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Mepergan (meperidine / promethazine) Disease Interactions

There are 34 disease interactions with Mepergan (meperidine / promethazine):

Major

Antihistamines (Includes Mepergan) ↔ Anticholinergic Effects

Severe Potential Hazard, High plausibility

Applies to: Gastrointestinal Obstruction, Glaucoma/Intraocular Hypertension, Urinary Retention

Antihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives.

References

  1. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  2. "Product Information. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
  3. "Product Information. Periactin (cyproheptadine)." Merck & Co, Inc, West Point, PA.
  4. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  5. "Product Information. Marezine (cyclizine)." Glaxo Wellcome, Research Triangle Park, NC.
  6. "Product Information. Drixoral (dextromethorphan)." Schering-Plough, Liberty Corner, NJ.
  7. "Product Information. Semprex-D (acrivastine-pseudoephedrine)." Endo Laboratories LLC, Chadds Ford, PA.
  8. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmaceutical Company, St. Louis, MO.
  9. Watemberg NM, Roth KS, Alehan FK, Epstein CE "Central anticholinergic syndrome on therapeutic doses of cyproheptadine." Pediatrics 103 (1999): 158-60
  10. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  11. "Product Information. Zyrtec (cetirizine)." Pfizer US Pharmaceuticals, New York, NY.
  12. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  13. "Product Information. Dramamine (dimenhydrinate)" Pharmacia and Upjohn, Kalamazoo, MI.
  14. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  15. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  16. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  17. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  18. "Product Information. Vistaril (hydroxyzine)." Pfizer US Pharmaceuticals, New York, NY.
  19. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  20. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
View all 20 references
Major

Antihistamines (Includes Mepergan) ↔ Asthma/Copd

Severe Potential Hazard, Moderate plausibility

Applies to: Asthma, Chronic Obstructive Pulmonary Disease

It has been suggested that the anticholinergic effect of antihistamines may reduce the volume and cause thickening of bronchial secretions, resulting in obstruction of respiratory tract. Some manufacturers and clinicians recommend that therapy with antihistamines be administered cautiously in patients with asthma or chronic obstructive pulmonary disease.

References

  1. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  2. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  3. "Product Information. Periactin (cyproheptadine)." Merck & Co, Inc, West Point, PA.
  4. "Product Information. Drixoral (dextromethorphan)." Schering-Plough, Liberty Corner, NJ.
  5. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  6. "Product Information. Marezine (cyclizine)." Glaxo Wellcome, Research Triangle Park, NC.
  7. "Product Information. Dramamine (dimenhydrinate)" Pharmacia and Upjohn, Kalamazoo, MI.
  8. Maddox DE, Reed CE "Clinical pharmacodynamics of antihistamines." Ann Allergy 59 (1987): 43-8
  9. "Product Information. Semprex-D (acrivastine-pseudoephedrine)." Endo Laboratories LLC, Chadds Ford, PA.
  10. "Product Information. Vistaril (hydroxyzine)." Pfizer US Pharmaceuticals, New York, NY.
  11. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmaceutical Company, St. Louis, MO.
  12. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  13. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  14. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  15. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  16. "Product Information. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
  17. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
View all 17 references
Major

Narcotic Analgesics (Includes Mepergan) ↔ 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. 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
  3. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  4. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  5. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  6. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  7. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  8. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  9. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  10. 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
  11. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  12. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  13. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  14. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  15. 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
  16. 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
  17. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  18. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  19. 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
  20. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  21. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  22. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  23. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  24. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  25. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  26. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
View all 26 references
Major

Narcotic Analgesics (Includes Mepergan) ↔ 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. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  2. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  3. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  4. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  5. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  6. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  7. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  8. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  9. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  10. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  11. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  12. 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
  13. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  14. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  15. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  16. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  17. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  18. 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
  19. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  20. 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
  21. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  22. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  23. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  24. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  25. 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
  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 Mepergan) ↔ 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. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  2. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  3. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  4. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  5. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  6. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  7. 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
  8. 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
  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. McClain DA, Hug CC, Jr "Intravenous fentanyl kinetics." Clin Pharmacol Ther 28 (1980): 106-14
  11. 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
  12. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  13. 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
  14. 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
  15. Haberer JP, Schoeffler P, Couderc E, Duvaldestin P "Fentanyl pharmacokinetics in anaesthetized patients with cirrhosis." Br J Anaesth 54 (1982): 1267-70
  16. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  17. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  18. 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
  19. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  20. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  21. 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
  22. Beckett AH, Vaughan DP, Essien EE "N-Oxidation--an important route in the metabolism of methadone in man." J Pharm Pharmacol 24 (1972): 244
  23. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  24. 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
  25. 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
  26. Glare PA, Walsh TD "Clinical pharmacokinetics of morphine." Ther Drug Monit 13 (1991): 1-23
  27. 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
  28. Kreek MJ, Fanizza AM, et al "Methadone disposition in patients with chronic liver disease." Clin Pharmacol Ther 30 (1981): 353-62
  29. 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
  30. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  31. 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
  32. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  33. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  34. 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
  35. 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
  36. 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
  37. 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
  38. 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
  39. Neal EA, Meffin PJ, Gregory PB, Blaschke TF "Enhanced bioavailability and decreased clearance of analgesics in patients with cirrhosis." Gastroenterology 77 (1979): 96-102
  40. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  41. 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
  42. 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
  43. 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
  44. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  45. 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
  46. 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
  47. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  48. 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
  49. 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
  50. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  51. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  52. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  53. 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
  54. 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
  55. 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
  56. 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
  57. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  58. 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
View all 58 references
Major

