The morphine is an analgesic that is obtained from the plant of the opium ( Papaver somniferum ), popularly known as poppy. Opium is one of the most widely used drugs in ancient times, which has now been replaced by its famous derivatives, morphine, and, especially, heroin.
A brief history of morphine
Morphine appeared in the early nineteenth century. At this time, opium (analgesic used to relieve pain) was prescribed. Still, doubts arose when it came to establishing what dose it was convenient to administer according to the purity of the preparation.
The village pharmacist commissioned Friedrich Sertürner to do a quality study of opium, which was dispensed at the pharmacy. The young Friedrich thought of dissolving the drug in acid, then reduced it with ammonia. Finally, he obtained gray crystals that he used experimentally in cats, thus manifesting his hypnotic power (produces sleep). Having a severe toothache, Friedrich decided to try it himself. When he took it, he went into a deep sleep for eight hours. When he woke up, he got up without any discomfort.
Therefore, due to its somniferous virtues, in honor of the god of sleep Morpheus, baptized the substance with the name of morphine.
The opioid was first marketed in 1817, announcing itself as an analgesic that, in addition, could be used in the treatment of addictions to certain substances, such as opium and alcohol. Over time, sadly, it’d be discovered that opiate is even additional addictive than alcohol or narcotics.
Although it has now been displaced by other drugs such as heroin, morphine remains one of the substances preferred by heroin addicts when they cannot access the latter.
Uses of morphine
It is used in the following cases:
- Postoperative pain
- Severe chronic pain resistant to other pain relievers
- Oncological pain
- Transient pain of severe intensity.
- Pain associated with myocardial infarction.
This opioid can be administered orally (oral solution, tablets, and capsules retard) and parenterally (subcutaneously, intravenously, intramuscularly, epidurally, and intrathecally). The dose should be individually adapted to each patient, depending on the severity of the pain that is present and the response to the analgesic.
In kids, it’s solely used exceptionally and in prescribed doses, per their body mass. Pregnant women are only given morphine when there is no alternative and, given that the substance passes into breast milk, breastfeeding should be discontinued when morphine treatment is started.
Contraindications to the use of morphine
In certain circumstances, your employment is contraindicated, such as:
- When the patient has an allergic reaction of any kind.
- When you can interact with other medications, the patient is taking.
- During pregnancy and lactation.
- In children under one year.
- If the patient suffers from respiratory depression or respiratory diseases that present with serious obstructions.
- In patients with cranial trauma or elevated intracranial pressure.
- Before the surgical intervention, or in the first 24 hours after it.
- When the patient suffers from convulsive disorders.
- In all cases in which the patient suffers, a disease that the doctor considers may be aggravated by the use of the drug.
Morphine side effects
Morphine has significant side effects, such as:
- Nausea or vomiting
- Alteration in blood test results.
- Drowsiness, disorientation, dizziness, instability.
- Blurry vision.
- Dry mouth.
- Respiratory disorders or variations in blood pressure.
- Dependency (may occur if its use is prolonged).
- It can aggravate the patient’s condition when he suffers from diseases such as pancreatitis, asthma, COPD, alcoholism, hypotension, chronic constipation, hypothyroidism, severe liver, or kidney disorders, among others.
- The physical dependence on the vertebrate and withdrawal syndrome within the baby if administered to a pregnant girl. In addition, it passes into breast milk, so it should not be used during breastfeeding.
Adderall is a medication that is prescribed for the treatment of attention deficit disorder. There comes its name from the English term: Attention Deficit Disorder.
It is currently a medication that is most often prescribed in adults and is quite popular among the university community, as well as among young professionals and also among athletes, which has generated a lot of controversies.
What exactly is the Adderall?
Adderall is a medicine made from amphetamines. For their part, amphetamines are synthetic substances that belong to the group of central nervous system stimulating agents (psychostimulants or psychoactive agents ), and as such, what they do is stimulate both attention and physical performance.
In other words, Adderall is a central nervous system stimulant that is medically prescribed, especially for attention deficit disorder (without hyperactivity). Still, it is also used, for example, to treat narcolepsy. Not only that, but in recent years, its recreational use and for purposes such as improving school, physical, or work performance has increased significantly.
It is approved for production and marketing in the United States since 2001 under the name ADDERALL TX, in tablets with a concentration of 5, 10, 15, 20, 25, or 30 mg.
