Pentazocine Hydrochloride

Pronunciation

Class: Opiate Partial Agonists
Note: This monograph also contains information on Pentazocine Lactate
VA Class: CN101
CAS Number: 64024-15-3
Brands: Talacen, Talwin, Talwin Nx

Introduction

Analgesic; synthetic opiate partial agonist.a

Uses for Pentazocine Hydrochloride

Pain

Relief of moderate to severe paina b c such as that associated with acute and chronic medical disorders including cancer, orthopedic problems, renal or biliary colic, and dental surgery.a

Slideshow: Fact or Fiction? The Top 15 Osteoarthritis Myths

Preoperative sedation and analgesia and as an adjunct to surgical anesthesia.a c

Obstetric analgesia during labor.a c

Oral dosage form reformulated to contain small amount of naloxone hydrochloride (opiate antagonist) to potentially eliminate misuse via parenteral injection by opiate addicts and drug abusers.a b Naloxone is inactive when administered orally in the amount (0.5 mg) present in the oral formulation and does not affect the efficacy of pentazocine when administered orally.a b

Pentazocine Hydrochloride Dosage and Administration

General

  • If pentazocine hydrochloride tablets containing small amount of naloxone hydrochloride are ground up and solubilized for parenteral administration, the naloxone will antagonize the effects of pentazocine and will precipitate withdrawal symptoms in drug abusers who are dependent on opiates.a b

Administration

Administer orally or by IV, IM, or sub-Q injection.b c

Oral Administration

Oral administration is preferable to parenteral administration for chronic therapy.a

IV Administration

For drug compatibility information, see Compatibility under Stability.

IM or Sub-Q Administration

Rotation of injection sites is essential.c

Administer sub-Q only when necessary, because of possible severe tissue damage at the injection site.c

Dosage

Available as pentazocine hydrochloride (tablets) and pentazocine lactate (injection); dosage expressed in terms of pentazocine.a c Also available as pentazocine and naloxone hydrochlorides; dosage expressed in terms of the bases.100 101

Adjust dosage according to severity of pain, physical status of the patient, and other drugs that the patient is receiving.a

Pediatric Patients

Pain
Preoperative Sedation
IM

Children 1–16 years of age: 0.5 mg/kg.c

Adults

Pain
Oral

Initially, 50 mg every 3–4 hours.a b Increase dosage to 100 mg when needed (maximum 600 mg daily).a b

IV, IM, or Sub-Q

Initially, 30 mg; may repeat dose every 3–4 hours as necessary.a c

Obstetric Analgesia
IV

20 mg IV when contractions become regular; may repeat dose 2 or 3 times at intervals of 2–3 hours as needed.a c

IM

30 mg IM as a single dose.a c

Prescribing Limits

Adults

Pain
Oral

Maximum 600 mg daily.b

IV

Maximum 30 mg as a single dose; maximum 360 mg daily.c

IM

Maximum 60 mg as a single dose; maximum 360 mg daily.c

Sub-Q

Maximum 60 mg as a single dose; maximum 360 mg daily.c

Special Populations

Hepatic Impairment

Doses and/or frequency of administration may need to be decreased, particularly when administered orally, in patients with hepatic impairment (e.g., cirrhosis).144 145 155

Geriatric Patients

Cautious dosage selection recommended; initiate therapy at the lower end of the usual range.b c

Cautions for Pentazocine Hydrochloride

Contraindications

  • Known hypersensitivity to pentazocine or any ingredient in the formulation.b c d

Warnings/Precautions

Warnings

Abuse Potential

Possible tolerance, psychologic dependence, and physical dependence.100 109 124 125 126 127 128 129 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 186

Prescribe cautiously for patients who are emotionally unstable or have a history of opiate abuse; closely supervise these patients when therapy for more than 4 or 5 days is contemplated.a Avoid unnecessary increases in dosage or frequency of administration; avoid use in anticipation of pain.a

