<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Tropical cyclone and explain in detail? [/INST] A tropical cyclone is a rapidly rotating storm system characterized by a low-pressure center, a closed low-level atmospheric circulation, strong winds, and a spiral arrangement of thunderstorms that produce heavy rain and squalls. Depending on its location and strength, a tropical cyclone is referred to by different names, including hurricane (), typhoon (), tropical storm, cyclonic storm, tropical depression, or simply cyclone. A hurricane is a strong tropical cyclone that occurs in the Atlantic Ocean or northeastern Pacific Ocean, and a typhoon occurs in the northwestern Pacific Ocean. In the Indian Ocean, south Pacific, or (rarely) South Atlantic, comparable storms are referred to simply as "tropical cyclones", and such storms in the Indian Ocean can also be called "severe cyclonic storms".
"Tropical" refers to the geographical origin of these systems, which form almost exclusively over tropical seas. "Cyclone" refers to their winds moving in a circle, whirling round their central clear eye, with their surface winds blowing counterclockwise in the Northern Hemisphere and clockwise in the Southern Hemisphere. The opposite direction of circulation is due to the Coriolis effect. Tropical cyclones typically form over large bodies of relatively warm water. They derive their energy through the evaporation of water from the ocean surface, which ultimately condenses into clouds and rain when moist air rises and cools to saturation. This energy source differs from that of mid-latitude cyclonic storms, such as noreasters and European windstorms, which are powered primarily by horizontal temperature contrasts. Tropical cyclones are typically between 100 and 2,000 km (62 and 1,243 mi) in diameter. Every year tropical cyclones impact various regions of the globe including the Gulf Coast of North America, Australia, India, and Bangladesh.
The strong rotating winds of a tropical cyclone are a result of the conservation of angular momentum imparted by the Earths rotation as air flows inwards toward the axis of rotation. As a result, they rarely form within 5° of the equator. Tropical cyclones are very rare in the South Atlantic (although occasional examples do occur) due to consistently strong wind shear and a weak Intertropical Convergence Zone. Conversely, the African easterly jet and areas of atmospheric instability give rise to cyclones in the Atlantic Ocean and Caribbean Sea, while cyclones near Australia owe their genesis to the Asian monsoon and Western Pacific Warm Pool.
The primary energy source for these storms is warm ocean waters. These storms are therefore typically strongest when over or near water, and they weaken quite rapidly over land. This causes coastal regions to be particularly vulnerable to tropical cyclones, compared to inland regions. Coastal damage may be caused by strong winds and rain, high waves (due to winds), storm surges (due to wind and severe pressure changes), and the potential of spawning tornadoes. Tropical cyclones draw in air from a large area and concentrate the water content of that air (from atmospheric moisture and moisture evaporated from water) into precipitation over a much smaller area. This replenishing of moisture-bearing air after rain may cause multi-hour or multi-day extremely heavy rain up to 40 km (25 mi) from the coastline, far beyond the amount of water that the local atmosphere holds at any one time. This in turn can lead to river flooding, overland flooding, and a general overwhelming of local water control structures across a large area. Although their effects on human populations can be devastating, tropical cyclones may play a role in relieving drought conditions, though this claim is disputed. They also carry heat and energy away from the tropics and transport it towards temperate latitudes, which plays an important role in regulating global climate.

Background
A tropical cyclone is the generic term for a warm-cored, non-frontal synoptic-scale low-pressure system over tropical or subtropical waters around the world. The systems generally have a well-defined center which is surrounded by deep atmospheric convection and a closed wind circulation at the surface.Historically, tropical cyclones have occurred around the world for thousands of years, with one of the earliest tropical cyclones on record estimated to have occurred in Western Australia in around 4000 BC. However, before satellite imagery became available during the 20th century, many of these systems went undetected unless it impacted land or a ship encountered it by chance.These days, on average around 80 to 90 named tropical cyclones form each year around the world, over half of which develop hurricane-force winds of 65 kn (120 km/h; 75 mph) or more. Around the world, a tropical cyclone is generally deemed to have formed once mean surface winds in excess of 35 kn (65 km/h; 40 mph) are observed. It is assumed at this stage that a tropical cyclone has become self-sustaining and can continue to intensify without any help from its environment.A study review article published in 2021 in Nature Geoscience concluded that the geographic range of tropical cyclones will probably expand poleward in response to climate warming of the Hadley circulation.

Intensity
Tropical cyclone intensity is based on wind speeds and pressure; relationships between winds and pressure are often utilized in determining the intensity of a storm. Tropical cyclone scales such as the Saffir-Simpson Hurricane Wind Scale and Australias scale (Bureau of Meteorology) only use wind speed for determining the category of a storm. The most intense storm on record is Typhoon Tip in the northwestern Pacific Ocean in 1979, which reached a minimum pressure of 870 hPa (26 inHg) and maximum sustained wind speeds of 165 kn (85 m/s; 306 km/h; 190 mph). The highest maximum sustained wind speed ever recorded was 185 kn (95 m/s; 343 km/h; 213 mph) in Hurricane Patricia in 2015—the most intense cyclone ever recorded in the Western Hemisphere.

Factors that influence intensity
Warm sea surface temperatures are required in order for tropical cyclones to form and strengthen. The commonly-accepted minimum temperature range for this to occur is 26–27 °C (79–81 °F), however, multiple studies have proposed a lower minimum of 25.5 °C (77.9 °F). Higher sea surface temperatures result in faster intensification rates and sometimes even rapid intensification. High ocean heat content, also known as Tropical Cyclone Heat Potential, allows storms to achieve a higher intensity. Most tropical cyclones that experience rapid intensification are traversing regions of high ocean heat content rather than lower values. High ocean heat content values can help to offset the oceanic cooling caused by the passage of a tropical cyclone, limiting the effect this cooling has on the storm. Faster-moving systems are able to intensify to higher intensities with lower ocean heat content values. Slower-moving systems require higher values of ocean heat content to achieve the same intensity.The passage of a tropical cyclone over the ocean causes the upper layers of the ocean to cool substantially, a process known as upwelling, which can negatively influence subsequent cyclone development. This cooling is primarily caused by wind-driven mixing of cold water from deeper in the ocean with the warm surface waters. This effect results in a negative feedback process that can inhibit further development or lead to weakening. Additional cooling may come in the form of cold water from falling raindrops (this is because the atmosphere is cooler at higher altitudes). Cloud cover may also play a role in cooling the ocean, by shielding the ocean surface from direct sunlight before and slightly after the storm passage. All these effects can combine to produce a dramatic drop in sea surface temperature over a large area in just a few days. Conversely, the mixing of the sea can result in heat being inserted in deeper waters, with potential effects on global climate.Vertical wind shear negatively impacts tropical cyclone intensification by displacing moisture and heat from a systems center. Low levels of vertical wind shear are most optimal for strengthening, while stronger wind shear induces weakening. Dry air entraining into a tropical cyclones core has a negative effect on its development and intensity by diminishing atmospheric convection and introducing asymmetries in the storms structure. Symmetric, strong outflow leads to a faster rate of intensification than observed in other systems by mitigating local wind shear. Weakening outflow is associated with the weakening of rainbands within a tropical cyclone.The size of tropical cyclones plays a role in how quickly they intensify. Smaller tropical cyclones are more prone to rapid intensification than larger ones. The Fujiwhara effect, which involves interaction between two tropical cyclones, can weaken and ultimately result in the dissipation of the weaker of two tropical cyclones by reducing the organization of the systems convection and imparting horizontal wind shear. Tropical cyclones typically weaken while situated over a landmass because conditions are often unfavorable as a result of the lack of oceanic forcing. The Brown ocean effect can allow a tropical cyclone to maintain or increase its intensity following landfall, in cases where there has been copious rainfall, through the release of latent heat from the saturated soil. Orographic lift can cause an significant increase in the intensity of the convection of a tropical cyclone when its eye moves over a mountain, breaking the capped boundary layer that had been restraining it. Jet streams can both enhance and inhibit tropical cyclone intensity by influencing the storms outflow as well as vertical wind shear.

Formation
Tropical cyclones tend to develop during the summer, but have been noted in nearly every month in most tropical cyclone basins. Tropical cyclones on either side of the Equator generally have their origins in the Intertropical Convergence Zone, where winds blow from either the northeast or southeast. Within this broad area of low-pressure, air is heated over the warm tropical ocean and rises in discrete parcels, which causes thundery showers to form. These showers dissipate quite quickly; however, they can group together into large clusters of thunderstorms. This creates a flow of warm, moist, rapidly rising air, which starts to rotate cyclonically as it interacts with the rotation of the earth.Several factors are required for these thunderstorms to develop further, including sea surface temperatures of around 27 °C (81 °F) and low vertical wind shear surrounding the system, atmospheric instability, high humidity in the lower to middle levels of the troposphere, enough Coriolis force to develop a low-pressure center, a pre-existing low-level focus or disturbance,
There is a limit on tropical cyclone intensity which is strongly related to the water temperatures along its path. and upper-level divergence.
An average of 86 tropical cyclones of tropical storm intensity form annually worldwide. Of those, 47 reach strength higher than 119 km/h (74 mph), and 20 become intense tropical cyclones (at least Category 3 intensity on the Saffir–Simpson scale).Climate cycles such as ENSO and the Madden–Julian oscillation modulate the timing and frequency of tropical cyclone development. Rossby waves can aid in the formation of a new tropical cyclone by disseminating the energy of an existing, mature storm. Kelvin waves can contribute to tropical cyclone formation by regulating the development of the westerlies. Cyclone formation is usually reduced 3 days prior to the waves crest and increased during the 3 days after.

