narcotic analgesics - for pain relief

Class Name: narcotic analgesics (

FOR PAIN RELIEF (Oral route, Parenteral route, Rectal route)

Commonly used brand name(s):

In the U.S.

  • Avinza
  • Darvon
  • Darvon-N
  • Dazidox
  • Demerol
  • Dilaudid
  • Dilaudid-5
  • Dolophine
  • Eth-Oxydose
  • Kadian
  • Kadian ER
  • Levo-Dromoran
  • Meperitab
  • Methadone HCl Intensol
  • Nucynta
  • Opana
  • Orlaam
  • Oxycontin CR
  • Pp-Cap
  • Ultram
  • Ultram ER

In Canada

  • Codeine Phosphate
  • Demerol 10%
  • Demerol 5%
  • Demerol 7.5%
  • Hycodan
  • M.O.S.-10
  • M.O.S.-20
  • M.O.S.-20 Concentrate
  • M.O.S.-30
  • Metadol
  • Metadol-D

Available Dosage Forms:

  • Tablet
  • Liquid
  • Tablet, Extended Release
  • Capsule, Extended Release
  • Suppository
  • Solution
  • Lozenge/Troche
  • Tablet for Suspension
  • Syrup
  • Capsule
  • Suspension
  • Capsule, Extended Release, 24 HR
  • Suppository, Extended Release
  • Powder for Suspension, Extended Release
  • Capsule, Delayed Release
  • Tincture

Uses For This Medicine

Narcotic analgesics are used to relieve pain. Some of these medicines are also used just before or during an operation to help the anesthetic work better. Codeine and hydrocodone are also used to relieve coughing. Methadone is also used to help some people control their dependence on heroin or other narcotics. Narcotic analgesics may also be used for other conditions as determined by your doctor.

Narcotic analgesics act in the central nervous system (CNS) to relieve pain. Some of their side effects are also caused by actions in the CNS.

If a narcotic is used for a long time, it may become habit-forming (causing mental or physical dependence). Physical dependence may lead to withdrawal side effects when you stop taking the medicine.

These medicines are available only with your medical doctor's or dentist's prescription. For some of them, prescriptions cannot be refilled and you must obtain a new prescription from your medical doctor or dentist each time you need the medicine. In addition, other rules and regulations may apply when methadone is used to treat narcotic dependence.

These medicines are available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although not specifically included in product labeling, morphine by injection is used in certain patients with the following medical conditions:

  • Pain, during mechanical ventilation, neonatal
  • Pain, postoperative, neonatal

Before Using This Medicine

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Breathing problems may be especially likely to occur in children younger than 2 years of age. These children are usually more sensitive than adults to the effects of narcotic analgesics. Also, unusual excitement or restlessness may be more likely to occur in children receiving these medicines. Hydromorphone extended-release capsules should not be used in children younger than 18 years of age.

Geriatric

Elderly people are especially sensitive to the effects of narcotic analgesics. This may increase the chance of side effects, especially breathing problems, during treatment.

Pregnancy

Although studies on birth defects with narcotic analgesics have not been done in pregnant women, these medicines have not been reported to cause birth defects. However, hydrocodone, hydromorphone, and morphine caused birth defects in animals when given in very large doses. Buprenorphine and codeine did not cause birth defects in animal studies, but they caused other unwanted effects. Butorphanol, nalbuphine, pentazocine, and propoxyphene did not cause birth defects in animals. There is no information about whether other narcotic analgesics cause birth defects in animals.

Too much use of a narcotic during pregnancy may cause the baby to become dependent on the medicine. This may lead to withdrawal side effects after birth. Also, some of these medicines may cause breathing problems in the newborn infant if taken just before delivery.

Breast Feeding

Most narcotic analgesics have not been reported to cause problems in nursing babies.

  • Codeine and other narcotic analgesics—Codeine is changed to morphine in the body. Some people change codeine to morphine more quickly than others. These individuals are called "ultra-rapid metabolizers of codeine". If a nursing mother is an ultra-rapid metabolizer of codeine, it could lead to a morphine overdose in the nursing baby and cause very serious side effects. A nursing mother should talk to her doctor if she has any questions about taking codeine or about how this medicine may affect her baby .
  • Butorphanol, meperidine, morphine, opium, and propoxyphene—These medicines pass into the breast milk.
  • Methadone—When a mother is taking large amounts of methadone (in a methadone maintenance program), the nursing baby may become dependent on the medicine.

