Dezocine (Systemic)


VA CLASSIFICATION
Primary: CN101

Commonly used brand name(s): Dalgan.

Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).

Not commercially available in Canada.



Category:


Analgesic—

Indications

Accepted

Pain (treatment)—Dezocine is indicated for the short-term relief of pain {01}. Dezocine's antagonist activity must be considered prior to administration because it may precipitate withdrawal symptoms if the patient is physically dependent on a mu-receptor opioid analgesic {01}. A patient who has developed a significant degree of tolerance to other opioids during long-term treatment is probably not a suitable candidate for dezocine treatment {01}.

Unaccepted
Dezocine has not been adequately studied, and is not currently recommended, for treatment of chronic pain {01}.


Pharmacology/Pharmacokinetics

Physicochemical characteristics:

Chemical group—
    An opioid agonist/antagonist analgesic of the aminotetralin series {01} {08} {09} {10}.
Molecular weight—
    245.36 {02}
    n–Octanol: Water partition coefficient—1.7 {01}

Mechanism of action/Effect:


Analgesic:

Opioid analgesics bind with stereospecific receptors at many sites within the central nervous system (CNS) to alter processes affecting both the perception of pain and the emotional response to pain. Although precise sites and mechanisms of action have not been fully determined, opioids have been shown to cause alterations in release of various neurotransmitters from afferent nerves sensitive to painful stimuli. {13}

It has been proposed that there are multiple subtypes of opioid receptors, each mediating various therapeutic and/or side effects of opioid drugs. The actions of an opioid analgesic may therefore depend upon its binding affinity for each type of receptor and whether it acts as a full agonist or a partial agonist or is inactive at each type of receptor. At least 2 of these types of receptors (mu and kappa) mediate analgesia. {13} Mu receptors are widely distributed throughout the CNS, especially in the limbic system (frontal cortex, temporal cortex, amygdala, and hippocampus), thalamus, striatum, hypothalamus, and midbrain as well as laminae I, II, IV, and V of the dorsal horn in the spinal cord. Kappa receptors are localized primarily in the spinal cord and in the cerebral cortex. A third type of receptor (sigma) does not mediate analgesia; actions at this receptor may produce the subjective and psychotomimetic effects characteristic of most opioids having mixed agonist/antagonist activity {13}. Dezocine may act primarily as a partial agonist at the mu receptor {03}. Dezocine has relatively low activity (compared with pentazocine) at the sigma receptor {03}, but psychotomimetic-like effects have been reported after administration of high doses {03} {05}.



Antagonist:

Dezocine may displace other mu-receptor opioid agonists from their receptor binding sites and competitively inhibit their actions {13}. It may therefore precipitate withdrawal symptoms in physically dependent patients who are chronically receiving these agonists {01}. If administered first, dezocine may also reduce or block the effects of subsequently administered mu-receptor agonists {03}. The antagonist actions of dezocine may impose a ceiling on its analgesic effects.



Other actions/effects:

Dezocine shares the CNS depressant and respiratory depressant effects of opioid analgesics {01} {03} {05}. The respiratory depressant effect of dezocine is subject to a ceiling effect, with maximal respiratory depression occurring at a total cumulative dose of about 30 mg per kg of body weight (mg/kg) {01} {03} {05}. Respiratory depression induced by dezocine occurs more rapidly {03} {05}, is more pronounced for about the first 1 {03} to 2 {05} hours, and persists for approximately the same time {03} {05} as that induced by equianalgesic doses of morphine.

Dezocine has not been shown to produce clinically significant cardiovascular adverse effects {01} {03} {07}. However, although cardiac or respiratory performance and systolic and diastolic blood pressures were not significantly altered, increases in cardiac index, stroke volume index, left ventricular stroke work index, and pulmonary vascular resistance occurred in one study when a single dose of 125 mcg per kg of body weight was administered intravenously to patients with stable coronary artery disease {07}. Dezocine has not been studied in patients with severe and/or unstable cardiovascular disease {16}.

Because of its antagonist activity, dezocine may have less potential for causing dependence or abuse than strong opioid analgesics having only agonist activity {01} {06}. However, when dezocine was administered to subjects with a history of opioid abuse, they reported typical subjective opioid effects (e.g., liking, euphoria) and identified the medication as ``dope'' {06}. Also, the medication substituted for morphine in abuse-liability testing in animals {01}. Therefore, dezocine has the potential to be abused {01} {06}, especially by individuals with a history of opioid abuse or dependence {01}.