If tablets are ground up and solubilized for parenteral administration, the naloxone will antagonize the effects of pentazocine and can precipitate withdrawal in individuals physically dependent on opiates.100 106 161 However, since naloxone is inactive when administered orally in the amount present in the tablets, the tablets are still subject to misuse and abuse by the oral route.100

Pentazocine has been abused in combination with tripelennamine (no longer commercially available in US) (T’s and blues) via parenteral injection by opiate addicts and drug abusers in an attempt to provide effects similar to those of IV heroin.106 109 110 111 112 113 114 115 116 117 118 119 130 186

Local Effects

Possible ulceration and severe sclerosis of the skin, subcutaneous tissues, and underlying muscle following repeated injection.c Rotation of injection sites is essential.c

Head Injury and Increased Intracranial Pressure

Potential for elevation of CSF pressure as a result of vasodilation following carbon dioxide retention.a c Opiate effects may obscure the existence, extent, or course of intracranial pathology.b c Use in patients with head injury, other intracranial lesions, or preexisting elevation in intracranial pressure only if the potential benefits justify the possible risks.a b c

Patients Dependent on Opiates

Partial opiate antagonist.b c Use with caution in patients who have been chronically receiving opiates (including methadone); pentazocine does not suppress the abstinence syndrome in these patients; high doses may precipitate withdrawal symptoms.b c

Respiratory Effects

Possible respiratory depression (decreased rate and depth of respiration), dyspnea, and laryngospasm.a b

Use with caution and in low doses in patients with impaired respiration caused by other drugs, uremia, or severe infection and in patients with severely limited respiratory reserve, bronchial asthma or other obstructive respiratory conditions, or cyanosis.b c

Pentazocine-induced respiratory depression can be reversed by naloxone.b

WIthdrawal Effects

Abrupt discontinuance after prolonged use may result in withdrawal symptoms (e.g., abdominal cramps, vomiting, increased temperature, sweating, chills, restlessness, anxiety, lethargy, rhinorrhea, sneezing, lacrimation).166 169 172 173 174 175 176 181 182 184 185 Reinstitution of parenteral pentazocine followed by gradual withdrawal of the drug may ameliorate withdrawal symptoms, if necessary.c Manufacturer states that substitution of methadone or other opiates to treat pentazocine abstinence syndrome should be avoided;184 however, opiates occasionally have been used in the management of pentazocine withdrawal;169 172 174 182 183 benzodiazepines also have been used in a limited number of individuals.181

CNS Depression

Performance of activities requiring mental alertness and physical coordination may be impaired.b c

Concurrent use of other CNS depressants may potentiate CNS depression.b c (See Specific Drugs and Laboratory Tests under Interactions.)

Acute CNS Manifestations

Hallucinations (usually visual), disorientation, and confusion have occurred following therapeutic doses but usually have cleared spontaneously within several hours.b c

If such symptoms occur, closely observe the patient and check vital signs.b c Caution if pentazocine is reinstated, since acute CNS reactions may recur.b c

AMI

Possible increased systemic and pulmonary arterial pressure and systemic vascular resistance with IV administration in patients with AMI.c Administer IV with caution in patients with AMI accompanied by hypertension or left ventricular failure.c

Adminster oral pentazocine with caution in patients with AMI accompanied by nausea and vomiting.b

Sensitivity Reactions

Sulfite Sensitivity

Some formulations contain sodium metabisulfite or acetone sodium bisulfite, which may cause allergic-type reactions (including anaphylaxis and life-threatening or less severe asthmatic episodes) in certain susceptible individuals.c

General Precautions

Biliary Tract Surgery

Possible spasm of Oddi’s sphincter; use with caution in patients about to undergo biliary tract surgery.b c

Seizures

Possible occurrence of seizures following administration in seizure-prone patients.b c Use with caution in such patients.b c

Use of Fixed Combinations

When used in fixed combination with acetaminophen, consider the cautions, precautions, and contraindications associated with acetaminophen.d

Specific Populations

Pregnancy

Category C.b

Safe use in pregnant women (except during labor) not established.b c Should not be administered to women who are pregnant unless potential benefits outweigh possible risks to fetus.b c Possible abstinence (withdrawal) syndrome in neonates after prolonged maternal use during pregnancy.100 150 151 152 153 154