Interactions with Medicines

Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.

  • Acecainide
  • Ajmaline
  • Amiodarone
  • Amisulpride
  • Amitriptyline
  • Amoxapine
  • Aprindine
  • Astemizole
  • Azimilide
  • Bepridil
  • Bretylium
  • Brofaromine
  • Chloral Hydrate
  • Chloroquine
  • Chlorpromazine
  • Cisapride
  • Citalopram
  • Clarithromycin
  • Clorgyline
  • Desipramine
  • Dibenzepin
  • Disopyramide
  • Dofetilide
  • Dolasetron
  • Doxepin
  • Dronedarone
  • Droperidol
  • Ebastine
  • Encainide
  • Erythromycin
  • Flecainide
  • Fluconazole
  • Flucytosine
  • Fluoxetine
  • Fluvoxamine
  • Foscarnet
  • Furazolidone
  • Halofantrine
  • Haloperidol
  • Hydroquinidine
  • Ibutilide
  • Imipramine
  • Iproniazid
  • Isocarboxazid
  • Isradipine
  • Itraconazole
  • Lazabemide
  • Lidoflazine
  • Linezolid
  • Lorcainide
  • Mefloquine
  • Mesoridazine
  • Methdilazine
  • Mexiletine
  • Mibefradil
  • Moclobemide
  • Naltrexone
  • Nialamide
  • Nicardipine
  • Nortriptyline
  • Octreotide
  • Olanzapine
  • Pargyline
  • Pentamidine
  • Phenelzine
  • Pimozide
  • Pirmenol
  • Prajmaline
  • Primaquine
  • Probucol
  • Procainamide
  • Procarbazine
  • Propafenone
  • Protriptyline
  • Quinidine
  • Rasagiline
  • Risperidone
  • Selegiline
  • Sematilide
  • Sertindole
  • Sertraline
  • Sotalol
  • Spiramycin
  • Sulfamethoxazole
  • Sultopride
  • Tedisamil
  • Telavancin
  • Terfenadine
  • Thioridazine
  • Tiapride
  • Toloxatone
  • Tranylcypromine
  • Trimeprazine
  • Trimethoprim
  • Trimipramine
  • Vasopressin
  • Zimeldine
  • Ziprasidone
  • Zolmitriptan
  • Zotepine

Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acebutolol
  • Acetazolamide
  • Acetophenazine
  • Adinazolam
  • Alfentanil
  • Almotriptan
  • Alphaprodine
  • Alprazolam
  • Alprenolol
  • Amiloride
  • Amiodarone
  • Amitriptyline
  • Amlodipine
  • Amobarbital
  • Amoxapine
  • Amprenavir
  • Anileridine
  • Aprepitant
  • Aprobarbital
  • Aripiprazole
  • Arsenic Trioxide
  • Asenapine
  • Atazanavir
  • Atenolol
  • Azosemide
  • Bemetizide
  • Bendroflumethiazide
  • Benzthiazide
  • Bepridil
  • Betaxolol
  • Bevantolol
  • Bisoprolol
  • Brofaromine
  • Bromazepam
  • Bromperidol
  • Brotizolam
  • Bucindolol
  • Bumetanide
  • Buprenorphine
  • Buspirone
  • Butabarbital
  • Butalbital
  • Butorphanol
  • Canrenoate
  • Carbamazepine
  • Carisoprodol
  • Carteolol
  • Carvedilol
  • Castor Oil
  • Celiprolol
  • Chloral Hydrate
  • Chlordiazepoxide
  • Chlorpromazine
  • Chlorprothixene
  • Chlorthalidone
  • Chlorzoxazone
  • Cimetidine
  • Citalopram
  • Clarithromycin
  • Clobazam
  • Clomipramine
  • Clonazepam
  • Clopamide
  • Clorazepate
  • Clorgyline
  • Clovoxamine
  • Clozapine
  • Codeine
  • Cyclobenzaprine
  • Cyclothiazide
  • Dantrolene
  • Desflurane
  • Desipramine
  • Desvenlafaxine
  • Dexmedetomidine
  • Dezocine
  • Diazepam
  • Difenoxin
  • Digoxin
  • Dihydrocodeine
  • Diltiazem
  • Diphenhydramine
  • Diphenoxylate
  • Docusate
  • Dofetilide
  • Dothiepin
  • Doxepin
  • Doxylamine
  • Droperidol
  • Duloxetine
  • Eletriptan
  • Enflurane
  • Erythromycin
  • Escitalopram
  • Esmolol
  • Estazolam
  • Eszopiclone
  • Ethacrynic Acid
  • Ethchlorvynol
  • Ethopropazine
  • Etozolin
  • Felodipine
  • Femoxetine
  • Fenquizone
  • Fentanyl
  • Fluconazole
  • Flumazenil
  • Flunitrazepam
  • Fluoxetine
  • Flupenthixol
  • Fluphenazine
  • Flurazepam
  • Fluvoxamine
  • Fosamprenavir
  • Fospropofol
  • Frovatriptan
  • Furazolidone
  • Furosemide
  • Gatifloxacin
  • Gemifloxacin
  • Halazepam
  • Halofantrine
  • Haloperidol
  • Halothane
  • Hydrochlorothiazide
  • Hydrocodone
  • Hydroflumethiazide
  • Hydromorphone
  • Hydroxyzine
  • Ibutilide
  • Iloperidone
  • Imipramine
  • Indapamide
  • Iproniazid
  • Isocarboxazid
  • Isoflurane
  • Isradipine
  • Itraconazole
  • Ketamine
  • Ketazolam
  • Ketoconazole
  • Labetalol
  • Lactulose
  • Lapatinib
  • Lazabemide
  • Levobunolol
  • Levofloxacin
  • Levomethadyl
  • Levorphanol
  • Linezolid
  • Lofepramine
  • Lorazepam
  • Lormetazepam
  • Loxapine
  • Magnesium
  • Mannitol
  • Medazepam
  • Melperone
  • Meperidine
  • Mephenesin
  • Mephobarbital
  • Mepindolol
  • Meprobamate
  • Mesoridazine
  • Metaxalone
  • Methadone
  • Methdilazine
  • Methocarbamol
  • Methohexital
  • Methotrimeprazine
  • Metipranolol
  • Metolazone
  • Metoprolol
  • Midazolam
  • Milnacipran
  • Mirtazapine
  • Moclobemide
  • Molindone
  • Morphine
  • Morphine Sulfate Liposome
  • Moxifloxacin
  • Nadolol
  • Nalbuphine
  • Naratriptan
  • Nebivolol
  • Nefazodone
  • Nelfinavir
  • Nialamide
  • Nicardipine
  • Nifedipine
  • Nilotinib
  • Nimodipine
  • Nisoldipine
  • Nitrazepam
  • Nitrous Oxide
  • Nordazepam
  • Nortriptyline
  • Olanzapine
  • Opium
  • Oxazepam
  • Oxprenolol
  • Oxycodone
  • Oxymorphone
  • Paliperidone
  • Pargyline
  • Paroxetine
  • Pazopanib
  • Penbutolol
  • Penfluridol
  • Pentazocine
  • Pentobarbital
  • Perphenazine
  • Phenelzine
  • Phenobarbital
  • Pimozide
  • Pindolol
  • Pipotiazine
  • Piretanide
  • Polythiazide
  • Prazepam
  • Procarbazine
  • Prochlorperazine
  • Promazine
  • Promethazine
  • Propiomazine
  • Propofol
  • Propoxyphene
  • Propranolol
  • Protriptyline
  • Quazepam
  • Quetiapine
  • Quinethazone
  • Quinidine
  • Quinine
  • Ramelteon
  • Ranolazine
  • Rasagiline
  • Remifentanil
  • Remoxipride
  • Risperidone
  • Ritonavir
  • Rizatriptan
  • Secobarbital
  • Selegiline
  • Sertraline
  • Sevoflurane
  • Sibutramine
  • Sildenafil
  • Sodium Oxybate
  • Sodium Phosphate
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate, Monobasic
  • Sorbitol
  • Sotalol
  • Spironolactone
  • Sufentanil
  • Sulpiride
  • Sumatriptan
  • Sunitinib
  • Talinolol
  • Tapentadol
  • Telavancin
  • Telithromycin
  • Temazepam
  • Tertatolol
  • Tetrabenazine
  • Thiethylperazine
  • Thiopental
  • Thioridazine
  • Thiothixene
  • Ticrynafen
  • Timolol
  • Toloxatone
  • Torsemide
  • Tramadol
  • Tranylcypromine
  • Triamterene
  • Triazolam
  • Trichlormethiazide
  • Trifluoperazine
  • Triflupromazine
  • Trimeprazine
  • Trimipramine
  • Troleandomycin
  • Urea
  • Vardenafil
  • Venlafaxine
  • Verapamil
  • Xipamide
  • Zaleplon
  • Ziprasidone
  • Zolmitriptan
  • Zolpidem
  • Zuclopenthixol