Although studies in humans have not been done, dezocine did not cause histamine release or bronchoconstriction in an animal study {10}.

Although specific studies with dezocine have not been done, the probability exists that the medication, like other opioid analgesics, may decrease gastrointestinal motility. Also, studies have not been done to determine whether dezocine, like most other opioids, has antitussive or antidiuretic activity or increases biliary tract pressure. {17}

Absorption:

Intramuscular—Rapid and complete {01}.

Biotransformation:

Hepatic, via conjugation (glucuronidation) {03} {04}.

Half-life:


Elimination—:

Intramuscular: Average 2.2 hours {04}

Intravenous:

5-mg dose—Average 1.7 {01} to 2.6 {04} hours (range 0.6 to 4.4 hours) {22}

10-mg dose (infused over 5 minutes)—Average 2.4 {01} to 2.6 {04} hours (range 1.2 to 7.4 hours) {01}. In patients with hepatic cirrhosis, the half-life is increased by 30 to 50% {01}, probably due to {03} the 30 to 50% expansion {01} of dezocine's volume of distribution in these patients {01} {03}.

20-mg dose—Average 2.4 {01} to 2.8 {04} hours (range 1.4 {01} to 6.5 {04} hours)


Onset of action:

Intramuscular—Within 30 minutes {01}.

Intravenous—Within 15 minutes {01}.

Time to peak concentration:

Intramuscular—10 to 90 minutes {22}; average about 35 minutes {03} {04}.

Therapeutic plasma concentration

Steady-state—5 to 9 nanograms per mL {01}.

Peak serum concentration

Intramuscular (10-mg single dose)—10 to 38 {01} (average 19) {01} {03} {04} nanograms per mL (0.03 to 0.11 [average 0.55] micromoles per L.

Time to peak effect

Intramuscular—0.6 to 2.5 hours {01} (average 1 to 2 hours) {03}.

Elimination:
    Renal (66% of a dose), about 1% as unchanged dezocine and the remainder as the glucuronide conjugate {05}. The effect of renal function impairment on clearance has not been studied {01}. Also, in healthy subjects, the total body clearance is greater than the sum of hepatic and renal blood flow {03} {04}, suggesting additional mechanisms of excretion {03} {04} (e.g., biliary) {03}.


Total body clearance— {01}
        5-mg intravenous dose: 3.52 (range 2.1–6.2) L per hour per kg of body weight (L/hr/kg).
        10-mg intravenous dose: 3.33 (range 1.7–7.2) L/hr/kg.
        20-mg intravenous dose: 2.76 (range 1.7–4.1) L/hr/kg.



Precautions to Consider

Pregnancy/Reproduction

Pregnancy—
Adequate and well-controlled studies have not been done in pregnant women. Although there is no experience with long-term administration of dezocine to pregnant women, the possibility must be considered that regular use during pregnancy may cause physical dependence in the fetus, leading to withdrawal symptoms (convulsions, irritability, excessive crying, tremors, hyperactive reflexes, fever, vomiting, diarrhea, sneezing, and yawning) in the neonate.

Studies in mice, rats, and rabbits did not show evidence of teratogenicity. However, intramuscular or intravenous administration of dezocine to rats produced a dose-related decrease in food consumption and body weight in the parental generation and a resultant decrease in pup body weight.

FDA Pregnancy Category C {01}.


Labor and delivery—

The safety of dezocine administration during labor has not been established {01}.

Breast-feeding

It is not known whether dezocine is distributed into breast milk {01}. However, problems in humans have not been documented.

Pediatrics

No information is available on the relationship of age to the effects of dezocine in pediatric patients. Safety and efficacy in patients up to 18 years of age have not been established {01}.


Geriatrics


No information is available on the relationship of age to the effects of dezocine in geriatric patients. However, geriatric patients are more susceptible to the effects, especially the respiratory depressant effects, of other opioid analgesics. {13} Also, geriatric patients have been shown to metabolize or eliminate some opioid analgesics more slowly, and/or to be more sensitive to the analgesic effects of opioid analgesics, than younger adults {13}. Therefore, lower doses and/or a longer interval between doses may be sufficient to provide effective analgesia {13} {14}. It is recommended that dezocine therapy in geriatric patients be initiated with lower doses than would be used for younger adults, and that subsequent doses be individualized according to patient tolerance and response {01}.

Drug interactions and/or related problems
The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):


Note: Combinations containing any of the following medications, depending on the amount present, may also interact with this medication.
Other interactions applying to opioid analgesics may apply to dezocine also, although documentation is currently not available.