Technically stimulants favor and increase the release of catecholamines in the brain, that is, substances such as norepinephrine, adrenaline, and dopamine that are transported in the bloodstream and the neural networks so that we can respond to stressful situations.
The latter has the effect of increasing reaction times, causing a sensation of alertness and of always being awake, and even producing euphoria, thus increasing tolerance to pain. Therefore, Adderall is used to maintain longer attention and to improve physical performance.
As for its adverse effects, the constant and prolonged use of amphetamines can cause sleep disturbances, anxiety, psychotic, and manic episodes, issues that may eventually require the taking of other drugs.
Among the most severe side effects, and since it significantly accelerates the heart rhythm, a relationship between amphetamine intake and sudden death, cardiovascular accidents, psychotic or manic episodes, visual disturbance, and the development of gastrointestinal diseases has been reported, Endocrine and liver.
Therefore, it is contraindicated in people who have symptoms of cardiovascular disease, hypertension, hyperthyroidism, glaucoma, agitated states, or a history of addiction to psychoactive drugs. Similarly, it can increase impulsivity in the case of children who have a diagnosis of Attention Deficit Hyperactivity Disorder.
Apart from all of the above, perhaps the most problematic and controversial effect of amphetamines is that they are highly addictive substances, which means that they generate a lot of problems, not only at the private but also public level: the need to consume them increases gradually, as well as tolerance (which also increases the dose that needs to be taken); and then the likelihood of uncontrolled use increases the number of people susceptible to developing chronic diseases and even the illegal market.
Difference between Adderall and Ritalin
The difference between Adderall and Ritalin is that the essential component of Adderall is an amphetamine, and the primary element of Ritalin is methylphenidate. Both amphetamine and methylphenidate are substances that stimulate the nervous system, so their effects are practically the same.
What is the controversy?
The use of Adderall (as well as Ritalin) has generated significant controversy in recent years, especially for its highly addictive and highly normalized effects.
It has also been widely discussed because, although educational and work performance has improved, the use of these types of drugs often hides shortcomings that are typical of educational and employment environments. In other words, they are used in an increasingly popular and standardized way, not only to compensate for difficulties in the teaching-learning process of children but also among the university community or among young professionals and athletes who are required to maintain productivity rhythms that They go beyond their abilities.
Consequently, its commercialization is growing, even when the tendency to diagnose attention deficit disorders on a large scale (especially in the United States) has already been questioned.
Some say that drugs were used to make people disconnect from social reality, as a means of escape and to reach different states of consciousness. Now, it seems that they are used for the opposite purpose, to make us connect with that social reality, as quickly and as best as possible.
Ketamine is used daily in emergency units everywhere to sedate people with pain. It is a basic element in the emergency kit of any doctor and is usually used to anesthetize people who are suffering from something unpleasant, such as draining an abscess or relocating a dislocated shoulder. Some research in recent years has revealed that keta could be a viable treatment for depression. In fact, the American Psychiatric Association itself has published an article about it.
But ketamine has another great use. It is found on dance floors around the world every week, where thousands of ravers use it to endure until the early hours of the morning. In 1999, the Drug Enforcement Administration considered it a drug susceptible to causing addiction and classified it as a controlled substance of list III.
Because of what we medically know about ketamine – which clouds your senses and influences brain functions – it is not difficult to imagine why some people consume it without a prescription. But to try to understand in depth why people take ketamine when they party, we consult with an expert.
Dr. Andrew Monte is an associate professor of Emergency Medicine and Medical Toxicology at the University of Colorado. He studies how illicit substances affect the body and is especially interested in what he calls an “abusive use of novel and synthetic drugs,” which is a term among doctors for “recreational drugs.” He explained what ketamine is, what its side effects are and how to consume it safely.
What is ketamine?
It is a central nervous system sedative. It is also used as a general anesthetic, a medicine that doctors and veterinarians use for surgical interventions.
What are the psychological and psychiatric effects of ketamine?
In low doses, it is a sedative. As the dose increases, it becomes what we call a “dissociative anesthetic,” which means that the central nervous system almost disconnects from the body. This allows a doctor or veterinarian to carry out a painful intervention without the person or animal feeling the effects. We are talking about dissociating the mental capacity to respond to painful stimulations. In an even higher dose, it is a general anesthetic that causes people to fall into a coma.
