Medicine Regulator Provides Further Advice For Women Exposed To Diethylstilboestrol ( DES ) , Australia

Australia's medicines regulator, the Therapeutic Goods Administration ( TGA ) , has issued further advice on its website for women exposed to diethylstilboestrol.

Diethylstilboestrol, or DES ( also known as stilboestrol ) , is a synthetic oestrogen which was used between 1940 and early 1970s to prevent miscarriage in women with a previous poor pregnancy outcome. DES is no longer available in Australia.

Exposure in womb to DES has been shown to be associated with an increase in risk of developing certain types of vaginal and cervical cancer. A recent review commissioned by the National Breast and Ovarian Cancer Centre suggests that DES daughters may have an increased risk of breast cancer.

Women who took DES and daughters of these women ( 'DES daughters' ) are reminded to follow the current national cervical and breast screening recommendations. The current cervical screening recommendations were published by National Health and Medical Research Council ( NHMRC ) in June 2005, " Screening to Prevent Cervical Cancer: Guidelines for the Management of Asymptomatic Women with Screen Detected Abnormalities " . These guidelines contain a specific section regarding women exposed to DES advising that they should be offered annual cytological screening and colposcopic examination of both cervix and the vagina.

The Cancer Council of New South Wales advises that women prescribed DES while pregnant and DES Daughters over age 40 should have annual mammography. They should also be 'Breast Aware' by familiarising themselves with normal look and feel of their breasts, and report any unusual breast changes to their doctor irrespective of whether they have had recent screening mammography with normal results.

More information on DES is available at Cancer Council of New South Wales - Diethylstilbestrol ( DES ) and Cancer; or at NSW Health - DES ( Diethylstilboestrol or Stilboestrol )

Therapeutic Goods Administration

Take care about yourself. Here is useful health tips for you.

Tramadol? For what?

Tramadol: uses

Tramadol is used to relieve ongoing, moderate pain in people who need all-day pain relief ( " around clock " dosing ) . It's similar to narcotic pain medications. It works on certain nerves in brain that control how we experience pain.

Tramadol: how to use

Take Tramadol by mouth, either always with food or always without food, usually once daily or as directed by your doctor. If nausea occurs, consult your doctor or pharmacist about ways to decrease it ( e. g. , antihistamines, lying down for 1 to 2 hours with as little head movement as possible ) .

Swallow Tramadol whole. Do not crush, chew, or split tablet. Doing so would release Tramadol into your bloodstream all at once, possibly causing serious ( sometimes fatal ) side effects.

The dosage is based on your medical condition and response to treatment. To reduce the risk of side effects, your doctor may tell we to gradually increase your dose when starting long-acting Tramadol. The maximum recommended dose is 300 milligrams a day.

If you have severe kidney disease ( e. g. , on dialysis ) or severe liver disease ( e. g. , cirrhosis ) , regular-release Tramadol is recommended instead of long-acting form.

Pain medications work best if they're used as the first signs of pain occur. If you wait until pain has worsened, medication mayn't work as well.

Follow your doctor's or pharmacist's instructions for safe use of non-narcotic pain relievers ( e. g. , acetaminophen, ibuprofen ) . Ask your doctor or pharmacist for more details regarding your treatment.

Tramadol may cause dependence, especially if it has been used regularly for an extended time or if it has been used in high doses. In such cases, withdrawal reactions ( e. g. , anxiety, sweating, sleeplessness, shaking, diarrhea, rapid breathing ) may occur while use Tramadol if we suddenly stop Tramadol. Also, if we are taking regular doses of narcotic medications for ongoing pain ( e. g. , cancer pain ) , starting Tramadol may cause a withdrawal reaction. To prevent withdrawal reactions when stopping extended, regular treatment with Tramadol, gradually reduce dosage as directed. Consult your doctor or pharmacist for more details, and report any withdrawal reactions immediately.

Rarely, abnormal drug-seeking behavior ( addiction ) is possible with Tramadol. Don't increase your dose, take it more frequently, or use it for a longer time than prescribed. Properly stop medication when so directed.

When used for an extended period, Tramadol mayn't work as well and may require different dosing. Talk with your doctor if Tramadol stops working well.

Tell your doctor if your pain does not decrease or if it worsens.