Following parenteral administration during labor, alterations (usually increases) in rate and strength of uterine contractions may occur.a

Respiratory depression and transient apnea may occur in neonates when administered during labor and delivery;a use with caution in women delivering premature infants.b c

Lactation

Not known whether pentazocine is distributed into milk; use with caution in nursing women.b

Pediatric Use

Safety and efficacy of oral pentazocine not established in children <12 years of age.a b

Safety and efficacy of parenteral pentazocine for preoperative sedation not established in infants <1 year of age.c

Geriatric Use

Possible increased sensitivity to pentazocine in some geriatric individuals.c

Insufficient experience with pentazocine tablets in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.b

Use with caution due to the greater frequency of decreased hepatic, renal, and/or cardiac function and of concomitant disease and drug therapy observed in the elderly.b c May be useful to monitor renal function.c

Select dosage with caution.b c (See Geriatric Patients under Dosage and Administration.)

Hepatic Impairment

Use with caution.b c Extensive liver disease may predispose to greater incidence or severity of adverse effects than would be expected from usual doses, probably as a result of decreased hepatic metabolism of the drug.b c

Renal Impairment

Use with caution.b c

Common Adverse Effects

Dizziness, lightheadedness, euphoria, sedation, nausea.a

Interactions for Pentazocine Hydrochloride

Specific Drugs and Laboratory Tests

Drug or Test

Interaction

Comments

CNS depressants (e.g., general anesthetics, phenothiazines or other tranquilizers, anxiolytics, sedatives, hypnotics, alcohol)

Possible additive effectsb c

Use with caution to avoid overdosageb c

Fluoxetine

Possible transient symptoms (e.g., diaphoresis, ataxia, flushing, tremor) suggestive of serotonin syndromea

Tests for urinary 17-hydroxycorticosteroids

Possible decrease in urinary 17-hydroxycorticosteroid determinations (Porter-Silber reaction)a

Clinical importance not establisheda

Pentazocine Hydrochloride Pharmacokinetics

Absorption

Bioavailability

Well absorbed from the GI tractb and from IM and sub-Q injection sites.a

Undergoes first-pass metabolism following oral administration, with <20% of an oral dose reaching systemic circulation as unchanged drug.a

Onset

Following oral administration, onset of analgesia occurs within 15–30 minutes; peak analgesia occurs within 1–3 hours.a b

Following IM or sub-Q injection, onset of analgesia occurs within 15–20 minutes; peak analgesia occurs within about 1 hour.a c

Following IV administration, onset of analgesia occurs within 2–3 minutes; peak analgesia occurs within 15 minutes.a c

Duration

Following oral administration, duration of analgesia is ≥3 hours.b

Following IM or sub-Q injection, duration of analgesia is about 2 hours; following IV administration, duration is about 1 hour.a

Special Populations

In patients with hepatic dysfunction, oral bioavailability may be substantially increased; about 60–70% of an oral dose is reportedly absorbed unchanged in individuals with cirrhosis.144 145

Distribution

Extent

Widely distributed in the body.a

Crosses the placenta; neonatal serum concentrations reported to average about 65% of maternal concentrations at delivery.a b

Not known whether pentazocine is distributed into milk.b

Plasma Protein Binding

About 60%.a

Elimination

Metabolism

Metabolized in the liver.b

Elimination Route

Excreted prinicipally in urine.b Less unchanged drug appears to be excreted in urine after oral administration than after IV administration.a

Half-life

2–3 hours.b

Special Populations

In patients with hepatic impairment, clearance may be decreased and elimination half-life prolonged.144 145 155

In geriatric patients, elimination half-life may be prolonged and systemic exposure to pentazocine increased.c

