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Indications and Usage for Genotropin

Somatuline Depot
Taking folic acid does not appear to improve the antidepressant effects of lithium in people with bipolar disorder. Primary prevention of neural tube defects with folic acid supplementation: Morphine pharmacokinetics have been reported to be significantly altered in patients with cirrhosis. Emmy winner discusses In Their Shoes, her hard-hitting documentary about drug addiction. It is not necessary to alter the starting dose in elderly patients; lanreotide serum concentrations in the elderly are well within the range of serum concentrations safely tolerated in healthy young subjects. So, a higher quality food will necessarily mean your plants are better fed, too. The rate of intestinal absorption of natural food folates is not related to the extent of folate conjugation.

Genotropin Dosage and Administration

Koi Pond Additives

Start patients with renal impairment on one-fourth to one-half the usual starting dose depending on the degree of impairment. In case of overdose, priorities are the reestablishment of a patent airway and protected airway and institution of assisted or controlled ventilation , if needed.

Employ other supportive measures including oxygen and vasopressors in the management of circulatory shock and pulmonary edema as indicated. Cardiac arrest or arrhythmias will require advanced life-support techniques. The opioid antagonists, naloxone or nalmefene are specific antidotes to respiratory depression resulting from opioid overdose. For clinically significant respiratory or circulatory depression secondary to hydromorphone overdose, administer an opioid antagonist.

Opioid antagonists should not be administered in the absence of clinically significant respiratory or circulatory depression secondary to hydromorphone overdose. If the response to an opioid antagonist is suboptimal or only brief in nature, administer additional antagonist as directed by the product's prescribing information.

In an individual physically dependent on opioids, administration of the recommended usual dosage of the antagonist will precipitate an acute withdrawal syndrome.

The severity of the withdrawal symptoms experienced will depend on the degree of physical dependence and the dose of the antagonist administered. If a decision is made to treat serious respiratory depression in the physically dependent patient, administration of the antagonist should be initiated with care and by titration with smaller than usual doses of the antagonist.

Hydromorphone is a full opioid agonist and is relatively selective for the mu-opioid receptor, although it can bind to other opioid receptors at higher doses.

The principal therapeutic action of hydromorphone is analgesia. Like all full opioid agonists, there is no ceiling effect for analgesia with morphine. Clinically, dosage is titrated to provide adequate analgesia and may be limited by adverse reactions, including respiratory and CNS depression. The precise mechanism of the analgesic action is unknown.

However, specific CNS opioid receptors for endogenous compounds with opioid-like activity have been identified throughout the brain and spinal cord and are thought to play a role in the analgesic effects of this drug. Hydromorphone produces respiratory depression by direct effect on brain stem respiratory centers. The respiratory depression involves a reduction in the responsiveness of the brain stem respiratory centers to both increases in carbon dioxide tension and electrical stimulation.

Hydromorphone causes miosis , even in total darkness. Pinpoint pupils are a sign of opioid overdose but are not pathognomonic e. Marked mydriasis rather than miosis may be seen due to hypoxia in overdose situations.

Hydromorphone causes a reduction in motility associated with an increase in smooth muscle tone in the antrum of the stomach and duodenum. Digestion of food in the small intestine is delayed and propulsive contractions are decreased.

Propulsive peristaltic waves in the colon are decreased, while tone may be increased to the point of spasm, resulting in constipation. Other opioid-induced effects may include a reduction in biliary and pancreatic secretions, spasm of sphincter of Oddi, and transient elevations in serum amylase.

They also stimulate prolactin , growth hormone GH secretion, and pancreatic secretion of insulin and glucagon. Chronic use of opioids may influence the hypothalamic- pituitary -gonadal axis , leading to androgen deficiency that may manifest as low libido , impotence , erectile dysfunction , amenorrhea , or infertility. The causal role of opioids in the clinical syndrome of hypogonadism is unknown because the various medical, physical, lifestyle, and psychological stressors that may influence gonadal hormone levels have not been adequately controlled for in studies conducted to date [see ADVERSE REACTIONS ].