Narcotic Analgesics (Includes Mepergan) ↔ 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 Mepergan) ↔ 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. Bechtel WD, Sinterhauf K "Plasma level and renal excretion of [3H] codeine phosphate in man and in the dog." Arzneimittelforschung 28 (1978): 308-11
  3. 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
  4. 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
  5. Charuvastra VC, Ouren J "Renal failure and treatment of a methadone maintenance patient." Med J Aust 09/24/77 (1977): 433-4
  6. Chan K, Jennings F, Orme ML "Pharmacokinetics of low-dose intravenous pethidine in patients with renal dysfunction." J Clin Pharmacol 27 (1987): 516-22
  7. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  8. 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
  9. Matske GR, Chan GL, Abraham PA "Codeine dosage in renal failure." Clin Pharm 5 (1986): 15-6
  10. 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
  11. Findlay JW, Butz RF, Welch RM "Codeine kinetics as determined by radioimmunoassay." Clin Pharmacol Ther 22 (1977): 439-46
  12. Drayer DE "Active drug metabolites and renal failure." Am J Med 62 (1977): 486-9
  13. 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
  14. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  15. Kreek MJ, Schecter AJ, Gutjahr CL, et al "Methadone use in patients with chronic renal failure." Drug Alcohol Depend 5 (1980): 197-205
  16. Glare PA, Walsh TD "Clinical pharmacokinetics of morphine." Ther Drug Monit 13 (1991): 1-23
  17. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  18. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  19. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  20. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  21. 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
  22. 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
  23. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  24. Baselt RC, Casarett LJ "Urinary excretion of methadone in man." Clin Pharmacol Ther 13 (1972): 64-70
  25. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  26. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  27. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  28. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  29. Wolfert AI, Sica DA "Narcotic usage in renal failure." Int J Artif Organs 11 (1988): 411-5
  30. 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
  31. 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
  32. 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
  33. 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
  34. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  35. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  36. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  37. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  38. Verbeeck RK, Branch RA, Wilkinson GR "Drug metabolites in renal failure: pharmacokinetic and clinical implications." Clin Pharmacokinet 6 (1981): 329-45
  39. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  40. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  41. 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
  42. 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
  43. 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
  44. Inturrisi CE "Disposition of narcotics in patients with renal disease." Am J Med 62 (1977): 528-9
  45. 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
  46. 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
  47. Sawe J, Odar-Cederlof I "Kinetics of morphine in patients with renal failure." Eur J Clin Pharmacol 32 (1987): 377-82
  48. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  49. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  50. Chauvin M, Sandouk P, Scherrmann JM, Farinotti R, Strumza P, Duvaldestin P "Morphine pharmacokinetics in renal failure." Anesthesiology 66 (1987): 327-31
  51. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  52. Covington EC, Gonsalves-Ebrahim L, Currie KO, et al "Severe respiratory depression from patient-controlled analgesia in renal failure." Psychosomatics 30 (1989): 226-8
  53. 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
  54. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  55. 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
  56. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
View all 56 references
Major

Opiate Agonists (Includes Mepergan) ↔ Acute Alcohol Intoxication

Severe Potential Hazard, High plausibility

Applies to: Acute Alcohol Intoxication

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

References

  1. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  3. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  4. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  5. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  6. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  7. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  8. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  9. "Multum Information Services, Inc. Expert Review Panel"
  10. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  11. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  12. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  13. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  14. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  15. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
View all 15 references
Major

