how to use Best Flunitrazepam Rohypnol 2Mg Tablet online
Best Flunitrazepam Rohypnol 2Mg Tablet online, also known as Rohypnol among other names,[1] is a benzodiazepine used to treat severe insomnia and assist with anesthesia.[2] As with other hypnotics, flunitrazepam has been advised to be prescribed only for short-term use or by those with chronic insomnia on an occasional basis.[2]
It was patented in 1962 and came into medical use in 1974.[3] Flunitrazepam, nicknamed “roofies” or “floonies,” is widely known for its use as a date rape drug.
Flunitrazepam, as with other benzodiazepines, can lead to drug dependence.[9] Discontinuation may result in benzodiazepine withdrawal syndrome, characterised by seizures, psychosis, insomnia, and anxiety. Rebound insomnia, worse than baseline insomnia, typically occurs after discontinuation of flunitrazepam even from short-term single nightly dose therapy
For oral administration of Best Flunitrazepam Rohypnol 2Mg Tablet online
Treatment should be as short as possible. Generally the duration of treatment varies from a few days to two weeks with a maximum, including the tapering off process, of four weeks. The tapering off process should be tailored to the individual.
As with all hypnotics, long-term use is not recommended and a course of treatment should not exceed four weeks. In certain cases extension beyond the maximum treatment period may be necessary; if so, it should not take place without re-evaluation of the patient’s status.
The product acts rapidly and therefore should be taken with fluid just before going to bed, or in bed.
Adults
The treatment should be taken in a single intake and not be re-administered during the same night.
The recommended daily dose for Best Flunitrazepam Rohypnol 2Mg Tablet online to adults is 10 mg to be taken immediately at bedtime. The lowest effective daily dose of zolpidem should be used and must not exceed 10 mg.
Elderly (over 65 years) or debilitated patients
Elderly or debilitated patients may be especially sensitive to the effects of Zolpidem therefore a 5 mg dose is recommended. These recommended doses should not be exceeded.
Hepatic impairment
Patients with hepatic insufficiency do not clear Best Flunitrazepam Rohypnol 2 Mg Tablet online as rapidly as normal individuals; therefore dosage should begin at 5 mg in these patients with particular caution being exercised in elderly patients. In adults (under 65 years) dosage may be increased to 10 mg only where the clinical response is inadequate and the drug is well tolerated.
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The total dose of Best Flunitrazepam Rohypnol 2Mg Tablet online should not exceed 10mg in any patients.
Paediatric population
Safety and effectiveness of zolpidem in paediatric patients under the age of 18 years have not been established.
The cause of insomnia should be identified wherever possible. The underlying factors should be treated before a hypnotic is prescribed. The failure of insomnia to remit after a 7-14 day course of treatment may indicate the presence of a primary psychiatric or physical disorder, which should be evaluated.
General information relating to effects seen following administration of Best Flunitrazepam Rohypnol 2Mg Tablet online or other hypnotic agents which should be taken into account by the prescribing physician are described below.
Tolerance
Some loss of efficacy to the hypnotic effects of short-acting Best Flunitrazepam Rohypnol 2Mg Tablet online and benzodiazapine-like agents may develop after repeated use for a few weeks.
Dependence
Use of Best Flunitrazepam Rohypnol 2Mg Tablet online or benzodiazapine-like agents may lead to the development of physical and psychological dependence of these products. The risk of dependence increases with dose and duration of treatment and is also greater in patients with a history of alcohol or drug abuse.
These patients should be under careful surveillance when receiving hypnotics. Once physical dependence has developed, abrupt termination of treatment will be accompanied by withdrawal symptoms. These may consist of headaches or muscle pain, extreme anxiety and tension, restlessness, confusion, irritability and insomnia. In severe cases the following symptoms may occur: derealisation, depersonalisation, hyperacusis, numbness and tingling of the extremities, hypersensitivity to light, noise and physical contact, hallucinations or epileptic seizures.
Rebound insomnia
A transient syndrome whereby the symptoms that led to treatment with a Best Flunitrazepam Rohypnol 2Mg Tablet online or benzodiazepine like agent recur in an enhanced form, may occur on withdrawal of hypnotic agent. It may be accompanied by other reactions including mood changes, anxiety and restlessness.