Opioids have been shown to have a variety of effects on components of the immune system in in vitro and animal models. The clinical significance of these findings is unknown. Overall, the effects of opioids appear to be modestly immunosuppressive. The minimum effective analgesic concentration will vary widely among patients, especially among patients who have been previously treated with potent agonist opioids. There is a relationship between increasing hydromorphone plasma concentration and increasing frequency of dose-related opioid adverse reactions such as nausea, vomiting, CNS effects, and respiratory depression.

The systemic clearance is approximately 1. The terminal elimination half-life of hydromorphone after an intravenous dose is about 2. Only a small amount of the hydromorphone dose is excreted unchanged in the urine.

Most of the dose is excreted as hydromorphoneglucuronide along with minor amounts of 6-hydroxy reduction metabolites. Patients with moderate hepatic impairment should be started at one-fourth to one-half the recommended starting dose and closely monitored during dose titration. A further increase in Cmax and AUC of hydromorphone in this group is expected and should be taken into consideration when selecting a starting dose [see Use In Specific Populations ]. The pharmacokinetics of hydromorphone following an oral administration of hydromorphone at a single 4 mg dose 2 mg hydromorphone immediate-release tablets are affected by renal impairment.

In addition, in patients with severe renal impairment, hydromorphone appeared to be more slowly eliminated with a longer terminal elimination half-life 40 hr compared to patients with normal renal function 15 hr. Patients with renal impairment should be closely monitored during dose titration [see Use In Specific Populations ]. Sex has little effect on the pharmacokinetics of hydromorphone. The difference observed in Cmax may not be clinically relevant.

Inform patients that opioids could cause a rare but potentially life-threatening condition resulting from concomitant administration of serotonergic drugs. Warn patients of the symptoms of serotonin syndrome and to seek medical attention right away if symptoms develop. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Do not use if color is darker than pale yellow, if it is discolored in any other way or if it contains a precipitate.

This syringe has a larger internal syringe tip and an external collar luer collar. The external collar must remain attached to the syringe. However, spontaneous disconnection of this glass syringe from needles and NLADs with leakage of drug product may occur.

Assure that the needle or NLAD is securely attached before beginning the injection. Visually inspect the glass syringe-needle or glass syringe. NLAD connection before and during drug administration. Do not remove the clear plastic wrap around the external collar. You are encouraged to report negative side effects of prescription drugs to the FDA. Last reviewed on RxList: Take the Pain Quiz. Find Lowest Prices on. Follow patients for signs and symptoms of respiratory depression and sedation.

For Consumers What are the possible side effects of hydromorphone? Call your doctor at once if you have: Inspect parenteral drug products visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

No loss of potency has been demonstrated. Discard any unused portion in an appropriate manner. Intravenous Administration The initial starting dose is 0. Lake Zurich, IL www. Adrenal Insufficiency Cases of adrenal insufficiency have been reported with opioid use, more often following greater than one month of use.

Dependence Both tolerance and physical dependence can develop during chronic opioid therapy. Life-Threatening Respiratory Depression Serious, life-threatening, or fatal respiratory depression has been reported with the use of opioids, even when used as recommended. Elderly, Cachectic, Or Debilitated Patients Life-threatening respiratory depression is more likely to occur in elderly, cachectic , or debilitated patients because they may have altered pharmacokinetics or altered clearance compared to younger, healthier patients [see Life-Threatening Respiratory Depression ].

Nonclinical Toxicology Carcinogenesis, Mutagenesis, Impairment Of Fertility Carcinogenesis Long term studies in animals to evaluate the carcinogenic potential of hydromorphone have not been conducted. Mutagenesis Hydromorphone was positive in the mouse lymphoma assay in the presence of metabolic activation, but was negative in the mouse lymphoma assay in the absence of metabolic activation.

Impairment Of Fertility Reduced implantation sites and viable fetuses were noted at 2. Labor or Delivery Opioids cross the placenta and may produce respiratory depression and psycho-physiologic effects in neonates.

Lactation Risk Summary Low levels of opioid analgesics have been detected in human milk. Females And Males Of Reproductive Potential Infertility Chronic use of opioids may cause reduced fertility in females and males of reproductive potential. Geriatric Use Elderly patients aged 65 years or older may have increased sensitivity to hydromorphone.

