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Butorphanol Disease Interactions

There are 16 disease interactions with butorphanol:

Major

Narcotic Analgesics (Includes Butorphanol) ↔ Impaired Gi Motility

Severe Potential Hazard, Moderate plausibility

Applies to: Constipation, Gastrointestinal Obstruction, Inflammatory Bowel Disease, Intestinal Anastomoses

Narcotic (opioid) analgesic agents increase smooth muscle tone in the gastrointestinal tract and decrease peristalsis, which can lead to elevated intraluminal pressure, spasm, and constipation following prolonged use. In patients with severe or acute inflammatory bowel disease, the decrease in colonic motility may induce toxic megacolon. Therapy with opioids should be administered cautiously in patients with gastrointestinal obstruction, constipation, inflammatory bowel disease, or recent gastrointestinal tract surgery. Gastrointestinal effects appear to be the most pronounced with morphine.

References

  1. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  3. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  4. White MJ, Berghausen EJ, Dumont SW, Tsueda K, Schroeder JA, Vogel RL, Heine MF, Huang KC "Side effects during continuous epidural infusion of morphine and fentanyl." Can J Anaesth 39 (1992): 576-82
  5. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  6. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  8. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  9. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  10. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  11. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  12. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  13. Bellville JW, Forrest WH, Elashoff J, Laska E "Evaluating side effects of analgesics in a cooperative clinical study." Clin Pharmacol Ther 9 (1968): 303-13
  14. Thorn SE, Wattwil M, Kallander A "Effects of epidural morphine and epidural bupivacaine on gastroduodenal motility during the fasted state and after food intake." Acta Anaesthesiol Scand 38 (1994): 57-62
  15. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  16. Bennett MWR, Shah MV, Bembridge JL "A comparison of the effect on gastric emptying of alfentanil or morphine given during anaesthesia for minor surgery." Anaesthesia 49 (1994): 155-6
  17. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  18. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  19. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  20. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  21. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  22. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  23. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  24. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  25. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  26. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
View all 26 references
Major

Narcotic Analgesics (Includes Butorphanol) ↔ Infectious Diarrhea

Severe Potential Hazard, Moderate plausibility

Applies to: Infectious Diarrhea/Enterocolitis/Gastroenteritis

Narcotic (opioid) analgesic agents may prolong and/or worsen diarrhea associated with organisms that invade the intestinal mucosa, such as toxigenic E. coli, Salmonella, Shigella, and pseudomembranous colitis due to broad-spectrum antibiotics. These agents decrease gastrointestinal motility, which may delay the excretion of infective gastroenteric organisms and/or their toxins. Other symptoms and complications such as fever, shedding of organisms and extraintestinal illness may also be increased or prolonged. Therapy with opioids should be avoided or administered cautiously in patients with infectious diarrhea, particularly that due to pseudomembranous enterocolitis or enterotoxin-producing bacteria or if accompanied by high fever, pus, or blood in the stool.

References

  1. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  2. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  3. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  4. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  5. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  6. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  8. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  9. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  10. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  12. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  13. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  14. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  15. White MJ, Berghausen EJ, Dumont SW, Tsueda K, Schroeder JA, Vogel RL, Heine MF, Huang KC "Side effects during continuous epidural infusion of morphine and fentanyl." Can J Anaesth 39 (1992): 576-82
  16. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  17. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  18. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  19. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  20. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  21. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  22. Bennett MWR, Shah MV, Bembridge JL "A comparison of the effect on gastric emptying of alfentanil or morphine given during anaesthesia for minor surgery." Anaesthesia 49 (1994): 155-6
  23. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  24. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  25. Thorn SE, Wattwil M, Kallander A "Effects of epidural morphine and epidural bupivacaine on gastroduodenal motility during the fasted state and after food intake." Acta Anaesthesiol Scand 38 (1994): 57-62
  26. Bellville JW, Forrest WH, Elashoff J, Laska E "Evaluating side effects of analgesics in a cooperative clinical study." Clin Pharmacol Ther 9 (1968): 303-13
View all 26 references
Major