Opiate Agonists (Includes Mepergan) ↔ Drug Dependence

Severe Potential Hazard, High plausibility

Applies to: Drug Abuse/Dependence, Alcoholism

Opiate agonists have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop after prolonged use. Abrupt cessation, reduction in dosage, or administration of an opiate antagonist such as naloxone may precipitate withdrawal symptoms. In patients who have developed tolerance to an opiate agonist, overdosage can still produce respiratory depression and death, and cross-tolerance usually will occur with other agents in the class. 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 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. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  2. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  3. Fishbain DA, Goldberg M, Rosomoff RS, Rosomoff H "Atypical withdrawal syndrome (organic delusional syndrome) secondary to oxycodone detoxification ." J Clin Psychopharmacol 8 (1988): 441-2
  4. Strode SW "Propoxyphene dependence and withdrawal." Am Fam Physician 32 (1985): 105-8
  5. Morrison AB "Toxicity and abuse of hydrocodone bitartrate." Can Med Assoc J 120 (1979): 1338
  6. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  7. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  8. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  9. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  10. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  11. Azorlosa JL, Stitzer ML, Greenwald MK "Opioid physical dependence development - effects of single versus repeated morphine pretreatments and of subjects opioid exposure history." Psychopharmacology (Berl) 114 (1994): 71-80
  12. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  13. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  14. Salguero CH, Villarreal JE, Hug CC Jr, Domino EF "Propoxyphene dependence." JAMA 210 (1969): 135-6
  15. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  16. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  17. Whittington RM "Dextropropoxyphene addiction." Lancet 2 (1979): 743-4
  18. Collins GB, Kiefer KS "Propoxyphene dependence: an update." Postgrad Med 70 (1981): 57-61
  19. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  20. 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
  21. Hedenmalm K "A case of severe withdrawal syndrome due to dextropropoxyphene." Ann Intern Med 123 (1995): 473
  22. Wall R, Linford SM, Akhter MI "Addiction to Distalgesic (dextropropoxyphene)." Br Med J 280 (1980): 1213-4
  23. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  24. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  25. Claghorn JL, Schoolar JC "Propoxyphene hydrochloride, a drug of abuse." JAMA 196 (1966): 1089-91
  26. Ng B, Alvear M "Dextropropoxyphene addiction--a drug of primary abuse." Am J Drug Alcohol Abuse 19 (1993): 153-8
View all 26 references
Major

Opiate Agonists (Includes Mepergan) ↔ Hypotension

Severe Potential Hazard, High plausibility

Applies to: Hypotension, Dehydration, Shock

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

References

  1. Cox RG "Hypoxaemia and hypotension after intravenous codeine phosphate." Can J Anaesth 41 (1994): 1211-3
  2. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  3. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  4. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  5. Sebel PS, Bovill JG, Boekhorst RA, Rog N "Cardiovascular effects of high-dose fentanyl anaesthesia." Acta Anaesthesiol Scand 26 (1982): 308-15
  6. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  7. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  8. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  9. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  10. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  11. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  12. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  13. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  14. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  15. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  16. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  17. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  18. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  19. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  20. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  21. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  22. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  23. Parke TJ, Nandi PR, Bird KJ, Jewkes DA "Profound hypotension following intravenous codeine phosphate: three case reports and some recommendations." Anaesthesia 47 (1992): 852-4
View all 23 references
Major

Opiate Agonists (Includes Mepergan) ↔ Intracranial Pressure

Severe Potential Hazard, High plausibility

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

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

References

  1. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  3. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  4. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  5. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  6. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  7. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  8. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  9. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  10. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  12. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  13. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  14. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  15. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  16. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  17. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  18. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  19. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  20. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
View all 20 references
Major