Rapid intensification
On occasion, tropical cyclones may undergo a process known as rapid intensification, a period in which the maximum sustained winds of a tropical cyclone increase by 30 kn (56 km/h; 35 mph) or more within 24 hours. Similarly, rapid deepening in tropical cyclones is defined as a minimum sea surface pressure decrease of 1.75 hPa (0.052 inHg) per hour or 42 hPa (1.2 inHg) within a 24-hour period; explosive deepening occurs when the surface pressure decreases by 2.5 hPa (0.074 inHg) per hour for at least 12 hours or 5 hPa (0.15 inHg) per hour for at least 6 hours. For rapid intensification to occur, several conditions must be in place. Water temperatures must be extremely high (near or above 30 °C (86 °F)), and water of this temperature must be sufficiently deep such that waves do not upwell cooler waters to the surface. On the other hand, Tropical Cyclone Heat Potential is one of such non-conventional subsurface oceanographic parameters influencing the cyclone intensity. Wind shear must be low; when wind shear is high, the convection and circulation in the cyclone will be disrupted. Usually, an anticyclone in the upper layers of the troposphere above the storm must be present as well—for extremely low surface pressures to develop, air must be rising very rapidly in the eyewall of the storm, and an upper-level anticyclone helps channel this air away from the cyclone efficiently. However, some cyclones such as Hurricane Epsilon have rapidly intensified despite relatively unfavorable conditions.

Dissipation
There are a number of ways a tropical cyclone can weaken, dissipate, or lose its tropical characteristics. These include making landfall, moving over cooler water, encountering dry air, or interacting with other weather systems; however, once a system has dissipated or lost its tropical characteristics, its remnants could regenerate a tropical cyclone if environmental conditions become favorable.A tropical cyclone can dissipate when it moves over waters significantly cooler than 26.5 °C (79.7 °F). This will deprive the storm of such tropical characteristics as a warm core with thunderstorms near the center, so that it becomes a remnant low-pressure area. Remnant systems may persist for several days before losing their identity. This dissipation mechanism is most common in the eastern North Pacific. Weakening or dissipation can also occur if a storm experiences vertical wind shear which causes the convection and heat engine to move away from the center; this normally ceases the development of a tropical cyclone. In addition, its interaction with the main belt of the Westerlies, by means of merging with a nearby frontal zone, can cause tropical cyclones to evolve into extratropical cyclones. This transition can take 1–3 days.Should a tropical cyclone make landfall or pass over an island, its circulation could start to break down, especially if it encounters mountainous terrain. When a system makes landfall on a large landmass, it is cut off from its supply of warm moist maritime air and starts to draw in dry continental air. This, combined with the increased friction over land areas, leads to the weakening and dissipation of the tropical cyclone. Over a mountainous terrain, a system can quickly weaken; however, over flat areas, it may endure for two to three days before circulation breaks down and dissipates.Over the years, there have been a number of techniques considered to try to artificially modify tropical cyclones. These techniques have included using nuclear weapons, cooling the ocean with icebergs, blowing the storm away from land with giant fans, and seeding selected storms with dry ice or silver iodide. These techniques, however, fail to appreciate the duration, intensity, power or size of tropical cyclones.

Methods for assessing intensity
A variety of methods or techniques, including surface, satellite, and aerial, are utilized to assess the intensity of a tropical cyclone. Reconnaissance aircraft fly around and through tropical cyclones, outfitted with specialized instruments, to collect information that can be used to ascertain the winds and pressure of a system. Tropical cyclones possess winds of different speeds at different heights. Winds recorded at flight level can be converted to find the wind speeds at the surface. Surface observations, such as ship reports, land stations, mesonets, coastal stations, and buoys, can provide information on a tropical cyclones intensity or the direction it is traveling. Wind-pressure relationships (WPRs) are used as a way to determine the pressure of a storm based on its wind speed. Several different methods and equations have been proposed to calculate WPRs. Tropical cyclones agencies each use their own, fixed WPR, which can result in inaccuracies between agencies that are issuing estimates on the same system. The ASCAT is a scatterometer used by the MetOp satellites to map the wind field vectors of tropical cyclones. The SMAP uses an L-band radiometer channel to determine the wind speeds of tropical cyclones at the ocean surface, and has been shown to be reliable at higher intensities and under heavy rainfall conditions, unlike scatterometer-based and other radiometer-based instruments.The Dvorak technique plays a large role in both the classification of a tropical cyclone and the determination of its intensity. Used in warning centers, the method was developed by Vernon Dvorak in the 1970s, and uses both visible and infrared satellite imagery in the assessment of tropical cyclone intensity. The Dvorak technique utilizes a scale of "T-numbers", scaling in increments of ½ from T1.0 to T8.0. Each T-number has an intensity assigned to it, with larger T-numbers indicating a stronger system. Tropical cyclones are assessed by forecasters according to an array of patterns, including curved banding features, shear, central dense overcast, and eye, in order to determine the T-number and thus assess the intensity of the storm. The Cooperative Institute for Meteorological Satellite Studies works to develop and improve automated satellite methods, such as the Advanced Dvorak Technique (ADT) and SATCON. The ADT, used by a large number of forecasting centers, utilizes infrared geostationary satellite imagery and an algorithm based upon the Dvorak technique to assess the intensity of tropical cyclones. The ADT has a number of differences from the conventional Dvorak technique, including changes to intensity constraint rules and the usage of microwave imagery to base a systems intensity upon its internal structure, which prevents the intensity from leveling off before an eye emerges in infrared imagery. The SATCON weights estimates from various satellite-based systems and microwave sounders, accounting for the strengths and flaws in each individual estimate, to produce a consensus estimate of a tropical cyclones intensity which can be more reliable than the Dvorak technique at times.

Intensity metrics
Multiple intensity metrics are utilized, including accumulated cyclone energy (ACE), the Hurricane Surge Index, the Hurricane Severity Index, the Power Dissipation Index (PDI), and integrated kinetic energy (IKE). ACE is a metric of the total energy a system has exerted over its lifespan. ACE is calculated by summing the squares of a cyclones sustained wind speed, every six hours as long as the system is at or above tropical storm intensity and either tropical or subtropical. The calculation of the PDI is similar in nature to ACE, with the major difference being that wind speeds are cubed rather than squared. The Hurricane Surge Index is a metric of the potential damage a storm may inflict via storm surge. It is calculated by squaring the dividend of the storms wind speed and a climatological value (33 metres per second (74 mph)), and then multiplying that quantity by the dividend of the radius of hurricane-force winds and its climatological value (96.6 kilometres (60.0 mi)). This can be represented in equation form as:

            (

                v

                  33
                  m

                    /

                  s

            )

            2

        ×

          (

              r

                96.6
                k
                m

          )

    {\displaystyle \left({\frac {v}{33m/s}}\right)^{2}\times \left({\frac {r}{96.6km}}\right)\,}
  where v is the storms wind speed and r is the radius of hurricane-force winds. The Hurricane Severity Index is a scale that can assign up to 50 points to a system; up to 25 points come from intensity, while the other 25 come from the size of the storms wind field. The IKE model measures the destructive capability of a tropical cyclone via winds, waves, and surge. It is calculated as:

          ∫

            V
            o
            l

            1
            2

        p

          u

            2

          d

            v

    {\displaystyle \int _{Vol}{\frac {1}{2}}pu^{2}d_{v}\,}
  where p is the density of air, u is a sustained surface wind speed value, and dv is the volume element.

Classification and naming
Intensity classifications
Around the world, tropical cyclones are classified in different ways, based on the location (tropical cyclone basins), the structure of the system and its intensity. For example, within the Northern Atlantic and Eastern Pacific basins, a tropical cyclone with wind speeds of over 65 kn (120 km/h; 75 mph) is called a hurricane, while it is called a typhoon or a severe cyclonic storm within the Western Pacific or North Indian Oceans. Within the Southern Hemisphere, it is either called a hurricane, tropical cyclone or a severe tropical cyclone, depending on if it is located within the South Atlantic, South-West Indian Ocean, Australian region or the South Pacific Ocean.

Naming
The practice of using names to identify tropical cyclones goes back many years, with systems named after places or things they hit before the formal start of naming. The system currently used provides positive identification of severe weather systems in a brief form, that is readily understood and recognized by the public. The credit for the first usage of personal names for weather systems is generally given to the Queensland Government Meteorologist Clement Wragge who named systems between 1887 and 1907. This system of naming weather systems subsequently fell into disuse for several years after Wragge retired, until it was revived in the latter part of World War II for the Western Pacific. Formal naming schemes have subsequently been introduced for the North and South Atlantic, Eastern, Central, Western and Southern Pacific basins as well as the Australian region and Indian Ocean.At present, tropical cyclones are officially named by one of twelve meteorological services and retain their names throughout their lifetimes to provide ease of communication between forecasters and the general public regarding forecasts, watches, and warnings. Since the systems can last a week or longer and more than one can be occurring in the same basin at the same time, the names are thought to reduce the confusion about what storm is being described. Names are assigned in order from predetermined lists with one, three, or ten-minute sustained wind speeds of more than 65 km/h (40 mph) depending on which basin it originates. However, standards vary from basin to basin with some tropical depressions named in the Western Pacific, while tropical cyclones have to have a significant amount of gale-force winds occurring around the center before they are named within the Southern Hemisphere. The names of significant tropical cyclones in the North Atlantic Ocean, Pacific Ocean, and Australian region are retired from the naming lists and replaced with another name. Tropical cyclones that develop around the world are assigned an identification code consisting of a two-digit number and suffix letter by the warning centers that monitor them.

Structure
Eye and center
At the center of a mature tropical cyclone, air sinks rather than rises. For a sufficiently strong storm, air may sink over a layer deep enough to suppress cloud formation, thereby creating a clear "eye". Weather in the eye is normally calm and free of convective clouds, although the sea may be extremely violent. The eye is normally circular and is typically 30–65 km (19–40 mi) in diameter, though eyes as small as 3 km (1.9 mi) and as large as 370 km (230 mi) have been observed.The cloudy outer edge of the eye is called the "eyewall". The eyewall typically expands outward with height, resembling an arena football stadium; this phenomenon is sometimes referred to as the "stadium effect". The eyewall is where the greatest wind speeds are found, air rises most rapidly, clouds reach their highest altitude, and precipitation is the heaviest. The heaviest wind damage occurs where a tropical cyclones eyewall passes over land.In a weaker storm, the eye may be obscured by the central dense overcast, which is the upper-level cirrus shield that is associated with a concentrated area of strong thunderstorm activity near the center of a tropical cyclone.The eyewall may vary over time in the form of eyewall replacement cycles, particularly in intense tropical cyclones. Outer rainbands can organize into an outer ring of thunderstorms that slowly moves inward, which is believed to rob the primary eyewall of moisture and angular momentum. When the primary eyewall weakens, the tropical cyclone weakens temporarily. The outer eyewall eventually replaces the primary one at the end of the cycle, at which time the storm may return to its original intensity.