What are the side effects?
There are three groups of major side effects. The first is a cardiovascular effect, an increase in heart rate and blood pressure. The second is the neuropsychiatric effect, a phenomenon we call an emergency reaction, which is when people wake up in a state of anguish and agitation, almost like leaving a bad trip. And the third is relatively uncommon, but it is an effect that can be life-threatening: laryngospasm when the vocal cords contract. If that happens, the person will need CPR (cardiopulmonary resuscitation) or mouth-to-mouth breathing. Sometimes patients also need assisted breathing. It is an unusual effect, but it happens.
Why do you think people consume ketamine to party?
The dissociative anesthetic effect is attractive to people who go to clubs and festivals because it causes hallucinations. If you take the exact dose, you will enter a ketamine hole [ K-hole ] that you have already heard about, and you will have hallucinations and a feeling of numbness in your arms and legs. When the perfect dose is used – something very difficult to achieve – it is probably a very attractive feeling.
But the hard part is finding the dose. If you fall short, you don’t notice any effect. If you pass, you can get into that hole, but you suffer the dissociative anesthetic effect and you lie around without remembering anything. With a little more and possibly you will fall into a coma.
Is it a safe drug?
We use ketamine daily in the ER for painful interventions. We use it to drain abscesses, to treat fractures and dislocated shoulders; well, we even use it for some patients who need a sedative for ailments like asthma Some of the side effects may even be clinically helpful. If a patient is critical and has low blood pressure or heart rate, but needs to be sedated for intervention, this drug is helpful because it increases the heart rate.
It is safe in the hospital, but we give it under controlled circumstances for specific indications and with thorough control. And we have numerous tools at our disposal to correct any adverse effects of the drug.
And how about out of the hospital?
What you buy on the street is not necessarily what you think you are buying. I do research on the excessive use of synthetic drugs and this summer we surveyed people at a Colorado music festival and tested those who said they had consumed ketamine. We did tests on a person who said he had taken it and we found no traces of ketamine in him, but of dextromethorphan (cough syrup). In addition, there are many ways to take this drug: in pills, snorting or injected; which is more dangerous. Each form has different effects. Ketamine deaths recorded mainly have been caused by combining this drug with others.
When you put it all together, without knowing what drug you are taking, the fact that people mix the drug with other substances and the unpredictability of the clinical effects associated with it and their different forms of administration make ketamine a drug too dangerous for the people who are partying.
Is there any way to take ketamine in the recreational field and safely?
The first thing is to do it with someone you trust, someone who can help you if you have problems. If you end up with laryngospasms, you need someone who is well to practice CPR. If you have an emergency reaction and you wake up in a state of agitation, you need someone there who can help you get back into you and take you to a safe place.
In any case, my biggest caveat regarding ketamine is that sometimes you think they are giving you ketamine when in most cases, I would say that 90 percent is not.
Methamphetamine is a powerful and highly addictive stimulant that affects the central nervous system. Crystal methamphetamine is a form of the drug that looks like glass fragments or bright blue-white stones. Its chemical structure is similar to that of amphetamine, a drug used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy, a sleep disorder.
Other common names of methamphetamine are blue, crystal, ice, met and ampheta ( blue, crystal, ice, meth and speed, in English).
How is methamphetamine consumed?
Methamphetamine can be:
- ingest (pills)
- inject (the powder is previously dissolved in water or alcohol)
Since the drug’s ” high ” high starts and ends quickly, people often take repeated doses in an “excess and collapse” mode. In some cases, the consumption is done in an excess modality known as “run”, in which the person does not eat or sleep but consumes the drug every few hours for several days.
What effect does methamphetamine have on the brain?
Methamphetamine increases the amount of dopamine in the brain, a natural chemical that participates in body movement, motivation, and reinforcement of behaviors that produce satisfaction. The ability of the drug to rapidly raise the level of dopamine in the reward areas of the brain greatly reinforces the behavior of using the drug and makes the person want to repeat the experience.
Short term effects
Consuming even small amounts of methamphetamine can produce many of the health effects produced by other stimulants, such as cocaine or amphetamines. Among them are:
- increased wakefulness and physical activity
- decreased appetite
- fast breathing
- fast or irregular heartbeat
- high blood pressure and body temperature
How is methamphetamine manufactured?