Opiate Agonists (Includes Mepergan) ↔ Respiratory Depression

Severe Potential Hazard, High plausibility

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

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

References

  1. Redpath JB, Pleuvry BJ "Double-blind comparison of the respiratory and sedative effects of codeine phosphate and (+/-)-glaucine phosphate in human volunteers." Br J Clin Pharmacol 14 (1982): 555-8
  2. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  3. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  4. Hudson RJ "Apnoea and unconsciousness after apparent recovery from alfentanil- supplemented anaesthesia." Can J Anaesth 37 (1990): 255-7
  5. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  6. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  7. Amin HM, Sopchak AM, Esposito BF, Henson LG, Batenhorst RL, Fox AW, Camporesi EM "Naloxone-induced and spontaneous reversal of depressed ventilatory responses to hypoxia during and after continuous infusion of remifentanil or alfentanil." J Pharmacol Exp Ther 274 (1995): 34-9
  8. Morley AD "Profound respiratory depression with morphine patient-controlled analgesia in an elderly patient." Anaesth Intensive Care 24 (1996): 287
  9. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  10. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  11. Brockway MS, Noble DW, Sharwood-Smith GH, McClure JH "Profound respiratory depression after extradural fentanyl." Br J Anaesth 64 (1990): 243-5
  12. Jackson FW "Fentanyl and the wooden chest." Gastroenterology 106 (1994): 820-1
  13. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  14. Elloway R, Sherman S, Maas L, et al "Meperidine-induced bronchospasm." Gastrointest Endosc 38 (1992): 93
  15. Comstock MK, Carter JG, Moyers JR, Stevens WC "Rigidity and hypercarbia associated with high dose fentanyl induction of anesthesia." Anesth Analg 60 (1981): 362-3
  16. 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
  17. Harper MH, Hickey RF, Cromwell TH, Linwood S "The magnitude and duration of respiratory depression produced by fentanyl and fentanyl plus droperidol in man." J Pharmacol Exp Ther 199 (1976): 464-8
  18. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  19. Varrassi G, Celleno D, Capogna G, et al. "Ventilatory effects of subarachnoid fentanyl in the elderly." Anaesthesia 47 (1992): 558-62
  20. 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
  21. Covington EC, Gonsalves-Ebrahim L, Currie KO, et al "Severe respiratory depression from patient-controlled analgesia in renal failure." Psychosomatics 30 (1989): 226-8
  22. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  23. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  24. Sackner MA "Effects of hydrocodone bitartrate on breathing pattern of patients with chronic obstructive pulmonary disease and restrictive lung disease." Mt Sinai J Med 51 (1984): 222-6
  25. Sandler AN, Baxter AD, Katz J, Samson B, Friedlander M, Norman P, Koren G, Roger S, Hull K, Klein J "A double-blind, placebo-controlled trial of transdermal fentanyl after abdominal hysterectomy: analgesic, respiratory, and pharmacokinetic effects." Anesthesiology 81 (1994): 1169-80
  26. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  27. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  28. Palmer CM "Early respiratory depression following intrathecal fentanyl-morphine combination." Anesthesiology 74 (1991): 1153-5
  29. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  30. Rigg JR, Ilsley AH, Vedig AE "Relationship of ventilatory depression to steady-state blood pethidine concentrations." Br J Anaesth 53 (1981): 613-9
  31. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  32. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  33. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  34. Bigler D, Eriksen J, Christensen CB "Prolonged respiratory depression caused by slow release morphine." Lancet 06/30/84 (1984): 1477
  35. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  36. Noble DW, Morrison LM, Brockway MS, Mcclure JH "Respiratory depression after extradural fentanyl." Br J Anaesth 72 (1994): 251
  37. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  38. Eisenach JC "Respiratory depression following intrathecal opioids." Anesthesiology 75 (1991): 712
  39. Etches RC "Respiratory depression associated with patient-controlled analgesia - a review of eight cases." Can J Anaesth 41 (1994): 125-32
  40. Samuels SI, Rabinov W "Difficulty reversing drug-induced coma in a patient with sleep apnea." Anesth Analg 65 (1986): 1222-4
  41. Houghton IT, Aun CST, Wong YC, Chan K, Lau JTF, Oh TE "The respiratory depressant effect of morphine - a comparative study in three ethnic groups." Anaesthesia 49 (1994): 197-201
  42. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  43. Ogawa K, Iranami H, Yoshiyama T, Maeda H, Hatano Y "Severe respiratory depression after epidural morphine in a patient with myotonic dystrophy." Can J Anaesth 40 (1993): 968-70
  44. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
View all 44 references
Major

Phenothiazines (Includes Mepergan) ↔ Acute Alcohol Intoxication

Severe Potential Hazard, High plausibility

Applies to: Alcoholism

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

References

  1. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  2. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  3. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  4. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  5. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  6. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  7. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  8. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  9. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  10. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  11. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  12. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  13. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
View all 13 references
Major

Phenothiazines (Includes Mepergan) ↔ Cardiovascular Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Dehydration, Cardiovascular Disease, Cerebrovascular Insufficiency, History - Cerebrovascular Disease, History - Myocardial Infarction, Hypotension, Pheochromocytoma

Phenothiazines may cause hypotension (including orthostatic hypotension), reflex tachycardia, increased pulse rate, syncope, and dizziness, particularly after the first parenteral dose but rarely after the first oral dose. Low-potency agents such as chlorpromazine and thioridazine are more likely to induce these effects, which usually subside within the first couple of hours following administration. Tolerance to the hypotensive effects often develops after a few doses. Rarely, fatal cardiac arrest has occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include edema, thrombosis, and ECG abnormalities such as PR and QT interval prolongation, diffuse T-wave flattening, and ST segment depression. Therapy with phenothiazines should be avoided or otherwise administered cautiously in patients with severe cardiovascular disease, pheochromocytoma, a predisposition to hypotension, or conditions that could be exacerbated by hypotension such as a history of myocardial infarction, angina, or ischemic stroke. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. If parenteral therapy is given, patients should be in a supine position during administration and for at least 30 to 60 minutes afterwards. Patients who experience orthostatic hypotension should be cautioned not to rise too abruptly. Occasionally, when severe, hypotension may require treatment with vasoconstrictive agents such as norepinephrine or phenylephrine. Epinephrine should not be used, however, since phenothiazines can reverse its vasopressor effects and cause a further lowering of blood pressure.