Size
There are a variety of metrics commonly used to measure storm size. The most common metrics include the radius of maximum wind, the radius of 34-knot (17 m/s; 63 km/h; 39 mph) wind (i.e. gale force), the radius of outermost closed isobar (ROCI), and the radius of vanishing wind. An additional metric is the radius at which the cyclones relative vorticity field decreases to 1×10−5 s−1.
On Earth, tropical cyclones span a large range of sizes, from 100–2,000 km (62–1,243 mi) as measured by the radius of vanishing wind. They are largest on average in the northwest Pacific Ocean basin and smallest in the northeastern Pacific Ocean basin. If the radius of outermost closed isobar is less than two degrees of latitude (222 km (138 mi)), then the cyclone is "very small" or a "midget". A radius of 3–6 latitude degrees (333–670 km (207–416 mi)) is considered "average sized". "Very large" tropical cyclones have a radius of greater than 8 degrees (888 km (552 mi)). Observations indicate that size is only weakly correlated to variables such as storm intensity (i.e. maximum wind speed), radius of maximum wind, latitude, and maximum potential intensity. Typhoon Tip is the largest cyclone on record, with tropical storm-force winds 2,170 km (1,350 mi) in diameter. The smallest storm on record is Tropical Storm Marco (2008), which generated tropical storm-force winds only 37 km (23 mi) in diameter.

Movement
The movement of a tropical cyclone (i.e. its "track") is typically approximated as the sum of two terms: "steering" by the background environmental wind and "beta drift". Some tropical cyclones can move across large distances, such as Hurricane John, the longest-lasting tropical cyclone on record, which traveled 13,280 km (8,250 mi), the longest track of any Northern Hemisphere tropical cyclone, over its 31-day lifespan in 1994.

Environmental steering
Environmental steering is the primary influence on the motion of tropical cyclones. It represents the movement of the storm due to prevailing winds and other wider environmental conditions, similar to "leaves carried along by a stream".Physically, the winds, or flow field, in the vicinity of a tropical cyclone may be treated as having two parts: the flow associated with the storm itself, and the large-scale background flow of the environment. Tropical cyclones can be treated as local maxima of vorticity suspended within the large-scale background flow of the environment. In this way, tropical cyclone motion may be represented to first-order as advection of the storm by the local environmental flow. This environmental flow is termed the "steering flow" and is the dominant influence on tropical cyclone motion. The strength and direction of the steering flow can be approximated as a vertical integration of the winds blowing horizontally in the cyclones vicinity, weighted by the altitude at which those winds are occurring. Because winds can vary with height, determining the steering flow precisely can be difficult.
The pressure altitude at which the background winds are most correlated with a tropical cyclones motion is known as the "steering level". The motion of stronger tropical cyclones is more correlated with the background flow averaged across a thicker portion of troposphere compared to weaker tropical cyclones whose motion is more correlated with the background flow averaged across a narrower extent of the lower troposphere. When wind shear and latent heat release is present, tropical cyclones tend to move towards regions where potential vorticity is increasing most quickly.Climatologically, tropical cyclones are steered primarily westward by the east-to-west trade winds on the equatorial side of the subtropical ridge—a persistent high-pressure area over the worlds subtropical oceans. In the tropical North Atlantic and Northeast Pacific oceans, the trade winds steer tropical easterly waves westward from the African coast toward the Caribbean Sea, North America, and ultimately into the central Pacific Ocean before the waves dampen out. These waves are the precursors to many tropical cyclones within this region. In contrast, in the Indian Ocean and Western Pacific in both hemispheres, tropical cyclogenesis is influenced less by tropical easterly waves and more by the seasonal movement of the Intertropical Convergence Zone and the monsoon trough. Other weather systems such as mid-latitude troughs and broad monsoon gyres can also influence tropical cyclone motion by modifying the steering flow.

Beta drift
In addition to environmental steering, a tropical cyclone will tend to drift poleward and westward, a motion known as "beta drift". This motion is due to the superposition of a vortex, such as a tropical cyclone, onto an environment in which the Coriolis force varies with latitude, such as on a sphere or beta plane. The magnitude of the component of tropical cyclone motion associated with the beta drift ranges between 1–3 m/s (3.6–10.8 km/h; 2.2–6.7 mph) and tends to be larger for more intense tropical cyclones and at higher latitudes. It is induced indirectly by the storm itself as a result of feedback between the cyclonic flow of the storm and its environment.Physically, the cyclonic circulation of the storm advects environmental air poleward east of center and equatorial west of center. Because air must conserve its angular momentum, this flow configuration induces a cyclonic gyre equatorward and westward of the storm center and an anticyclonic gyre poleward and eastward of the storm center. The combined flow of these gyres acts to advect the storm slowly poleward and westward. This effect occurs even if there is zero environmental flow. Due to a direct dependence of the beta drift on angular momentum, the size of a tropical cyclone can impact the influence of beta drift on its motion; beta drift imparts a greater influence on the movement of larger tropical cyclones than that of smaller ones.

Multiple storm interaction
A third component of motion that occurs relatively infrequently involves the interaction of multiple tropical cyclones. When two cyclones approach one another, their centers will begin orbiting cyclonically about a point between the two systems. Depending on their separation distance and strength, the two vortices may simply orbit around one another, or else may spiral into the center point and merge. When the two vortices are of unequal size, the larger vortex will tend to dominate the interaction, and the smaller vortex will orbit around it. This phenomenon is called the Fujiwhara effect, after Sakuhei Fujiwhara.

Interaction with the mid-latitude westerlies
Though a tropical cyclone typically moves from east to west in the tropics, its track may shift poleward and eastward either as it moves west of the subtropical ridge axis or else if it interacts with the mid-latitude flow, such as the jet stream or an extratropical cyclone. This motion, termed "recurvature", commonly occurs near the western edge of the major ocean basins, where the jet stream typically has a poleward component and extratropical cyclones are common. An example of tropical cyclone recurvature was Typhoon Ioke in 2006.

Formation regions and warning centers
The majority of tropical cyclones each year form in one of seven tropical cyclone basins, which are monitored by a variety of meteorological services and warning centres. Ten of these warning centres worldwide are designated as either a Regional Specialized Meteorological Centre or a Tropical Cyclone Warning Centre by the World Meteorological Organisations (WMO) tropical cyclone programme. These warning centres issue advisories which provide basic information and cover a systems present, forecast position, movement and intensity, in their designated areas of responsibility. Meteorological services around the world are generally responsible for issuing warnings for their own country, however, there are exceptions, as the United States National Hurricane Center and Fiji Meteorological Service issue alerts, watches and warnings for various island nations in their areas of responsibility. The United States Joint Typhoon Warning Center and Fleet Weather Center also publicly issue warnings, about tropical cyclones on behalf of the United States Government. The Brazilian Navy Hydrographic Center names South Atlantic tropical cyclones, however the South Atlantic is not a major basin, and not an official basin according to the WMO.

Preparations
Ahead of the formal season starting, people are urged to prepare for the effects of a tropical cyclone by politicians and weather forecasters, amongst others. They prepare by determining their risk to the different types of weather, tropical cyclones cause, checking their insurance coverage and emergency supplies, as well as determining where to evacuate to if needed. When a tropical cyclone develops and is forecast to impact land, each member nation of the World Meteorological Organization issues various watches and warnings to cover the expected impacts. However, there are some exceptions with the United States National Hurricane Center and Fiji Meteorological Service responsible for issuing or recommending warnings for other nations in their area of responsibility.: 2–4

Impacts
Natural phenomena caused or worsened by tropical cyclones
Tropical cyclones out at sea cause large waves, heavy rain, floods and high winds, disrupting international shipping and, at times, causing shipwrecks. Tropical cyclones stir up water, leaving a cool wake behind them, which causes the region to be less favorable for subsequent tropical cyclones. On land, strong winds can damage or destroy vehicles, buildings, bridges, and other outside objects, turning loose debris into deadly flying projectiles. The storm surge, or the increase in sea level due to the cyclone, is typically the worst effect from landfalling tropical cyclones, historically resulting in 90% of tropical cyclone deaths. Cyclone Mahina produced the highest storm surge on record, 13 m (43 ft), at Bathurst Bay, Queensland, Australia, in March 1899. Other ocean-based hazards that tropical cyclones produce are rip currents and undertow. These hazards can occur hundreds of kilometers (hundreds of miles) away from the center of a cyclone, even if other weather conditions are favorable.
The broad rotation of a landfalling tropical cyclone, and vertical wind shear at its periphery, spawns tornadoes. Tornadoes can also be spawned as a result of eyewall mesovortices, which persist until landfall. Hurricane Ivan produced 120 tornadoes, more than any other tropical cyclone. Lightning activity is produced within tropical cyclones; this activity is more intense within stronger storms and closer to and within the storms eyewall. Tropical cyclones can increase the amount of snowfall a region experiences by delivering additional moisture. Wildfires can be worsened when a nearby storm fans their flames with its strong winds.