Narcotic Analgesics (Includes Butorphanol) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Narcotic (opioid) analgesic agents are extensively metabolized by the liver, and several of them (e.g., codeine, hydrocodone, meperidine, methadone, morphine, propoxyphene) have active metabolites that are further converted to inactive substances. The serum concentrations of these agents and their metabolites may be increased and the half-lives prolonged in patients with impaired hepatic function. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with liver disease. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

References

  1. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  2. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  3. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  4. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  5. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  6. Yue QY, Hasselstrom J, Svensson JO, Sawe J "Pharmacokinetics of codeine and its metabolites in Caucasian healthy volunteers: comparisons between extensive and poor hydroxylators of debrisoquine." Br J Clin Pharmacol 31 (1991): 635-42
  7. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  8. McClain DA, Hug CC, Jr "Intravenous fentanyl kinetics." Clin Pharmacol Ther 28 (1980): 106-14
  9. Yun CH, Wood M, Wood AJ, Guengerich FP "Identification of the pharmacogenetic determinants of alfentanil metabolism: cytochrome P-450 3A4: an explanation of the variable elimination clearance." Anesthesiology 77 (1992): 467-74
  10. Flanagan RJ, Johnston A, White AS, Crome P "Pharmacokinetics of dextropropoxyphene and nordextropropoxyphene in young and elderly volunteers after single and multiple dextropropoxyphene dosage." Br J Clin Pharmacol 28 (1989): 463-9
  11. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  12. Haberer JP, Schoeffler P, Couderc E, Duvaldestin P "Fentanyl pharmacokinetics in anaesthetized patients with cirrhosis." Br J Anaesth 54 (1982): 1267-70
  13. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  14. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  15. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  16. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  17. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  18. Cone EJ, Darwin WD, Gorodetzky CW, Tan T "Comparative metabolism of hydrocodone in man, rat, guinea pig, rabbit, and dog." Drug Metab Dispos 6 (1978): 488-93
  19. Dershwitz M, Hoke JF, Rosow CE, Michalowski P, Connors PM, Muir KT, Dienstag JL "Pharmacokinetics and pharmacodynamics of remifentanil in volunteer subjects with severe liver disease." Anesthesiology 84 (1996): 812-20
  20. Glare PA, Walsh TD "Clinical pharmacokinetics of morphine." Ther Drug Monit 13 (1991): 1-23
  21. Westmoreland CL, Hoke JF, Sebel PS, Hug CC Jr, Muir KT "Pharmacokinetics of remifentanil (GI87084B) and its major metabolite (GI90291) in patients undergoing elective inpatient surgery." Anesthesiology 79 (1993): 893-903
  22. Osborne R, Joel S, Trew D, Slevin M "Morphine and metabolite behavior after different routes of morphine administration: demonstration of the importance of the active metabolite morphine-6-glucoronide." Clin Pharmacol Ther 47 (1990): 12-9
  23. Dershwitz M, Randel GI, Rosow CE, Fragen RJ, Connors PM, Librojo ES, Shaw DL, Peng AW, Jamerson BD "Initial clinical experience with remifentanil, a new opioid metabolized by esterases." Anesth Analg 81 (1995): 619-23
  24. Leow KP, Smith MT, Williams B, Cramond T "Single-dose and steady-state pharmacokinetics and pharmacodynamics of oxycodone in patients with cancer." Clin Pharmacol Ther 52 (1992): 487-95
  25. Otton SV, Schadel M, Cheung SW, Kaplan HL, Busto UE, Sellers EM "CYP2D6 phenotype determines the metabolic conversion of hydrocodone to hydromorphone." Clin Pharmacol Ther 54 (1993): 463-72
  26. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  27. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  28. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  29. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  30. Beckett AH, Taylor JF, Casy AF, Hassan MM "The biotransformation of methadone in man: synthesis and identification of a major metabolite." J Pharm Pharmacol 20 (1968): 754-62