Currently, the majority of methamphetamine found in the United States is manufactured by transnational criminal organizations in Mexico. This methamphetamine is extremely pure, very powerful and very cheap. It is also possible to manufacture the drug in small clandestine laboratories with over-the-counter and relatively inexpensive ingredients such as pseudoephedrine, a common component of cold medicines. To hinder this type of production, the laws require that pharmacies and other retail stores keep a record of purchases of products containing pseudoephedrine and take measures to limit sales.
The production of methamphetamine also requires the use of other very dangerous chemicals. The toxic effects of these products may remain in the environment long after the laboratory is closed and cause a variety of health problems for those living in the area. These chemicals can also cause or fatal explosions in laboratories and home fires.
What different effects will methamphetamine on health?
People who inject methamphetamine have a higher risk of contracting infectious diseases such as HIV and hepatitis B and C. These diseases are transmitted by contact with blood or other body fluids that may remain in the accessories used for consumption. Methamphetamine can also alter judgment and decision making, which creates risky behaviors such as unprotected sexual activity, for example, which also increases the risk of infection.
Methamphetamine use can also aggravate the evolution of HIV and AIDS, as well as its consequences. There are studies that indicate that HIV causes more damage to nerve cells and more cognitive problems in people who use methamphetamine than in those who are infected with HIV but do not use the drug. Cognitive problems include problems with thinking, comprehension, learning, and memory.
Long-term consumption of methamphetamine has many other negative consequences, including:
- excessive weight loss
- severe dental problems (“methamphetamine mouth”)
- severe itching leading to skin lesions caused by scratching
- changes in the structure and functioning of the brain
- Loss of memory
- trouble sleeping
- violent behavior
- paranoia (extreme and unjustified distrust of others)
- hallucinations (sensations and images that seem real but are not)
In addition, the continued consumption of methamphetamine causes changes in the brain’s dopamine system; These changes are associated with less coordination and decreased verbal learning. In studies of people who used methamphetamine for a long time, it was observed that profound changes also affected areas of the brain that are related to emotion and memory. This may explain many of the emotional and cognitive problems seen in those who consume methamphetamine.
While it may happen that some of these brain changes are reversed after leaving the drug for more than a year, it is possible that other changes may not be reversed even after a long time. A recent study even suggests that those who have ever used methamphetamine have an increased risk of getting Parkinson’s disease, a nervous disorder that affects movement.
Does exposure to secondhand smoke from methamphetamine have health effects?
Researchers do not yet know if people who breathe secondhand methamphetamine smoke can dop or suffer other health effects. What they do know is that a methamphetamine screening test can yield a positive result after a person has been exposed to secondhand smoke. More research is needed in this area.
Is it possible to suffer an overdose of methamphetamine?
Yes, it is possible to suffer an overdose of methamphetamine. An overdose occurs when the person consumes too much of a drug and suffers a toxic reaction that causes serious harmful symptoms or death.
In 2017, about 15% of all overdose deaths were related to methamphetamine; 50% of those deaths also included an opioid, and half of those cases were related to the synthetic opioid fentanyl. (CDC Wonder Multiple Causes of Death — see # 42 on Meth RR.) It is important to note that sometimes cheap and dangerous synthetic opioids are added to street methamphetamine without the consumer knowing.
How is an overdose of methamphetamine treated?
Since an amphetamine overdose often triggers a stroke, heart attack or problems with other organs, initial relief staff and emergency room doctors treat overdoses with the treatment of these disorders, with the intention of:
- Restore blood circulation to the affected part of the brain (cerebral embolism)
- Restore blood circulation to the heart (heart attack)
- Treat affected organs
Is methamphetamine addictive?
Yes, methamphetamine is highly addictive. When a person stops using it, withdrawal symptoms may include:
- deep depression
- strong desire to use the drug
How is methamphetamine addiction treated?
While research is ongoing, there are currently no government-approved medications for the treatment of methamphetamine addiction. The good news is that improper methamphetamine use can be prevented and drug addiction can be treated with behavioral therapies. The most effective treatments for upper addiction up to now are activity therapies:
- Cognitive-behavioral therapy, which helps patients recognize, avoid and cope with situations in which they are likely to use drugs
- Motivational incentives that use coupons or small cash rewards to encourage patients not to use the drug
Research is also continuing to create medications and other new treatments for methamphetamine use (including vaccines) and non-invasive brain stimulation through magnetic fields. People can recover from methamphetamine addiction – and indeed they do – if they have simple and direct access to effective treatments that encompass the multiple medical and personal problems caused by prolonged drug use.
