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Average daily doses of approximately 250 mg of tramadol hydrochloride in divided doses were generally comparable to five doses of acetaminophen 300 mg with codeine phosphate 30 mg (TYLENOLwith Codeine #3) daily, five doses of aspirin 325 mg with codeine phosphate 30 mg daily, or two to three doses of acetaminophen 500 mg with oxycodone hydrochloride 5 mg (TYLOX) daily. Inform female patients of reproductive potential that prolonged use of tramadol during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated {buy tramadols online|buy genuine tramadol online|buy generic tramadol overnight|buy generic tramadol|o-desmethyltramadol buy|buy zydol tramadol|buy 1000 tramadol|buy 100mg tramadol online|cheap tramadol 100mg|buy cheap tramadol 100mg online|buy cheap tramadol 100mg|tramadol 100 buy|cheap tramadol 200mg} and that the patient should inform their healthcare provider if they have used opioids at any time during their pregnancy, especially near the time of birth (see WARNINGS , PRECAUTIONS; Labor or Delivery ). The concomitant use of tramadol and CYP3A4 inhibitors, such as macrolide antibiotics (e.g., erythromycin), azole-antifungal agents (e.g. ketoconazole), protease inhibitors (e.g., ritonavir), can increase the plasma concentration of tramadol, and may result in a greater amount of metabolism via CYP2D6 and greater levels of M1. Follow patients closely for increased risk of serious adverse events including seizures and serotonin syndrome, and adverse reactions related to opioid toxicity including potentially fatal respiratory depression, particularly when a CYP3A4 inhibitor is added after a stable dose of tramadol is achieved


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