Hepatic Impairment The pharmacokinetics of hydromorphone are affected by hepatic impairment. Renal Impairment The pharmacokinetics of hydromorphone are affected by renal impairment.

Branched Chain Amino Acids BCAAs are a group of three amino acids leucine , isoleucine , and valine which are involved with skeletal muscle synthesis and degradation. Of these three, leucine is commonly said to be the most 'important' since it is the prime mediator of muscle protein synthesis and that appears to be the most common reason people supplement BCAAs.

When looking at citrulline ingestion at rest, 0. During exercise, 6g citrulline in trained cyclists prior to a km cycling test noted that plasma BCAAs were reduced relative to control and attributed to increase utilization of BCAAs for fuel. Similar to how citrulline is able to restore muscle protein synthesis rates [59] [60] and muscular function [61] during aging and malnourishment in rats via mTORc1 dependent means, [62] [63] citrulline itself is a weak agonist enough that it could be false positive from sensitizing mTORc1 [59].

Conversely, leucine itself is a potent activator of mTORc1 activity. L-citrulline increases levels of nitric oxide NO , a vasodilator. Although NO effects are potent, the extent of vasodilation is limited by the short half life of NO, which is broken down by oxidation soon after it is formed.

In vitro studies in human umbilical vein endothelial cells demonstrated that L-citrulline 0. Consistent with in vitro and rat studies, subjects taking GSH along with L-citrulline had significantly higher nitrite and nitric oxide levels 30 minutes after exercise relative to placebo or L-citrulline alone. Nitrate is a small nitric oxide donor that is the main bioactive of beetroot juice. Serum nitrite reduced form of nitrate appears to be increased during exercise following consumption of 6g citrulline malate, which is thought to be an indicator of increase nitric oxide production.

Sodium bicarbonate baking soda is an ergogenic supplement that is reported to increase physical performance, and although overall it is somewhat unreliable in doing so it appears to be effective for short duration activities characterized by metabolic acidosis 'the burn'.

Citrulline administration appears to promote ureogenesis production of urea and secondary to this promoted the renal resorption of bicarbonate; [52] it is thought that citrulline may promote a slight buffering effect via preserving bicarbonate. A study assessing synergism between citrulline and bicarbonate supplementation is currently not available.

As simvastatin, [70] atorvastatin, [71] [72] and lovastatin [73] bioactive in red yeast rice have all been noted to increase eNOS, [71] iNOS, [71] [73] and nNOS [72] it is thought that this is a common mechanisms to statin drugs in general. In humans, 15g citrulline taken acutely does not appear to cause diarrhea or intestinal upset [23] which is notably different than both ornithine and arginine that may cause diarrhea at 10g dosages when taken in boluses [74] [75] due to limited absorption of these amino acids which then proceed to the colon to cause osmotic diarrhea.

Please click here if you are not redirected within a few seconds. This page is regularly updated, to include the most recently available clinical trial evidence. History Research analysis by Kamal Patel and verified by the Examine. Last updated on Jun 14, Grade Level of Evidence Robust research conducted with repeated double-blind clinical trials Multiple studies where at least two are double-blind and placebo controlled Single double-blind study or multiple cohort studies Uncontrolled or observational studies only.

The amount of high quality evidence. The more evidence, the more we can trust the results. The direction and size of the supplement's impact on each outcome.

Some supplements can have an increasing effect, others have a decreasing effect, and others have no effect. Scientific research does not always agree. There do not appear to be any significant influences of supplemental citrulline on blood glucose concentrations. Most studies note that there is no significant change in insulin concentrations, although a lone study not replicated suggested that the exercise-induced increase in insulin was suppressed with citrulline. As this study also noted performance degradation, it may be a flaw.

The decrease in fatigue during exercise is thought to underlie most of the benefit seen with training capacity work volume , although in men who self-report fatigue issues supplemental citrulline appears to help with that as well independent of exercise.

Nitric oxide derivatives nitrate and urinary cGMP, since nitric oxide itself is hard to measure these biomarkers are indicative of nitric oxide production appear to be reliably increased following oral consumption of citrulline supplementation.

Citrulline can increase plasma arginine concentrations, and due to acting as a resevoir of arginine it is actually more effective overall at increasing plasma arginine than arginine itself acute peaks are still observed to a higher level with arginine supplementation.