It is important that the patient should be aware of the possibility of rebound phenomena, thereby minimising anxiety over such symptoms if they occur when the medicinal product is being discontinued. There are indications that, in the case of Best Flunitrazepam Rohypnol 2Mg Tablet onlineand benzodiazepine-like agents with a short duration of action, withdrawal phenomena can become manifest within the dosage interval, especially when the dosage is high.
As the risk of withdrawal symptoms/rebound phenomena are more likely to develop after abrupt discontinuation of treatment, it is recommended to decrease the dose gradually.
Duration of treatment
The duration of treatment should be as short as possible , and should not exceed 4 weeks including the tapering off process. Extension beyond these periods should not take place without re-evaluation of the situation.
It may be useful to inform the patient when treatment is started that it will be of limited duration.
Amnesia
Best Flunitrazepam Rohypnol 2Mg Tablet online or benzodiazapine-like agents may induce anterograde amnesia. The condition usually occurs several hours after ingesting the product. In order to reduce the risk, patients should ensure that they will be able to have an uninterrupted sleep of 8 hours.
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Psychiatric and “paradoxical†reactions
When using benzodiazepines or Best Flunitrazepam Rohypnol 2Mg Tablet online, reactions like restlessness, agitation, irritability, aggressiveness, delusion, rages, nightmares, hallucinations, psychoses, somnambulism and other nightly unconscious behaviours, like eating and car driving, inappropriate behaviour, increased insomnia and other adverse behavioural effects are known to occur. Should this occur, use of the product should be discontinued. These reactions are more likely to occur in the elderly.
Somnambulism and associated behaviours
Sleep walking and other associated behaviours such as “sleep drivingâ€, preparing and eating food, making phone calls or having sex, with amnesia for the event, have been reported in patients who had taken zolpidem and were not fully awake. The use of alcohol and other CNS-depressants with zolpidem appears to increase the risk of such behaviours, as does the use of zolpidem at doses exceeding the maximum recommended dose. Discontinuation of Best Flunitrazepam Rohypnol 2Mg Tablet online should be strongly considered for patients who report such behaviours.
Serious injuries
Because of its pharmacological properties, Best Flunitrazepam Rohypnol 2Mg Tablet online can cause drowsiness and reduced levels of awareness, which can lead to falls and thereby serious injury.
Next-day psychomotor impairment
The risk of next-day psychomotor impairment, including impaired driving ability, is increased if:
– zolpidem is taken within less than 8 hours before performing activities that require mental alertness ;
– a dose higher than the recommended dose is taken;
– Best Flunitrazepam Rohypnol 2Mg Tablet online is co-administered with other CNS depressants or with other drugs that increase the blood levels of zolpidem, or with alcohol or illicit drugs.
Zolpidem should be taken in a single intake immediately at bedtime and not be re-administered during the same night.
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Specific patient groups
Due to the myorelaxant effect there is a risk of falls and consequent injury particularly for elderly patients when they get up at night.
Although dose adjustment is not necessary, caution should be exercised in patients with renal insufficiency.
Caution should be observed when prescribing Best Flunitrazepam Rohypnol 2Mg Tablet online to patients with chronic respiratory insufficiency since benzodiazepines have been shown to impair respiratory drive. It should also be taken into consideration that anxiety or agitation have been described as signs of deterioration of respiratory insufficiency.
Benzodiazepines and benzodiazapine-like agents are not indicated for the treatment of patients with severe hepatic insufficiency as they may precipitate encephalopathy.
Use in patients with psychotic illness: benzodiazepines and benzodiazapine-like agents are not recommended for the primary treatment.
Depression
Best Flunitrazepam Rohypnol 2Mg Tablet online and benzodiazepine-like agents should not be used alone to treat depression or anxiety associated with depression (suicide may be precipitated in such patients). Zolpidem should be administered with caution in patients exhibiting symptoms of depression. Suicidal tendencies may be present. Due to the possibility of intentional overdose by the patient, the lowest amount of the drug that is feasible should be supplied to these patients. Pre-existing depression may be unmasked during use of zolpidem. Since insomnia may be a symptom of depression, the patient should be re-evaluated if insomnia persists.