  31. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  32. Hasselstrom J, Sawe J "Morphine pharmacokinetics and metabolism in humans. Enterohepatic cycling and relative contribution of metabolites to active opioid concentrations." Clin Pharmacokinet 24 (1993): 344-54
  33. Gram LF, Schou J, Way WL, et al "delta-Propoxyphene kinetics after single oral and intravenous doses in man." Clin Pharmacol Ther 26 (1979): 473-82
  34. Poyhia R, Seppala T, Olkkola KT, Kalso E "The pharmacokinetics and metabolism of oxycodone after intramuscular and oral administration to healthy subjects." Br J Clin Pharmacol 33 (1992): 617-21
  35. Hasselstrom J, Eriksson S, Persson A, Rane A, Svensson JO, Sawe J "The metabolism and bioavailability of morphine in patients with severe liver cirrhosis." Br J Clin Pharmacol 29 (1990): 289-97
  36. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  37. McHorse TS, Klotz U, Wilkinson G, Schenker S "Impaired elimination of meperidine in patients with liver disease." Trans Assoc Am Physicians 87 (1974): 281-7
  38. Neal EA, Meffin PJ, Gregory PB, Blaschke TF "Enhanced bioavailability and decreased clearance of analgesics in patients with cirrhosis." Gastroenterology 77 (1979): 96-102
  39. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  40. Mazoit J-X, Sandouk P, Zetlaoui P, Scherrmann J-M "Pharmacokinetics of unchanged morphine in normal and cirrhotic subjects." Anesth Analg 66 (1987): 293-8
  41. Goromaru T, Matsuura H, Yoshimura N, Miyawaki T, Sameshima T, Miyao J, Furuta T, Baba S "Identification and quantitative determination of fentanyl metabolites in patients by gas chromatography--mass spectrometry." Anesthesiology 61 (1984): 73-7
  42. Giacomini KM, Giacomini JC, Gibson TP, Levy G "Propoxyphene and norpropoxyphene plasma concentrations after oral propoxyphene in cirrhotic patients with and without surgically constructed portacaval shunt." Clin Pharmacol Ther 28 (1980): 417-24
  43. Pond SM, Tong T, Benowitz NL, et al "Presystemic metabolism of meperidine to normeperidine in normal and cirrhotic subjects." Clin Pharmacol Ther 30 (1981): 183-8
  44. Novick DM, Kreek MJ, Arns PA, et al "Effect of severe alcoholic liver disease on the disposition of methadone in maintenance patients." Alcohol Clin Exp Res 9 (1985): 349
  45. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  46. Cone EJ, Darwin WD, Gorodetzky CW "Comparative metabolism of codeine in man, rat, dog, guinea-pig and rabbit: identification of four new metabolites." J Pharm Pharmacol 31 (1979): 314-7
  47. Dixon R, Crews T, Inturrisi C, Foley K "Levorphanol: pharmacokinetics and steady-state plasma concentrations in patients with pain." Res Commun Chem Pathol Pharmacol 41 (1983): 3-17
  48. Chen ZR, Somogy AA, Reynolds G, Bochner F "Disposition and metabolism of codeine after single and chronic doses in one poor and seven extensive metabolisers." Br J Clin Pharmacol 31 (1991): 381-90
  49. Beckett AH, Vaughan DP, Essien EE "N-Oxidation--an important route in the metabolism of methadone in man." J Pharm Pharmacol 24 (1972): 244
  50. Hagen N, Thirlwell MP, Dhaliwal HS, Babul N, Harsanyi Z, Darke AC "Steady-state pharmacokinetics of hydromorphone and hydromorphone-3-glucuronide in cancer patients after immediate and controlled-release hydromorphone." J Clin Pharmacol 35 (1995): 37-44
  51. Kreek MJ, Fanizza AM, et al "Methadone disposition in patients with chronic liver disease." Clin Pharmacol Ther 30 (1981): 353-62
  52. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  53. Parab PV, Ritschel WA, Coyle DE, et al "Pharmacokinetics of hydromorphone after intravenous, peroral and rectal administration to human subjects." Biopharm Drug Dispos 9 (1988): 187-99
  54. Leow KP, Smith MT, Watt JA, Williams BE, Cramond T "Comparative oxycodone pharmacokinetics in humans after intravenous, oral, and rectal administration." Ther Drug Monit 14 (1992): 479-84
  55. Hill HF, Coda BA, Tanaka A, Schaffer R "Multiple-dose evaluation of intravenous hydromorphone pharmacokinetics in normal human subjects." Anesth Analg 72 (1991): 330-6
  56. Bower S, Sear JW, Roy RC, Carter RF "Effects of different hepatic pathologies on disposition of alfentanil in anaesthetized patients." Br J Anaesth 68 (1992): 462-5
  57. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  58. Poyhia R, Olkkola KT, Seppala T, Kalso E "The pharmacokinetics of oxycodone after intravenous injection in adults." Br J Clin Pharmacol 32 (1991): 516-8
View all 58 references
Major