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using medicines in this class with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use your medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Ethanol

Other Medical Problems

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

  • Alcohol abuse, or history of, or
  • Drug dependence, especially narcotic abuse, or history of, or
  • 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.
  • Brain disease or head injury or
  • Emphysema, asthma, or other chronic lung disease or
  • Enlarged prostate or problems with urination or
  • Gallbladder disease or gallstones—Some of the side effects of narcotic analgesics can be dangerous if these conditions are present.
  • Colitis or
  • Heart disease or
  • Kidney disease or
  • Liver disease or
  • Underactive thyroid—The chance of side effects may be increased.
  • Convulsions (seizures), history of—Some of the narcotic analgesics can cause convulsions.

Proper Use of This Medicine

Some narcotic analgesics given by injection may be given at home to patients who do not need to be in the hospital. If you are using an injection form of this medicine at home, make sure you clearly understand and carefully follow your doctor's instructions.

To take long-acting hydromorphone capsules:

  • These capsules must be swallowed whole. Do not chew, crush or dissolve.
  • If the capsules is not swallowed whole, you could overdose on this medicine.
  • Check with your doctor right away if you are not sure how to take extended-release hydromorphone capsules.

To take the syrup form of meperidine:

  • Unless otherwise directed by your medical doctor or dentist, take this medicine mixed with a half glass (4 ounces) of water to lessen the numbing effect of the medicine on your mouth and throat.

To take the oral liquid forms of methadone

  • This medicine may have to be mixed with water or another liquid before you take it. Read the label carefully for directions. If you have any questions about this, check with your health care professional.

To take the dispersible tablet form of methadone:

  • These tablets must be stirred into water or fruit juice just before each dose is taken. Read the label carefully for directions. If you have any questions about this, check with your health care professional.

To take oral liquid forms of morphine:

  • This medicine may be mixed with a glass of fruit juice just before you take it, if desired, to improve the taste.

To take long-acting morphine and oxycodone tablets:

  • These tablets must be swallowed whole. Do not break, crush, or chew them before swallowing.

To take long-acting morphine capsules:

  • These capsules must be swallowed whole. Do not chew, crush or dissolve.
  • Or, the capsule can be opened and all of the beads inside sprinkled over applesauce and used right away. The beads must not be chewed, crushed, or dissolved.
  • If capsules or beads from the capsules are not swallowed whole, you could overdose on this medicine.
  • Check with your doctor right away if you are not sure how to take long-acting morphine capsules.

To use suppositories:

  • If the suppository is too soft to insert, chill it in the refrigerator for 30 minutes or run cold water over it before removing the foil wrapper.
  • To insert the suppository: First remove the foil wrapper and moisten the suppository with cold water. Lie down on your side and use your finger to push the suppository well up into the rectum.

Take this medicine only as directed by your medical doctor or dentist. Do not take more of it, do not take it more often, and do not take it for a longer time than your medical doctor or dentist ordered. This is especially important for young children and elderly patients, who are especially sensitive to the effects of narcotic analgesics. If too much is taken, the medicine may become habit-forming (causing mental or physical dependence) or lead to medical problems because of an overdose.