Antidiarrheals, antiperistaltic, such as:{18}
Difenoxin and atropine
Diphenoxylate and atropine
Kaolin, pectin, belladonna alkaloids and opium
Loperamide
Opium tincture
Paregoric    (repeated administration of both dezocine and any of these antidiarrheals may increase the risk of severe constipation as well as CNS depression)


» CNS depression–producing medications, other (See Appendix II ) or
Monoamine oxidase (MAO) inhibitors, including furazolidone, procarbazine, and selegiline    (concurrent use may increase the CNS depressant, respiratory depressant, and hypotensive effects of these medications and/or dezocine; caution and a reduction in dosage of either or both medications are recommended {01})


Hydroxyzine{18}    (concurrent use with dezocine may result in increased analgesia as well as increased CNS depressant and hypotensive effects)


Naloxone    (antagonizes the analgesic, CNS, and respiratory depressant effects of dezocine; however, because naloxone may precipitate withdrawal symptoms in physically dependent patients, dosage of naloxone should be carefully titrated when used to treat opioid overdosage in dependent patients {13})


» Naltrexone    (although not documented, the possibility must be considered that usual doses of dezocine will be ineffective if administered to a patient receiving naltrexone therapy [because naltrexone blocks the therapeutic effects of other potent opioids] and that administration of increased doses of dezocine to override naltrexone-induced blockade of opioid receptors may increase the risk of adverse effects {13} {14})


» Opioid analgesics, other    (if administered prior to another mu-receptor agonist, dezocine may reduce the therapeutic effects of the other opioid {03})

    (dezocine may precipitate withdrawal symptoms in physically dependent patients who are chronically receiving potent mu-receptor agonists such as morphine {01})



Laboratory value alterations
The following have been selected on the basis of their potential clinical significance (possible effect in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):

With diagnostic test results {19}
Amylase activity, in plasma and
Lipase activity, in plasma    (increases associated with opioid-induced contractions of the sphincter of Oddi and increased biliary tract pressure have been reported with most other opioid analgesics; although these effects have not been reported with dezocine, the possibility should be considered that the diagnostic utility of determinations of these enzymes may be compromised after dezocine administration)


Gastric emptying studies    (opioid analgesics such as dezocine may delay gastric emptying, thereby invalidating test results)


Hepatobiliary imaging, radionuclide    (like most other opioid analgesics, dezocine may prevent or delay delivery of the radionuclide to the small bowel, resulting in delayed visualization and in results resembling obstruction of the common bile duct)

With physiology/laboratory test values {01}
Alkaline phosphatase activity and
Aspartate aminotransferase (AST [SGOT]) activity    (may be increased [incidences <1%])


Cerebrospinal fluid (CSF) pressure    (may be increased; effect is secondary to respiratory depression–induced carbon dioxide retention)


Hemoglobin    (concentrations may be decreased [incidence <1%])


Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).


Except under special circumstances, this medication should not be used when the following medical problem exists:
» Respiratory depression, acute    (may be exacerbated {13})


Risk-benefit should be considered when the following medical problems exist
Abdominal conditions, acute    (diagnosis or clinical course may be obscured {13} {14})


» Asthma, acute attack or
» Respiratory impairment or disease, chronic    (opioid analgesics may decrease respiratory drive and increase airway resistance; a reduction in dosage is recommended {01})


Cardiovascular disease, severe and/or unstable    (although clinically significant cardiovascular adverse effects have not been reported to date with dezocine, the opioid has not been studied in patients with severe and/or unstable cardiovascular disease; caution is recommended if dezocine is to be administered to patients with angina pectoris or compromised cardiac function, following cardiac or cardiovascular surgery, or to relieve pain due to acute myocardial infarction {20})


» Dependence on opioid analgesics, current, confirmed or
Dependence on opioid analgesics, current, suspected    (because of the risk of precipitating withdrawal symptoms, dezocine should be administered only after a suitable period of withdrawal from other opioids {01})


Diarrhea associated with pseudomembranous colitis caused by cephalosporins, lincomycins (possibly including topical clindamycin) or penicillins or
Diarrhea caused by poisoning, until toxic material has been eliminated from the gastrointestinal tract    (possibility should be considered that dezocine, like other opioid analgesics, may slow elimination of toxic material, thereby worsening and/or prolonging the diarrhea {20}, when administered repeatedly {21})


Drug abuse or dependence, history of, including acute alcoholism or
Emotional instability or
Suicidal ideation or attempts    (risk of abuse, especially relapse by patients recovering from a drug dependency; it is recommended that dezocine be administered to patients with such problems only in a medically controlled environment {01})