Stability

Storage

Oral

Tablets

25°C (may be exposed to 15–30°C).b

Parenteral

Injection

15–30°C.c

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Drug Compatibility

Admixture CompatibilityHID

Incompatible

Aminophylline

Amobarbital sodium

Pentobarbital sodium

Phenobarbital sodium

Sodium bicarbonate

Y-site CompatibilityHID

Compatible

Heparin sodium

Hydrocortisone sodium succinate

Potassium chloride

Vitamin B complex with C

Incompatible

Nafcillin sodium

Actions

  • Believed to be a competitive antagonist at μ opiate receptors and an agonist at κ and Σ opiate receptors.a

  • Analgesic and respiratory depressant activity apparently results mainly from the l-isomer.a

  • Produces respiratory depression, sedation, miosis, and antitussive effects.a

  • In low doses (15 mg IM), pentazocine inhibits GI motility and slows the rate of gastric emptying; higher doses (30–45 mg) reportedly increase intestinal transit time and produce less elevation of biliary pressure than equianalgesic doses of morphine.a

Advice to Patients

  • Potential for pentazocine to impair mental alertness or physical coordination; do not drive or operate machinery until effects on individual are known.b

  • Importance of taking exactly as prescribed; do not exceed the recommended dosage.b

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and alcohol consumption.b Importance of avoiding alcohol while receiving the drug.b

  • Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.b

  • Importance of advising patients of other important precautionary information.b c (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Subject to control under the Federal Controlled Substances Act of 1970 as schedule IV (C-IV) drugs. May be subject to more stringent control in some states.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Pentazocine and Naloxone Hydrochlorides

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

Pentazocine Hydrochloride 50 mg (of pentazocine) and Naloxone Hydrochloride 0.5 mg (of naloxone)*

Pentazocine and Naloxone Hydrochlorides Tablets ( C-IV)

Amide, Ranbaxy, Watson

Talwin Nx (C-IV; scored)

Sanofi-Synthelabo

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Pentazocine Hydrochloride Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

25 mg (of pentazocine) with Acetaminophen 650 mg*

Pentazocine Hydrochlorides with Acetaminophen Tablets ( C-IV)

Amide, Watson

Talacen Caplets (C-IV; with sodium metabisulfite, scored)

Sanofi-Synthelabo

Pentazocine Lactate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection

30 mg (of pentazocine) per mL

Talwin (C-IV; preservative-free in ampuls or with acetone sodium bisulfite and methylparaben in multiple-dose vials)

Hospira

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Pentazocine-Naloxone HCl 50-0.5MG Tablets (WATSON LABS): 30/$42.99 or 90/$112.97

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions August 1, 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

100. Talwin NX prescribing information. In: Huff BB, ed. Physicians’ desk reference. 39th ed. Oradell, NJ: Medical Economics Company Inc; 1985:2230-2.

101. The United States pharmacopeia, 21st rev, and The national formulary, 16th ed. Suppl 2. Rockville, MD: The United States Pharmacopeial Convention, Inc; 1985:1876-7.

102. Hoppin EC, Greenberg BR, Walter RM. Agranulocytosis secondary to pentazocine therapy. Arch Intern Med. 1978; 138:533-4. [PubMed 637634]

103. Marks A, Abramson N. Pentazocine and agranulocytosis. Ann Intern Med. 1980; 92:433. [IDIS 110089] [PubMed 7356240]

104. Haibach H, Yesus YW, Doggett JJ. Pentazocine-induced agranulocytosis. Can Med Assoc J. 1984; 130:1165-6. [IDIS 185108] [PubMed 6713337]

105. Sheehan M, Hyland RH, Norman C. Pentazocine-induced agranulocytosis. Can Med Assoc J. 1985; 132:1401. [IDIS 201020] [PubMed 4005730]

106. Reinhart S, Barrett SM. An acute hypertensive response after intravenous use of a new pentazocine formulation. Ann Emerg Med. 1985; 14:591-3. [PubMed 3994086]

107. Adams EM, Horowitz HW, Sundstrom WR. Fibrous myopathy in association with pentazocine. Arch Intern Med. 1983; 143:2203-4. [IDIS 177811] [PubMed 6639246]

