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“Someone is trying to jump off a bridge and they give him ketamine in the ambulance to calm him down and 9 months later, he says, ‘I haven’t felt suicidal for 9 months.’ “When enough stories like that started to pile up, doctors said, ‘Maybe there’s something here,’” says Stewart, an emergency physician and founder of Insight Ketamine in Santa Fe, NM. Like the drug itself, Stewart got his start in combat medicine during the Vietnam War. Some doctors also use ketamine to treat suicidal thoughts.

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There is a growing understanding that paracetamol is not as safe as once believed. The long-term use of paracetamol is now discouraged due to concerns that may increase the risk of heart attack or stroke. The results from four studies suggest that long-term use of paracetamol is associated with a 19% to 68% higher risk of developing cardiovascular problems. Another study found that long-term use of paracetamol was associated with an 11% to 49% increased the risk of intestinal bleeding. Researchers have also found that long-term use of acetaminophen (paracetamol) is associated with a 21% increase in self-reported hearing loss. Whether these findings relate to the use of the painkiller, or to the underlying conditions for which it is used, remains uncertain.

Use paracetamol concurrently. The concurrent use of paracetamol with tramadol or codeine is more effective than tramadol or codeine alone.2 Co-prescribing of paracetamol is an effective and widely used strategy for reducing tramadol and codeine use thereby improving patient safety and providing pain relief as these Step 2 analgesics are withdrawn. Tramadol is associated with a decreased risk of respiratory depression and is therefore often preferred over codeine or dihydrocodeine in patients who are at increased risk of breathing difficulties, e.g. for musculoskeletal pain in a person with chronic obstructive pulmonary disease (COPD).2 Tramadol may also be preferred over codeine or dihydrocodeine in patients with a history of constipation or in those taking anticholinergic medicines. There is weak evidence that tramadol is effective in patients with neuropathic pain.

Whenever the result of taking a drug is less than desired, it might be time to consider changing medication, Goldstein suggests. Some children experience different effects from a different formulation of the same medication. “Many children with appetite, sleep, or irritability problems with a methylphenidate-based medication do very well with an amphetamine-based drug, or vice versa,” he notes. Who prescribes and monitors ADHD medication? A vast majority of children in our survey received medication from a pediatrician (60 percent), followed by a child psychiatrist (18 percent) and a general psychiatrist (15 percent). All of the drugs carry a warning about rare cases of sudden, unexplained death. It is recommended practice to test for life-threatening conditions, including heart-related issues, before prescribing these medications.

Over-the-counter sleep aids: Most of these sleeping pills are antihistamines. There is no proof that they work well for insomnia, and they can cause some drowsiness the next day. They’re safe enough to be sold without a prescription. But if you’re taking other drugs that also contain antihistamines — like cold or allergy medications — you could inadvertently take too much.

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