Impact on property and human life
Tropical cyclones regularly affect the coastlines of most of Earths major bodies of water along the Atlantic, Pacific, and Indian oceans. Tropical cyclones have caused significant destruction and loss of human life, resulting in about 2 million deaths since the 19th century. Large areas of standing water caused by flooding lead to infection, as well as contributing to mosquito-borne illnesses. Crowded evacuees in shelters increase the risk of disease propagation. Tropical cyclones significantly interrupt infrastructure, leading to power outages, bridge and road destruction, and the hampering of reconstruction efforts. Winds and water from storms can damage or destroy homes, buildings, and other manmade structures. Tropical cyclones destroy agriculture, kill livestock, and prevent access to marketplaces for both buyers and sellers; both of these result in financial losses. Powerful cyclones that make landfall – moving from the ocean to over land – are some of the most impactful, although that is not always the case. An average of 86 tropical cyclones of tropical storm intensity form annually worldwide, with 47 reaching hurricane or typhoon strength, and 20 becoming intense tropical cyclones, super typhoons, or major hurricanes (at least of Category 3 intensity).In Africa, tropical cyclones can originate from tropical waves generated over the Sahara Desert, or otherwise strike the Horn of Africa and Southern Africa. Cyclone Idai in March 2019 hit central Mozambique, becoming the deadliest tropical cyclone on record in Africa, with 1,302 fatalities, and damage estimated at US$2.2 billion. Réunion island, located east of Southern Africa, experiences some of the wettest tropical cyclones on record. In January 1980, Cyclone Hyacinthe produced 6,083 mm (239.5 in) of rain over 15 days, which was the largest rain total recorded from a tropical cyclone on record. In Asia, tropical cyclones from the Indian and Pacific oceans regularly affect some of the most populated countries on Earth. In 1970, a cyclone struck Bangladesh, then known as East Pakistan, producing a 6.1 m (20 ft) storm surge that killed at least 300,000 people; this made it the deadliest tropical cyclone on record. In October 2019, Typhoon Hagibis struck the Japanese island of Honshu and inflicted US$15 billion in damage, making it the costliest storm on record in Japan. The islands that comprise Oceania, from Australia to French Polynesia, are routinely affected by tropical cyclones. In Indonesia, a cyclone struck the island of Flores in April 1973, killing 1,653 people, making it the deadliest tropical cyclone recorded in the Southern Hemisphere.Atlantic and Pacific hurricanes regularly affect North America. In the United States, hurricanes Katrina in 2005 and Harvey in 2017 are the countrys costliest ever natural disasters, with monetary damage estimated at US$125 billion. Katrina struck Louisiana and largely destroyed the city of New Orleans, while Harvey caused significant flooding in southeastern Texas after it dropped 60.58 in (1,539 mm) of rainfall; this was the highest rainfall total on record in the country. Europe is rarely affected by tropical cyclones; however, the continent regularly encounters storms after they transitioned into extratropical cyclones. Only one tropical depression – Vince in 2005 – struck Spain, and only one subtropical cyclone – Subtropical Storm Alpha in 2020 – struck Portugal. Occasionally, there are tropical-like cyclones in the Mediterranean Sea. The northern portion of South America experiences occasional tropical cyclones, with 173 fatalities from Tropical Storm Bret in August 1993. The South Atlantic Ocean is generally inhospitable to the formation of a tropical storm. However, in March 2004, Hurricane Catarina struck southeastern Brazil as the first hurricane on record in the South Atlantic Ocean.

Environmental impact
Although cyclones take an enormous toll in lives and personal property, they may be important factors in the precipitation regimes of places they impact, as they may bring much-needed precipitation to otherwise dry regions. Their precipitation may also alleviate drought conditions by restoring soil moisture, though one study focused on the Southeastern United States suggested tropical cyclones did not offer significant drought recovery. Tropical cyclones also help maintain the global heat balance by moving warm, moist tropical air to the middle latitudes and polar regions, and by regulating the thermohaline circulation through upwelling. The storm surge and winds of hurricanes may be destructive to human-made structures, but they also stir up the waters of coastal estuaries, which are typically important fish breeding locales. Ecosystems, such as saltmarshes and Mangrove forests, can be severely damaged or destroyed by tropical cyclones, which erode land and destroy vegetation. Tropical cyclones can cause harmful algae blooms to form in bodies of water by increasing the amount of nutrients available. Insect populations can decrease in both quantity and diversity after the passage of storms. Strong winds associated with tropical cyclones and their remnants are capable of felling thousands of trees, causing damage to forests.When hurricanes surge upon shore from the ocean, salt is introduced to many freshwater areas and raises the salinity levels too high for some habitats to withstand. Some are able to cope with the salt and recycle it back into the ocean, but others can not release the extra surface water quickly enough or do not have a large enough freshwater source to replace it. Because of this, some species of plants and vegetation die due to the excess salt. In addition, hurricanes can carry toxins and acids onshore when they make landfall. The floodwater can pick up the toxins from different spills and contaminate the land that it passes over. These toxins are harmful to the people and animals in the area, as well as the environment around them. Tropical cyclones can cause oil spills by damaging or destroying pipelines and storage facilities. Similarly, chemical spills have been reported when chemical and processing facilities were damaged. Waterways have become contaminated with toxic levels of metals such as nickel, chromium, and mercury during tropical cyclones.Tropical cyclones can have an extensive effect on geography, such as creating or destroying land. Cyclone Bebe increased the size of Tuvalu island, Funafuti Atoll, by nearly 20%. Hurricane Walaka destroyed the small East Island in 2018, which destroyed the habitat for the endangered Hawaiian monk seal, as well as, threatened sea turtles and seabirds. Landslides frequently occur during tropical cyclones and can vastly alter landscapes; some storms are capable of causing hundreds to tens of thousands of landslides. Storms can erode coastlines over an extensive area and transport the sediment to other locations.

Response
Hurricane response is the disaster response after a hurricane. Activities performed by hurricane responders include assessment, restoration, and demolition of buildings; removal of debris and waste; repairs to land-based and maritime infrastructure; and public health services including search and rescue operations. Hurricane response requires coordination between federal, tribal, state, local, and private entities. According to the National Voluntary Organizations Active in Disaster, potential response volunteers should affiliate with established organizations and should not self-deploy, so that proper training and support can be provided to mitigate the danger and stress of response work.Hurricane responders face many hazards. Hurricane responders may be exposed to chemical and biological contaminants including stored chemicals, sewage, human remains, and mold growth encouraged by flooding, as well as asbestos and lead that may be present in older buildings. Common injuries arise from falls from heights, such as from a ladder or from level surfaces; from electrocution in flooded areas, including from backfeed from portable generators; or from motor vehicle accidents. Long and irregular shifts may lead to sleep deprivation and fatigue, increasing the risk of injuries, and workers may experience mental stress associated with a traumatic incident. Additionally, heat stress is a concern as workers are often exposed to hot and humid temperatures, wear protective clothing and equipment, and have physically difficult tasks.

Climatology
Tropical cyclones have occurred around the world for millennia. Reanalyses and research are being undertaken to extend the historical record, through the usage of proxy data such as overwash deposits, beach ridges and historical documents such as diaries. Major tropical cyclones leave traces in overwash records and shell layers in some coastal areas, which have been used to gain insight into hurricane activity over the past thousands of years. Sediment records in Western Australia suggest an intense tropical cyclone in the 4th millennium BC. Proxy records based on paleotempestological research have revealed that major hurricane activity along the Gulf of Mexico coast varies on timescales of centuries to millennia. In the year 957, a powerful typhoon struck southern China, killing around 10,000 people due to flooding. The Spanish colonization of Mexico described "tempestades" in 1730, although the official record for Pacific hurricanes only dates to 1949. In the south-west Indian Ocean, the tropical cyclone record goes back to 1848. In 2003, the Atlantic hurricane reanalysis project examined and analyzed the historical record of tropical cyclones in the Atlantic back to 1851, extending the existing database from 1886.Before satellite imagery became available during the 20th century, many of these systems went undetected unless it impacted land or a ship encountered it by chance. Often in part because of the threat of hurricanes, many coastal regions had sparse population between major ports until the advent of automobile tourism; therefore, the most severe portions of hurricanes striking the coast may have gone unmeasured in some instances. The combined effects of ship destruction and remote landfall severely limit the number of intense hurricanes in the official record before the era of hurricane reconnaissance aircraft and satellite meteorology. Although the record shows a distinct increase in the number and strength of intense hurricanes, therefore, experts regard the early data as suspect. The ability of climatologists to make a long-term analysis of tropical cyclones is limited by the amount of reliable historical data. During the 1940s, routine aircraft reconnaissance started in both the Atlantic and Western Pacific basin during the mid-1940s, which provided ground truth data, however, early flights were only made once or twice a day. Polar-orbiting weather satellites were first launched by the United States National Aeronautics and Space Administration in 1960 but were not declared operational until 1965. However, it took several years for some of the warning centres to take advantage of this new viewing platform and develop the expertise to associate satellite signatures with storm position and intensity.Each year on average, around 80 to 90 named tropical cyclones form around the world, of which over half develop hurricane-force winds of 65 kn (120 km/h; 75 mph) or more. Worldwide, tropical cyclone activity peaks in late summer, when the difference between temperatures aloft and sea surface temperatures is the greatest. However, each particular basin has its own seasonal patterns. On a worldwide scale, May is the least active month, while September is the most active month. November is the only month in which all the tropical cyclone basins are in season. In the Northern Atlantic Ocean, a distinct cyclone season occurs from June 1 to November 30, sharply peaking from late August through September. The statistical peak of the Atlantic hurricane season is September 10. The Northeast Pacific Ocean has a broader period of activity, but in a similar time frame to the Atlantic. The Northwest Pacific sees tropical cyclones year-round, with a minimum in February and March and a peak in early September. In the North Indian basin, storms are most common from April to December, with peaks in May and November. In the Southern Hemisphere, the tropical cyclone year begins on July 1 and runs all year-round encompassing the tropical cyclone seasons, which run from November 1 until the end of April, with peaks in mid-February to early March.Of various modes of variability in the climate system, El Niño–Southern Oscillation has the largest impact on tropical cyclone activity. Most tropical cyclones form on the side of the subtropical ridge closer to the equator, then move poleward past the ridge axis before recurving into the main belt of the Westerlies. When the subtropical ridge position shifts due to El Niño, so will the preferred tropical cyclone tracks. Areas west of Japan and Korea tend to experience much fewer September–November tropical cyclone impacts during El Niño and neutral years. During La Niña years, the formation of tropical cyclones, along with the subtropical ridge position, shifts westward across the western Pacific Ocean, which increases the landfall threat to China and much greater intensity in the Philippines. The Atlantic Ocean experiences depressed activity due to increased vertical wind shear across the region during El Niño years. Tropical cyclones are further influenced by the Atlantic Meridional Mode, the Quasi-biennial oscillation and the Madden–Julian oscillation.