Gallbladder disease or gallstones    (possibility should be considered that dezocine, like other opioid analgesics, may cause biliary contraction {20})


Gastrointestinal surgery, recent or
Inflammatory bowel disease, severe    (possibility should be considered that dezocine, like other opioid analgesics, may alter gastrointestinal motility; in patients with severe inflammatory bowel disease, an increased risk of toxic megacolon may result {20})


Head injury or
Increased intracranial pressure, pre-existing or
Intracranial lesions    (risk of respiratory depression and further elevation of cerebrospinal fluid pressure may be increased; also, opioid analgesics may cause sedation and pupillary changes that may obscure clinical course of head injury {01})


Hepatic function impairment    (the elimination half-life of dezocine may be prolonged by up to 50% in patients with hepatic cirrhosis {01}, probably because of an increase in the medication's volume of distribution {03}; although any effect of other forms of hepatic function impairment on the pharmacokinetics of dezocine has not been determined, caution and a reduction in dosage are recommended {01})


Hypothyroidism    (risk of respiratory depression and prolonged CNS depression is greatly increased {13} {14})


Prostatic hypertrophy or obstruction or
Urethral stricture or
Urinary tract surgery, recent    (possibility must be considered that dezocine, like other opioid analgesics, may cause urinary retention, which may be detrimental to the patient {20})


Renal function impairment    (although the effect of renal function impairment on the elimination of dezocine has not been determined, caution and a reduction in dose are recommended {01})


Sensitivity to dezocine, history of
Caution is also advised in administration to geriatric or very ill or debilitated patients, who may be more sensitive to the effects, especially the respiratory depressant effects, of opioid analgesics.


Side/Adverse Effects

Note: Side effects are more frequent when the dezocine plasma concentration is 45 nanograms per mL (0.13 micromoles per L) or higher {01}. The highest dose administered to nontolerant healthy adults without toxicity is 30 mg per 70 kg of body weight.
Dezocine appears less likely than pentazocine to cause the subjective and psychotomimetic effects characteristic of sigma-receptor agonists. These effects may include several or all of the following, occurring as a group: confusion, delusions, feelings of depersonalization or unreality, hallucinations (usually visual), dysphoria, nightmares, and nervousness or anxiety. {13} {14} However, psychotomimetic-like effects have been reported with high doses of dezocine {03} {05}.
Dezocine may have less dependence or abuse liability than other potent opioid analgesics (i.e., potent mu-receptor agonists). However, the medication has the potential for abuse, especially by individuals with a history of opioid abuse {01} {06}.

The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Those indicating need for medical attention {01}, unless otherwise referenced
Incidence rare (<1%)
    
Atelectasis{15} (coughing; difficult breathing)
    
chest pain
    
CNS toxicity (delirium; delusions; mental depression)
    
dermatitis (skin rash; itching)
    
difficult, decreased, or frequent urination
    
edema (swelling of face, fingers, lower legs, or feet; weight gain)
    
hypertension
    
hypotension (if severe—dizziness, tiredness)
    
irregular heartbeat
    
respiratory depression (slow, shallow, or difficult breathing)
    
thrombophlebitis



Those indicating need for medical attention only if they continue or are bothersome
Incidence more frequent (3–9%)
    
Drowsiness
    
gastric upset (nausea; vomiting)

Incidence less frequent (1–3%) or rare (<1%)
    
CNS effects (anxiety; blurred or double vision; confusion; crying; dizziness or lightheadedness; slurred speech)
    
flushing or redness of skin
    
gastrointestinal effects (abdominal pain or distress; constipation; diarrhea)



Those indicating possible withdrawal and the need for medical attention if they occur after medication is discontinued {13} {14}
    
Body aches
    
diarrhea
    
fast heartbeat
    
fever, runny nose, or sneezing
    
gooseflesh
    
increased sweating
    
loss of appetite
    
nausea or vomiting
    
nervousness, restlessness, or irritability
    
shivering or trembling
    
stomach cramps
    
trouble in sleeping
    
unusually large pupils of eyes
    
weakness
    
yawning




Overdose
For specific information on the agents used in the management of dezocine overdose, see Naloxone (Systemic) monograph.

For more information on the management of overdose or unintentional ingestion, contact a Poison Control Center (see Poison Control Center Listing ).

