CNS depressants, alcohol, carbamazepine, SSRIs, SNRIs, TCADs, triptan, MAOs , Quinidine, ketoconazole, erythromycin, Lithium, Anticoagulants, warfarin, digoxin, Drugs that increase serotinin , fluoextine, paroxetine,amytriptyline. Linezolid, St Johnns wart, Probenecid Bisulphan, metoclopramide, chloestyramine Opiod antagonists

Moderate to severe pain

Sweating, dizziness, nausea, Dry mouth,, vomiting, fatigue Allergic reactions, Diaphoresis, urticaria, Pruritus dependence, Habituation Abuse, Convulsions, confusion, mood changes, sleep disorders GI upset, Rarely rash, Respiratory depression, cardiovascular abnormalities,

Flushing, syncope, anaphylaxis, Blood dyscrasias Blurred vision, urinary retention Withdrawal syndrome if discontinued abruptly even after treatment for one week (anxiety, sweating, insomnia, rigors, pain, nausea, tremors, muscle cramps, nervousness, parathesia, diarrheaoa, upper respiratory symtoms, piloerection and rarely hallucinations ) Constipation, headache, somnolence,

CNS stimulation, asthenia, seizures, anaphylaxis, Risk of heptotoxicity ( overdosages only ) Serotomin syndrome ( agitation, hallucinations, coma, ataxia, increased sweating, diarrheoa, fever shivering, myoclonus, labile blood pressure, tachycardia, hyperreflexia, incordination )

Acute intoxication with alcohol Hypnotics, analgesics, opiods, psychotropics Concurrent use of MAOIs or within last 14 days not for use in narcotic withdrawal opiod sensitivity, Opiod -dependent patients severe renal or hepatic impairment uncontrolled epilepsy Suicidal tendency Pregnancy,lactation

Special precautions-

Acute abdominal conditions, Renal or hepatic impairment , Head injury, Raised intracranial pressure History of convulsions Respiratory depression History of drug dependence or abuse May impair abilty to drive or operate machinery Biliary tract disorders,shock Long term use Avoid abrupt withdrawal Elderly Labour and delivery

Moderate to severe pain

Dosage-

2 tabs initially then 1-2 tabs evert 6 hours daily Maximum 8 tabs daily Not recommended for children

Contraindicated for use during pregnancy and lactation