The increase in work capacity seen with citrulline supplementation appears to be time dependent. While there are no inherent and immediate effect, the reduction of fatigue later in a weight lifting workout causes a relative increase that has at least one doubled reps conducted on set 8 of exhaustive exercise. An increase in blood flow is noted with citrulline supplementation in persons with impaired blood flow. A decrease in blood pressure is noted secondary to increasing plasma arginine and thus increasing nitric oxide , but this blood pressure reduction may only occur in those with hypertension or prehypertension.

A slight increase in creatinine has been noted with citrulline supplementation, practical relevance unknown. An increase in growth hormone has been noted with exercise, but not at rest. Practical significance of this information is unknown, since Arginine supplementation has unreliable effects itself. Neutrophil oxidative burst post-workout appears to be enhanced when the exercise is preloaded with citrulline supplementation.

Although acute usage does not appear to influence plasma glutamine, a week of high dose supplementation 0. An increase in plasma nitrate has been noted with citrulline supplementation, but not to the degree of supplemental nitrate itself. An increase in urea is seen with citrulline supplementation possibly due to increased serum ornithine sequestering ammonia.

During the arrest, Lucky mistakes Liz's footsteps for Jason's backup. Lucky starts shooting while Jason tackles him to the ground. Liz barely escapes injury. Furious Elizabeth starts yelling at Lucky, telling him that he could have hurt the baby.

Lucky and Jason assume Liz is pregnant with Lucky's child. Lucky vows to clean up and checks into rehab. Liz is determined to go through with the divorce despite Lucky's efforts. Jason and Sam try to work on their relationship but Jason continues to have a difficult time getting past her night with Ric. Alexis is brought out of her coma despite the risks. Her pneumonia begins improving but Alexis isn't hopeful.

She seems angry and announces that she is refusing chemo, opting instead to research alterative ways to combat her cancer. Carly moves in with Sonny after her house is flooded. Sparks fly between Carly and Sonny as they continually lock heads over the issue of Jax. Patrick is worried when he runs a low-grade fever for several days. Robin nurses Patrick as they await news. Both are greatly relieved when an HIV test turns out negative.

Robert ends up on the wrong side of fists when he confronts Lorenzo and his thugs. Robin finds Robert crumpled on the docks. Colleen goes to some drastic measures in order to get closer to Nik including sabotaging his saddle before he rides his beloved horse, Sheba.

Maxie decides to take a pregnancy test after she learns that Elizabeth is pregnant. Lucky's stay in rehab is interrupted by visits from Maxie who announces that she is pregnant with his child.

Jason realizes that the baby that Liz is carrying could be his. Carly heads straight to Jason's when she overhears Liz talking about Jason possibly being the father of her child.

Carly strongly urges Jason to focus on his relationship with Sam, not Liz or the baby. Emily goes to talk to Jason when she learns the news and, without telling her brother what she knows, tries to impress upon him that Liz and Lucky will eventually get back together.

Liz is stunned when Jason proposes marriage. Click here for the complete recap of this week October 9 to 13, Liz is more determined than ever to divorce Lucky after she learns that Maxie is pregnant with his child.

Jason tells Sam and Sonny that Liz is pregnant. Carly overhears Liz talking about Jason possibly being her baby's father and goes to talk to Jason. She is worried that Liz is going to trap him into marriage. Jason proposes marriage to Liz. Liz reminds him that they are both in love with other people. She intends to raise her children as a single mother.

After confrontations with Lulu, Carly and Sam, Liz goes to the hospital for a paternity test. Lorenzo catches up with Skye. Luke returns to town with some answers about the proposed treatment for Laura. Lucky returns to rehab after failing to convince Liz of giving him another chance. He is not surprised to learn that Luke intends to leave town to rescue Skye from Lorenzo. Sam tells Nik that she is convinced that the baby Liz is carrying is Jason's.

Emily returns home from the medical conference in Greece after she learns it was for surgeons. She is just in time to keep Colleen from taking advantage of Nik whom Colleen drugged earlier. Jason finds Sam on the floor of the nursery in the penthouse. She is devastated that Liz is having Jason's baby. Click here for the complete recap of this week October 16 to 20, Luke and Robert go to rescue Skye but before they can make good on their escape Skye goes into labor.