108. Staritz M, Poralla T, Manns M et al. Pentazocine hampers bile flow. Lancet. 1985; 1:573-4. [IDIS 197341] [PubMed 2857916]

109. Anon. Pentazocine abuse rises—schedule IV status proposed. FDA Drug Bull. 1978; 8:34.

110. Lahmeyer HW, Steingold RG. Pentazocine and tripelennamine: a drug abuse epidemic? Int J Addict. 1980; 15:1219-32.

111. Showalter CV. T’s and blues: abuse of pentazocine and tripelennamine. JAMA. 1980; 224:1224-5.

112. Poklis A. Pentazocine/tripelennamine (T’s and blues) abuse: a five year survey of St. Louis, Missouri. Drug Alcohol Depend. 1982; 10:257-67. [PubMed 7166138]

113. De Bard ML, Jagger JA. T’s and B’s—midwestern heroin substitute. Clin Toxicol. 1981; 18:1117-23. [IDIS 146064] [PubMed 7318393]

114. Itkonen J, Schnoll S, Daghestani A et al. Accelerated development of pulmonary complications due to illicit intravenous use of pentazocine and tripelennamine. Am J Med. 1984; 76:617-22. [IDIS 183883] [PubMed 6711575]

115. Butch AJ, Yokel RA, Sigell LT et al. Abuse and pulmonary complications of injecting pentazocine and tripelennamine tablets. Clin Toxicol. 1979; 14:301-6. [IDIS 101009] [PubMed 455920]

116. Lahmeyer HW, Steingold RG. Medical and psychiatric complications of pentazocine and tripelennamine abuse. J Clin Psychiatry. 1980; 41:275-8. [IDIS 119193] [PubMed 7400105]

117. Caplan LR, Thomas C, Banks G. Central nervous system complications of addiction to T’s and blues. Neurology. 1982; 32:623-8. [IDIS 152457] [PubMed 7201092]

118. Poklis A, Mackell MA. Pentazocine and tripelennamine (T’s and blues) abuse: toxicological findings in 39 cases. J Anal Toxicol. 1982; 6:110-4.

119. Heaney RM, Gotlieb N. Granulocytopenia after intravenous abuse of pentazocine and tripelennamine (“T’s and blues”). South Med J. 1983; 76:654-6. [IDIS 170733] [PubMed 6844971]

120. Burton JF, Zawadzki S, Wetherell HR et al. Mainliners and blue velvet. J Forensic Sci. 1965; 10:466-72. [PubMed 5839798]

121. Zwed JJ. Pulmonary angiothrombosis caused by “blue velvet” addiction. Ann Intern Med. 1970; 73:771-4. [IDIS 17458] [PubMed 5476210]

122. Lerner AM, Oerther FJ. Characteristics and sequelae of paregoric abuse. Ann Intern Med. 1966; 65:1019-30. [PubMed 5923084]

123. Wendt VE, Puro HE, Shapira J et al. Angiothrombotic pulmonary hypertension in addicts. “Blue velvet” addiction. JAMA. 1964; 188:755-7. [PubMed 14122687]

124. Houck RJ, Bailey GL, Daroca PJ Jr et al. Pentazocine abuse: report of a case with pulmonary arterial cellulose granulomas and pulmonary hypertension. Chest. 1980; 77:227-9. [IDIS 111427] [PubMed 7353425]

125. Tomashefski JF Jr, Hirsch CS, Jolly PN. Microcrystalline cellulose pulmonary embolism and granulomatosis: a complication of illicit intravenous injections of pentazocine tablets. Arch Pathol Lab Med. 1981; 105:89-93. [IDIS 132848] [PubMed 6893924]

126. Farber HW, Mathers JAL Jr, Glauser FL. Gallium scans and serum angiotensin converting enzyme levels in talc granulomatosis and lymphocytic interstitial pneumonitis. South Med J. 1980; 73:1663-7. [IDIS 127596] [PubMed 6255609]

127. Farber HW, Falls R, Glauser FL. Transient pulmonary hypertension from the intravenous injection of crushed, suspended pentazocine tablets. Chest. 1981; 80:178-82. [IDIS 136692] [PubMed 7249763]