References

  1. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. Jones J, Sklar D, Dougherty J, White W "Randomized double-blind trial of intravenous prochlorperazine for the treatment of acute headache." JAMA 261 (1989): 1174-6
  3. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  4. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  5. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  6. Kumar BB "Letter: Acute hypotension from thioridazine." JAMA 234 (1975): 1321
  7. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  8. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  9. Witz L, Shapiro M, Shenkman L "Chlorpromazine induced fluid retention masquerading as idiopathic oedema." Br Med J 294 (1987): 807-8
  10. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  11. Margolis J "Massive edema induced by thioridazine (Mellaril): an unusual complication." J Am Geriatr Soc 20 (1972): 593-4
  12. Schreiber G, Belmaker R "In vivo differentiation of cardiac vagal blocking effects of chlorpromazine and haloperidol." Biol Psychiatry 22 (1987): 1417-21
  13. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  14. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  15. Fletcher GF, Kazamias TM "Cardiotoxic effects of Mellaril: conduction disturbances and supraventricular arrhythmias." Am Heart J 78 (1969): 135-8
  16. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  17. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  18. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  19. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  20. Fruncillo R, Gibbons W, Vlasses P, Ferguson R "Severe hypotension associated with concurrent clonidine and antipsychotic medication." Am J Psychiatry 142 (1985): 274
  21. Stevenson R, Blanshard C, Patterson D "Ventricular fibrillation due to lithium withdrawal: an interaction with chlorpromazine?" Postgrad Med J 65 (1989): 936-8
  22. Dorson P, Crismon M "Chlorpromazine accumulation and sudden death in a patient with renal insufficiency." Drug Intell Clin Pharm 22 (1988): 776-8
  23. Varia I, Krishnan R, Davidson J "Deep-vein thrombosis with antipsychotic drugs." Psychosomatics 24 (1983): 1097-8
  24. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
View all 24 references
Major

Phenothiazines (Includes Mepergan) ↔ Cns Depression

Severe Potential Hazard, High plausibility

Applies to: Altered Consciousness, Respiratory Arrest

The use of phenothiazines is contraindicated in comatose patients and patients with severe central nervous system depression. Phenothiazines may potentiate the CNS and respiratory depression in these patients.

References

  1. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  2. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  3. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  4. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  5. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  6. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  7. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  8. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  9. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  10. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  11. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  12. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  13. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
View all 13 references
Major

Phenothiazines (Includes Mepergan) ↔ Head Injury

Severe Potential Hazard, High plausibility

Applies to: Head Injury

The use of phenothiazines is contraindicated in patients with suspected or established subcortical brain damage, with or without hypothalamic involvement. Phenothiazines can interfere with thermoregulatory mechanisms, and a hyperthermic reaction with temperatures in excess of 104 F may occur in such patients, sometimes not until 14 to 16 hours after drug administration.

References

  1. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  2. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  3. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  4. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  5. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  6. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  7. Keshavan MS, Kambhampati RK "Prolonged fever without extrapyramidal symptoms during neuroleptic treatment" J Clin Psychopharmacol 9 (1989): 230-1
  8. Caroff S, Rosenberg H, Gerber JC "Neuroleptic malignant syndrome and malignant hyperthermia" Lancet 1 (1983): 244
  9. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  10. Dilsaver SC "Effects of neuroleptics on body temperature" J Clin Psychiatry 49 (1988): 78-9
  11. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  12. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  13. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 13 references
Major

Promethazine (Includes Mepergan) ↔ Antidopaminergic Effects 1

Severe Potential Hazard, Moderate plausibility

Applies to: Dehydration, Hypocalcemia, Tardive Dyskinesia, Neuroleptic Malignant Syndrome

Promethazine has weak central antidopaminergic activity. While its use is rarely associated with adverse effects secondary to dopaminergic blockade, large doses have produced extrapyramidal reactions. During chronic administration and/or high-dose therapy, the usual contraindications, warnings and precautions applicable to phenothiazines should be observed with promethazine.