Carly and Jax stop by Alexis's house to announce their engagement. They find Alexis alone and having a bad reaction to her chemo treatments. Jax is furious that neither Sam nor Ric were there to help her. Ric learns that Jason may be the father of Liz's baby. He goes to see Lucky and promises him to give him back his job if he gets clean. He explains that he's doing it for Liz. Ric baits Jason until Jason snaps and assaults him.

Having received a call from Ric earlier telling him to meet him, Sonny arrives just in time to keep Jason from killing Ric. Sonny threatens to tell Alexis the truth about Ric's infidelity with Sam if Ric doesn't drop the attempted murder charges against Jason. Maxie continues to believe that Lucky will move in with her because of the baby despite Lucky's insistence that he intends to do everything he can to get Elizabeth back.

Lulu is suspicious about Maxie's claim that she is pregnant. Liz receives the results of her paternity test but doesn't have a chance to read them because a woman in labor cries out for help. As Liz goes to assist the woman into the hospital, she is unaware that she has dropped the test results. Click here for the complete recap of this week October 23 to 27, Lorenzo offered Diego the opportunity to join the family business.

During a confrontation with Ric, Alexis finally revealed that she knew about him sleeping with Sam. She ended their marriage and threw him out. She had a similar confrontation with Sam, who decided to leave before Alexis could ask her to.

Carly found Alexis in bad shape and rushed her to the hospital. Sonny and Carly suggested to Alexis that they could care for the girls while she was in the hospital. Carly told Jason that the paternity test had revealed that Lucky was the father. Later, Jason admitted to Sonny that he was disappointed with the results of the paternity test.

Liz later burned the paternity test. Skye introduced her daughter, Lila Rae, to the family. He didn't want the children to know so that they wouldn't be burdened with the responsibility if things should go wrong. Laura emerged from her catatonic state. Her last memories were of preparing for the wedding. She seemed to have no recollection of Rick's death or the events that had precipitated it.

She was shocked when she saw her children, realizing for the first time that significant time had passed. Click here for the complete recap of this week October 30 to November 3, Ric frames Sam for stealing a flashcard with incriminating evidence against Sonny and Jason.

After Sam is arrested, Ric shows her pictures of Jason comforting Elizabeth spinning it so that an innocent encounter seems like a torrid affair. Sam panics and escapes the jail with the help of Det. Jason manages to find Sam who is being pursued by the police. A shoot-out ensues but they manage to get away without harm. Ric shows Elizabeth the pictures he used to manipulate Sam. Later he appears to take them to Lucky but it turns out that they are other surveillance photos much to Elizabeth's relief.

Laura is determined to reclaim her life. She leaves Shadybrook in the hopes of finding answers. She has a touching reunion with her mother and as well as others but everyone is careful not to say too much to her.

Lulu continues to act out over the decision to have an abortion. Carly and Jax set a wedding date, November 16th. Carly decides to call off the November 16th wedding after she realizes that she can't pull together the wedding she wants on time. She and Jax reschedule it for a later date when Jason will be able to attend.

Laura begins to remember the events that led to her catatonic state. She ends up in the attic where Luke finds her. He is reluctant to tell her the details of Rick's death but Laura insists on being told everything. As Luke tells her about Theresa's accidental death and then later Rick's, both at Laura's hand, Laura's memory returns fully.

She is horrified but what she had done but is able to put it in perspective. They proceed with plans to marry on November 16th.

Helena learns of their plans and makes arrangements to escape Shadybrook with the help of an orderly on her payroll. Sam and Jason continue to elude Ric until Sam visits her daughter's grave on the anniversary of her death. As Sam tries to flee, she is grazed by a bullet. Ric sets up a trap by having her taken to the hospital and having false reports leaked to the news stating that she is in critical condition. Jason asks Liz for help. She manages to whisk Sam out of the hospital while Jason barely escapes capture.

Back at the safehouse, all three are unaware that Ric had planted a tracking device on Liz, certain that Jason would turn to her for help.