Influence of climate change
Climate change can affect tropical cyclones in a variety of ways: an intensification of rainfall and wind speed, a decrease in overall frequency, an increase in the frequency of very intense storms and a poleward extension of where the cyclones reach maximum intensity are among the possible consequences of human-induced climate change. Tropical cyclones use warm, moist air as their fuel. As climate change is warming ocean temperatures, there is potentially more of this fuel available. Between 1979 and 2017, there was a global increase in the proportion of tropical cyclones of Category 3 and higher on the Saffir–Simpson scale. The trend was most clear in the North Atlantic and in the Southern Indian Ocean. In the North Pacific, tropical cyclones have been moving poleward into colder waters and there was no increase in intensity over this period. With 2 °C (3.6 °F) warming, a greater percentage (+13%) of tropical cyclones are expected to reach Category 4 and 5 strength. A 2019 study indicates that climate change has been driving the observed trend of rapid intensification of tropical cyclones in the Atlantic basin. Rapidly intensifying cyclones are hard to forecast and therefore pose additional risk to coastal communities.Warmer air can hold more water vapor: the theoretical maximum water vapor content is given by the Clausius–Clapeyron relation, which yields ≈7% increase in water vapor in the atmosphere per 1 °C (1.8 °F) warming. All models that were assessed in a 2019 review paper show a future increase of rainfall rates. Additional sea level rise will increase storm surge levels. It is plausible that extreme wind waves see an increase as a consequence of changes in tropical cyclones, further exacerbating storm surge dangers to coastal communities. The compounding effects from floods, storm surge, and terrestrial flooding (rivers) are projected to increase due to global warming.There is currently no consensus on how climate change will affect the overall frequency of tropical cyclones. A majority of climate models show a decreased frequency in future projections. For instance, a 2020 paper comparing nine high-resolution climate models found robust decreases in frequency in the Southern Indian Ocean and the Southern Hemisphere more generally, while finding mixed signals for Northern Hemisphere tropical cyclones. Observations have shown little change in the overall frequency of tropical cyclones worldwide, with increased frequency in the North Atlantic and central Pacific, and significant decreases in the southern Indian Ocean and western North Pacific. There has been a poleward expansion of the latitude at which the maximum intensity of tropical cyclones occurs, which may be associated with climate change. In the North Pacific, there may also have been an eastward expansion. Between 1949 and 2016, there was a slowdown in tropical cyclone translation speeds. It is unclear still to what extent this can be attributed to climate change: climate models do not all show this feature.

Observation and forecasting
Observation
Intense tropical cyclones pose a particular observation challenge, as they are a dangerous oceanic phenomenon, and weather stations, being relatively sparse, are rarely available on the site of the storm itself. In general, surface observations are available only if the storm is passing over an island or a coastal area, or if there is a nearby ship. Real-time measurements are usually taken in the periphery of the cyclone, where conditions are less catastrophic and its true strength cannot be evaluated. For this reason, there are teams of meteorologists that move into the path of tropical cyclones to help evaluate their strength at the point of landfall.Tropical cyclones are tracked by weather satellites capturing visible and infrared images from space, usually at half-hour to quarter-hour intervals. As a storm approaches land, it can be observed by land-based Doppler weather radar. Radar plays a crucial role around landfall by showing a storms location and intensity every several minutes. Other satellites provide information from the perturbations of GPS signals, providing thousands of snapshots per day and capturing atmospheric temperature, pressure, and moisture content.In situ measurements, in real-time, can be taken by sending specially equipped reconnaissance flights into the cyclone. In the Atlantic basin, these flights are regularly flown by United States government hurricane hunters. These aircraft fly directly into the cyclone and take direct and remote-sensing measurements. The aircraft also launch GPS dropsondes inside the cyclone. These sondes measure temperature, humidity, pressure, and especially winds between flight level and the oceans surface. A new era in hurricane observation began when a remotely piloted Aerosonde, a small drone aircraft, was flown through Tropical Storm Ophelia as it passed Virginias eastern shore during the 2005 hurricane season. A similar mission was also completed successfully in the western Pacific Ocean.

Forecasting
High-speed computers and sophisticated simulation software allow forecasters to produce computer models that predict tropical cyclone tracks based on the future position and strength of high- and low-pressure systems. Combining forecast models with increased understanding of the forces that act on tropical cyclones, as well as with a wealth of data from Earth-orbiting satellites and other sensors, scientists have increased the accuracy of track forecasts over recent decades. However, scientists are not as skillful at predicting the intensity of tropical cyclones. The lack of improvement in intensity forecasting is attributed to the complexity of tropical systems and an incomplete understanding of factors that affect their development. New tropical cyclone position and forecast information is available at least every six hours from the various warning centers.

Geopotential height
In meteorology, geopotential heights are used when creating forecasts and analyzing pressure systems. Geopotential heights represent the estimate of the real height of a pressure system above the average sea level. Geopotential heights for weather are divided up into several levels. The lowest geopotential height level is 850 hPa (25.10 inHg), which represents the lowest 1,500 m (5,000 ft) of the atmosphere. The moisture content, gained by using either the relative humidity or the precipitable water value, is used in creating forecasts for precipitation. The next level, 700 hPa (20.67 inHg), is at a height of 2,300–3,200 m (7,700–10,500 ft); 700 hPa is regarded as the highest point in the lower atmosphere. At this layer, both vertical movement and moisture levels are used to locate and create forecasts for precipitation. The middle level of the atmosphere is at 500 hPa (14.76 inHg) or a height of 4,900–6,100 m (16,000–20,000 ft). The 500 hPa level is used for measuring atmospheric vorticity, commonly known as the spin of air. The relative humidity is also analyzed at this height in order to establish where precipitation is likely to materialize </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Amisulpride and explain in detail? [/INST] Amisulpride is an antiemetic and antipsychotic medication used at lower doses intravenously to prevent and treat postoperative nausea and vomiting; and at higher doses by mouth to treat schizophrenia and acute psychotic episodes. It is sold under the brand names Barhemsys (as an antiemetic) and Solian, Socian, Deniban and others (as an antipsychotic). It is also used to treat dysthymia.It is usually classed with the atypical antipsychotics. Chemically it is a benzamide and like other benzamide antipsychotics, such as sulpiride, it is associated with a high risk of elevating blood levels of the lactation hormone, prolactin (thereby potentially causing the absence of the menstrual cycle, breast enlargement, even in males, breast milk secretion not related to breastfeeding, impaired fertility, impotence, breast pain, etc.), and a low risk, relative to the typical antipsychotics, of causing movement disorders.Amisulpride is indicated for use in the United States in adults for the prevention of postoperative nausea and vomiting (PONV), either alone or in combination with an antiemetic of a different class; and to treat PONV in those who have received antiemetic prophylaxis with an agent of a different class or have not received prophylaxis.Amisulpride is believed to work by blocking, or antagonizing, the dopamine D2 receptor, reducing its signalling. The effectiveness of amisulpride in treating dysthymia and the negative symptoms of schizophrenia is believed to stem from its blockade of the presynaptic dopamine D2 receptors. These presynaptic receptors regulate the release of dopamine into the synapse, so by blocking them amisulpride increases dopamine concentrations in the synapse. This increased dopamine concentration is theorized to act on dopamine D1 receptors to relieve depressive symptoms (in dysthymia) and the negative symptoms of schizophrenia.It was introduced by Sanofi-Aventis in the 1990s. Its patent expired by 2008, and generic formulations became available. It is marketed in all English-speaking countries except for Canada. A New York City based company, LB Pharmaceuticals, has announced the ongoing development of LB-102, also known as N-methyl amisulpride, an antipsychotic specifically targeting the United States. A poster presentation at European Neuropsychopharmacology seems to suggest that this version of amisulpride, known as LB-102 displays the same binding to D2, D3 and 5HT7 that amisulpride does.

Medical uses
Schizophrenia
Although according to other studies it appears to have comparable efficacy to olanzapine in the treatment of schizophrenia, amisulpride augmentation, similarly to sulpiride augmentation, has been considered a viable treatment option (although this is based on low-quality evidence) in clozapine-resistant cases of schizophrenia. Another recent study concluded that amisulpride is an appropriate first-line treatment for the management of acute psychosis.

Postoperative nausea and vomiting
Amisulpride is indicated for use in the United States in adults for the prevention of postoperative nausea and vomiting (PONV), either alone or in combination with an antiemetic of a different class; and to treat PONV in those who have received antiemetic prophylaxis with an agent of a different class or have not received prophylaxis.

Contraindications
Amisulprides use is contraindicated in the following disease states
Pheochromocytoma
Concomitant prolactin-dependent tumours e.g. prolactinoma, breast cancer
Movement disorders (e.g. Parkinsons disease and dementia with Lewy bodies)
Lactation
Children before the onset of pubertyNeither is it recommended to use amisulpride in patients with hypersensitivities to amisulpride or the excipients found in its dosage form.