Use in patients with a history of drug or alcohol abuse: Best Flunitrazepam Rohypnol 2Mg Tablet online and benzodiazapine-like agents should be used with extreme caution in patients with a history of alcohol or drug abuse. These patients should be under careful surveillance when receiving zolpidem since they are at risk of habituation and psychological dependence.
Since this product contains lactose, patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
Best Flunitrazepam Rohypnol 2Mg Tablet online should not be taken in combination with alcohol. The sedative effect may be enhanced when the product is used in combination with alcohol. This affects the ability to drive or use machines.
Combination with CNS depressants:
Enhancement of the central depressive effect may occur in cases of concomitant use with antipsychotics (neuroleptics), hypnotics, anxiolytics/sedatives/muscle relaxants, antidepressant agents, narcotic analgesics, antiepileptic drugs, anaesthetics and sedative antihistamines. Therefore, concomitant use of zolpidem with these drugs may increase drowsiness and next-day psychomotor impairment, including impaired driving ability. Also, isolated cases of visual hallucinations were reported in patients taking zolpidem with antidepressants including bupropion, desipramine, fluoxetine, sertraline and venlafaxine.
In the case of narcotic analgesics enhancement of euphoria may also occur leading to an increase in psychological dependence.
Best Flunitrazepam Rohypnol 2Mg Tablet online tartrate appears to interact with sertraline. This interaction may cause increased drowsiness. Also, isolated cases of visual hallucinations were reported.
CYP450 inhibitors and inducers:
Best Flunitrazepam Rohypnol 2Mg Tablet online is metabolised by some enzymes of the cytochrome P450-family. The main enzyme is CYP3A4, but CYP1A2 is involved as well. Since CYP3A4 plays an important role in zolpidem tartrate metabolism, possible interactions with drugs that are substrates or inducers of CYP3A4 should be considered.
Co-administration of ciprofloxacin may increase blood levels of zolpidem, concurrent use is not recommended.
Co-administration of fluvoxamine may increase blood levels of zolpidem, concurrent use is not recommended.
Rifampicin (a CYP3A4 inducer) induces the metabolism of Best Flunitrazepam Rohypnol 2Mg Tablet online, resulting in approximately 60% reduction in peak plasma concentrations and possibly decreased efficacy. Similar effects might be expected also with other strong inducers of cytochrome P450-enzymes. However when zolpidem tartrate was administered with itraconazole (a CYP3A4 inhibitor) its pharmacokinetics and pharmacodynamics were not significantly modified. The clinical relevance of these results is unknown.
Co-administration of zolpidem with ketoconazole (200mg twice daily), a potent CYP3A4 inhibitor, prolonged zolpidem elimination half-life, increased total AUC, and decreased apparent oral clearance when compared to zolpidem plus placebo. The total AUC for zolpidem, when co-administered with ketoconazole, increased by a factor of 1.83 when compared to Best Flunitrazepam Rohypnol 2Mg Tablet online alone. A routine dosage adjustment of zolpidem is not considered necessary, but patients, should be advised that use of zolpidem with ketoconazole may enhance the sedative effects.
Other drugs:
Caution should be observed when other psychoactive drugs are used.
No clinical significant pharmacokinetic interactions have been shown with selective serotonin reuptake inhibitors (fluoxetine and sertraline).
When Best Flunitrazepam Rohypnol 2Mg Tablet online tartrate was administered with ranitidine, no significant pharmacokinetic interactions were observed.
Best Flunitrazepam Rohypnol 2Mg Tablet online does not interact with warfarin, haloperidol, chlorpromazine, itraconazole or digoxin.
Pharmacotherapeutic group: Hypnotics and Sedatives, Benzodiazepine related drugs
Absorption
Zolpidem has both a rapid absorption and onset of hypnotic effect. Bioavailability is 70% following oral administration. It demonstrates linear kinetics in the therapeutic dose range. The therapeutic plasma level is between 80 and 200 ng/ml. Peak plasma concentration is reached at between 0.5 and 3 hours after administration.
Distribution
The distribution volume in adults is 0.54 l/kg and decreases to 0.34 l/kg in the elderly.
Protein binding amounts to 92%. First pass metabolism by the liver amounts to approximately 35%. Repeated administration has been shown not to modify protein binding, indicating a lack of competition between zolpidem and its metabolites for binding sites.
Elimination
The elimination half-life is short, with a mean of 2.4 hours and a duration of action up to 6 hours.
All metabolites are pharmacologically inactive and are eliminated in the urine (56%) and in the faeces (37%).
Zolpidem has been shown in trials to be non-dialysable.
Special populations
In patients with renal insufficiency, including patients on dialysis a moderate reduction in clearance is observed. The other pharmacokinetic parameters remain unaffected.
In elderly patients and in patients with hepatic insufficiency, the bio-availability of zolpidem is increased. Clearance is reduced and the elimination half-life is prolonged (approximately 10 hours).
In patients with liver cirrhosis a 5-fold increase in AUC and a 3-fold increase in half-life was observed.
ATC Code: N05C F02
Best Flunitrazepam Rohypnol 2Mg Tablet online, an imidazopyridine, is a benzodiazepine-like hypnotic agent. In experimental studies it was shown that it has sedative effects at lower dosages than those required to exert anticonvulsant, myorelaxant or anxiolytic effects. These effects are related to a specific agonist action at central receptors belonging to the “GABA-omega†(BZ1 & BZ2) macromolecular receptor complex, modulating the opening of the chloride ion channel. Zolpidem acts primarily upon omega (BZ1) receptor subtypes.
The randomised trials only showed convincing evidence of efficacy of Best Flunitrazepam Rohypnol 2Mg Tablet online.
In a randomised double-blind trial in 462 non-elderly healthy volunteers with transient insomnia, zolpidem 10 mg decreased the mean time to fall asleep by 10 minutes compared to placebo, while for 5 mg zolpidem this was 3 minutes.
In a randomised double-blind trial in 114 non-elderly patients with chronic insomnia, zolpidem 10 mg decreased the mean time to fall asleep by 30 minutes compared to placebo, while for 5 mg zolpidem this was 15 minutes.
In some patients, a lower dose of 5 mg could be effective.
Paediatric population: Safety and efficacy of zolpidem have not been established in children aged less than 18 years. A randomised placebo-controlled study in 201 children aged 6-17 years with insomnia associated with Attention Deficit Hyperactivity Disorder (ADHD) failed to demonstrate efficacy of zolpidem 0.25 mg/kg/day (with a maximum of 10 mg/day) as compared to placebo. Psychiatric and nervous system disorders comprised the most frequent treatment emergent adverse events observed with zolpidem versus placebo and included dizziness (23.5% versus 1.5%), headache (12.5% versus 9.2%), and hallucinations (7.4% versus 0%).
In reports of overdose with zolpidem alone or with other CNS-depressant agents (including alcohol), impairment of consciousness has ranged from somnolence to coma and fatal outcomes have been reported.
Individuals have fully recovered from overdoses up to 400 mg of zolpidem, 40 times the recommended dose.
General symptomatic and supportive measures should be used. Immediate gastric lavage should be used where appropriate. Intravenous fluids should be administered as needed. If there is no advantage in emptying the stomach, activated charcoal should be given to reduce absorption. Monitoring of respiratory and cardiovascular functions should be considered. Sedating medicinal products should be withheld even if excitation occurs.
Use of Best Flunitrazepam Rohypnol 2Mg Tablet online may be considered when serious symptoms are observed. Flumazenil is reported to have an elimination half-life of about 40 to 80 minutes. Patients should be kept under close observation because of this short duration of action; further doses of flumazenil may be necessary. However, flumazenil administration may contribute to the appearance of neurological symptoms (convulsions).
In the treatment of overdose with any medicinal product, it should be borne in mind that multiple agents may have been taken.
Due to the high distribution volume and protein binding of zolpidem, haemodialysis and forced diuresis are not effective measures.