Narcotic Analgesics (Includes Butorphanol) ↔ Prematurity

Severe Potential Hazard, High plausibility

Applies to: Prematurity/Underweight in Infancy

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

References

  1. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  2. "Multum Information Services, Inc. Expert Review Panel"
Major

Narcotic Analgesics (Includes Butorphanol) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Although narcotic (opioid) analgesic agents are generally metabolized by the liver, renal impairment can alter the elimination of these agents and their metabolites (some of which are pharmacologically active), resulting in drug accumulation and increased risk of toxicity. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with significantly impaired renal function. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

References

  1. Hanna MH, D'Costa F, Peat SJ, Fung C, Venkat N, Zilkha TR, Davies S "Morphine-6-glucuronide disposition in renal impairment." Br J Anaesth 70 (1993): 511-4
  2. Wolff J, Bigler D, Christensen CB, et al "Influence of renal function on the elimination of morphine and morphine glucoronides." Eur J Clin Pharmacol 34 (1988): 353-7
  3. Aitkenhead AR, Vater M, Achola K, Cooper CM, Smith G "Pharmacokinetics of single-dose i.v. morphine in normal volunteers and patients with end-stage renal failure." Br J Anaesth 56 (1984): 813-9
  4. Charuvastra VC, Ouren J "Renal failure and treatment of a methadone maintenance patient." Med J Aust 09/24/77 (1977): 433-4
  5. Chan K, Jennings F, Orme ML "Pharmacokinetics of low-dose intravenous pethidine in patients with renal dysfunction." J Clin Pharmacol 27 (1987): 516-22
  6. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  7. Leow KP, Smith MT, Williams B, Cramond T "Single-dose and steady-state pharmacokinetics and pharmacodynamics of oxycodone in patients with cancer." Clin Pharmacol Ther 52 (1992): 487-95
  8. Bechtel WD, Sinterhauf K "Plasma level and renal excretion of [3H] codeine phosphate in man and in the dog." Arzneimittelforschung 28 (1978): 308-11
  9. Poyhia R, Olkkola KT, Seppala T, Kalso E "The pharmacokinetics of oxycodone after intravenous injection in adults." Br J Clin Pharmacol 32 (1991): 516-8
  10. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  11. Guy DR, Awni WM, Findlay JW, et al "Pharmacokinetics and pharmacodynamics of codeine in end-stage renal disease." Clin Pharmacol Ther 43 (1988): 63-71
  12. Kreek MJ, Schecter AJ, Gutjahr CL, et al "Methadone use in patients with chronic renal failure." Drug Alcohol Depend 5 (1980): 197-205
  13. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  14. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  15. Glare PA, Walsh TD "Clinical pharmacokinetics of morphine." Ther Drug Monit 13 (1991): 1-23
  16. Matske GR, Chan GL, Abraham PA "Codeine dosage in renal failure." Clin Pharm 5 (1986): 15-6
  17. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  18. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  19. Barnes JN, Williams AJ, Tomson MJ, et al "Dihydrocodeine in renal failure: further evidence for an important role of the kidney in the handling of opioid drugs." Br Med J (Clin Res Ed) 290 (1985): 740-2
  20. Drayer DE "Pharmacologically active drug metabolites: therapeutic and toxic activities, plasma and urine data in man, accumulation in renal failure." Clin Pharmacokinet 1 (1976): 426-43
  21. Findlay JW, Butz RF, Welch RM "Codeine kinetics as determined by radioimmunoassay." Clin Pharmacol Ther 22 (1977): 439-46
  22. Drayer DE "Active drug metabolites and renal failure." Am J Med 62 (1977): 486-9
  23. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  24. Hill HF, Coda BA, Tanaka A, Schaffer R "Multiple-dose evaluation of intravenous hydromorphone pharmacokinetics in normal human subjects." Anesth Analg 72 (1991): 330-6
  25. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  26. Giacomini KM, Gibson TP, Levy G "Plasma protein binding of d-propoxyphene in normal subjects and anephric patients." J Clin Pharmacol 18 (1978): 106-9