128. Farber HW, Fairman RP, Glauser FL. Talc granulomatosis: laboratory findings similar to sarcoidosis. Am Rev Respir Dis. 1982; 125:258-61. [IDIS 145259] [PubMed 6278999]

129. Farber H, Glauser FL. The effect of oral hydralazine on the pulmonary hemodynamics of patients with pulmonary foreign body granulomatosis. Chest. 1982; 82:708-12. [IDIS 162619] [PubMed 7140398]

130. Meador KH, Sharon Z, Lewis EJ. Renal amyloidosis and subcutaneous drug abuse. Ann Intern Med. 1979; 91:565-7. [IDIS 104190] [PubMed 484955]

131. Mizutani T, Lewis RA, Gonatas NK. Medial medullary syndrome in a drug abuser. Arch Neurol. 1980; 37:425-8. [PubMed 7387487]

132. AtLee WE Jr. Talc and corn starch emboli in eyes of drug abusers. JAMA. 1972; 219:49-51. [IDIS 22548] [PubMed 5066587]

133. Kresca LJ, Goldberg MF, Jampol LM. Talc emboli and retinal neovascularization in a drug abuser. Am J Ophthalmol. 1979; 87:334-9. [IDIS 106530] [PubMed 434093]

134. Friberg TR, Gragoudas ES, Regan CDJ. Talc emboli and macular ischemia in intravenous drug abuse. Arch Ophthalmol. 1979; 97:1089-91. [IDIS 98357] [PubMed 444139]

135. Schatz H, Drake M. Self-injected retinal emboli. Ophthalmology. 1979; 86:468-83. [PubMed 530595]

136. Shook JE, Kallman MJ, Martin BR et al. Characterization of the interaction of pentazocine and tripelennamine: drug discrimination and mu-receptor binding assay. Pharmacol Biochem Behav. 1984; 21:877-81. [PubMed 6097919]

137. Shannon HE, Su TP. Effects of the combination of tripelennamine and pentazocine at the behavioral and molecular levels. Pharmacol Biochem Behav. 1982; 17:789-95. [PubMed 6294681]

138. Su TP. Possible explanations of “T’s and Blues” interaction: tripelennamine and pentazocine are potent ligands for psychotomimetic sigma-opioid receptor. Fed Proc. 1983; 42:1017.

139. Tagashira E, Kachur JF, Carter WH Jr et al. Pentazocine-tripelennamine (“T’s and Blues”) substitution studies in morphine-dependent rodents. J Pharmacol Exp Ther. 1984; 231:97-101. [PubMed 6541694]

140. Bhargava HN. Mechanism of toxicity and rationale for use of the combination of pentazocine and Pyribenzamine in morphine-dependent subjects. Clin Toxicol. 1981; 18:175-88. [PubMed 7194759]

141. Waller DP, Katz NL, Morris RW. Potentiation of lethality in mice by combinations of pentazocine and tripelennamine. Clin Toxicol. 1980; 16:17-23. [PubMed 7389279]

142. Martin WR. Pharmacology of opioids. Pharmacol Rev. 1983; 35:283-323. [IDIS 182771] [PubMed 6144112]

143. Oh SJ, Rollins JL, Lewis I. Pentazocine-induced fibrous myopathy. JAMA. 1975; 231:271-3. [IDIS 49148] [PubMed 1172732]

144. Pond SM, Tong T, Benowitz NL et al. Enhanced bioavailability of pethidine and pentazocine in patients with cirrhosis of the liver. Aust N Z J Med. 1980; 10:515-9. [PubMed 6937164]

145. Neal EA, Meffin PJ, Gregory PB et al. Enhanced bioavailability and decreased clearance of analgesics in patients with cirrhosis. Gastroenterology. 1979; 77:96-102. [PubMed 447033]

146. Padilla RS, Becker LE, Hoffman H et al. Cutaneous and venous complications of pentazocine abuse. Arch Dermatol. 1979; 115:975-7. [IDIS 100107] [PubMed 464626]

