Remifentanil Hydrochloride interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Ethanol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur.

  What to do: Concomitant use of opioid analgesics with ethanol should be avoided.

  9 sources

  1. Linnoila M, Hakkinen S "Effects of diazepam and codeine, alone and in combination with alcohol, on simulated driving." Clin Pharmacol Ther 15 (1974): 368-73
  2. Sturner WQ, Garriott JC "Deaths involving propoxyphene: a study of 41 cases over a two-year period." JAMA 223 (1973): 1125-30
  3. Girre C, Hirschhorn M, Bertaux L, et al. "Enhancement of propoxyphene bioavailability by ethanol: relation to psychomotor and cognitive function in healthy volunteers." Eur J Clin Pharmacol 41 (1991): 147-52
  4. Levine B, Saady J, Fierro M, Valentour J "A hydromorphone and ethanol fatality." J Forensic Sci 29 (1984): 655-9
  5. Sellers EM, Hamilton CA, Kaplan HL, Degani NC, Foltz RL "Pharmacokinetic interaction of propoxyphene with ethanol." Br J Clin Pharmacol 19 (1985): 398-401
  6. Carson DJ "Fatal dextropropoxyphene poisoning in Northern Ireland. Review of 30 cases." Lancet 1 (1977): 894-7
  7. Rosser WW "The interaction of propoxyphene with other drugs." Can Med Assoc J 122 (1980): 149-50
  8. Edwards C, Gard PR, Handley SL, Hunter M, Whittington RM "Distalgesic and ethanol-impaired function." Lancet 2 (1982): 384

  Show all 9 sourcesShow fewer sources

  9. Kiplinger GF, Sokol G, Rodda BE "Effect of combined alcohol and propoxyphene on human performance." Arch Int Pharmacodyn Ther 212 (1974): 175-80

Conditions

Conditions in which Remifentanil Hydrochloride needs care, as documented in this source.

• Alcoholic Intoxication

  Major

  The use of opiate agonists is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of opiate agonists may be additive with those of alcohol. Severe respiratory depression and death may occur. Therapy with opiate agonists should be administered cautiously in patients who might be prone to acute alcohol intake.

  16 sources

  1. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  2. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  3. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  4. "Product Information. MS Contin (morphine)." Purdue Frederick Company (2002):
  5. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  6. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  7. "Multum Information Services, Inc. Expert Review Panel"
  8. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  10. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceuticals (2001):
  11. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  12. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  13. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  14. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  15. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  16. "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals (2009):

• Hypotension

  Major

  Opiate agonists can induce vasodilation and significant hypotension, particularly when given in high dosages and/or by rapid intravenous administration. Opiate analgesics cause vasodilatation that may exacerbate hypotension and hypoperfusion and, therefore, are contraindicated in circulatory shock. At therapeutic analgesic dosages, ambulatory patients are more likely to experience dizziness and hypotension than patients who are confined to bed. However, orthostatic hypotension may occur in supine patients upon rising. Therapy with opiate agonists should be administered cautiously and initiated at reduced dosages in patients with hypovolemia, or a predisposition to hypotension. When given by intramuscular or subcutaneous administration, clinicians should also be aware that impaired perfusion in these patients may prevent complete absorption of the drug. With repeated injections, an excessive amount may be absorbed suddenly if normal circulation is reestablished.

  26 sources

  1. Parke TJ, Nandi PR, Bird KJ, Jewkes DA "Profound hypotension following intravenous codeine phosphate: three case reports and some recommendations." Anaesthesia 47 (1992): 852-4
  2. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  3. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  4. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  5. "Product Information. MS Contin (morphine)." Purdue Frederick Company (2002):
  6. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  7. Sebel PS, Bovill JG, Boekhorst RA, Rog N "Cardiovascular effects of high-dose fentanyl anaesthesia." Acta Anaesthesiol Scand 26 (1982): 308-15
  8. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):

  Show all 26 sourcesShow fewer sources

  9. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  10. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  11. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceuticals (2001):
  12. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  13. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  14. Cox RG "Hypoxaemia and hypotension after intravenous codeine phosphate." Can J Anaesth 41 (1994): 1211-3
  15. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceuticals (2001):
  16. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceuticals (2001):
  17. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  18. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) (2001):
  19. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  20. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  21. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  22. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  23. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc (2001):
  24. "Product Information. DepoDur (morphine liposomal)." Endo Laboratories LLC (2004):
  25. "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals (2009):
  26. "Product Information. Apadaz (acetaminophen-benzhydrocodone)." KemPharm, Inc (2018):

• Intestinal Obstruction

  Major

  Opioid agonists are contraindicated in patients with known or suspected gastrointestinal obstruction, including paralytic ileus.