References

  1. Nicholson AN "Central effects of H1 and H2 antihistamines." Aviat Space Environ Med 56 (1985): 293-8
  2. Schwinghammer TL, Kroboth FJ, Juhl RP "Extrapyramidal reaction secondary to oral promethazine." Clin Pharm 3 (1984): 83-5
  3. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
Major

Promethazine (Includes Mepergan) ↔ Asthma

Severe Potential Hazard, High plausibility

Applies to: Pulmonary Impairment

Promethazine is contraindicated for use in the treatment of lower respiratory tract symptoms including asthma. Furthermore, promethazine tablets may lead to potentially fatal respiratory depression, and its use should be avoided in patients with compromised respiratory function such as patients with COPD, and sleep apnea.

Moderate

Narcotic Analgesics (Includes Mepergan) ↔ 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. 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):
  5. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  6. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  7. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  8. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  9. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  10. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  11. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  12. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  13. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  14. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  15. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  16. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  17. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  18. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  19. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  20. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  21. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  22. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  23. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  24. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  25. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  26. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
View all 26 references
Moderate

Narcotic Analgesics (Includes Mepergan) ↔ 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. Daikos GK, Kosmidis JC "Propoxyphene jaundice." JAMA 232 (1975): 835
  6. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  7. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  8. McCammon RL, Viegas OJ, Stoelting RK, Dryden GE "Naloxone reversal of choledochoduodenal sphincter spasm associated with narcotic administration." Anesthesiology 48 (1978): 437
  9. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  10. Lang DW, Pilon RN "Naloxone reversal of morphine-induced biliary colic." Anesth Analg 59 (1980): 619-20
  11. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  12. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  13. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  14. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  15. Ford MJ, Kellett RJ, Busuttil A, Finlayson ND "Dextropropoxyphene and jaundice." Br Med J 2 (1977): 674
  16. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  17. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  18. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  19. 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
  20. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  21. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  22. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  23. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  24. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  25. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  26. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  27. Jones RM, Fiddian-Green R, Knight PR "Narcotic-induced choledochoduodenal sphincter spasm reversed by glucagon." Anesth Analg 59 (1980): 946-7
  28. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  29. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  30. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
View all 30 references
Moderate

Narcotic Analgesics (Includes Mepergan) ↔ 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. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  8. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  9. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  10. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  11. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  12. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  13. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  14. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  15. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  16. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  17. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  18. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  19. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  20. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  21. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  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 Mepergan) ↔ Seizure Disorders

Moderate Potential Hazard, Moderate 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. Strong WE, Matson M "Probable seizure after alfentanil." Anesth Analg 68 (1989): 692-3
  2. Armstrong PJ, Bersten A "Normeperidine toxicity." Anesth Analg 65 (1986): 536-8
  3. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  4. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  5. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  6. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  7. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  8. Sebel PS, Bovill JG "Fentanyl and convulsions." Anesth Analg 62 (1983): 858-9
  9. 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
  10. Goroszeniuk T, Albin M, Jones RM "Generalized grand mal seizure after recovery from uncomplicated fentanyl-etomidate anesthesia." Anesth Analg 65 (1986): 979-81
  11. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  12. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  13. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  14. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  15. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  16. Babul N, Darke AC "Putative role of hydromorphone metabolites in myoclonus." Pain 51 (1992): 260-1
  17. Hagmeyer KO, Mauro LS, Mauro VF "Meperidine-related seizures associated with patient-controlled analgesia pumps." Ann Pharmacother 27 (1993): 29-32
  18. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  19. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  20. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  21. Stone PA, Macintyre PE, Jarvis DA "Norpethidine toxicity and patient controlled analgesia." Br J Anaesth 71 (1993): 738-40
  22. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  23. Safwat AM, Daniel D "Grand mal seizure after fentanyl administration." Anesthesiology 59 (1983): 78
  24. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  25. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  26. 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
  27. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  28. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  29. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  30. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  31. Reutens DC, Stewart-Wynne EG "Norpethidine induced myoclonus in a patient with renal failure." J Neurol Neurosurg Psychiatry 52 (1989): 1450-1
  32. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  33. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  34. Hoien AO "Another case of grand mal seizure after fentanyl administration." Anesthesiology 60 (1984): 387-8
  35. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  36. Kaiko RF, Foley KM, Grabinski PY, et al "Central nervous system excitatory effects of meperidine in cancer patients." Ann Neurol 13 (1983): 180-5
  37. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc, Columbus, OH.
  38. Rao TL, Mummaneni N, El-Etr AA "Convulsions: an unusual response to intravenous fentanyl administration." Anesth Analg 61 (1982): 1020-1
  39. Goetting MG, Thirman MJ "Neurotoxicity of meperidine." Ann Emerg Med 14 (1985): 1007-9
  40. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  41. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  42. 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
  43. Benthuysen JL, Stanley TH "Concerning the possible nature of reported fentanyl seizures." Anesthesiology 62 (1985): 205
View all 43 references
Moderate

