Narcotic Analgesics for Pain Relief (Systemic)

• Categories:

  • Analgesic--Anileridine; Buprenorphine; Butorphanol; Codeine; Hydrocodone; Hydromorphone; Levorphanol; Meperidine; Methadone; Morphine; Nalbuphine; Opium Injection; Oxycodone; Oxymorphone; Pentazocine; Propoxyphene
  • Anesthesia adjunct--Anileridine; Buprenorphine
  • Anesthesia adjunct, opioid analgesic--Butorphanol; Hydromorphone; Levorphanol; Meperidine; Morphine; Nalbuphine; Oxymorphone; Pentazocine
  • Antidiarrheal--Codeine; Morphine
  • Antitussive--Codeine; Hydrocodone; Hydromorphone; Methadone; Morphine
  • Pulmonary edema therapy adjunct--Morphine
  • Suppressant, narcotic abstinence syndrome--Methadone

   

• Brand Names U.S.: Astramorph PF¹⁰, Buprenex², Cotanal-65¹⁶, Darvon¹⁶, Demerol⁸, Dilaudid⁶, Dolophine⁹, Duramorph¹⁰, Hydrostat IR⁶, Kadian¹⁰, Levo-Dromoran⁷, Methadose⁹, M S Contin¹⁰, MSIR¹⁰, MS/L¹⁰, Nubain¹¹, Numorphan¹⁴, OMS Concentrate¹⁰, Oramorph SR¹⁰, OxyContin¹³, PP-Cap¹⁶, Rescudose¹⁰, Roxanol¹⁰, Roxicodone¹³, Stadol³, Talwin¹⁵
• Brand Names Canada: Darvon-N¹⁶, Demerol⁸, Dilaudid⁶, Epimorph¹⁰, Hycodan⁵, Kadian¹⁰, Leritine¹, Levo-Dromoran⁷, M-Eslon¹⁰, Morphine Forte¹⁰, Morphitec¹⁰, M.O.S.¹⁰, M.O.S.-S.R.¹⁰, M S Contin¹⁰, Nubain¹¹, Numorphan¹⁴, Oramorph SR¹⁰, OxyContin SR¹³, Pantopon¹², Paveral⁴, PMS-Hydromorphone⁶, Robidone⁵, 642¹⁶, Statex¹⁰, Supeudol¹³, Talwin¹⁵
• Other commonly used names: dextropropoxyphene, dihydromorphinone, levorphan, papaveretum, pethidine

¹Anileridine · ²Buprenorphine · ³Butorphanol · ⁴Codeine · ⁵Hydrocodone · ⁶Hydromorphone · ⁷Levorphanol · ⁸Meperidine · ⁹Methadone · ¹⁰Morphine · ¹¹Nalbuphine · ¹²Opium Injection · ¹³Oxycodone · ¹⁴Oxymorphone · ¹⁵Pentazocine · ¹⁶Propoxyphene

• Carbamazepine (e.g., Tegretol)--Propoxyphene may increase the blood levels of carbamazepine, which increases the chance of serious side effects
• Central nervous system (CNS) depressants or
• Monoamine oxidase (MAO) inhibitors (furazolidone [e.g., Furoxone], isocarboxazid [e.g., Marplan], pargyline [e.g., Eutonyl], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], tranylcypromine [e.g., Parnate] (taken currently or within the past 2 weeks) or
• Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil])--The chance of side effects may be increased; the combination of meperidine (e.g., Demerol) and MAO inhibitors is especially dangerous
• Naltrexone (e.g., Trexan)--Narcotics will not be effective in people taking naltrexone
• Rifampin (e.g., Rifadin)--Rifampin decreases the effects of methadone and may cause withdrawal symptoms in people who are dependent on methadone
• Zidovudine (e.g., AZT, Retrovir)--Morphine may increase the blood levels of zidovudine and increase the chance of serious side effects

Potential Side Effects of This Medication:

Get emergency help immediately if any of the following symptoms of overdose occur : cold, clammy skin; confusion; convulsions (seizures); dizziness (severe); drowsiness (severe); low blood pressure; nervousness or restlessness (severe); pinpoint pupils of eyes; slow heartbeat; slow or troubled breathing; weakness (severe)

Check with your doctor as soon as possible if any of the following side effects occur: dark urine (for propoxyphene only); fast, slow, or pounding heartbeat; feelings of unreality; hallucinations (seeing, hearing, or feeling things that are not there); hives, itching, or skin rash; increased sweating (more common with hydrocodone, meperidine, and methadone); irregular breathing; mental depression or other mood or mental changes; pale stools (for propoxyphene only); redness or flushing of face (more common with hydrocodone, meperidine, and methadone); ringing or buzzing in the ears; shortness of breath, wheezing, or troubled breathing; swelling of face; trembling or uncontrolled muscle movements; unusual excitement or restlessness (especially in children); yellow eyes or skin (for propoxyphene only)