Adverse effects
Very Common (≥10% incidence)Extrapyramidal side effects (EPS; including dystonia, tremor, akathisia, parkinsonism).Common (≥1%, <10% incidence)
Hyperprolactinaemia (which can lead to galactorrhoea, breast enlargement and tenderness, sexual dysfunction, etc.)
Weight gain (produces less weight gain than chlorpromazine, clozapine, iloperidone, olanzapine, paliperidone, quetiapine, risperidone, sertindole, zotepine and more (although not statistically significantly) weight gain than haloperidol, lurasidone, ziprasidone and approximately as much weight gain as aripiprazole and asenapine)
Anticholinergic side effects (although it does not bind to the muscarinic acetylcholine receptors and hence these side effects are usually quite mild) such as- constipation
- dry mouth
- disorder of accommodation
- Blurred vision
Rare (<1% incidence)
Blood dyscrasias such as leucopenia, neutropenia and agranulocytosis
QT interval prolongation (in a recent meta-analysis of the safety and efficacy of 15 antipsychotic drugs amisulpride was found to have the 2nd highest effect size for causing QT interval prolongation)Hyperprolactinaemia results from antagonism of the D2 receptors located on the lactotrophic cells found in the anterior pituitary gland. Amisulpride has a high propensity for elevating plasma prolactin levels as a result of its poor blood-brain barrier penetrability and hence the resulting greater ratio of peripheral D2 occupancy to central D2 occupancy. This means that to achieve the sufficient occupancy (~60–80%) of the central D2 receptors in order to elicit its therapeutic effects a dose must be given that is enough to saturate peripheral D2 receptors including those in the anterior pituitary.
Somnolence.

Discontinuation
The British National Formulary recommends a gradual withdrawal when discontinuing antipsychotics to avoid acute withdrawal syndrome or rapid relapse. Symptoms of withdrawal commonly include nausea, vomiting, and loss of appetite. Other symptoms may include restlessness, increased sweating, and trouble sleeping. Less commonly there may be a feeling of the world spinning, numbness, or muscle pains. Symptoms generally resolve after a short period of time.There is tentative evidence that discontinuation of antipsychotics can result in psychosis. It may also result in reoccurrence of the condition that is being treated. Rarely tardive dyskinesia can occur when the medication is stopped.

Overdose
Torsades de pointes is common in overdose. Amisulpride is moderately dangerous in overdose (with the TCAs being very dangerous and the SSRIs being modestly dangerous).

Interactions
Amisulpride should not be used in conjunction with drugs that prolong the QT interval (such as citalopram, bupropion, clozapine, tricyclic antidepressants, sertindole, ziprasidone, etc.), reduce heart rate and those that can induce hypokalaemia. Likewise it is imprudent to combine antipsychotics due to the additive risk for tardive dyskinesia and neuroleptic malignant syndrome.

Pharmacology
Pharmacodynamics
Amisulpride functions primarily as a dopamine D2 and D3 receptor antagonist. It has high affinity for these receptors with dissociation constants of 3.0 and 3.5 nM, respectively. Although standard doses used to treat psychosis inhibit dopaminergic neurotransmission, low doses preferentially block inhibitory presynaptic autoreceptors. This results in a facilitation of dopamine activity, and for this reason, low-dose amisulpride has also been used to treat dysthymia.Amisulpride and its relatives sulpiride, levosulpiride, and sultopride have been shown to bind to the high-affinity GHB receptor at concentrations that are therapeutically relevant (IC50 = 50 nM for amisulpride).Amisulpride, sultopride and sulpiride respectively present decreasing in vitro affinities for the D2 receptor (IC50 = 27, 120 and 181 nM) and the D3 receptor (IC50 = 3.6, 4.8 and 17.5 nM).Though it was long widely assumed that dopaminergic modulation is solely responsible for the respective antidepressant and antipsychotic properties of amisulpride, it was subsequently found that the drug also acts as a potent antagonist of the serotonin 5-HT7 receptor (Ki = 11.5 nM). Several of the other atypical antipsychotics such as risperidone and ziprasidone are potent antagonists at the 5-HT7 receptor as well, and selective antagonists of the receptor show antidepressant properties themselves. To characterize the role of the 5-HT7 receptor in the antidepressant effects of amisulpride, a study prepared 5-HT7 receptor knockout mice. The study found that in two widely used rodent models of depression, the tail suspension test, and the forced swim test, those mice did not exhibit an antidepressant response upon treatment with amisulpride. These results suggest that 5-HT7 receptor antagonism mediates the antidepressant effects of amisulpride.Amisulpride also appears to bind with high affinity to the serotonin 5-HT2B receptor (Ki = 13 nM), where it acts as an antagonist. The clinical implications of this, if any, are unclear. In any case, there is no evidence that this action mediates any of the therapeutic effects of amisulpride.Amisulpride shows stereoselectivity in its actions. Aramisulpride ((R)-amisulpride) has higher affinity for the 5-HT7 receptor (Ki = 47 nM vs. 1,900 nM) while esamisulpride ((S)-amisulpride) has higher affinity for the D2 receptor (4.0 nM vs. 140 nM). An 85:15 ratio of aramisulpride to esamisulpride (SEP-4199) which provides more balanced 5-HT7 and D2 receptor antagonism than racemic amisulpride (50:50 ratio of enantiomers) is under development for the treatment of bipolar depression.

Society and culture
Brand names
Brand names include: Amazeo, Amipride (AU), Amival, Solian (AU, IE, RU, UK, ZA), Soltus, Sulpitac (IN), Sulprix (AU), Midora (RO) and Socian (BR).

Availability
Amisulpride was not approved by the Food and Drug Administration for use in the United States until February 2020, but it is used in Europe, Israel, Mexico, India, New Zealand and Australia to treat psychosis and schizophrenia.An IV formulation of Amisulpride was approved for the treatment of postoperative nausea and vomiting ("PONV") in the United States in February 2020.

History
The U.S. Food and Drug Administration (FDA) approved amisulpride based on evidence from four clinical trials of 2323 subjects undergoing surgery or experiencing nausea and vomiting after the surgery. The trials were conducted at 80 sites in the United States, Canada and Europe.Two trials (Trials 1 and 2) enrolled subjects scheduled to have surgery. Subjects were randomly assigned to receive either amisulpride or a placebo drug at the beginning of general anesthesia </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Laudanum and explain in detail? [/INST] Laudanum is a tincture of opium containing approximately 10% powdered opium by weight (the equivalent of 1% morphine). Laudanum is prepared by dissolving extracts from the opium poppy (Papaver somniferum Linnaeus) in alcohol (ethanol).
Reddish-brown in color and extremely bitter, laudanum contains several opium alkaloids, including morphine and codeine. Laudanum was historically used to treat a variety of conditions, but its principal use was as a pain medication and cough suppressant. Until the early 20th century, laudanum was sold without a prescription and was a constituent of many patent medicines. Today, laudanum is recognized as addictive and is strictly regulated and controlled as such throughout most of the world. The United States Controlled Substances Act, for one example, lists it on Schedule II, the second strictest category.
Laudanum is known as a "whole opium" preparation since it historically contained all the alkaloids found in the opium poppy, which are extracted from the dried latex of ripe seed pods (Papaver somniferum L., succus siccum). Today, however, the drug is often processed to remove all or most of the noscapine (also called narcotine) present as this is a strong emetic and does not add appreciably to the analgesic or antipropulsive properties of opium; the resulting solution is called Denarcotized Tincture of Opium or Deodorized Tincture of Opium (DTO).
Laudanum remains available by prescription in the United States (under the generic name "opium tincture") and in the European Union and United Kingdom (under the trade name Dropizol), although today the drugs therapeutic indication is generally limited to controlling diarrhea when other medications have failed.
The terms laudanum and tincture of opium are generally interchangeable, but in contemporary medical practice, the latter is used almost exclusively.

History
Paracelsuss laudanum
Paracelsus, a 16th-century Swiss alchemist, experimented with various opium concoctions, and recommended opium for reducing pain. One of his preparations, a pill which he extolled as his "archanum" or "laudanum", may have contained opium. Paracelsus laudanum was strikingly different from the standard laudanum of the 17th century and beyond, containing crushed pearls, musk, amber, and other substances.

British laudanum
One researcher has documented that "Laudanum, as listed in the London Pharmacopoeia (1618), was a pill made from opium, saffron, castor, ambergris, musk and nutmeg".: 45

Sydenhams laudanum
In the 1660s English physician Thomas Sydenham (1624–1689) popularized a proprietary opium tincture that he also named laudanum, although it differed substantially from the laudanum of Paracelsus. In 1676 Sydenham published a seminal work, Medical Observations Concerning the History and Cure of Acute Diseases, in which he promoted his brand of opium tincture, and advocated its use for a range of medical conditions.

18th century laudanum
By the 18th century, the medicinal properties of opium and laudanum were well known, and the term "laudanum" came to refer to any combination of opium and alcohol.
In the eighteenth century several physicians published work about it, including John Jones, who wrote The Mysteries of Opium Revealed (1700), which was described by one commentator as "extraordinary and perfectly unintelligible." The Scottish physician John Brown, creator of the Brunonian system of medicine, recommended opium for what he termed asthenic conditions, but his system was discredited by the time of his death. The most influential work was by  George Young, who published a comprehensive medical text entitled Treatise on Opium (1753). Young, an Edinburgh surgeon and physician, wrote this to counter an essay on opium by his contemporary Charles Alston, professor of botany and materia medica at Edinburgh who had recommended the use of opium for a wide variety of conditions. Young countered this  by emphasising the risks ...that I may prevent such mischief as I can, I here give it as my sincere opinion... that opium is a poison by which great numbers are daily destroyed. Young gives a comprehensive account of the indications for the drug including its complications. He is critical about writers whose knowledge of the drug is based on chemical or animal experiments rather than clinical practice. The treatise is a detailed, balanced and valuable guide to prevailing knowledge and practice. As it gained popularity, opium, and after 1820, morphine, was mixed with a wide variety of agents, drugs and chemicals including mercury, hashish, cayenne pepper, ether, chloroform, belladonna, whiskey, wine and brandy.": 104

As one researcher has noted: "To understand the popularity of a medicine that eased—even if only temporarily—coughing, diarrhoea and pain, one only has to consider the living conditions at the time". In the 1850s, "cholera and dysentery regularly ripped through communities, its victims often dying from debilitating diarrhoea", and dropsy, consumption, ague and rheumatism were all too common.: 44–49 An 1869 article in Scientific American describes a farmer growing and harvesting poppy in Indian Springs, Georgia, and subsequently selling the raw material to a local pharmacist who prepared laudanum.