147. Dunn DW, Reynolds J. Neonatal withdrawal symptoms associated with “T’s and blues” (pentazocine and tripelennamine). Am J Dis Child. 1982; 136:644-5. [IDIS 153354] [PubMed 7091098]

148. Chasnoff IJ, Hatcher R, Burns WJ et al. Pentazocine and tripelennamine (T’s and blues): effects on the fetus and neonate. Dev Pharmacol Ther. 1983; 6:162-9. [PubMed 6861602]

149. American Academy of Pediatrics Committee on Drugs. Neonatal drug withdrawal. Pediatrics. 1983; 72:895-902. [IDIS 179457] [PubMed 6139783]

150. Scanlon JW. Pentazocine and neonatal narcotic withdrawal. J Pediatr. 1974; 85:735-6. [PubMed 4213858]

151. Reeds TO. Withdrawal symptoms in a neonate associated with maternal pentazocine abuse. J Pediatr. 1975; 87:324. [IDIS 58168] [PubMed 1151571]

152. Goetz RL, Bain RV. Neonatal withdrawal symptoms associated with maternal use of pentazocine. J Pediatr. 1974; 84:887-8. [PubMed 4275009]

153. Preis O, Choi S, Rudolph N. Pentazocine withdrawal syndrome in the newborn infant. Am J Obstet Gynecol. 1977; 127:205-6. [PubMed 831505]

154. Kopelman AE. Fetal addiction to pentazocine. Pediatrics. 1975; 55:888-9. [PubMed 1134890]

155. Williams RL. Drug administration in hepatic disease. N Engl J Med. 1983; 309:1616-22. [IDIS 179500] [PubMed 6358891]

156. Shannon HE, Su TP. Effects of the combination of tripelennamine and pentazocine at the behavioral and molecular levels. Pharmacol Biochem Behav. 1982; 17:789-95. [PubMed 6294681]

157. Su TP. Possible explanations of “T’s and blues” interaction: tripelennamine and pentazocine are potent ligands for psychotomimetic sigma-opioid receptor. Fed Proc. 1983; 42:1017.

158. Tagashira E, Kachur JF, Carter WH Jr et al. Pentazocine-tripelennamine (“T’s and Blues”) substitution studies in morphine-dependent rodents. J Pharmacol Exp Ther. 1984; 231:97-101. [PubMed 6541694]

159. Bhargava HN. Mechanism of toxicity and rationale for use of the combination of pentazocine and Pyribenzamine in morphine-dependent subjects. Clin Toxicol. 1981; 18:175-88. [PubMed 7194759]

160. Waller DP, Katz NL, Morris RW. Potentiation of lethality in mice by combinations of pentazocine and tripelennamine. Clin Toxicol. 1980; 16:17-23. [PubMed 7389279]

161. C.dtdon C. Talwin 50 reformulated to avert “T’s and blues” abuse. JAMA. 1983; 249:1689.

162. Shekar R, Rice TW, Zierdt CH et al. Outbreak of endocarditis caused by Pseudomonas aeruginosa serotype 011 among pentazocine and tripelennamine abusers in Chicago. J Infect Dis. 1985; 151:203-8. [IDIS 196111] [PubMed 3918121]

163. Botsford KB, Weinstein RA, Nathan CR et al. Selective survival in pentazocine and tripelennamine of Pseudomonas aeruginosa serotype 011 from drug addicts. J Infect Dis. 1985; 151:209-16. [IDIS 196112] [PubMed 3918122]