  4 sources

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical (2001):
  2. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  3. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  4. "Product Information. Apadaz (acetaminophen-benzhydrocodone)." KemPharm, Inc (2018):

• Intracranial Hypertension

  Major

  The hypoventilation associated with administration of opiate agonists, particularly by the intravenous route, can induce cerebral hypoxia and vasodilatation with resultant increase in intracranial pressure. Opiate agonists should not be used in patients with suspected or known head injury or increased intracranial pressure. Also, clinicians treating such patients should be aware that opiate agonists may interfere with the evaluation of CNS function, especially with respect to consciousness levels, respiratory status, and pupillary changes.

  23 sources

  1. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  2. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  3. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  4. "Product Information. MS Contin (morphine)." Purdue Frederick Company (2002):
  5. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  6. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  7. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  8. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.

  Show all 23 sourcesShow fewer sources

  9. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceuticals (2001):
  10. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  11. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  12. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceuticals (2001):
  13. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceuticals (2001):
  14. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  15. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) (2001):
  16. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  17. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  18. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  19. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  20. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc (2001):
  21. "Product Information. DepoDur (morphine liposomal)." Endo Laboratories LLC (2004):
  22. "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals (2009):
  23. "Product Information. Apadaz (acetaminophen-benzhydrocodone)." KemPharm, Inc (2018):

• Premature Birth

  Major

  The use of narcotic (opioid) analgesic agents is contraindicated in premature infants. These agents may cross the immature blood-brain barrier to a greater extent than in adults, resulting in disproportionate respiratory depression.

  2 sources

  1. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  2. "Multum Information Services, Inc. Expert Review Panel"

• Respiratory Insufficiency

  Major

  Opiate agonists may produce significant central nervous system and respiratory depression of varying duration, particularly when given in high dosages and/or by rapid intravenous administration. Apnea may result from decreased respiratory drive as well as increased airway resistance, and rigidity of respiratory muscles may occur during rapid IV administration or when these agents are used in the induction of anesthesia. At therapeutic analgesic dosages, the respiratory effects are usually not clinically important except in patients with preexisting pulmonary impairment. Therapy with opiate agonists should be avoided or administered with extreme caution and initiated at reduced dosages in patients with severe CNS depression; sleep apnea; hypoxia, anoxia, or hypercapnia; upper airway obstruction; chronic pulmonary insufficiency; a limited ventilatory reserve; or other respiratory disorders. In the presence of excessive respiratory secretions, the use of opiate agonists may also be problematic because they decrease ciliary activity and reduce the cough reflex. Caution is also advised in patients who may be at increased risk for respiratory depression, such as comatose patients or those with head injury, intracranial lesions, or intracranial hypertension. Clinical monitoring of pulmonary function is recommended, and equipment for resuscitation should be immediately available if parenteral or neuraxial routes are used. Naloxone may be administered to reverse clinically significant respiratory depression, which may be prolonged depending on the opioid agent, cumulative dose, and route of administration.

  47 sources

  1. Redpath JB, Pleuvry BJ "Double-blind comparison of the respiratory and sedative effects of codeine phosphate and (+/-)-glaucine phosphate in human volunteers." Br J Clin Pharmacol 14 (1982): 555-8
  2. Rigg JR, Ilsley AH, Vedig AE "Relationship of ventilatory depression to steady-state blood pethidine concentrations." Br J Anaesth 53 (1981): 613-9
  3. Samuels SI, Rabinov W "Difficulty reversing drug-induced coma in a patient with sleep apnea." Anesth Analg 65 (1986): 1222-4
  4. Elloway R, Sherman S, Maas L, et al. "Meperidine-induced bronchospasm." Gastrointest Endosc 38 (1992): 93
  5. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  6. Bellville JW, Forrest WH, Elashoff J, Laska E "Evaluating side effects of analgesics in a cooperative clinical study." Clin Pharmacol Ther 9 (1968): 303-13
  7. Bigler D, Eriksen J, Christensen CB "Prolonged respiratory depression caused by slow release morphine." Lancet 06/30/84 (1984): 1477
  8. Covington EC, Gonsalves-Ebrahim L, Currie KO, et al. "Severe respiratory depression from patient-controlled analgesia in renal failure." Psychosomatics 30 (1989): 226-8