Click here for the complete recap of this week November 13 to 17, Lady Jane has reservations about Jax marrying Carly after she talks to Sonny. Carly and Jax decide to postpone the wedding. Luke and Laura marry. Laura senses something is wrong with her and asks Luke about it after the wedding.

He explains that the drug she was given only has a temporary effect. She will soon return to the catatonic state she lingered in over the past 4 years.

Laura tells her children that their time is limited. Elizabeth faints at the reception when she learns that Ric might have set up an ambush for Jason. Kristina is traumatized when she witnesses Sam shooting and killing Diego in self defense. Lorenzo is devastated when he sees Diego's body. Jason is shot as he dives into the water amid a hail of gunfire. Jason finds his way to the church where Elizabeth is praying for his safety. He is seriously injured. Elizabeth tells him that he has to hang on for the baby.

Jason opens his eyes when Elizabeth goes on to tell him that the baby that she is carrying is his, not Lucky's. Click here for the complete recap of this week November 20 to 24, Luke was forced to tell Laura what was happening to her when she pushed him for answers. Laura decided to tell her children so that they all had a chance to say goodbye before she slipped back into a catatonic state. Laura's last wish was to celebrate Christmas with her family.

Everyone worked hard to make that wish come true, but Laura's condition deteriorated rapidly. Laura insisted on returning to Shadybrook while she was still able to function because she didn't want men in white jackets carting her off in front of her children. Laura spoke privately to each of her children, starting with Nikolas, whom she most understood because they shared the same heart.

Laura encouraged Lucky to continue to stay on his road to recovery because she was very proud of him.

Laura assured Lulu that both of Lulu's parents had wanted her, but it broke Laura's heart that Lulu had been the most shortchanged of the children because of Laura's illness. Before Laura completely slipped away, Laura confessed a secret: Laura was certain that she hadn't killed Rick, even accidentally. Jason recovered from his gunshot wound thanks to Liz, who nursed him back to health in her old studio apartment. Carly was not pleased when she sensed that Jason's feelings for Liz went beyond just friendship.

Ric's interest was piqued when he overheard Lucky ask Liz about a bloodstain on her dress. Click here for the complete recap of this week November 27 to December 1, Skye tried to forge a truce between Sonny and Alcazar. Alcazar lied to Skye about his willingness to keep the peace.

Lulu was caught up in the Spinelli mess because Peter handed her incriminating evidence when Alcazar's men showed up looking Peter. Alcazar ordered his men to kill Spinelli and Lulu, but he wanted it to appear like an accident.

Jason rescued Spinelli and Lulu, but in the chaos, Spinelli managed to slip away. Alcazar's men captured Jason and Lulu before they could escape. Liz placed a well-timed phone call to Sonny, so Sonny arrived before Lulu or Jason was killed. Sam and Liz traded words about Jason. Liz accused Sam of endangering Jason.

Nikolas and Emily reconnected on what would have been their two-year wedding anniversary. Jax and Carly decided on a New Year's Eve wedding. Jason is determined to find Spinelli and takes Lulu along for the search. Nikolas decides to let Colleen go. He gives her a month to find another position. Colleen surprises everyone when she announces that she's decided to leave immediately. Unbeknownst to anyone, she has Helena tied up in one of the turret rooms and intends to let Helena die of dehydration.

She also quietly promises Spencer that nothing will ever separate them. Things become uncomfortable when Lucky points out that she's standing under some mistletoe. She tenses up when he starts to lean in for a kiss. Jax tells Carly about the strange calls he's been receiving from Jerry.

Robin continues to have difficulty dealing with her role in Laura's relapse. Tensions mount between her and Patrick as he tries to help her through her difficult time.

Maxie continues to fake her pregnancy going so far as to wear padding. Click here for the complete recap of this week December 11 to 15, Skye moves in with Lorenzo much to Edward's dismay.

Sonny attempts to win Carly back with a romantic dinner but fails to convince her to reunite with him. Jax has strong objections when Carly tells him of her determination to bring Sonny home for his sons' sakes.

Jason and Spinelli surrender to the police. Spinelli manages to convince the authorities that he fabricated the flash-drive that Ric claims implicates Jason and Sonny in illegal activity. Lorenzo manages to steal the flash-drive before Ric is forced to turn it over.