These side effects usually do not need medical attention, but check with your doctor if they continue or are bothersome: dizziness, lightheadedness, or feeling faint; drowsiness; nausea or vomiting; blurred or double vision or other changes in vision; constipation (more common with long-term use and with codeine); decrease in amount of urine; difficult or painful urination; dry mouth; false sense of well-being; frequent urge to urinate; general feeling of discomfort or illness; headache; loss of appetite; nervousness or restlessness; nightmares or unusual dreams; redness, swelling, pain, or burning at place of injection; stomach cramps or pain; trouble in sleeping; unusual tiredness or weakness

Although not all of the side effects listed above have been reported for all of these combination medicines, they have been reported for at least one of them. However, since all of the narcotic analgesics are very similar, any of the above side effects may occur with any of these medicines.

• If you are taking this medicine for an extended period, or in high doses, your doctor should check your progress at regular intervals.
• Check the labels of all nonprescription and prescription medicines you now take. If any contain acetaminophen or a narcotic be especially careful, since taking them while taking this medicine may lead to overdose.
• The narcotic analgesic in this medicine will add to the effects of alcohol and other CNS depressants. Also, there may be a greater risk of liver damage if you drink three or more alcoholic beverages while you are taking acetaminophen. Do not drink alcoholic beverages, and check with your medical doctor or dentist before taking any of the medicines listed above, while you are using this medicine .
• Too much use of the acetaminophen in this combination medicine together with certain other medicines may increase the chance of unwanted effects. If your doctor directs you to take these medicines together on a regular basis, follow his or her directions carefully. However, do not take this medicine together with any of the following medicines for more than a few days, unless your doctor has directed you to do so and is following your progress:
  • Aspirin or other salicylates
  • Diclofenac (e.g., Voltaren)
  • Diflunisal (e.g., Dolobid)
  • Etodolac (e.g., Lodine)
  • Fenoprofen (e.g., Nalfon)
  • Floctafenine (e.g., Idarac)
  • Flurbiprofen, oral (e.g., Ansaid)
  • Ibuprofen (e.g., Motrin)
  • Indomethacin (e.g., Indocin)
  • Ketoprofen (e.g., Orudis)
  • Ketorolac (e.g., Toradol)
  • Meclofenamate (e.g., Meclomen)
  • Mefenamic acid (e.g., Ponstel)
  • Nabumetone (e.g., Relafen)
  • Naproxen (e.g., Naprosyn)
  • Oxaprozin (e.g., Daypro)
  • Phenylbutazone (e.g., Butazolidin)
  • Piroxicam (e.g., Feldene)
  • Sulindac (e.g., Clinoril)
  • Tenoxicam (e.g., Mobiflex)
  • Tiaprofenic acid (e.g., Surgam)
  • Tolmetin (e.g., Tolectin)
• Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert and clearheaded. Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem.
• Nausea or vomiting may occur, especially after the first couple of doses. This effect may go away if you lie down for a while. However, if nausea or vomiting continues, check with your medical doctor or dentist. Lying down for a while may also help relieve some other side effects, such as dizziness or lightheadedness, that may occur.
• Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine.
• If you think you or someone else may have taken an overdose of this medicine, get emergency help at once. Taking an overdose of this medicine or taking alcohol or CNS depressants with this medicine may lead to unconsciousness or death. Signs of overdose of narcotics include convulsions (seizures), confusion, severe nervousness or restlessness, severe dizziness, severe drowsiness, shortness of breath or troubled breathing, and severe weakness. Signs of severe acetaminophen overdose may not occur until several days after the overdose is taken.

• Alcohol abuse, or history of
• Brain disease or head injury
• Colitis
• Convulsions (seizures), history of--Some of the narcotic analgesics can cause convulsions
• Drug dependence, especially narcotic abuse, or history of
• Emotional problems--The chance of side effects may be increased; also, withdrawal symptoms may occur if a narcotic you are dependent on is replaced by buprenorphine, butorphanol, nalbuphine, or pentazocine
• Emphysema, asthma, or other chronic lung disease
• Enlarged prostate or problems with urination
• Gallbladder disease or gallstones
• Heart disease
• Kidney disease
• Liver disease
• Underactive thyroid--The chance of side effects may be increased