  Show all 47 sourcesShow fewer sources

  9. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  10. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  11. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  12. "Product Information. MS Contin (morphine)." Purdue Frederick Company (2002):
  13. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  14. Sackner MA "Effects of hydrocodone bitartrate on breathing pattern of patients with chronic obstructive pulmonary disease and restrictive lung disease." Mt Sinai J Med 51 (1984): 222-6
  15. Comstock MK, Carter JG, Moyers JR, Stevens WC "Rigidity and hypercarbia associated with high dose fentanyl induction of anesthesia." Anesth Analg 60 (1981): 362-3
  16. Eisenach JC "Respiratory depression following intrathecal opioids." Anesthesiology 75 (1991): 712
  17. Palmer CM "Early respiratory depression following intrathecal fentanyl-morphine combination." Anesthesiology 74 (1991): 1153-5
  18. Brockway MS, Noble DW, Sharwood-Smith GH, McClure JH "Profound respiratory depression after extradural fentanyl." Br J Anaesth 64 (1990): 243-5
  19. Harper MH, Hickey RF, Cromwell TH, Linwood S "The magnitude and duration of respiratory depression produced by fentanyl and fentanyl plus droperidol in man." J Pharmacol Exp Ther 199 (1976): 464-8
  20. Varrassi G, Celleno D, Capogna G, et al. "Ventilatory effects of subarachnoid fentanyl in the elderly." Anaesthesia 47 (1992): 558-62
  21. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  22. Ogawa K, Iranami H, Yoshiyama T, Maeda H, Hatano Y "Severe respiratory depression after epidural morphine in a patient with myotonic dystrophy." Can J Anaesth 40 (1993): 968-70
  23. Noble DW, Morrison LM, Brockway MS, Mcclure JH "Respiratory depression after extradural fentanyl." Br J Anaesth 72 (1994): 251
  24. Houghton IT, Aun CST, Wong YC, Chan K, Lau JTF, Oh TE "The respiratory depressant effect of morphine - a comparative study in three ethnic groups." Anaesthesia 49 (1994): 197-201
  25. Jackson FW "Fentanyl and the wooden chest." Gastroenterology 106 (1994): 820-1
  26. Etches RC "Respiratory depression associated with patient-controlled analgesia - a review of eight cases." Can J Anaesth 41 (1994): 125-32
  27. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  28. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  29. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceuticals (2001):
  30. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  31. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  32. Sandler AN, Baxter AD, Katz J, Samson B, Friedlander M, Norman P, Koren G, Roger S, Hull K, Klein J "A double-blind, placebo-controlled trial of transdermal fentanyl after abdominal hysterectomy: analgesic, respiratory, and pharmacokinetic effects." Anesthesiology 81 (1994): 1169-80
  33. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceuticals (2001):
  34. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceuticals (2001):
  35. Hudson RJ "Apnoea and unconsciousness after apparent recovery from alfentanil- supplemented anaesthesia." Can J Anaesth 37 (1990): 255-7
  36. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  37. Morley AD "Profound respiratory depression with morphine patient-controlled analgesia in an elderly patient." Anaesth Intensive Care 24 (1996): 287
  38. Amin HM, Sopchak AM, Esposito BF, Henson LG, Batenhorst RL, Fox AW, Camporesi EM "Naloxone-induced and spontaneous reversal of depressed ventilatory responses to hypoxia during and after continuous infusion of remifentanil or alfentanil." J Pharmacol Exp Ther 274 (1995): 34-9
  39. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) (2001):
  40. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  41. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  42. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  43. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  44. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc (2001):
  45. "Product Information. DepoDur (morphine liposomal)." Endo Laboratories LLC (2004):
  46. "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals (2009):
  47. "Product Information. Apadaz (acetaminophen-benzhydrocodone)." KemPharm, Inc (2018):

• Adrenal Insufficiency

  Moderate

  Patients with Addison's disease may have increased risk of respiratory depression and prolonged CNS depression associated with the use of narcotic (opioid) analgesic agents. Conversely, these agents may cause or potentiate adrenal insufficiency. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with adrenocortical insufficiency. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

  27 sources

  1. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  2. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  3. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  4. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc (2002):
  5. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  6. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  7. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  8. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.