Lucky realizes that Ric has ulterior motives for reinstating him on the police force. Maxie's fake pregnancy is almost exposed when Dr.

Lee informs Lucky that she hasn't seen Maxie as a patient in weeks. Dillon decides to help Lulu and Spinelli investigate Rick Webber's murder. Sam returns to the penthouse with Jason and tells him that she wants to begin immediately on starting a family with him.

Click here for the complete recap of this week December 18 to 22, Liz is disappointed when she finds drugs in Lucky's drawer at work. She is more determined than ever to go through with the divorce. Ric, who would later admit in confession that he planted the drugs, is pleased with how well things are working in his favor.

Maxie fakes a fall during an argument with Lucky. Claiming that she's experiencing cramps and pain, Lucky rushes her to the hospital where he is later told that she lost the baby. Spinelli moves in with Jason and Sam. Sam has an idea after Jason catches Spinelli with marijuana. She takes Spinelli over to Alexis's house in the hopes of talking her into smoking some pot to relieve the debilitating side effects of chemo.

Jason overhears Liz's attempts to get Cameron a hard to find toy. He surprises her on the docks with the toy Kristina has a break through. Jax leaves Port Charles, with Carly's approval, to rescue Jerry. Sonny returns home in time to see his son's in the nativity play. Nikolas is stunned to discover that Spencer is not in the manger cradle where he is supposed to be. Unbeknownst to Nikolas, Colleen has returned to Port Charles in disguises and was nearby singing with the carolers during the nativity play.

Click here for the complete recap of this week December 25 to 29, Spinelli and Lulu narrow down the list of suspects in the murder to Rick Webber to Alan Quartermaine, much to Dillon's dismay. Jax fails to return home for New Year's Eve, which gives Sonny the opportunity to spend it with Carly and their sons. Jason is conflicted about Sam's wish to become a mother. Sam has a few reservations but is determined to move ahead with her plans of convincing Jason to change his mind.

Liz is faced with a situation similar to her own that leaves her quite shaken. She is more confused than ever if she made the right decision to keep the baby's true paternity a secret. A car accident leaves her unconscious by the side of the road during a blizzard. Lucky rings in the New Years with Maxie at Kelly's where they share a dance and a kiss.

Read or review recaps posted during Character profiles Cast and credits About the Actors: GH previews, teasers, and spoilers The Scoop: GH vet Susan Brown has died. Week of Sep General Hospital Daily Recaps: Other recaps for the year More than two decades' worth of recaps are archived for your convenience. Read up and enjoy!! Lulu continues to find trouble, forcing a reluctant Luke to step up as a father.

Determined to see Laura, Lulu takes off for Shadybrook with Luke close on her heels. He finds his daughter outside of her mother's room, too afraid to enter. They share a moment of closeness as Luke helps Lulu walk into the room and visit with Laura. Afterwards Luke takes Lulu to a diner where Luke shares some of his memories of Laura. Emily confesses her feelings to Sonny.

She becomes embarrassed when it appears that Sonny doesn't reciprocate her feelings. Emily makes a clumsy exit and goes to talk to Liz at the hospital. Sonny asks Jason to come over so that he can talk to him about Emily. He admits to Jason that his feelings for Emily are more than mere friendship. After Carly discipline's Michael and sends him to his room, Michael slips out of the house.

Carly goes to Greystone, believing that is where Michael went. Meanwhile Michael ends up on the end of a dock and slips into the icy water. Emily, on her way home from the hospital, sees Michael in distress and immediately jumps into the water and rescues him. A grateful Sonny and Carly arrive moments later and Michael home. Emily decides to change at Sonny's. Later, as Sonny is thanking Emily for saving Michael's life, they give into their passions and kiss. Patrick and Robin can't seem to avoid each other.

Patrick takes every opportunity to flirt and push Robin's buttons. Patrick asks Robin out to dinner but she turns his invitation down flat. Later, when she learns that Patrick went to Carly's place, Robin decides to go to Carly's on the pretense of trying to make peace now that she's staying in town.

Upon seeing Patrick, Robin lets both of them know what she is thinking. Carly enjoys seeing Robin's reaction and confirms Robin's misconception. Click here for the complete recap of this week. Courtney confronts Jax after learning he had the first paternity results altered to name him as the father of Courtney's baby. Jax justifies his actions, claiming that he loves Courtney and wanted to spare the baby a life as a Cassadine.