19th century laudanum
By the 19th century, laudanum was used in many patent medicines to "relieve pain ... to produce sleep ... to allay irritation ... to check excessive secretions ... to support the system ... [and] as a soporific". The limited pharmacopoeia of the day meant that opium derivatives were among the most effective of available treatments, so laudanum was widely prescribed for ailments from colds to meningitis to cardiac diseases, in both adults and children. Laudanum was used during the yellow fever epidemic.
Innumerable Victorian women were prescribed the drug for relief of menstrual cramps and vague aches. Nurses also spoon-fed laudanum to infants. The Romantic and Victorian eras were marked by the widespread use of laudanum in Europe and the United States. Mary Todd Lincoln, for example, the wife of the US president Abraham Lincoln, was a laudanum addict, as was the English poet Samuel Taylor Coleridge, who was famously interrupted in the middle of an opium-induced writing session of Kubla Khan by a "person from Porlock". Initially a working class drug, laudanum was cheaper than a bottle of gin or wine, because it was treated as a medication for legal purposes and not taxed as an alcoholic beverage.
Laudanum was used in home remedies and prescriptions, as well as a single medication. For example, a 1901 medical book published for home health use gave the following two "Simple Remedy Formulas" for "dysenterry" [sic]: (1) Thin boiled starch, 2 ounces; Laudanum, 20 drops; "Use as an injection [meaning as an enema] every six to twelve hours"; (2) Tincture rhubarb, 1 ounce; Laudanum 4 drachms; "Dose: One teaspoonful every three hours." In a section entitled "Professional Prescriptions" is a formula for "diarrhoea (acute)": Tincture opium, deodorized, 15 drops; Subnitrate of bismuth, 2 drachms; Simple syrup, 1⁄2 ounce; Chalk mixture, 11⁄2 ounces, "A teaspoonful every two or three hours to a child one year old." "Diarrhoea (chronic)": Aqueous extract of ergot, 20 grains; Extract of nux vomica, 5 grains; Extract of Opium, 10 grains, "Make 20 pills. Take one pill every three or four hours."

20th century laudanum
The early 20th century brought increased regulation of all manner of narcotics, including laudanum, as the addictive properties of opium became more widely understood, and "patent medicines came under fire, largely because of their mysterious compositions".: 126  In the US, the Food and Drug Act of 1906 required that certain specified drugs, including alcohol, cocaine, heroin, morphine, and cannabis, be accurately labeled with contents and dosage. Previously many drugs had been sold as patent medicines with secret ingredients or misleading labels. Cocaine, heroin, cannabis, and other such drugs continued to be legally available without prescription as long as they were labeled. It is estimated that sale of patent medicines containing opiates decreased by 33% after labeling was mandated. In 1906 in Britain and in 1908 in Canada "laws requiring disclosure of ingredients and limitation of narcotic content were instituted".: 126 The Harrison Narcotics Tax Act of 1914 restricted the manufacture and distribution of opiates, including laudanum, and coca derivatives in the US. This was followed by Frances Loi des stupéfiants in 1916, and Britains Dangerous Drugs Act in 1920.: 126 Laudanum was supplied to druggists and physicians in regular and concentrated versions. For example, in 1915, Frank S. Betz Co., a medical supply company in Hammond, Indiana, advertised Tincture of Opium, U.S.P., for $2.90 per lb., Tincture of Opium Camphorated, U.S.P, for 85 cents per lb., and Tincture of Opium Deodorized, for $2.85 per lb. Four versions of opium as a fluid extract were also offered: (1) Opium, Concentrated (assayed) "For making Tincture Opii (Laudanum) U.S.P. Four times the strength of the regular U.S.P." tincture, for $9.35 per pint; (2) Opium, Camphorated Conc. "1 oz. making 8 ozs. Tr. Opii Camphorated U.S.P (Paregoric)" for $2.00 per pint; (3) Opium, Concentrated (Deodorized and Denarcotized) "Four times the strength of tincture, Used when Tinct. Opii U.S.P. is contraindicated" for $9.50 per pint, and (4) Opium (Aqueous), U.S.P., 1890, "Tr. (assayed) Papaver Somniferum" for $2.25 per pint.In 1929–30, Parke, Davis & Co., a major US drug manufacturer based in Detroit, Michigan, sold "Opium, U.S.P. (Laudanum)", as Tincture No. 23, for $10.80 per pint (16 fluid ounces), and "Opium Camphorated, U.S.P. (Paregoric)", as Tincture No. 20, for $2.20 per pint. Concentrated versions were available. "Opium Camphorated, for U.S.P. Tincture: Liquid No. 338" was "exactly 8 times the strength of Tincture Opium Camphorated (Paregoric) [italics in original], U.S.P., "designed for preparing the tincture by direct dilution," and cost $7 per pint. Similarly, at a cost of $36 per pint, "Opium Concentrated, for U.S.P. Tincture: Liquid No. 336", was "four times the strength of the official tincture", and "designed for the extemporaneous preparation of the tincture". The catalog also noted: "For quarter-pint bottles add 80c. per pint to the price given for pints."
Toward the middle 20th century, the use of opiates was generally limited to the treatment of pain, and opium was no longer a medically accepted "cure-all". Further, the pharmaceutical industry began synthesizing various opioids, such as propoxyphene, oxymorphone and oxycodone. These synthetic opioids, along with codeine and morphine were preferable to laudanum since a single opioid could be prescribed for different types of pain rather than the "cocktail" of laudanum, which contains nearly all of the opium alkaloids. Consequently, laudanum became mostly obsolete as an analgesic, since its principal ingredient is morphine, which can be prescribed by itself to treat pain. Until now, there has been no medical consensus on which of the two (laudanum or morphine alone) is the better choice for treating pain.
In 1970, the US adopted the Uniform Controlled Substances Act, which regulated opium tincture (Laudanum) as a Schedule II substance (currently DEA #9630), placing even tighter controls on the drug.
By the late 20th century, laudanums use was almost exclusively confined to treating severe diarrhea.

21st century laudanum
The current prescribing information for laudanum in the US states that opium tinctures sole indication is as an anti-diarrheal, although the drug is occasionally prescribed off-label for treating pain and neonatal withdrawal syndrome.

Historical varieties
Several historical varieties of laudanum exist, including Paracelsus laudanum, Sydenhams Laudanum (also known as tinctura opii crocata), benzoic laudanum (tinctura opii benzoica), and deodorized tincture of opium (the most common contemporary formulation), among others. Depending on the version, additional amounts of the substances and additional active ingredients (e.g. saffron, sugar, eugenol) are added, modifying its effects (e.g., amount of sedation, or antitussive properties).
There is probably no single reference that lists all the pharmaceutical variations of laudanum that were created and used in different countries during centuries since it was initially formulated. The reasons are that in addition to official variations described in pharmacopeias, pharmacists and drug manufacturers were free to alter such formulas. The alcohol content of Laudanum probably varied substantially; on the labels of turn-of-the-century bottles of Laudanum, alcoholic content is stated as 48%. In contrast, the current version of Laudanum contains about 18% alcohol.
The four variations of laudanum listed here were used in the United States during the late 19th century. The first, from an 1870 publication, is "Best Turkey opium 1 oz., slice, and pour upon it boiling water 1 gill, and work it in a bowl or mortar until it is dissolved; then pour it into the bottle, and with alcohol of 70 percent proof 1⁄2 pt., rinse the dish, adding the alcohol to the preparation, shaking well, and in 24 hours it will be ready for use. Dose—From 10 to 30 drops for adults, according to the strength of the patient, or severity of the pain. Thirty drops of this laudanum will be equal to one grain of opium. And this is a much better way to prepare it than putting the opium into alcohol, or any other spirits alone, for in that case much of the opium does not dissolve." The remaining three formulas are copied from an 1890 publication of the day:

Sydenhams Laudanum: "According to the Paris Codex this is prepared as follows: opium, 2 ounces; saffron, 1 ounce; bruised cinnamon and bruised cloves, each 1 drachm; sherry wine, 1 pint. Mix and macerate for 15 days and filter. Twenty drops are equal to one grain of opium."
Rousseaus Laudanum: "Dissolve 12 ounces white honey in 3 pounds warm water, and set it aside in a warm place. When fermentation begins add to it a solution of 4 ounces selected opium in 12 ounces water. Let the mixture stand for a month at a temperature of 86° Fahr.; then strain, filter, and evaporate to 10 ounces; finally strain and add 41⁄2 ounces proof alcohol. Seven drops of this preparation contain about 1 grain of opium."
Tincture of Opium (Laudanum), U.S.P., attributed to the United States Pharmacoepia of 1863: "Macerate 21⁄2 ounces opium, in moderately fine powder in 1 pint water for 3 days, with frequent agitation. Add 1 pint alcohol, and macerate for 3 days longer. Percolate, and displace 2 pints tincture by adding dilute alcohol in the percolator."

Modern status
United Kingdom
Opium tincture remains in the British Pharmacopoeia, where it is referred to as Tincture of Opium, B.P., Laudanum, Thebaic Tincture or Tinctura Thebaica, and "adjusted to contain 1% w/v of anhydrous morphine." It is a Class A substance under the Misuse of Drugs Act of 1971. At least one manufacturer (Macfarlan Smith) still produces opium tincture in the UK as of 2011.
"Gees Linctus" is also available from most UK pharmacies, especially independent stores. This contains "Opium Tincture", at 0.083 mL, per 5 mL.