If you think this medicine is not working properly after you have been taking it for a few weeks, do not increase the dose. Instead, check with your doctor.

Dosing

The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For anileridine
  • For oral dosage forms:
    • For pain:
      • Adults and teenagers—25 to 50 milligrams (mg) every 6 hours as needed.
      • Children up to 13 years of age—Dose must be determined by your doctor.
  • For buprenorphine
  • For injection dosage form:
    • For pain:
      • Adults and teenagers—0.3 milligrams (mg), injected into a muscle or a vein every six hours as needed.
      • Children 2 to 12 years of age—0.002 to 0.006 mg per kilogram (kg) (0.0008 to 0.0024 mg per pound) of body weight, injected into a muscle or a vein every four to six hours as needed.
      • Children up to 2 years of age—Dose must be determined by your doctor.
  • For butorphanol
  • For injection dosage form
    • For pain:
      • Adults—1 to 4 milligrams (mg) (usually 2 mg), injected into a muscle every three or four hours as needed. Some people may receive 0.5 to 2 mg (usually 1 mg) injected into a vein every three or four hours as needed.
      • Children and teenagers—Dose must be determined by your doctor.
  • For codeine
  • For oral dosage forms (oral solution or tablets):
    • For pain:
      • Adults—15 to 60 milligrams (mg) (usually 30 mg) every three to six hours as needed.
      • Children—0.5 mg per kilogram (kg) (0.2 mg per pound) of body weight every four to six hours as needed. Young children will probably take the oral solution, rather than tablets. Small doses may need to be measured by a special dropper instead of a teaspoon.
    • For cough:
      • Adults—10 to 20 mg every four to six hours.
      • Children 6 to 12 years of age—5 to 10 mg every four to six hours, up to a maximum of 60 mg a day.
      • Children 5 years of age—4.5 mg every four to six hours, up to a maximum of 18 mg a day. Children this young will probably take the oral solution, rather than tablets. Small doses may need to be measured by a special dropper instead of a teaspoon.
      • Children 4 years of age—4 mg every four to six hours, up to a maximum of 16 mg a day. Children this young will probably take the oral solution, rather than tablets. Small doses may need to be measured by a special dropper instead of a teaspoon.
      • Children 3 years of age—3.5 mg every four to six hours, up to a maximum of 14 mg a day. Children this young will probably take the oral solution, rather than tablets. Small doses may need to be measured by a special dropper instead of a teaspoon.
      • Children 2 years of age—3 mg every four to six hours, up to a maximum of 12 mg a day. Children this young will probably take the oral solution, rather than tablets. Small doses may need to be measured by a special dropper instead of a teaspoon.
      • Children up to 2 years of age—Use is not recommended.
  • For injection dosage form:
    • For pain:
      • Adults—15 to 60 mg (usually 30 mg), injected into a muscle or a vein or under the skin every four to six hours as needed.
      • Children—0.5 mg per kg (0.2 mg per pound) of body weight, injected into a muscle or under the skin every four to six hours as needed.
  • For hydrocodone
  • For oral dosage forms (syrup or tablets):
    • For pain:
      • Adults—5 to 10 milligrams (mg) every four to six hours as needed.
      • Children—0.15 mg per kilogram (kg) (0.06 mg per pound) of body weight every six hours as needed.
    • For cough:
      • Adults—5 mg every four to six hours as needed.
      • Children—Dose must be determined by your doctor.
  • For hydromorphone
  • For short-acting oral dosage forms (oral solution or tablets):
    • For pain:
      • Adults—2 or 2.5 milligrams (mg) every three to six hours as needed.
      • Children—Dose must be determined by your doctor.
  • For long-acting oral dosage form (extended-release capsules):
    • For severe, chronic pain (severe pain that lasts a long time):
      • Adults—Long-acting forms of hydromorphone are usually used for patients who have already been receiving narcotics to relieve pain. The starting dose will depend on the amount of narcotic you have been receiving every day. Your doctor will then adjust the dose according to your individual needs. To be helpful, these medicines need to be taken at regularly scheduled times according to your doctor's instructions. It is important that you take the dose at the time and as often as your doctor tells you.
      • Children—Dose must be determined by your doctor.
  • For injection dosage form:
    • For pain:
      • Adults—1 or 2 mg, injected into a muscle or under the skin every three to six hours as needed. Some people may receive 0.5 mg, injected slowly into a vein every three hours as needed.
      • Children—Dose must be determined by your doctor.
  • For rectal suppository dosage form:
    • For pain:
      • Adults—3 mg every four to eight hours as needed.
      • Children—Dose must be determined by your doctor.
  • For levorphanol
  • For oral dosage form (tablets):
    • For pain:
      • Adults—2 milligrams (mg). Some people with severe pain may need 3 or 4 mg.
      • Children—Dose must be determined by your doctor.
  • For injection dosage form:
    • For pain:
      • Adults—2 mg, injected under the skin or into a vein. Some people may need 3 mg.
      • Children—Dose must be determined by your doctor.
  • For meperidine
  • For oral dosage forms (syrup or tablets):
    • For pain:
      • Adults—50 to 150 milligrams (mg) (usually 100 mg) every three or four hours as needed.
      • Children—1.1 to 1.76 mg per kilogram (kg) (0.44 to 0.8 mg per pound) of body weight, up to a maximum of 100 mg, every three or four hours as needed. Young children will probably take the syrup, rather than tablets. Small doses may need to be measured by a special dropper instead of a teaspoon.
  • For injection dosage form:
    • For pain:
      • Adults—50 to 150 milligrams (mg) (usually 100 mg), injected into a muscle or under the skin every three or four hours as needed. The medicine may also be injected continuously into a vein at a rate of 15 to 35 mg an hour.
      • Children—1.1 to 1.76 mg per kg (0.44 to 0.8 mg per pound) of body weight, up to a maximum of 100 mg, injected into a muscle or under the skin every three or four hours as needed.
  • For methadone
  • For oral dosage form (solution):
    • For pain:
      • Adults—5 to 20 mg every four to eight hours.
      • Children—Dose must be determined by your doctor.
    • For narcotic addiction:
      • Adults 18 years of age or older—
        • For detoxification—At first, 15 to 40 mg once a day. Your doctor will gradually decrease the dose you take every day until you do not need the medicine any more.
        • For maintenance—Dose must be determined by the needs of the individual patient, up to a maximum of 120 mg a day.
      • Children up to 18 years of age—Special conditions must be met before methadone can be used for narcotic addiction in patients younger than 18 years of age. Use and dose must be determined by your doctor.
  • For oral dosage form (tablets):
    • For pain:
      • Adults—2.5 to 10 mg every three or four hours as needed.
      • Children—Dose must be determined by your doctor.
    • For narcotic addiction:
      • Adults 18 years of age or older—
        • For detoxification—At first, 15 to 40 mg once a day. Your doctor will gradually decrease the dose you take every day until you do not need the medicine any more.
        • For maintenance—Dose must be determined by the needs of the individual patient, up to a maximum of 120 mg a day.
      • Children up to 18 years of age—Special conditions must be met before methadone can be used for narcotic addiction in patients younger than 18 years of age. Use and dose must be determined by your doctor.
  • For injection dosage form:
    • For pain:
      • Adults—2.5 to 10 mg, injected into a muscle or under the skin, every three or four hours as needed.
      • Children—Dose must be determined by your doctor.
    • For narcotic addiction:
      • Adults 18 years of age or older—
        • For detoxification only, in patients unable to take medicine by mouth—At first, 15 to 40 mg a day. Your doctor will gradually decrease the dose you receive every day until you do not need the medicine any more.
      • Children younger than 18 years of age—Use and dose must be determined by your doctor.
  • For morphine
  • For short-acting oral dosage forms (capsules, oral solution, syrup, or tablets):
    • For severe, chronic pain (severe pain that lasts a long time):
      • Adults—At first, 10 to 30 milligrams (mg) every four hours. Your doctor will then adjust the dose according to your individual needs. If you have already been taking other narcotics to relieve severe, chronic pain, your starting dose will depend on the amount of other narcotic you were taking every day.
      • Children—Dose must be determined by your doctor.
  • For long-acting oral dosage forms (extended-release capsules or tablets):
    • For severe, chronic pain (severe pain that lasts a long time):
      • Adults—Long-acting forms of morphine are usually used for patients who have already been receiving narcotics to relieve pain. The starting dose will depend on the amount of narcotic you have been receiving every day. Your doctor will then adjust the dose according to your individual needs. To be helpful, these medicines need to be taken at regularly scheduled times according to your doctor's instructions. It is important that you take the dose at the time and as often as your doctor tells you. Some people may need to take a short-acting form of morphine if breakthrough pain occurs between doses of the long-acting medicine.
      • Children—Dose must be determined by your doctor.