Clinical effects of overdose
The following effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:
Acute and chronic {13}
    
Cold, clammy skin
    
confusion, nervousness, or restlessness, severe
    
convulsions
    
dizziness, severe
    
drowsiness, severe
    
low blood pressure
    
pinpoint pupils of eyes
    
slow heartbeat
    
slow or troubled breathing
    
unconsciousness
    
weakness, severe


Treatment of overdose
Although there is no experience with dezocine overdose, recommended treatment of overdose of opioid analgesics consists of the following: {13}

Specific treatment—Use of the opioid antagonist naloxone. See the package insert or Naloxone (Systemic) monograph for specific dosing guidelines for use of this product. The fact that naloxone may also antagonize the analgesic actions of opioid analgesics and may precipitate withdrawal symptoms in physically dependent patients must be kept in mind.

Monitoring—Continue to monitor the patient (mandatory because the duration of action of the opioid analgesic may exceed that of the antagonist) and administer additional naloxone as needed. Alternatively, initial treatment may be followed by continuous intravenous infusion of naloxone, with the rate of infusion being adjusted according to patient response.

Supportive care—May include establishing adequate respiratory exchange through provision of a patent airway and institution of assisted or controlled respiration.

May also include administering intravenous fluids and/or vasopressors and using other supportive measures as needed. Patients in whom intentional overdose is confirmed or suspected should be referred for psychiatric consultation.


Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Dezocine (Systemic).

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Before using this medication
»   Conditions affecting use, especially:
Sensitivity to dezocine, history of





Use in the elderly—Increased risk of respiratory depression or other adverse effects
Other medications, especially other CNS depression–producing medications, other opioids, and naltrexone
Other medical problems, especially asthma or other acute or chronic respiratory problems

Proper use of this medication
Proper administration technique (if dispensed for home use)

» Importance of not taking more medication than the amount prescribed because of danger of overdose and habit-forming potential

» Proper dosing
Missed dose (if on scheduled dosing): Using as soon as possible; not using if almost time for next dose; not doubling doses

» Proper storage

Precautions while using this medication
» Avoiding alcohol or other CNS depressants during therapy

» Caution if dizziness, drowsiness, or lightheadedness occurs

Caution when getting up suddenly from a lying or sitting position

Lying down if nausea, vomiting, dizziness, or lightheadedness occurs

Caution if any kind of surgery (including dental surgery) or emergency treatment is required

» Suspected overdose: Getting emergency help at once


Side/adverse effects
Signs and symptoms of potential side effects, especially atelectasis; chest pain; CNS toxicity; dermatitis; difficult, decreased, or frequent urination; edema; hypertension; hypotension; irregular heartbeat; respiratory depression; and thrombophlebitis


General Dosing Information
In recommended doses, dezocine is equipotent with morphine on a mg-per-mg basis {01} {03}.

Dosage and dosing intervals should be adjusted according to the patient's age, weight, and physical status, as well as the severity of pain, other medications given concurrently {01}, and patient response to initial doses {13} {14}.

Dezocine is administered intravenously or intramuscularly. Subcutaneous administration is not recommended {01}. In animal studies, repeated injection at a single site has caused subcutaneous inflammation, vascular irritation, and venous thrombosis {01}.

Opioid analgesics may depress respiration, especially in geriatric, very ill, or debilitated patients and patients with respiratory problems {13} {14}. It is recommended that dosage of dezocine for these patients be reduced initially, then adjusted as required and tolerated {01}. However, geriatric patients may also be more sensitive to the analgesic effects of opioid analgesics so that lower doses and/or a longer interval between doses may be sufficient to provide effective analgesia {13} {14}.

Concurrent administration of a non-opioid analgesic (such as aspirin or other salicylates, other nonsteroidal anti-inflammatory drugs, or acetaminophen) with an opioid analgesic provides additive analgesia and may permit lower doses of the opioid analgesic to be utilized {13} {14}.

Rapid intravenous injection of other strong opioid analgesics has caused anaphylactoid reactions, severe respiratory depression, hypotension, peripheral circulatory collapse, and cardiac arrest. Although these effects have not been documented with dezocine, precautions applying to other opioid analgesics may apply, i.e., administering the medication slowly, with an opioid antagonist and equipment for artificial ventilation available. {13} {14}

When an opioid analgesic is administered parenterally, the patient usually should be lying down and should remain recumbent for a period of time to minimize side effects such as hypotension, dizziness, lightheadedness, nausea, and vomiting. If these side effects occur in an ambulatory patient, they may be relieved if the patient lies down. {13} {14}

In patients with shock, impaired perfusion may prevent complete absorption following intramuscular injection. Repeated administration may result in overdose due to an excessive amount suddenly being absorbed when circulation is restored. {13} {14}


Parenteral Dosage Forms

DEZOCINE INJECTION

Usual adult dose
Analgesic
Intramuscular, 5 to 20 mg (usually 10 mg, initially). May be repeated every three to six hours as needed. {01}

Intravenous, 2.5 to 10 mg (usually 5 mg, initially). May be repeated every two to four hours as needed {01}.