  27. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  28. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  29. Gram LF, Schou J, Way WL, et al "delta-Propoxyphene kinetics after single oral and intravenous doses in man." Clin Pharmacol Ther 26 (1979): 473-82
  30. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  31. Gibson TP, Giacomini KM, Briggs WA, Whitman W, Levy G "Propoxyphene and norpropoxyphene plasma concentrations in the anephric patient." Clin Pharmacol Ther 27 (1980): 665-70
  32. Sjogren P, Dragsted L, Christensen CB "Myoclonic spasms during treatment with high doses of intravenous morphine in renal failure." Acta Anaesthesiol Scand 37 (1993): 780-2
  33. Verbeeck RK, Branch RA, Wilkinson GR "Drug metabolites in renal failure: pharmacokinetic and clinical implications." Clin Pharmacokinet 6 (1981): 329-45
  34. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  35. Inturrisi CE "Disposition of narcotics in patients with renal disease." Am J Med 62 (1977): 528-9
  36. Sawe J, Odar-Cederlof I "Kinetics of morphine in patients with renal failure." Eur J Clin Pharmacol 32 (1987): 377-82
  37. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  38. Baselt RC, Casarett LJ "Urinary excretion of methadone in man." Clin Pharmacol Ther 13 (1972): 64-70
  39. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  40. Chauvin M, Sandouk P, Scherrmann JM, Farinotti R, Strumza P, Duvaldestin P "Morphine pharmacokinetics in renal failure." Anesthesiology 66 (1987): 327-31
  41. Parab PV, Ritschel WA, Coyle DE, et al "Pharmacokinetics of hydromorphone after intravenous, peroral and rectal administration to human subjects." Biopharm Drug Dispos 9 (1988): 187-99
  42. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  43. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  44. Covington EC, Gonsalves-Ebrahim L, Currie KO, et al "Severe respiratory depression from patient-controlled analgesia in renal failure." Psychosomatics 30 (1989): 226-8
  45. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  46. Leow KP, Smith MT, Watt JA, Williams BE, Cramond T "Comparative oxycodone pharmacokinetics in humans after intravenous, oral, and rectal administration." Ther Drug Monit 14 (1992): 479-84
  47. Wolfert AI, Sica DA "Narcotic usage in renal failure." Int J Artif Organs 11 (1988): 411-5
  48. Dhonneur G, Gilton A, Sandouk P, Scherrmann JM, Duvaldestin P "Plasma and cerebrospinal fluid concentrations of morphine and morphine glucuronides after oral morphine - the influence of renal failure." Anesthesiology 81 (1994): 87-93
  49. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  50. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  51. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  52. Poyhia R, Seppala T, Olkkola KT, Kalso E "The pharmacokinetics and metabolism of oxycodone after intramuscular and oral administration to healthy subjects." Br J Clin Pharmacol 33 (1992): 617-21
  53. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  54. Dixon R, Crews T, Inturrisi C, Foley K "Levorphanol: pharmacokinetics and steady-state plasma concentrations in patients with pain." Res Commun Chem Pathol Pharmacol 41 (1983): 3-17
  55. Flanagan RJ, Johnston A, White AS, Crome P "Pharmacokinetics of dextropropoxyphene and nordextropropoxyphene in young and elderly volunteers after single and multiple dextropropoxyphene dosage." Br J Clin Pharmacol 28 (1989): 463-9
  56. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
View all 56 references
Major

Opiate Partial Agonists (Includes Butorphanol) ↔ Acute Mi

Severe Potential Hazard, Moderate plausibility

Applies to: Ischemic Heart Disease

Opiate partial agonists may increase systemic and pulmonary arterial pressure and systemic vascular resistance, particularly when given by intravenous administration. Data are available for pentazocine and butorphanol. Therapy with opiate partial agonists should be administered cautiously and only if the benefit justifies the risk in patients with acute myocardial infarction (especially if accompanied by hypertension or left ventricular failure) or coronary insufficiency.

