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The opioid drug withdrawal syndrome is characterised by some or all of the following: restlessness, lacrimation, rhinorrhoea, yawning, buy dihydrocodeine uk perspiration, chills, myalgia, mydriasis and palpitations. Other signs may additionally develop together with irritability, agitation, anxiety, hyperkinesia, tremor, weakness, insomnia, anorexia, abdominal cramps, nausea, vomiting, diarrhoea, increased blood strain, increased respiratory rate or heart price.
Bismuth Subcitrate Potassium; Metronidazole; Tetracycline: (Average) Concomitant use of metronidazole and ciprofloxacin may enhance the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Consider taking steps to reduce the chance of QT/QTc interval prolongation and TdP, akin to avoidance, electrolyte monitoring and repletion, and ECG monitoring, especially in patients with further risk elements for TdP.
Hydrocodone; Ibuprofen: (Reasonable) Consider a lowered dose of hydrocodone with frequent monitoring for respiratory depression and sedation if concurrent use of ketoconazole is necessary. It is recommended to avoid this mixture when hydrocodone is being used for cough. Hydrocodone is a CYP3A4 substrate, and coadministration with CYP3A4 inhibitors like ketoconazole can enhance hydrocodone exposure resulting in elevated or extended opioid results together with fatal respiratory depression, significantly when an inhibitor is added to a stable dose of hydrocodone. These results might be more pronounced in patients also receiving a CYP2D6 inhibitor. If ketoconazole is discontinued, hydrocodone plasma concentrations will lower resulting in lowered efficacy of the opioid and potential withdrawal syndrome in a patient who has developed bodily dependence to hydrocodone.