Despite the strain in their relationship over Jax's lie, Nik asks Courtney to marry him. Courtney hesitates to accept, prompting Nik to suggest a mini vacation where she can obtain a quickie divorce. Jax learns of the getaway but not the details, after Courtney and Nik take off in a private jet. Emily decides to move on after Sonny's rejection by asking Patrick Drake out. She makes it clear she is trying to get over someone. Patrick accepts her offer for a date which ends in a bar fight.

Emily is the center of attention the next day when Nik and Patrick end up in a physical altercation over the incident and Sonny shows up at the hospital to threaten Patrick. Emily is furious with Sonny and goes to his home to tell him to stay out of her life if he isn't interested in her. Sonny admits that he does have feelings for her and that he wants to be with her. During Manny's transfer to prison, Manny's cousin tries to free him by setting up a roadblock.

Jesse is shot in the back during the ambush. Jason, on Sonny's orders to kill Manny, overhears the cousins argue as Manny refuses to escape. Alexis and Ric arrive at the scene just in time to see Jason with his gun pointed at Manny. When Alexis has Jason arrested, Sam shows up at the police station. Sam slaps Alexis after she tries to caution Sam against having children with Jason, a known criminal.

Later, Sam and Jason talk about starting a family. When Tracy gains the upper hand, Dillon suggests that Luke make her believe that he's trying to kill her in the hopes of forcing Tracy to divorce him. Luke sets the plans in motion but things go awry and Tracy ends up ingesting rat poison when she pours herself a drink. Outraged, Tracy heads to the police station but her car ends up in the lake and Tracy, who doesn't know how to swim, disappears. Luke fears he will be charged for attempted murder and decides to skip town.

Tracy turns up unharmed. Skye realizes that Alan helped Tracy fake her death when she overhears them talking. Courtney decides to leave town to have her baby after seeing Nik's reaction to Emily's date with Sonny.

Nik insists that he loves her and wants to marry her but Courtney is convinced that Nik is lying to himself. With Carly's help, Courtney is able to disappear much to Jax and Nik's frustration. Unfortunately one other person besides Carly knows where Courtney is. Helena quickly kidnaps Courtney before Jax is able to convince Carly to tell him where she is. Manny goes on trial and much to Sam's frustration seems to convincing the court that he's a changed man.

Convinced that Manny is lying, Sam tries to prove Manny is the same homicidal maniac he was prior to his brain surgery. Her plan backfires when Manny is able to destroy the recording she made of him showing his true colors.

After feigning a minor spell, the judge orders a recess. Manny is put into a holding room and moments after he's left alone someone enters and shoots him. After Manny is shot, he points to Jason as his shooter before he is taken to the hospital.

Sam is later arrested while she is showering and brought down to the police station as is Jason. The real shooter turns out to be one of Alcazar's henchmen. Rather than finish the job, Alcazar strikes a deal with Manny to eliminate Sonny once and for all.

Later, Manny is found not guilty by reason of mental defect. He is ordered to wear an ankle bracelet and seek psychiatric counseling and sentenced to community service at General Hospital. He wastes no time tracking down Sam and trapping her in the stairwell of the penthouse. Luckily, Lucky and Jesse arrive but are unable to arrest him as Sam admits that he did not threaten her. At the police station, Lucas is arrested for assault. In a fit of anger, he reveals to Bobbie that he is gay.

Bobbie is shocked and is certain that Lucas is only going through a phase. She convinces him to get counseling. On the run, Luke ends up in Africa posing as a doctor. He is kidnapped by a remote tribe and taken to the leader's young ailing son. Unfortunately, fighting soon breaks out and the village is burned. As Luke races to save himself and the pet monkey of the chief's son, Robert Scorpio enters the village January 30 to February 3, Luke returns to Port Charles with a rescued chimp and a contagious encephalitis virus with a high mortality rate.

Robert Scorpio is close on his heels and is dismayed to discover that his worst fears are being realized as one by one: Forced to break into the hospital records to see how many patients are infected, Robert is discovered by Robin.

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