United States
Tincture of Opium is available by prescription in the United States. It is regulated as a Schedule II drug (No. 9639) under the Controlled Substances Act.
In the United States, opium tincture is marketed and distributed by several pharmaceutical firms, each producing a single formulation of the drug, which is deodorized. Each mL contains 10 mg of anhydrous morphine (the equivalent of 100 mg of powdered opium), other opium alkaloids (except noscapine), and ethanol, 19%. It is available packaged in bottles of four US fluid ounces (118 mL) and 16 US fluid ounces (1 US pt; 473 mL).
Tincture of Opium is known as one of many "unapproved drugs" regulated by the U.S. Food and Drug Administration (FDA); the marketing and distribution of opium tincture prevails today only because opium tincture was sold prior to the Federal Food, Drug & Cosmetic Act of 1938. Its "grandfathered" status protects opium tincture from being required to undergo strict FDA drug reviews and subsequent approval processes. However, the FDA closely monitors the labeling of opium tincture. Bottles of opium tincture are required by the FDA to bear a bright red "POISON" label given the potency of the drug and the potential for overdose (see discussion about confusion with Paregoric below). Additionally, in a warning letter to a manufacturer of opium tincture in late 2009, the FDA noted that "we found that your firm is manufacturing and distributing the prescription drug Opium Tincture USP (Deodorized – 10 mg/mL). Based on our information, there are no FDA-approved applications on file for this drug product."

Pharmacology
Opium tincture is useful as an analgesic and antidiarrheal. Opium enhances the tone in the long segments of the longitudinal muscle and inhibits propulsive contraction of circular and longitudinal muscles. The pharmacological effects of opium tincture are due principally to its morphine content. The quantity of the papaverine and codeine alkaloids in opium tincture is too small to have any demonstrable central nervous system effect.Most modern formulations of opium tincture do not contain the alkaloid narcotine (also known as noscapine), which has antitussive properties. Even modest doses of narcotine can induce profound nausea and vomiting. Since opium tincture is usually prescribed for its antidiarrheal and analgesic properties (rather than as an antitussive), opium tincture without narcotine is generally preferred. This "de-narcotized" or "deodorized" opium tincture is formulated using a petroleum distillate to remove the narcotine.Oral doses of opium tincture are rapidly absorbed in the gastrointestinal tract and metabolized in the liver. Peak plasma concentrations of the morphine content are reached in about one hour, and nearly 75% of the morphine content of the opium tincture is excreted in the urine within 48 hours after oral administration.

Medical uses
Diarrhea
Opium tincture is indicated for the treatment of severe fulminant (intense, prolific) diarrhea that does not respond to standard therapy (e.g., Imodium or Lomotil).
The usual starting dose is 0.3 mL to 0.6 mL (about six to 12 drops) in a glass of water or juice four times a day. Refractory cases (such as diarrhea resulting from the complications of HIV/AIDS) may require higher than normal dosing, for example, 1 to 2 mL every 3 hours, for a total daily dose of up to 16mL a day. In terminal diseases, there is no ceiling dose for opium tincture; the dose is increased slowly until diarrhea is controlled.

Neonatal abstinence syndrome
Opium tincture is used to treat neonatal opioid withdrawal syndrome (NOWS) when diluted 1:25 (one part opium tincture to 25 parts water). The recommended dose is 0.2 mL of the diluted solution under the tongue every three hours, which may be increased by 0.05 mL every three hours until no objective signs of withdrawal are observed. In no event, however, should the dose exceed 0.7 mL every three hours. The opium tincture is gradually tapered over a 3- to 5-week period, at which point the newborn should be completely free of withdrawal symptoms.

Hazards
Potency of laudanum
Opium tincture is one of the most potent oral formulations of morphine available by prescription. Accidental or deliberate overdose is common with opium tincture given the highly concentrated nature of the solution. Overdose and death may occur with a single oral dose of between 100 and 150 mg of morphine in a healthy adult who has no tolerance to opiates. This represents the equivalent of between two to three teaspoons (10–15 mL) of opium tincture. Suicide by laudanum was common in the mid-19th century. Prudent medical judgment necessitates toward dispensing very small quantities of opium tincture in small dropper bottles or in pre-filled syringes to reduce the risk of intentional or accidental overdose.

Danger of confusion with paregoric
In the United States, opium tincture contains 10 mg per mL of anhydrous morphine. By contrast, opium tinctures weaker cousin, paregoric, also confusingly known as "camphorated tincture of opium", is 1/25th the strength of opium tincture, containing only 0.4 mg of morphine per mL. A 25-fold morphine overdose may occur if opium tincture is used where paregoric is indicated. Opium tincture is almost always dosed in drops, or fractions of a mL, or less commonly, in minims, while paregoric is dosed in teaspoons or tablespoons. Thus, an order for opium tincture containing directions in teaspoons is almost certainly in error. To avoid this potentially fatal outcome, the term "camphorated tincture of opium" is avoided in place of paregoric since the former can easily be mistaken for opium tincture.In 2004, the FDA issued a "Patient Safety" news bulletin stating that "To help resolve the confusion [between opium tincture and paregoric], FDA will be working with the manufacturers of these two drugs to clarify the labeling on the containers and in the package inserts." Indeed, in 2005, labels for opium tincture began to include the concentration of morphine (10 mg/mL) in large text beneath the words "Opium Tincture". The FDA has also alerted pharmacists and other medical practitioners about the dangers of confusing these drugs, and has recommended that opium tincture not be stocked as a standard item (i.e., that it should not be "on the shelf"), that opium tincture be dispensed in oral syringes, and that pharmacy software alert the dispenser if unusually large doses of opium tincture appear to be indicated.Despite the FDAs efforts over the past few years, the confusion persists, sometimes with deadly results. The Institute for Safe Medication Practices recommends that opium tincture not be stocked at all in a pharmacys inventory, and that "It may be time to relegate opium tincture and paregoric to the museum of outmoded opioid therapy." Despite the risk of confusion, opium tincture, like many end-stage medications, is indispensable for intractable diarrhea for terminally ill patients, such as those with AIDS and cancer.

Misinterpretation of "DTO"
The abbreviation "DTO," traditionally used to refer to Deodorized Tincture of Opium, is sometimes also erroneously employed to abbreviate "diluted tincture of opium." Diluted tincture of opium, also known as Camphorated Tincture of Opium (Paregoric) is a 1:25 mixture of opium tincture to water prescribed to treat withdrawal symptoms in newborns whose mothers were using opioids while pregnant. The United States Pharmacopeia and FDA recommend that practitioners refrain from using DTO in prescriptions, given this potential for confusion. In cases where pharmacists have misinterpreted DTO, and given "deodorized tincture of opium" when "diluted tincture of opium" was meant, infants have received a massive 25-fold overdose of morphine, sometimes resulting in fatalities.

Side effects
Side effects of laudanum are generally the same as with morphine, and include euphoria, dysphoria, pruritus, sedation, constipation, reduced tidal volume, respiratory depression, as well as psychological dependence, physical dependence, miosis, and xerostomia. Overdose can result in severe respiratory depression or collapse and death. The ethanol component can also induce adverse effects at higher doses; the side effects are the same as with alcohol.
Long-term use of laudanum in nonterminal diseases is discouraged due to the possibility of drug tolerance and addiction. Long-term use can also lead to abnormal liver function tests; specifically, prolonged morphine use can increase ALT and AST blood serum levels.

Treatment for overdose
Life-threatening overdose of opium tincture owes to the preparations morphine content. Morphine produces a dose-dependent depressive effect on the respiratory system, which can lead to profound respiratory depression, hypoxia, coma and finally respiratory arrest and death. If overdose of opium tincture is suspected, rapid professional intervention is required. The primary concern is re-establishing a viable airway and institution of assisted or controlled ventilation if the patient is unable to breathe on their own. Other supportive measures such as the use of vasopressors and oxygen may be indicated to treat cardiac and/or pulmonary failure. Cardiac arrhythmias or arrest will require advanced life-saving measures.
Intravenous naloxone or nalmefene, quick-acting opioid antagonists, are the first-line treatment to reverse respiratory depression caused by an overdose of opium tincture. Gastric lavage may be of some use in certain cases.

In fiction
In Mary Shelleys novel Frankenstein (1818), Victor Frankenstein takes laudanum as his only means of sleeping and thus preserving his life while in recovery from months of fever and a series of horrible events.
In Charles Dickenss novel Oliver Twist (1837), Nancy gave William "Bill" Sikes laudanum to keep him asleep while she ran away to meet Rose Maylie.
In Uncle Toms Cabin (1852), an anti-slavery novel by Harriet Beecher Stowe, an enslaved woman named Cassy talks about how she killed her newborn by laudanum overdose to spare him from experiencing the horrors of slavery.
In the novel Silas Marner: The Weaver of Raveloe by George Eliot (Mary Ann Evans) (1861), Silas finds and adopts a two-year old girl who had wandered into his house. The girl had been abandoned while walking with her opium-addicted mother, Molly Farren, who had fallen asleep in the snow and died. Earlier in the novel, in Chapter 3, it is specified that she uses laudanum.... if Molly should take a drop too much laudanum some day, and make a widower of you.
Wilkie Collins novel The Moonstone (1868) features laudanum "as an essential ingredient of the plot." Collins based his description of the drugs effects on his own experiences with it.
A laudanum-addicted character also appeared in Wilkie Collins novel Armadale (1864–66).
Laudanum appears in Charles Baudelaires prose poem The Double Room, published in his collection Le Spleen de Paris in 1869.
Laudanum is portrayed as the surgical drug of choice for fifteenth-century physicians in Lawrence Schoonovers novel The Burnished Blade (1948), the plot of which deals in part with the smuggling of expensive raw opium into France from the Empire of Trebizond.
In William Faulkners novel Requiem for a Nun (1951), Compson, Doctor Peabody, and Ratcliffe give whiskey tainted with laudanum to a group of rowdy lynchers and a militia band that had joined together. Upon their falling asleep, they were gathered up and locked in jail while still unconscious.
Stephen Maturin, one of the main characters in Patrick OBrians Aubrey–Maturin series of novels (1969–2004) about the Napoleonic wars, is a sometime laudanum addict.
Laudanum is prescribed in Glendon Swarthouts novel The Shootist (1975) to the character J.B </s>