  Show all 27 sourcesShow fewer sources

  9. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceuticals (2001):
  10. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceuticals (2001):
  12. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceuticals (2001):
  13. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  14. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) (2001):
  15. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  16. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  17. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb (2001):
  18. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  19. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  20. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  21. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  22. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
  23. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):
  24. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  25. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  26. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc (2001):
  27. "Product Information. Olinvyk (oliceridine)." Trevena Inc (2020):

• Arrhythmias, Cardiac

  Moderate

  Opiate agonists have cholinergic activity. Large doses and/or rapid intravenous administration may produce bradycardia and arrhythmia via stimulation of medullary vagal nuclei. Unlike other agents in the class, meperidine also has anticholinergic activity and may cause either bradycardia or tachycardia. Therapy with opiate agonists should be administered cautiously in patients with a history of arrhythmias. Clinical monitoring of cardiovascular status is recommended during therapy. Bradycardia and other cholinergic effects produced by these agents may be controlled with atropine.

  21 sources

  1. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  2. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  3. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  4. "Product Information. MS Contin (morphine)." Purdue Frederick Company (2002):
  5. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  6. Hilgenberg JC, Johantgen WC "Bradycardia after intravenous fentanyl during subarachnoid anesthesia." Anesth Analg 59 (1980): 162-3
  7. Blair JR, Pruett JK, Crumrine RS, Balser JJ "Prolongation of QT interval in association with the administration of large doses of opiates." Anesthesiology 67 (1987): 442-3
  8. Sebel PS, Bovill JG, Boekhorst RA, Rog N "Cardiovascular effects of high-dose fentanyl anaesthesia." Acta Anaesthesiol Scand 26 (1982): 308-15

  Show all 21 sourcesShow fewer sources

  9. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  10. Heaney RM "Left bundle branch block associated with propoxyphene hydrochloride poisoning." Ann Emerg Med 12 (1983): 780-2
  11. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  12. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  13. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceuticals (2001):
  14. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceuticals (2001):
  15. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceuticals (2001):
  16. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  17. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) (2001):
  18. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  19. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  20. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  21. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):

• Epilepsy

  Moderate

  Narcotic (opioid) analgesic agents may exacerbate seizures in patients with seizure disorders and, at higher dosages, have been reported to induce seizures in patients without previous history of seizures. The proconvulsant activity may be the greatest with meperidine, the active metabolite of which is thought to be responsible. Therapy with opioids should be administered cautiously in patients with or predisposed to seizures.

  44 sources

  1. Kaiko RF, Foley KM, Grabinski PY, et al. "Central nervous system excitatory effects of meperidine in cancer patients." Ann Neurol 13 (1983): 180-5
  2. Goetting MG, Thirman MJ "Neurotoxicity of meperidine." Ann Emerg Med 14 (1985): 1007-9
  3. Mauro VF, Bonfiglio MF, Spunt AL "Meperidine-induced seizure in a patient without renal dysfunction or sickle cell anemia." Clin Pharm 5 (1986): 837-9
  4. Reutens DC, Stewart-Wynne EG "Norpethidine induced myoclonus in a patient with renal failure." J Neurol Neurosurg Psychiatry 52 (1989): 1450-1
  5. Armstrong PJ, Bersten A "Normeperidine toxicity." Anesth Analg 65 (1986): 536-8
  6. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  7. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  8. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):