References

  1. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  2. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  3. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  4. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  5. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  6. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
View all 6 references
Major

Opiate Partial Agonists (Includes Butorphanol) ↔ Drug Dependence

Severe Potential Hazard, High plausibility

Applies to: Drug Abuse/Dependence, Alcoholism

Opiate partial agonists have the potential to cause dependence and abuse, particularly in patients with a history of drug abuse. Tolerance as well as physical and psychological dependence can develop after prolonged use, and abrupt cessation or a significant reduction in dosage may precipitate withdrawal symptoms. Because of their opiate antagonistic effect, withdrawal symptoms may also occur if opiate partial agonists are administered to patients with an opiate dependence or in whom substantial amounts of narcotics have recently been administered. Therapy with opiate partial agonists is not recommended in patients who are physically dependent on narcotics. Addiction-prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance or medical supervision when treated with opiate partial agonists. It may be prudent to refrain from dispensing large quantities of medication to these patients. After prolonged use or if dependency is suspected, withdrawal of opiate therapy should be undertaken gradually using a dosage-tapering schedule.

References

  1. Miser AW, Chayt KJ, Sandlund JT, Cohen PS, Dothage JA, Miser JS "Narcotic withdrawal syndrome in young adults after the therapeutic use of opiates." Am J Dis Child 140 (1986): 603-4
  2. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  3. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  4. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  5. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  6. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  7. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
View all 7 references
Major

Opiate Partial Agonists (Includes Butorphanol) ↔ Intracranial Pressure

Severe Potential Hazard, High plausibility

Applies to: Head Injury, Cerebral Vascular Disorder, Brain/Intracranial Tumor

The hypoventilation associated with administration of opiate partial agonists can induce cerebral hypoxia and vasodilatation with resultant increase in intracranial pressure. Unless mechanical ventilation is provided, extreme caution is advised when opiate partial agonists are given to patients head injury, intracranial lesions, or a preexisting elevated CSF pressure. Also, clinicians treating such patients should be aware that opiate partial agonists may interfere with the evaluation of CNS function, especially with respect to consciousness levels, respiratory status, and pupillary changes.

References

  1. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  2. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  3. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  4. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  5. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  6. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
View all 6 references
Major

Opiate Partial Agonists (Includes Butorphanol) ↔ Respiratory Depression

Severe Potential Hazard, High plausibility

Applies to: Head Injury, Cerebral Vascular Disorder, Acute Alcohol Intoxication, Altered Consciousness, Asphyxia, Brain/Intracranial Tumor, Pulmonary Impairment, Respiratory Arrest

Opiate partial agonists may produce respiratory depression by decreasing respiratory drive and increasing airway resistance. A "ceiling effect" has been noted for these agents, and increasing doses do not produce proportional or further respiratory depression. However, the duration of effect is prolonged. At therapeutic analgesic dosages, the respiratory effects are usually not clinically important except in patients with preexisting pulmonary impairment. Therapy with opiate partial agonists should be avoided or administered with extreme caution and initiated at reduced dosages in patients with severe CNS or respiratory depression; acute alcohol intoxication; sleep apnea; hypoxia, anoxia, or hypercapnia; upper airway obstruction; chronic pulmonary insufficiency; a limited ventilatory reserve; or other respiratory disorders. In the presence of excessive respiratory secretions, the use of opiate partial agonists may also be problematic because they decrease ciliary activity and reduce the cough reflex. Caution is also advised in patients who may be at increased risk for respiratory depression, such as comatose patients or those with head injury, intracranial lesions, or intracranial hypertension. Clinical monitoring of pulmonary function is recommended, and equipment for resuscitation should be immediately available if parenteral routes are used. Naloxone may be administered to reverse clinically significant respiratory depression. However, in the case of buprenorphine, naloxone may not be effective due to buprenorphine's slow rate of dissociation from mu receptors.