164. Snyder SH. Drug and neurotransmitter receptors in the brain. Science. 1984; 224:22-31. [PubMed 6322304]

165. Nicol CG. Abuse of pentazocine. Br Med J. 1978; 2:357-8. [IDIS 88360] [PubMed 687923]

166. Waldmann E, Horsfall PAL. Pentazocine addiction: a warning. Br Med J. 1977; 1:642.

167. Kirts TE. Pentazocine abuse. JAMA. 1973; 224:1532. [IDIS 35603] [PubMed 4739966]

168. Halliday WR. Abuse of pentazocine. JAMA. 1973; 223:801. [IDIS 32629] [PubMed 4265252]

169. Schoolar JC, Idanpaan-Heikkila P, Keats AS. Pentazocine addiction? Lancet. 1969; 1:1263. Letter. (IDIS 10705)

170. Finkelstein IS. Pentazocine abuse. JAMA. 1973; 224:249. [IDIS 31253] [PubMed 4739509]

171. Kubicki S. Abuse of pentazocine. Br Med J. 1978; 2:955-6. [IDIS 88432] [PubMed 709150]

172. Raskin NN. Methadone for the pentazocine-dependent patient. N Engl J Med. 1970; 283:1349. [IDIS 15385] [PubMed 5478464]

173. Weber WF, Frome HP. Addiction to pentazocine: report of two cases. JAMA. 1970; 212:1708. [IDIS 13750] [PubMed 5467857]

174. Sandoval RG, Wang RIH. Tolerance and dependence on pentazocine. N Engl J Med. 1969; 280:1391-2. [IDIS 8148] [PubMed 5771364]

175. American Medical Association Council on Drugs. The misuse of pentazocine: its dependence-producing potential. JAMA. 1969; 209:1518-9. [IDIS 9271] [PubMed 5820108]

176. Hart RH. Pentazocine addiction. Lancet. 1969; 2:690. [IDIS 11406] [PubMed 4185426]

177. Hunter R, Ingram IM. Intravenous pentazocine abuse by a nurse. Lancet. 1983; 2:227. [IDIS 173753] [PubMed 6135066]

178. Bailey WJ. Nonmedical use of pentazocine. JAMA. 1979; 242:2392. [IDIS 108051] [PubMed 490845]

179. Ungerleider JT, Lundberg GD, Sunshine I et al. The drug abuse warning network (DAWN) program. Arch Gen Psychiatry. 1980; 37:106-9. [IDIS 109106] [PubMed 7352834]

180. Sandoval RG, Wang RIH. Characteristics of pentazocine dependence in hospitalized patients after naloxone administration. Psychopharmacologia. 1973; 30:205-15. [PubMed 4577443]

181. Swanson DW, Weddige RL, Morse RM. Hospitalized pentazocine abusers. Mayo Clin Proc. 1973; 48:85-93. [IDIS 33277] [PubMed 4689658]

182. Parwatikar S, Gomez H, Knowles RR. Pentazocine dependency. Int J Addict. 1973; 8:87-98. [IDIS 32857] [PubMed 4713708]

183. Fleiss D. Pentazocine-induced fibrous myopathy. JAMA. 1975; 232:1126. [IDIS 51833] [PubMed 1173609]

184. Talwin injection prescribing information. In: Huff BB, ed. Physicians’ desk reference. 39th ed. Oradell, NJ: Medical Economics Company Inc; 1985:2228-9.

185. Jaffe JH, Martin WR. Opioid analgesics and antagonists. In: Gilman AG, Goodman LS, Rall TW et al, eds. Goodman and Gilman’s the pharmacological basis of therapeutics. 7th ed. New York: The Macmillan Company; 1985:491-531.

186. Pentazocine. In: WHO Expert Committee on Drug Dependence. 25th report. Technical report series 775. Geneva: World Health Organization: 1989:32-6.

a. AHFS Drug Information 2004. McEvoy GK, ed. Pentazocine Hydrochloride. Bethesda, MD: American Society of Health-System Pharmacists; 2004.

b. Sanofi-Synthelabous. Talwin Nx (pentazocine and naloxone hydrochlorides) prescribing information. New York, NY; 2003 May.

c. Abbott Laboratories. Talwin (pentazocine lactate) injection prescribing information. North Chicago, IL; 2001 Jan.

d. Sanofi-Synthelabous. Talacen (pentazocine hydrochloride and acetaminophen) prescribing information. New York, NY; 2003 May.

HID. Trissel LA. Handbook on injectable drugs. 14th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2007:1316-9.

Hide
(web2)