Narcotic Analgesics (Includes Mepergan) ↔ 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. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  3. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  4. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  5. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  6. Petersen TK, Husted SE, Rybro L, et al "Urinary retention during I.M. and extradural morphine analgesia." Br J Anaesth 54 (1982): 1175-8
  7. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  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. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  11. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  12. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  13. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  14. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  15. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  16. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  17. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  18. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  19. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc, Columbus, OH.
  20. 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
  21. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  22. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  23. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  24. 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
  25. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  26. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  27. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  28. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  29. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
View all 29 references
Moderate

Opiate Agonists (Includes Mepergan) ↔ Arrhythmias

Moderate Potential Hazard, Moderate plausibility

Applies to: Arrhythmias

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

References

  1. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  3. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  4. Hilgenberg JC, Johantgen WC "Bradycardia after intravenous fentanyl during subarachnoid anesthesia." Anesth Analg 59 (1980): 162-3
  5. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  6. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  7. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  8. Blair JR, Pruett JK, Crumrine RS, Balser JJ "Prolongation of QT interval in association with the administration of large doses of opiates." Anesthesiology 67 (1987): 442-3
  9. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  10. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  11. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  12. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  13. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  14. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  15. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  16. Heaney RM "Left bundle branch block associated with propoxyphene hydrochloride poisoning." Ann Emerg Med 12 (1983): 780-2
  17. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  18. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  19. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  20. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  21. Sebel PS, Bovill JG, Boekhorst RA, Rog N "Cardiovascular effects of high-dose fentanyl anaesthesia." Acta Anaesthesiol Scand 26 (1982): 308-15
View all 21 references
Moderate

Phenothiazines (Includes Mepergan) ↔ Breast Cancer

Moderate Potential Hazard, Moderate plausibility

Applies to: Breast Cancer

The chronic use of phenothiazines is associated with persistent elevations in prolactin levels. Based on in vitro data, approximately one-third of human breast cancers are thought to be prolactin-dependent. The clinical significance of this observation is unknown. Chronic administration of neuroleptic drugs has been associated with mammary tumorigenesis in rodent studies but not in human clinical or epidemiologic studies. Therapy with phenothiazines should be administered cautiously in patients with existing or suspected malignancy of the breast.

References

  1. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  2. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  3. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  4. Kane JM "Antipsychotic drug side effects: their relationship to dose." J Clin Psychiatry 46 (1985): 16-21
  5. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  6. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  7. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  8. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  9. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  10. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  11. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  12. Gift T, Plum K, Price M "Depot fluphenazine and plasma prolactin." Prog Neuropsychopharmacol Biol Psychiatry 9 (1985): 407-12
  13. Ash PR, Bouma D "Exaggerated hyperprolactinemia in response to thiothixene ." Arch Neurol 38 (1981): 534-5
  14. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  15. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  16. Ristic PI, Ory SJ, Lurain JR "Endometrial adenocarcinoma associated with drug-induced hyperprolactinemia." Obstet Gynecol 67 (1986): s86-8
View all 16 references
Moderate

Phenothiazines (Includes Mepergan) ↔ Dystonic Reactions

Moderate Potential Hazard, Moderate plausibility

Applies to: Dehydration, Hypocalcemia

Phenothiazines may cause acute, dose-related dystonic reactions secondary to central dopaminergic blockade. These reactions are characterized by spastic contraction of discrete muscle groups and may include torticollis, opisthotonos, carpopedal spasm, trismus, difficulty swallowing, perioral spasms with protrusion of the tongue, and oculogyric crisis. Onset is usually within 24 to 96 hours following initiation of therapy or an increase in dosage. Risk factors include young age, male gender, use of high-potency agents (e.g., fluphenazine, perphenazine, trifluoperazine), high dosages, and IM administration. Therapy with phenothiazines should be administered cautiously in patients, particularly children, with hypocalcemia or severe dehydration, since these patients may be more susceptible to dystonic reactions. Most symptoms subside within a few hours and are almost always reversible within 24 to 48 hours following withdrawal of therapy. However, severe reactions such as laryngospasm may be life-threatening and require appropriate supportive therapy. Parenteral administration of an anticholinergic antiparkinsonian agent (e.g., benztropine, trihexyphenidyl) or diphenhydramine usually produces a prompt response and may be given orally for short-term maintenance to prevent recurrence of symptoms if phenothiazine therapy must be continued.

