Tramadol may be expected to have additive effects when used in conjunction with alcohol, other opioids, or illicit drugs that cause central nervous system depression. Drug Abuse And Addiction

Administer Betram cautiously in patients at risk for respiratory depression. In these patients alternative non-opioid analgesics should be considered. When large doses of tramadol are administered with anesthetic medications or alcohol, respiratory depression may result. Respiratory depression should be treated as an overdose. If naloxone is to be administered, use cautiously because it may precipitate seizures (see WARNINGS, Seizure Risk and OVERDOSAGE). Interaction With Central Nervous System (CNS) Depressants

Betram® should not be used in pregnant women prior to or during labour unless the potential benefits outweigh the risks. Safe use in pregnancy has not been established. Chronic use during pregnancy may lead to physical dependence and postpartum withdrawal symptoms in the newborn (see Drug Abuse, Addiction and Dependence). Tramadol has been shown to cross the placenta. The mean ratio of serum tramadol in the umbilical veins compared to maternal veins was 0.83 for 40 women given tramadol during labour. ULTRAM® is not recommended for minor pain that may be treated adequately through lesser means where benefit does not outweigh the possible opioid-related side effects.

Betram® should not be used in opioid-dependent patients since it cannot suppress morphine withdrawal symptoms, even though it is an opioid agonist. Drug addiction is characterized by compulsive use, use for non-medical purposes, and continued use despite harm or risk of harm. Drug addiction is a treatable disease, utilizing a multi-disciplinary approach, but relapse is common.For the subset of patients for whom rapid onset of analgesic effect is required and for whom the benefits outweigh the risk of discontinuation due to adverse events associated with higher initial doses, ULTRAM® 50 mg to 100 mg can be administered as needed for pain relief every 4 to 6 hours, not to exceed 400 mg per day. Use in Renal Impairment I wish I were still a dancer... that is a skill I can no longer claim to have. I began ballet classes just before my fourth birthday with a local dance teacher and some other neighborhood girls. I was a student for twelve years and now wish that I had kept it up - dancers are just so amazing to watch. I would hardly consider myself a "triple threat" - but that's kinda cool that someone would consider me as such. To add to that, my voice is also nothing to write home about. After losing a fist fight, Miss Marjorie comforts a crying Bertram and asks him where the third part of their trio, the dwarf Magnifico, ran off to. While being resistant to answer the question at first, he eventually tells Marjorie that their fellow performer is hiding in the woods. Betram is intended for oral use only. The crushed tablet poses a hazard of overdose and death. This risk is increased with concurrent abuse of alcohol and other substances. With parenteral abuse, the tablet excipients can be expected to result in local tissue necrosis, infection, pulmonary granulomas, and increased risk of endocarditis and valvular heart injury. Parenteral drug abuse is commonly associated with transmission of infectious diseases such as hepatitis and HIV. Risk of Overdosage ULTRAM® should not be taken in doses higher than those recommended by the physician. The judicious prescribing of tramadol is essential to the safe use of this drug. With patients who are depressed or suicidal, consideration should be given to the use of non-narcotic analgesics. Patients should be cautioned about the concomitant use of tramadol products and alcohol because of potentially serious CNS-additive effects of these agents. Because of its added depressant effects, tramadol should be prescribed with caution for those patients whose medical condition requires the concomitant administration of sedatives, tranquilizers, muscle relaxants, antidepressants, or other CNS-depressant drugs. Patients should be advised of the additive depressant effects of these combinations. Intracranial Pressure Or Head Trauma

Home to some of the most beautiful wildlife like the golden-cheeked warbler, the Balcones Canyonlands National Wildlife Refuge maintains the animals and their native habitats that are flourishing in the Texas Hill Country. This is what makes the refuge so special! Jim Hogg Park (Georgetown)

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This stunning winery, located just 15 minutes outside of Bertram, is built on California grapes grown right here in Texas. Get the full vineyard experience with one of Thirsty Mule’s wine tastings. Oh, and did I mention that they are the only underground winery in all of Texas? Yeah. Enough said. It definitely needs to be on your list of things to do in Bertram! Grab a Cold One at the Brewery (Liberty Hill) ULTRAM® has the potential to cause psychic and physical dependence of the morphine-type (μ-opioid). The drug has been associated with craving, drug-seeking behaviour and tolerance development. Cases of abuse and dependence on ULTRAM® have been reported. ULTRAM® tablets should not be used in opioid-dependent patients. ULTRAM® can re-initiate physical dependence in patients who have been previously dependent or chronically using other opioids. In patients with a tendency to abuse drugs or a history of drug dependence, and in patients who are chronically using opioids, treatment with ULTRAM® is not recommended. Bertram is both a Germanic given name and a surname, from berht ("bright") and hramn ("raven"). Notable people with the name include: