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SOMA (carisoprodol) Tablets are available as 250 mg and 350 mg round, white tablets. Carisoprodol is a white, crystalline powder, having a mild, characteristic odor and a bitter taste. It is slightly soluble in water; freely soluble in alcohol, in chloroform, and in acetone; and its solubility is practically independent of pH. Carisoprodol is present as a racemic mixture. Chemically, carisoprodol is N-isopropyl-2-methyl-2-propyl-1,3-propanediol dicarbamate and the molecular formula is C12H24N2O4, with a molecular weight of 260.33. The structural formula is:

 A muscle relaxant is a drug which affects skeletal muscle function and decreases the muscle tone. It may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia. The term “muscle relaxant” is used to refer to two major therapeutic groups: neuromuscular blockers and spasmolytics. Neuromuscular blockers act by interfering with transmission at the neuromuscular end plate and have no CNS activity. They are often used during surgical procedures and in intensive care and emergency medicine to cause paralysis. Spasmolytics, also known as “centrally-acting” muscle relaxants, are used to alleviate musculoskeletal pain and spasms and to reduce spasticity in a variety of neurological conditions. While both neuromuscular blockers and spasmolytics are often grouped together as muscle relaxants, the term is commonly used to refer to spasmolytics only.

Carisoprodol is a muscle relaxer that works by blocking pain sensations between the nerves and the brain.   Carisoprodol is used together with rest and physical therapy to treat injuries and other painful musculoskeletal conditions.

What is the most important information I should know about carisoprodol?

This medication may be habit-forming and should be used only by the person it was prescribed for. Carisoprodol should never be given to another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. You may have withdrawal symptoms when you stop using carisoprodol after using it over a long period of time. Do not stop using this medication suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely. Carisoprodol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol. It can increase drowsiness and dizziness caused by carisoprodol.

What should I discuss with my healthcare provider before taking carisoprodol?

Do not use this medication if you are allergic to carisoprodol or meprobamate (Equanil, Miltown), or if you have porphyria.

Before using this medication, tell your doctor if you are allergic to any drugs, or if you have:

• epilepsy or other seizure disorder;
• liver disease; or
• kidney disease.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take carisoprodol.

This medication may be habit-forming and should be used only by the person it was prescribed for. Carisoprodol should never be given to another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. You may have withdrawal symptoms when you stop using carisoprodol after using it over a long period of time. Withdrawal symptoms include stomach pain, sleep problems, headache, nausea, and seizure (convulsions). Do not stop using this medication suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether carisoprodol passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give this medication to a child younger than 12 years old.. 

Muscle relaxation and paralysis can theoretically occur by interrupting function at several sites, including the central nervous system, myelinated somatic nerves, unmyelinated motor nerve terminals, nicotinic acetylcholine receptors, the motor end plate, and the muscle membrane or contractile apparatus. Most neuromuscular blockers function by blocking transmission at the end plate of the neuromuscular junction. Normally, a nerve impulse arrives at the motor nerve terminal, initiating an influx of calcium ions which causes the exocytosis of synaptic vesicles containing acetylcholine. Acetylcholine then diffuses across the synaptic cleft. It may be hydrolysed by Acetylcholine esterase (AchE) or bind to the nicotinic receptors located on the motor end plate. The binding of two acetylcholine molecules results in a conformational change in the receptor that opens the sodium-potassium channel of the nicotinic receptor. This allows Na⁺ and Ca²⁺ ions to enter the cell and K⁺ ions to leave the cell causing a depolarization of the end plate, resulting in muscle contraction.  Following depolarization, the acetylcholine molecules are then removed from the end plate region and enzymatically hydrolysed by acetylcholinesterase.

Normal end plate function can be blocked by two mechanisms. Nondepolarizing agents like tubocurarine block the agonist, acetylcholine, from binding nicotinic receptors and activating them, thereby preventing depolarization. Alternatively, depolarizing agents such as succinylcholine are nicotinic receptor agonists which mimic Ach, block muscle contraction by depolarizing to such an extent that it desensitizes the receptor and it can no longer initiate an action potential and cause muscle contraction. These neuromuscular blocking drugs are structurally similar to acetylcholine, the endogenous ligand, in many cases containing two acetylcholine molecules linked end-to-end by a rigid carbon ring system, as in pancuronium.

Spasmolytics like carisoprodol, cyclobenzaprine, metaxalone, and methocarbamol are commonly prescribed for low back pain or neck pain, fibromyalgia, tension headaches and myofascial pain syndrome. However, they are not recommended as first-line agents; in acute low back pain, they are not more effective than paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs),  and in fibromyalgia they are not more effective than antidepressants.  Nevertheless, there is some (low quality) evidence suggesting that muscle relaxants can add benefit to treatment with NSAIDs.  In general, there is no high quality evidence to support their use.  No drug has been shown to be better than another, and all of them have adverse effects, particularly dizziness and drowsiness. Concerns about possible abuse and interaction with other drugs, especially if increased sedation is a risk, further limit their use.

Agents like dantrolene and baclofen are not advised for orthopedic conditions, but rather for neurological conditions such as spasticity in cerebral palsy and multiple sclerosis.  Dantrolene, although thought of primarily as a peripherally acting agent, is associated with CNS effects, whereas baclofen activity is strictly associated with the CNS.

Muscle relaxants are thought to be useful in painful disorders based on the theory that pain induces spasm and spasm causes pain. However, there is considerable evidence to contradict this theory.

Carisoprodol side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using carisoprodol and call your doctor at once if you have any of these serious side effects:

• paralysis (loss of feeling);
• extreme weakness or lack of coordination;
• feeling light-headed, fainting;
• fast heartbeat;
• seizure (convulsions);
• vision loss; or
• agitation, confusion.

Less serious side effects may include:

• drowsiness, dizziness, tremor;
• headache;
• depression, feeling irritable;
• blurred vision;
• sleep problems (insomnia); or
• nausea, vomiting, hiccups, upset stomach.

What does Carisoprodol generic Soma Looks Like ?

Usual Adult Dose for Muscle Spasm

250 mg or 350 mg orally 3 times a day and at bedtime

Usual Geriatric Dose for Muscle Spasm

The efficacy and safety of carisoprodol in patients over 65 years old has not been established.

Usual Pediatric Dose for Muscle Spasm

Greater than or equal to 12 years: 250 mg or 350 mg orally 3 times a day and at bedtime

Renal Dose Adjustments

Carisoprodol is excreted by the kidney. To avoid its excess accumulation, caution should be exercised in administration to patients with compromised kidney function.

Liver Dose Adjustments

Carisoprodol is metabolized in the liver. To avoid its excess accumulation, caution should be exercised in administration to patients with compromised liver function.

Precautions

Long-term therapy is not recommended because of the risk of psychologic dependence.

If used chronically at high doses, abrupt discontinuation is not recommended.

Because patients with reduced CYP450 2C19 activity have a greater exposure to carisoprodol, caution is recommended if carisoprodol is used in this patient population.

Dialysis

Carisoprodol is dialyzable by peritoneal and hemodialysis.

Other Comments

The recommended maximum duration of carisoprodol use is up to two or three weeks.