  • For once daily long-acting oral dosage forms (extended-release capsules):
    • For severe, chronic pain (severe pain that lasts a long time):
      • Adults—Long-acting forms of morphine are usually used for patients who have already been receiving narcotics to relieve pain. The starting dose will depend on the amount of narcotic you have been receiving every day. Your doctor will then adjust the dose according to your individual needs. To be helpful, these medicines need to be taken once a day at regularly scheduled times according to your doctor's instructions. It is important that you take the dose at the time and as often as your doctor tells you. Some people may need to take a short-acting form of morphine if breakthrough pain occurs between doses of the long-acting medicine.
      • Children—Dose must be determined by your doctor.
  • For injection dosage form:
    • For pain:
      • Adults—5 to 20 mg (usually 10 mg), injected into a muscle or under the skin every four hours as needed. Some people may receive 4 to 10 mg, injected slowly into a vein. Morphine may also be injected continuously into a vein or under the skin at a rate that depends on the needs of the patient. This medicine may also be injected into the spinal area. The dose will depend on where and how the medicine is injected into the spinal area and on the needs of the patient.
      • Children—0.1 to 0.2 mg per kg (0.04 or 0.09 mg per pound) of body weight, up to a maximum of 15 mg, injected under the skin every four hours as needed. Some patients may receive 0.05 to 0.1 mg per kg (0.02 to 0.04 mg per pound) of body weight, injected slowly into a vein.
  • For rectal dosage form (suppositories):
    • For pain:
      • Adults—10 to 30 mg every four to six hours as needed.
      • Children—Dose must be determined by your doctor.
  • For nalbuphine
  • For injection dosage form:
    • For pain:
      • Adults—10 milligrams (mg) every three to six hours as needed, injected into a muscle or a vein or under the skin.
      • Children—Dose must be determined by your doctor.
  • For opium
  • For injection dosage form:
    • For pain:
      • Adults—5 to 20 milligrams (mg), injected into a muscle or under the skin every four to five hours as needed.
      • Children—Dose must be determined by your doctor.
  • For oxycodone
  • For oral dosage forms (oral solution or tablets):
    • For pain:
      • Adults—5–15 milligrams (mg) every 4–6 hours as needed.
      • Children—Dose must be determined by your doctor. Children up to 6 years of age will probably take the oral solution, rather than tablets. Small doses may need to be measured by a special dropper instead of a teaspoon.
  • For long-acting oral dosage form (extended-release tablets):
    • For pain (continuous and lasts a long time):
      • Adults—Your doctor will determine the dose according to your individual needs. To be helpful, these medicines need to be taken two times a day at regularly scheduled times.
      • Children—Use and dose must be determined by your doctor.
  • For rectal dosage form (suppositories):
    • For pain (continuous and lasts a long time):
      • Adults—10 to 40 mg three or four times a day.
      • Children—Dose must be determined by your doctor.
  • For oxymorphone
  • For injection dosage form:
    • For pain:
      • Adults—1 to 1.5 milligrams (mg), injected into a muscle or under the skin every three to six hours as needed. Some patients may receive 0.5 mg, injected into a vein.
      • Children—Dose must be determined by your doctor.
  • For rectal dosage form (suppositories):
    • For pain:
      • Adults—5 mg every four to six hours as needed.
      • Children—Dose must be determined by your doctor.
  • For pentazocine
  • For oral dosage form (tablets):
    • For pain:
      • Adults—50 mg every three to four hours as needed. Some patients may need 100 mg every three to four hours. The usual maximum dose is 600 mg a day.
      • Children—Dose must be determined by your doctor.
  • For injection dosage form:
    • For pain:
      • Adults—30 mg, injected into a muscle or a vein or under the skin every three to four hours as needed.
      • Children—Dose must be determined by your doctor.
  • For propoxyphene
  • For oral dosage forms (capsules, oral suspension, or tablets):
    • For pain:
      • Adults—Propoxyphene comes in two different forms, propoxyphene hydrochloride and propoxyphene napsylate. 100 mg of propoxyphene napsylate provides the same amount of pain relief as 65 mg of propoxyphene hydrochloride. The dose of propoxyphene hydrochloride is 65 milligrams (mg) every four hours as needed, up to a maximum of 390 mg a day. The dose of propoxyphene napsylate is 100 mg every four hours as needed, up to a maximum of 600 mg a day.
      • Children—Dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Store hydromorphone, oxycodone, or oxymorphone suppositories in the refrigerator.