References

  1. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  2. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  3. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  4. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  5. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  6. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  7. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  8. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
View all 8 references
Moderate

Butorphanol (Includes Butorphanol) ↔ Hypertension

Moderate Potential Hazard, Moderate plausibility

Applies to: Hypertension

Butorphanol may increase blood pressure and rarely causes severe hypertension. Therapy with butorphanol should be administered cautiously in hypertensive patients, particularly when given before surgery or anesthesia.

References

  1. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  2. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
Moderate

Butorphanol (Includes Butorphanol) ↔ Hypotension

Moderate Potential Hazard, Moderate plausibility

Applies to: Hypotension, Dehydration, Shock

Butorphanol may rarely induce vasodilation and hypotension with syncope during the first hour following intranasal administration, particularly in patients with a history of similar reactions to opioid analgesic agents. Therapy with butorphanol should be administered cautiously in patients with circulatory shock, hypovolemia, or a predisposition to hypotension.

References

  1. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  2. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
Moderate

Narcotic Analgesics (Includes Butorphanol) ↔ Adrenal Insufficiency

Moderate Potential Hazard, Moderate plausibility

Applies to: Adrenal Insufficiency

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

References

  1. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  2. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc, Columbus, OH.
  3. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  4. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  5. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  6. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  7. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  8. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  9. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  10. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  11. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  12. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  13. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  14. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  15. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  16. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  17. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  18. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  19. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  20. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  21. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  22. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  23. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  24. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  25. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  26. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
View all 26 references
Moderate

Narcotic Analgesics (Includes Butorphanol) ↔ Biliary Spasm

Moderate Potential Hazard, Moderate plausibility

Applies to: Biliary Obstruction, Gallbladder Disease

Narcotic (opioid) analgesic agents increase smooth muscle tone in the biliary tract, which can lead to spasm and elevated biliary tract pressure, especially in the sphincter of Oddi. Biliary effects appear to be the most pronounced with morphine, although they do not always occur with therapeutic doses. Therapy with opioids should be administered cautiously in patients with biliary or gallbladder disease.

References

  1. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  2. Hey VM, Ostick DG, Mazumder JK, Lord WD "Pethidine, metoclopramide and the gastro-oesophageal sphincter." Anaesthesia 36 (1981): 173-6
  3. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  4. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  5. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  6. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  7. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  8. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  9. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  10. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  11. Daikos GK, Kosmidis JC "Propoxyphene jaundice." JAMA 232 (1975): 835
  12. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  13. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  14. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  15. McCammon RL, Viegas OJ, Stoelting RK, Dryden GE "Naloxone reversal of choledochoduodenal sphincter spasm associated with narcotic administration." Anesthesiology 48 (1978): 437
  16. Zsigmond EK, Vieira ZEG, Duarte B, Renigers SA, Hirota K "Double-blind placebo-controlled ultrasonographic confirmation of constriction of the common bile duct by morphine." Int J Clin Pharmacol Ther Toxicol 31 (1993): 506-9
  17. Lang DW, Pilon RN "Naloxone reversal of morphine-induced biliary colic." Anesth Analg 59 (1980): 619-20
  18. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  19. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  20. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  21. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  22. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  23. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  24. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  25. Jones RM, Fiddian-Green R, Knight PR "Narcotic-induced choledochoduodenal sphincter spasm reversed by glucagon." Anesth Analg 59 (1980): 946-7
  26. Ford MJ, Kellett RJ, Busuttil A, Finlayson ND "Dextropropoxyphene and jaundice." Br Med J 2 (1977): 674
  27. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  28. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  29. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  30. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
View all 30 references
Moderate

Narcotic Analgesics (Includes Butorphanol) ↔ Hypothyroidism

Moderate Potential Hazard, Moderate plausibility

Applies to: Hypothyroidism, Panhypopituitarism

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

References

  1. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  2. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  3. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  4. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  5. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  6. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  7. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  8. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  9. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  10. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  12. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  13. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  14. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  15. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  16. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  17. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  18. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  19. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  20. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  21. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  22. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  23. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  24. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  25. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
View all 25 references
Moderate