  Show all 44 sourcesShow fewer sources

  9. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc (2002):
  10. "Product Information. MS Contin (morphine)." Purdue Frederick Company (2002):
  11. Babul N, Darke AC "Putative role of hydromorphone metabolites in myoclonus." Pain 51 (1992): 260-1
  12. Hagmeyer KO, Mauro LS, Mauro VF "Meperidine-related seizures associated with patient-controlled analgesia pumps." Ann Pharmacother 27 (1993): 29-32
  13. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  14. Sebel PS, Bovill JG "Fentanyl and convulsions." Anesth Analg 62 (1983): 858-9
  15. Rao TL, Mummaneni N, El-Etr AA "Convulsions: an unusual response to intravenous fentanyl administration." Anesth Analg 61 (1982): 1020-1
  16. Goroszeniuk T, Albin M, Jones RM "Generalized grand mal seizure after recovery from uncomplicated fentanyl-etomidate anesthesia." Anesth Analg 65 (1986): 979-81
  17. Hoien AO "Another case of grand mal seizure after fentanyl administration." Anesthesiology 60 (1984): 387-8
  18. Safwat AM, Daniel D "Grand mal seizure after fentanyl administration." Anesthesiology 59 (1983): 78
  19. Smith NT, Benthuysen JL, Bickford RG, Sanford TJ, Blasco T, Duke PC, Head N, Dec-Silver H "Seizures during opioid anesthetic induction--are they opioid-induced rigidity?" Anesthesiology 71 (1989): 852-62
  20. Benthuysen JL, Stanley TH "Concerning the possible nature of reported fentanyl seizures." Anesthesiology 62 (1985): 205
  21. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  22. Stone PA, Macintyre PE, Jarvis DA "Norpethidine toxicity and patient controlled analgesia." Br J Anaesth 71 (1993): 738-40
  23. Sjogren P, Dragsted L, Christensen CB "Myoclonic spasms during treatment with high doses of intravenous morphine in renal failure." Acta Anaesthesiol Scand 37 (1993): 780-2
  24. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  25. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  26. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceuticals (2001):
  27. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  28. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceuticals (2001):
  29. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceuticals (2001):
  30. Strong WE, Matson M "Probable seizure after alfentanil." Anesth Analg 68 (1989): 692-3
  31. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  32. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) (2001):
  33. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  34. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  35. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb (2001):
  36. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  37. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  38. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  39. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  40. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
  41. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  42. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  43. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc (2001):
  44. "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals (2009):

• Hypothyroidism

  Moderate

  Patients with hypothyroidism may have increased risk of respiratory depression and prolonged CNS depression associated with the use of narcotic (opioid) analgesic agents. These agents may also exacerbate the effects of hypothyroidism such as lethargy, impaired mentation, depression, and constipation. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with uncontrolled hypothyroidism or myxedema. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

  25 sources

  1. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  2. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  3. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  4. "Product Information. MS Contin (morphine)." Purdue Frederick Company (2002):
  5. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  6. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  7. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  8. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.

  Show all 25 sourcesShow fewer sources

  9. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceuticals (2001):
  10. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceuticals (2001):
  12. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceuticals (2001):
  13. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  14. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) (2001):
  15. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  16. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  17. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb (2001):
  18. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  19. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  20. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  21. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  22. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
  23. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  24. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  25. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc (2001):

• Urinary Retention

  Moderate

  Narcotic (opioid) analgesic agents may inhibit the urinary voiding reflex and increase the tone of the vesical sphincter in the bladder. Acute urinary retention requiring catheterization may occur, particularly in patients with prostatic hypertrophy or urethral stricture and in elderly patients. These agents may also decrease urine production via direct effects on the kidney and central stimulation of the release of vasopressin. Therapy with opioids should be administered cautiously in patients with or predisposed to urinary retention and/or oliguria. The effects on smooth muscle tone appear to be the most pronounced with morphine.

  30 sources

  1. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  2. Petersen TK, Husted SE, Rybro L, et al. "Urinary retention during I.M. and extradural morphine analgesia." Br J Anaesth 54 (1982): 1175-8
  3. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  4. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  5. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  6. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc (2002):
  7. Petros JG, Mallen JK, Howe K, Rimm EB, Robillard RJ "Patient-controlled analgesia and postoperative urinary retention after open appendectomy." Surg Gynecol Obstet 177 (1993): 172-5
  8. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):

  Show all 30 sourcesShow fewer sources

  9. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  10. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  11. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  12. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceuticals (2001):
  13. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  14. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  15. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceuticals (2001):
  16. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceuticals (2001):
  17. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  18. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) (2001):
  19. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  20. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  21. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb (2001):
  22. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  23. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  24. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  25. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  26. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
  27. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  28. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  29. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc (2001):
  30. "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals (2009):