different products. Carefully read the instructions in the manufacturer's information for the patient. If you have any questions, call your doctor or pharmacist. If you miss pills, you may need to use a backup method of birth control for 7 days or until the end of the cycle.

What side effects can this medication cause?

Oral contraceptives may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • upset stomach
  • vomiting
  • stomach cramps or bloating
  • diarrhea
  • constipation
  • gingivitis (swelling of the gum tissue)
  • weight gain or weight loss
  • brown or black skin patches
  • acne
  • swelling of the hands, feet, or lower legs (fluid retention)
  • hair growth in unusual places
  • bleeding or spotting between menstrual periods
  • changes in menstrual flow
  • painful or missed periods
  • breast tenderness, enlargement, or discharge
  • difficulty wearing contact lenses

Some side effects can be seious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

  • severe headache
  • shortness of breath
  • severe vomiting
  • partial or complete loss of vision
  • double vision
  • speech problems
  • dizziness or faintness
  • weakness or numbness of an arm or leg
  • crushing chest pain or chest heaviness
  • coughing up blood
  • calf pain
  • severe stomach pain
  • yellowing of the skin or eyes
  • severe depression
  • unusual bleeding
  • loss of appetite
  • extreme tiredness, weakness, or lack of energy
  • fever
  • dark-colored urine
  • light-colored stool
  • rash

Oral contraceptives may increase the risk of developing endometrial and breast cancer, gallbladder disease, liver tumors, heart attack, stroke, and blood clots. Talk to your doctor about the risks of taking this medication.

Oral contraceptives may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

What storage conditions are needed for this medicine?

Keep this medication in the packet it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

What other information should I know?

Keep all appointments with your doctor and the laboratory. You should have a complete physical examination every year, including blood pressure measurements, breast and pelvic exams, and a Pap test. Follow your doctor's directions for examining your breasts; report any lumps immediately.

Before you have any laboratory tests, tell the laboratory personnel that you take oral contraceptives, as this medication may interfere with some laboratory tests.

If you miss one menstrual period and have taken your tablets as directed, continue taking them. However, if you miss one period and have not taken your tablets as directed or if you miss two menstrual periods and have taken the tablets as directed, call your doctor and use another method of birth control until you have a pregnancy test.

If you wish to stop taking oral contraceptives and become pregnant, use another method of birth control for at least 3 months after you stop taking the tablets to be sure that the medication will not harm the fetus. It may take a long time for you to become pregnant after you stop taking oral contraceptives, especially if you have never had a baby or if you had irregular, infrequent, or complete absence of menstrual periods before taking oral contraceptives. Questions should be discussed with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

Qnexa

Qnexa

Qnexa is a powerful anti-obesity medication that is currently undergoing clinical trials by the FDA. It will be added to our formulary as soon as it is approved for prescription and sale over the internet.

Qnexa™ is a proprietary therapeutic formulation and dosing regimen that incorporates the active ingredients from two previously approved products with demonstrated weight loss properties: phentermine and topiramate. By combining the activity of each of these compounds in a novel, once-daily, low-dose capsule formulation, Qnexa simultaneously addresses appetite and satiety, the two main mechanisms that impact eating behavior. As such, Qnexa appears to induce significantly greater weight loss than either individual compound.

The buzz about Qnexa is strong and we’re excited about the possibility of adding it to our formulary. You can read about it in recent issues of The New York Times and The Wall Street Journal.

While we await FDA approval of Qnexa, please have a look at the weight loss medications we currently offer:

Herbal Phentramin

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With Phentramin you will enjoy the benefits of a pharmaceutical grade weight control aid without the necessity of a prescription. Designed to produce effects similar to the most popular prescription weight loss medications.

Decreases Appetite, Increases metabolism, Stimulates thermogenesis, Acts as a mild diuretic, Increases energy.

Ingredients: Chromium, Caffeine, Hoodia Gordoni Cactus Powder, Magnolia Bark, Glucomannan, Green Tea, Theobromine, Guarana extract, Cha de Bugre, Maca Extract, L-Theanine, Banaba extract and Gugglesterone.

Phentramin-D

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You can now buy prescription Phentramin-d online through a licensed US pharmacy located in your region using your credit card, including the one issued by your HSA.

With Phentramin you will enjoy the benefits of a pharmaceutical grade weight control aid without the necessity of a prescription. Designed to produce effects similar to the most popular prescription weight loss medications.

Decreases Appetite, Increases metabolism, Stimulates thermogenesis, Acts as a mild diuretic, Increases energy.

Ingredients: Chromium, Caffeine, Hoodia Gordoni Cactus Powder, Magnolia Bark, Glucomannan, Green Tea, Theobromine, Guarana extract, Cha de Bugre, Maca Extract, L-Theanine, Banaba extract and Gugglesterone.

Xenical

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Xenical 120mg 30 tablets $115.50 Click to Buy  
Xenical 120mg 60 tablets $165.50 Click to Buy  
Xenical 120mg 90 tablets $215.50 Click to Buy  

Online Next Day Overnight Delivery of xenical Prescription Medication You can now buy prescription Xenical online through a licensed US pharmacy located in your region using your credit card, including the one issued by your HSA. Xenical is used with a reduced-calorie diet to help significantly overweight persons lose weight. It also helps to prevent regaining weight previously lost. Orlistat works by blocking some of the fat normally digested by the intestine.

Other items in this category include: Hoodia, Phentramin

Click any link below to complete the health questionnaire and order form or call one of our helpful customer service representatives at 1 (888) 738-3822.

Hoodia

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Online Pharmacy Next Day Overnight Delivery of hoodia Prescription Medication You can now buy prescription Hoodia online through a licensed US pharmacy located in your region using your credit card, including the one issued by your HSA.

Hoodia is a genus of succulent plants in the family Apocynaceae that is widely used traditionally by the San people of southern Africa as an appetite suppressant, thirst quencher and as a cure for severe abdominal cramps, haemorrhoids, tuberculosis, indigestion, hypertension and diabetes.

Recent press reports from various large media outlets such as 60 minutes, BBC, and ABC News have shone a light on Hoodia's long standing positive appetite suppressing effects.

“Imagine this: an organic pill that kills the appetite and attacks obesity. It has no known side-effects, and contains a molecule that fools your brain into believing you are full. ”

“The plant is said to have a feel-good almost aphrodisiac quality, and I have to say, we felt good.”


- BBC News Report

The San Bushmen of the Kalahari, one of the world's oldest and most primitive tribes, has been eating the Hoodia for thousands of years, to stave off hunger during long hunting trips. Hoodia is derived from Hoodia gordonii (Masson) Sweet ex Decne. of the dogbane family (Apocynaceae), a succulent plant that grows primarily in Namibia as well as in northwestern parts of South Africa.

Other items in this category include: Phentramin, Xenical

Click any link below to complete the health questionnaire and order form or call one of our helpful customer service representatives at 1 (888) 738-3822.