Narcotic Analgesics (Includes Butorphanol) ↔ Seizure Disorders

Moderate Potential Hazard, Low plausibility

Applies to: Seizures

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

References

  1. Armstrong PJ, Bersten A "Normeperidine toxicity." Anesth Analg 65 (1986): 536-8
  2. Strong WE, Matson M "Probable seizure after alfentanil." Anesth Analg 68 (1989): 692-3
  3. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  4. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  5. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  6. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  7. Smith NT, Benthuysen JL, Bickford RG, Sanford TJ, Blasco T, Duke PC, Head N, Dec-Silver H "Seizures during opioid anesthetic induction--are they opioid-induced rigidity?" Anesthesiology 71 (1989): 852-62
  8. Goroszeniuk T, Albin M, Jones RM "Generalized grand mal seizure after recovery from uncomplicated fentanyl-etomidate anesthesia." Anesth Analg 65 (1986): 979-81
  9. Sebel PS, Bovill JG "Fentanyl and convulsions." Anesth Analg 62 (1983): 858-9
  10. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  11. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  12. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  13. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  14. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  15. Hagmeyer KO, Mauro LS, Mauro VF "Meperidine-related seizures associated with patient-controlled analgesia pumps." Ann Pharmacother 27 (1993): 29-32
  16. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  17. Mauro VF, Bonfiglio MF, Spunt AL "Meperidine-induced seizure in a patient without renal dysfunction or sickle cell anemia." Clin Pharm 5 (1986): 837-9
  18. Stone PA, Macintyre PE, Jarvis DA "Norpethidine toxicity and patient controlled analgesia." Br J Anaesth 71 (1993): 738-40
  19. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  20. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  21. Safwat AM, Daniel D "Grand mal seizure after fentanyl administration." Anesthesiology 59 (1983): 78
  22. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  23. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  24. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  25. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  26. Reutens DC, Stewart-Wynne EG "Norpethidine induced myoclonus in a patient with renal failure." J Neurol Neurosurg Psychiatry 52 (1989): 1450-1
  27. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc, Columbus, OH.
  28. Kaiko RF, Foley KM, Grabinski PY, et al "Central nervous system excitatory effects of meperidine in cancer patients." Ann Neurol 13 (1983): 180-5
  29. Hoien AO "Another case of grand mal seizure after fentanyl administration." Anesthesiology 60 (1984): 387-8
  30. Babul N, Darke AC "Putative role of hydromorphone metabolites in myoclonus." Pain 51 (1992): 260-1
  31. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  32. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  33. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  34. Goetting MG, Thirman MJ "Neurotoxicity of meperidine." Ann Emerg Med 14 (1985): 1007-9
  35. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  36. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  37. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  38. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  39. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  40. Benthuysen JL, Stanley TH "Concerning the possible nature of reported fentanyl seizures." Anesthesiology 62 (1985): 205
  41. Sjogren P, Dragsted L, Christensen CB "Myoclonic spasms during treatment with high doses of intravenous morphine in renal failure." Acta Anaesthesiol Scand 37 (1993): 780-2
  42. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  43. Rao TL, Mummaneni N, El-Etr AA "Convulsions: an unusual response to intravenous fentanyl administration." Anesth Analg 61 (1982): 1020-1
View all 43 references
Moderate

Narcotic Analgesics (Includes Butorphanol) ↔ Urinary Retention

Moderate Potential Hazard, Moderate plausibility

Applies to: Urinary Retention

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

References

  1. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  2. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  3. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  4. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  5. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  6. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  7. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  8. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  9. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  10. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  11. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  12. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  13. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  14. Petersen TK, Husted SE, Rybro L, et al "Urinary retention during I.M. and extradural morphine analgesia." Br J Anaesth 54 (1982): 1175-8
  15. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  16. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  17. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  18. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc, Columbus, OH.
  19. Petros JG, Mallen JK, Howe K, Rimm EB, Robillard RJ "Patient-controlled analgesia and postoperative urinary retention after open appendectomy." Surg Gynecol Obstet 177 (1993): 172-5
  20. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  21. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  22. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  23. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  24. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  25. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  26. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  27. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  28. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  29. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
View all 29 references

butorphanol drug Interactions

There are 924 drug interactions with butorphanol

butorphanol alcohol/food Interactions

There are 2 alcohol/food interactions with butorphanol

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

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