Tramadol: side effects

Nausea, vomiting, constipation, lightheadedness, dizziness, drowsiness, headache, or weakness may occur while use Tramadol. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

To prevent constipation, maintain a diet adequate in fiber, drink plenty of water, and exercise. If we are taking Tramadol regularly, it may be useful to start using a laxative right away instead of waiting until you become constipated. Consult your pharmacist for details regarding correct use of laxatives ( e. g. , stimulant-type with stool softener ) .

Remember that your doctor has prescribed Tramadol because he or she has judged that the benefit to we is greater than the risk of side effects. Many people using Tramadol don't have serious side effects.

Tell your doctor immediately if any of these unlikely but serious side effects occur:

Tell your doctor immediately if any of these rare but very serious side effects occur:

A very serious allergic reaction to Tramadol ( which may occur while use Tramadol as early as first dose ) is rare. However, seek immediate medical attention if we notice any of the following symptoms:

This isn't a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Tramadol: precautions

Before taking long-acting Tramadol, tell your doctor or pharmacist if we are allergic to it; or to other narcotics ( e. g. , codeine ) ; or if we have any other allergies.

Tramadol shouldn't be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if we have:

Before using Tramadol, tell your doctor or pharmacist your medical history, especially of:

Tramadol may make you dizzy or drowsy. Use caution while driving, using machinery, or doing any activity that requires alertness. Avoid alcoholic beverages because they may increase risk of Tramadol's side effects.

To reduce dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Before having surgery, tell your doctor or dentist that we are using Tramadol.

Caution is advised when using Tramadol in elderly because they may be more sensitive to its effects, especially slow/shallow breathing and drowsiness.

During pregnancy, Tramadol should be used only when clearly needed. It's not recommended for use for long periods or in high doses late in pregnancy because of possible serious harm to your baby. Discuss the risks and benefits with your doctor. Infants born to mothers who have been using Tramadol for an extended time may have seizures or withdrawal symptoms such as irritability, abnormal/persistent crying, or diarrhea. Tell your doctor immediately if we notice any of these symptoms in your newborn.

Tramadol passes into breast milk. While there have been no reports of harm to nursing infants, consult your doctor before breast-feeding.

Tramadol: interactions

Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring we for them. Do not start, stop, or change dosage of any medicine before checking with them first.

Tramadol shouldn't be used with following medications because very serious ( possibly fatal ) interactions may occur while use Tramadol:

Avoid taking MAO inhibitors within 2 weeks before, during, and after treatment with Tramadol.

If we are currently using any of these medications listed above, tell your doctor or pharmacist before starting Tramadol.

Before using Tramadol, tell your doctor or pharmacist of all prescription and nonprescription/herbal products we may use, especially of:

Also report use of drugs that might increase seizure risk when combined with Tramadol such as isoniazid ( INH ) , phenothiazines ( e. g. , thioridazine, chlorpromazine, promethazine ) , theophylline, or tricyclic antidepressants ( e. g. , amitriptyline ) , among others. Consult your doctor or pharmacist for details.

Tell your doctor or pharmacist if we also take drugs that cause drowsiness such as certain antihistamines ( e. g. , diphenhydramine ) , anti-anxiety drugs ( e. g. , diazepam ) , anti-seizure drugs ( e. g. , phenytoin ) , medicine for sleep ( e. g. , zolpidem ) , muscle relaxants ( e. g. , cyclobenzaprine ) .

Check the labels on all your medicines ( e. g. , cough-and-cold products ) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

This document doesn't contain all possible interactions. Therefore, before using Tramadol, tell your doctor or pharmacist of all products we use. Keep a list of all your medications with you, and share list with your doctor and pharmacist.

Tramadol: overdose

If overdose of Tramadol is suspected, contact your local poison control center or emergency room immediately. US residents can call the US National Poison Hotline at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: slow/shallow breathing, very slow/irregular heartbeat, loss of consciousness, heart attack.

Tramadol: notes

Do not share Tramadol with others. It is against law.

Tramadol has been prescribed for your current condition only. Don't use it later for another condition unless told to do so by your doctor. A different medication may be necessary in that case.

Tramadol: missed dose

If we miss a dose Tramadol, take it as soon as you remember. If it's near time of next dose, skip missed dose and resume your usual dosing schedule. Do not double the dose of Tramadol to catch up.

Tramadol: storage

Store Tramadol at room temperature at 77 degrees F ( 25 degrees C ) away from light and moisture. Brief storage between 59-86 degrees F ( 15-30 degrees C ) is permitted. Don't store Tramadol in the bathroom. Keep all medicines away from children and pets.

Properly discard Tramadol when it's expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

Where to buy Tramadol

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