Destroy any medicine that you do not need by flushing it down the toilet.

Precautions While Using This Medicine

If you will be taking this medicine for a long time (for example, for several months at a time), your doctor should check your progress at regular visits

For patients taking a codeine-containing medicine or any other narcotic analgesic:

  • Contact your doctor immediately if you experience extreme sleepiness, confusion, or shallow breathing. These symptoms may indicate that you are an "ultra-rapid metabolizer of codeine". Ultra-rapid metabolizers change codeine to morphine more quickly and completely than other people. As a result, there is too much morphine in the body and more side effects of morphine than usual

For nursing mothers taking a codeine-containing medicine or any other narcotic analgesic:

  • Call your doctor if you become extremely tired and have difficulty caring for your baby.
  • Your baby should generally nurse every two to three hours and should not sleep more than four hours at a time.
  • Check with your doctor or hospital emergency room immediately if your baby shows signs of increased sleepiness (more than usual), difficulty breast-feeding, difficulty breathing, or limpness. These may be symptoms of an overdose and need immediate medical attention .

Narcotic analgesics will add to the effects of alcohol and other central nervous system (CNS) depressants (medicines that slow down the nervous system, possibly causing drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; other prescription pain medicines including other narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. 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.

This medicine may cause some people to become drowsy, dizzy, or lightheaded, or to feel a false sense of well-being. 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, light-headedness, 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 light-headedness, 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.

Narcotic analgesics may cause dryness of the mouth. For temporary relief, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if dry mouth continues for more than 2 weeks, check with your dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

If you have been taking this medicine regularly for several weeks or more, do not suddenly stop using it without first checking with your doctor. Your doctor may want you to reduce gradually the amount you are taking before stopping completely, in order to lessen the chance of withdrawal side effects.

If you think you or someone else may have taken an overdose, 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 include convulsions (seizures), confusion, severe nervousness or restlessness, severe dizziness, severe drowsiness, slow or troubled breathing, and severe weakness.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Get emergency help immediately if any of the following symptoms of overdose occur:

If you are a nursing mother and you notice any of the following symptoms of overdose in your baby, get emergency help immediately:

  • 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)
  • Difficulty breathing
  • difficulty nursing
  • increased sleepiness (more than usual)
  • limpness

Check with your doctor as soon as possible if any of the following side effects occur:

Less common or rare
  • 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)

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Dizziness, light-headedness, or feeling faint
  • drowsiness
  • nausea or vomiting
Less common or rare
  • 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

After you stop using this medicine, your body may need time to adjust. The length of time this takes depends on the amount of medicine you were using and how long you used it. During this period of time check with your doctor if you notice any of the following side effects:

  • Body aches
  • diarrhea
  • fast heartbeat
  • fever, runny nose, or sneezing
  • gooseflesh
  • increased sweating
  • increased yawning
  • loss of appetite
  • nausea or vomiting
  • nervousness, restlessness, or irritability
  • shivering or trembling
  • stomach cramps
  • trouble in sleeping
  • unusually large pupils of eyes
  • weakness

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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