What is cocaine?
The word cocaine refers to the drug in a powder form or crystal form. The powder is usually mixed with substances such as corn starch, talcum powder and/or sugar or other drugs such as procaine (a local anesthetic) or amphetamines. Extracted from coca leaves, this was originally developed as a painkiller. It is most often sniffed, with the powder absorbed into the bloodstream through the nasal tissues. It can also be ingested or rubbed into the gums. To more rapidly absorb the drug into the body, abusers inject, but this substantially increases the risk of overdose. Inhaling it as smoke or vapor speeds absorption with less health risk than injection.
This drug is a powerfully addictive stimulant. For thousands of years, people in South America have chewed and ingested coca leaves (Erythroxylon coca), the source of cocaine, for their stimulant effects. The purified chemical, cocaine hydrochloride, was isolated from the plant more than 100 years ago. In the early 1900s, purified cocaine was the main active ingredient in many tonics and elixirs developed to treat a wide variety of illnesses and was even an ingredient in the early formulations of Coca-Cola®. Before the development of synthetic local anesthetic, surgeons used this drug to block pain. However, research has since shown that cocaine is a powerfully addictive substance that can alter brain structure and function if used repeatedly.
Today, cocaine is a Schedule II drug, which means that it has high potential for abuse but can be administered by a doctor for legitimate medical uses, such as local anesthesia for some eye, ear, and throat surgeries. As a street drug, cocaine appears as a fine, white, crystalline powder and is also known as Coke, C, Snow, Powder, or Blow. Street dealers often dilute (or “cut”) it with non-psychoactive substances such as cornstarch, talcum powder, flour, or baking soda to increase their profits. They may also adulterate cocaine with other drugs like procaine (a chemically related local anesthetic) or amphetamine (another psychoactive stimulant). Some users combine cocaine with heroin—called a Speedball.
People abuse two chemical forms of cocaine: the water-soluble hydrochloride salt and the water-insoluble cocaine base (or freebase). Users inject or snort the hydrochloride salt, which is a powder. The base form of cocaine is created by processing the drug with ammonia or sodium bicarbonate (baking soda) and water, then heating it to remove the hydrochloride to produce a smokable substance. The term crack, which is the street name given to freebase cocaine, refers to the crackling sound heard when the mixture is smoked.
Cocaine is one of the most dangerous drugs known to man. Once a person begins taking the drug, it has proven almost impossible to become free of its grip physically and mentally. Physically it stimulates key receptors (nerve endings that sense changes in the body) within the brain that, in turn, create a euphoria to which users quickly develop a tolerance. Only higher dosages and more frequent use can bring about the same effect. Today, this drug is a worldwide, multibillion-dollar enterprise. Users encompass all ages, occupations and economic levels, even schoolchildren as young as eight years old.
Cocaine use can lead to death from respiratory (breathing) failure, stroke, cerebral hemorrhage (bleeding in the brain) or heart attack. Children of cocaine-addicted mothers come into the world as addicts themselves. Many suffer birth defects and many other problems. Despite its dangers, cocaine use continues to increase—likely because users find it so difficult to escape from the first steps taken down the long dark road that leads to addiction.
Uses of cocaine
Cocaine is used by health care professionals to temporarily numb the lining of the mouth, nose, and throat (mucous membranes) before certain medical procedures (e.g., biopsy, stitches, wound cleaning). It is an anesthetic that works quickly to numb the area about 1-2 minutes after application. Cocaine also causes blood vessels to narrow, an effect that can decrease bleeding and swelling from the procedure.
How Do People Use Cocaine?
Cocaine can be ingested in several ways, but most people snort it. Snorting this drug regularly can cause serious health problems, including severe damage to the nose. The drug can also be smoked, injected into a vein or swallowed. Some cocaine users rub powdered cocaine on their gums to get high. Others mix cocaine with marijuana or cigarettes and smoke it. It can also be consumed with heroin in a particularly toxic drug mix known as speedball. While smoking or injecting cocaine can lead to a quicker high, any method of use can result in addiction or an overdose.