Note: Lower doses may be required for geriatric, very ill, or debilitated patients and patients with respiratory problems {13} {14}.


Usual adult prescribing limits
Single intramuscular dose—20 mg, although there is some evidence that, because of dezocine's antagonist activity, 15 mg may be the maximally effective dose {01}.

Total daily dose—120 mg {01}.

Usual pediatric and adolescent dose
Patients up to 18 years of age—Safety and efficacy have not been established {01}.

Strength(s) usually available
U.S.—


5 mg per mL (Rx) [Dalgan (sodium metabisulfite)]


10 mg per mL (Rx) [Dalgan (sodium metabisulfite)]


15 mg per mL (Rx) [Dalgan (sodium metabisulfite)]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), protected from light, unless otherwise specified by manufacturer.

Auxiliary labeling:
   • May cause drowsiness.
   • Avoid alcoholic beverages.
   • May be habit-forming.

Note: Although a potent opioid (narcotic) analgesic, dezocine is not a controlled substance in the U.S.




Revised: 08/29/1994



References
  1. Dalgan package insert (Astra—US), New 2/90, Rec 7/90.
  1. Fleeger CA, editor. USAN 1994. USAN and the USP dictionary of drug names. Rockville, MD: The United States Pharmacopeial Convention, Inc., 1993: 205.
  1. O'Brien JJ, Benfield P. Dezocine. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy. Drugs 1989; 38: 226-48.
  1. Locniskar A, Greenblatt DJ, Zinny MA. Pharmacokinetics of dezocine, a new analgesic: effect of dose and route of administration. Eur J Clin Pharmacol 1986; 30: 121-3.
  1. Romagnoli A, Keats AS. Ceiling respiratory depression by dezocine. Clin Pharmacol Ther 1984 Mar; 35: 367-73.
  1. Jasinski DR, Preston KL. Assessment of dezocine for morphine-like subjective effects and miosis. Clin Pharmacol Ther 1985; 38: 544-8.
  1. Rothbard RL, Schreiner BF, Yu PN. Hemodynamic and respiratory effects of dezocine, ciramadol, and morphine. Clin Pharmacol Ther 1985; 38: 84-8.
  1. Stanbaugh JE, McAdams J. Comparison of intramuscular dezocine with butorphanol and placebo in chronic cancer pain: A method to evaluate analgesia after both single and repeated doses. Clin Pharmacol Ther 1987; 42: 210-9.
  1. Pandit SK, Kothary SP, Pandit UA, Kunz NR. Double-blind placebo-controlled comparison of dezocine and morphine for post-operative pain relief. Can Anaesth Soc J 1985; 32: 583-91.
  1. Galloway FM, Varma S. Double-blind comparison of intravenous doses of dezocine, butorphanol, and placebo for relief of postoperative pain. Anesth Analg 1986; 65: 283-7.
  1. Warren MM, Boyce WH, Evans JW, Peters PC. A double-blind comparison of dezocine and morphine in patients with acute renal and ureteral colic. J Urol 1985 Sep; 134: 457-9.
  1. Gal TJ, DiFazio CA. Ventilatory and analgesic effects of dezocine in humans. Anesthesiology 1984 Dec; 61: 716-22.
  1. Reviewers' consensus on Opioid (Narcotic) Analgesics monograph.
  1. Reviewers' consensus on Buprenorphine monograph.
  1. Finkel AJ, editor. CMIT. Current medical information and terminology. 5th ed. Chicago: American Medical Association, 1981: 65.
  1. Reviewers' consensus on monograph revision 11/90.
  1. Reviewers' consensus on monograph revision 11/90.
  1. Reviewers' consensus on monograph revision 11/90.
  1. Reviewers' consensus on monograph revision 11/90.
  1. Reviewers' consensus on monograph revision 11/90.
  1. Panelist coment, 11/90.
  1. Dalgan (Astra), Rev 7/90. In: PDR Physicians' desk reference. 48th ed. 1994. Montvale, NJ: Medical Economics Data Production Company, 1994: 537-9.
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