While the Drug Enforcement Administration classifies cocaine as a Schedule II drug because of its high potential for abuse, the drug does have limited medical uses. Doctors sometimes use it as a topical anesthetic to numb the nose, mouth or throat. It can also stop bleeding in these areas because cocaine is effective at shrinking blood vessels. Because drug manufacturers have developed better pharmaceutical alternatives, medical use of cocaine is rare today.
Ritalin is a medicine that has as its active ingredient Methylphenidate Hydrochloride, a central nervous system stimulant, indicated for the treatment of attention deficit hyperactivity disorder, also called ADHD, and narcolepsy.
This medicine is a type of amphetamine that works by stimulating mental activities, so it has become popular among adults who want to study or stay awake for longer; however, this use is not recommended, and these effects are not proven.
In addition to this, methylphenidate can have various dangerous side effects for those who use it without indication, such as nervousness, increased blood pressure, palpitations, muscle spasms, hallucinations, or chemical dependence. Ritalin can only be purchased at prescription pharmacies.
What is it for?
Ritalin has methylphenidate, which is a psychostimulant. This medication stimulates concentration and reduces drowsiness, which is indicated in the treatment for attention deficit hyperactivity disorder in children and adults.
It can also be indicated to treat narcolepsy, a disorder characterized by the manifestation of symptoms of daytime sleepiness, inappropriate sleep episodes, and sudden loss of voluntary muscle tone.
Is Ritalin good for memory and studies?
Ritalin is popular among students who call this medicine ‘the intelligence pill’ because it helps with memory and concentration, being useful during the study period; however, the efficacy of this medicine in healthy people has never been proven.
In this way, the person can even spend the night awake studying, but the attention will not necessarily improve, and he may not remember the content the next day.
Therefore, Ritalin should not be used to improve memory and concentration, being used only for the treatment of diseases such as narcolepsy, attention deficit disorder, and hyperactivity, as indicated in its leaflet. If you are a student and need a remedy to stay more awake, and you need to increase your retention and concentration.
How to take Ritalin
1. Attention deficit and hyperactivity
The dosage should be indicated according to the individual needs and clinical response of each person, also varying according to age. So the recommended dose of Ritalin are the following:
Children aged six years or older: should be started with 5 mg, 1 or 2 times a day, increasing the dose weekly from 5 to 10 mg. The total daily dose ought to be administered in divided doses.
The dosage of Ritalin LA, which are the modified-release capsules is as follows:
Children aged six years or older: can be started with 10 or 20 mg, according to medical criteria, once a day in the morning.
Adults: For people who still do not have a treatment with methylphenidate, the recommended starting dose of Ritalin LA is 20 mg once daily. People who already have treatment with methylphenidate, treatment can be continued with the same daily dose.
In adults, the maximum daily dose of 80 mg should not be exceeded, and in children, both with Ritalin and Ritalin LA, the dose of 60 mg should not be exceeded.
Ritalin is only approved for the treatment of narcolepsy in adults. The daily dose is 20 to 30 mg, administered in 2 to 3 divided doses.
Some people may need a dose higher than 40 to 60 mg, while for another 10 to 15 mg daily, it is sufficient; the attending physician will determine this. In people who have difficulty sleeping, the medication should not be administered at night, and the last dose should be before 18 hours.
It is essential not to exceed the maximum daily dose of this medicine, which is 60 mg.
The most common side effects that can be caused by treatment with Ritalin include nasopharyngitis, decreased appetite, abdominal discomfort, nausea, heartburn, nervousness, insomnia, fainting, headache, drowsiness, dizziness, changes in the heartbeat. Heart, fever, allergic reactions, and decreased appetite can result in weight loss or stunted growth in children.
In addition, because it is an amphetamine, methylphenidate can cause dependence, if misused.
Ritalin is contraindicated in people with hypersensitivity to methylphenidate or any excipient, people suffering from anxiety, tension, agitation, hyperthyroidism, pre-existing cardiovascular disorders including severe hypertension, angina, occlusive arterial disease, heart failure, hemodynamically significant congenital heart disease, cardiomyopathies, myocardial infarction, life-threatening arrhythmias and complications caused by ionic channel dysfunction.
It should also not be used during treatment with monoamine oxidase inhibitors, or at least two weeks after discontinuation of therapy, due to the risk of hypertensive crises; people with glaucoma; pheochromocytoma; diagnosis or family history of Tourette syndrome; pregnant or breastfeeding.
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