References

  1. Sheppard C, Merlis S "Drug-induced extrapyramidal symptoms: their incidence and treatment." Am J Psychiatry 123 (1967): 886-9
  2. Wood G, Waters A "Prolonged dystonic reaction to chlorpromazine in myxoedema coma." Postgrad Med J 56 (1980): 192-3
  3. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  4. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  5. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  6. Singh H, Levinson DF, Simpson GM, Lo ES, Friedman E "Acute dystonia during fixed-dose neuroleptic treatment." J Clin Psychopharmacol 10 (1990): 389-96
  7. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  8. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  9. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  10. Baker FM, Cook P "Compazine complications: a review." J Natl Med Assoc 73 (1981): 409-12
  11. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  12. Reecer MV, Clinchot DM, Tipton DB "Drug-induced dystonia in a patient with C4 quadriplegia. Case report." Am J Phys Med Rehabil 72 (1993): 97-8
  13. Curson DA, Barnes TR, Bamber RW, Platt SD, Hirsch SR, Duffy JC "Long-term depot maintenance of chronic schizophrenic out-patients: the seven year follow-up of the Medical Research Council fluphenazine/placebo trial. II. The incidence of compliance problems,side-effects, neurotic symptoms and depression" Br J Psychiatry 146 (1985): 469-74
  14. Nahata MC, Clotz MA, Krogg EA "Adverse effects of meperidine, promethazine, and chlorpromazine for sedation in pediatric patients." Clin Pediatr (Phila) 24 (1985): 558-60
  15. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  16. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  17. Schwinghammer TL, Kroboth FJ, Juhl RP "Extrapyramidal reaction secondary to oral promethazine." Clin Pharm 3 (1984): 83-5
  18. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  19. Boston Collaborative Drug Surveillance Program "Drug-induced extrapyramidal symptoms." JAMA 224 (1973): 889-91
  20. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  21. Harries JR "Oculogyric crises due to phenothiazines." Br Med J 3 (1967): 241
  22. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  23. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  24. Schumock GT, Martinez E "Acute oculogyric crisis after administration of prochlorperazine." South Med J 84 (1991): 407-8
  25. Marcotte DB "Neuroleptics and neurologic reactions." South Med J 66 (1973): 321-4
  26. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  27. Lamont S "Acute reactions to phenothiazine derivatives." Br J Anaesth 44 (1972): 539-40
  28. Idzorek S "Antiparkinsonian agents and fluphenazine decanoate." Am J Psychiatry 133 (1976): 80-2
  29. Oyewumi LK, Lapierre YD, Gray R, Batth S, Gelfand R "Abnormal involuntary movements in patients on long-acting neuroleptics." Prog Neuropsychopharmacol Biol Psychiatry 7 (1983): 719-23
  30. Bailie GR, Nelson MV, Krenzelok EP, Lesar T "Unusual treatment response of a severe dystonia to diphenhydramine." Ann Emerg Med 16 (1987): 705-8
  31. West D "Dangers of fluphenazine." Br J Psychiatry 117 (1970): 718-9
View all 31 references
Moderate

Phenothiazines (Includes Mepergan) ↔ Hematologic Toxicity

Moderate Potential Hazard, Moderate plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

Phenothiazines may infrequently cause hematologic toxicity, including agranulocytosis, thrombocytopenia, eosinophilia, aplastic anemia, purpura, granulocytopenia, and hemolytic anemia. Mild leukopenia may occur frequently with large doses over prolonged periods but is generally reversible despite continued treatment. Therapy with phenothiazines should be administered cautiously, if at all, in patients with preexisting blood dyscrasias or bone marrow suppression. Complete blood counts should be obtained regularly, and patients should be instructed to immediately report any signs or symptoms suggestive of blood dyscrasia such as fever, sore throat, local infection, bleeding, pallor, dizziness, or jaundice. Most cases of agranulocytosis have occurred between the fourth and tenth weeks of therapy.

References

  1. Yassa R "Agranulocytosis in the course of phenothiazine therapy." J Clin Psychiatry 46 (1985): 341-3
  2. Holt RJ "Fluphenazine decanoate-induced cholestatic jaundice and thrombocytopenia." Pharmacotherapy 4 (1984): 227-9
  3. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  4. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  5. Rosenthal DS, Stein GF, Santos JC "Thioridazine agranulocytosis." JAMA 200 (1967): 81-2
  6. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  7. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  8. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  9. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  10. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  11. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  12. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  13. Stein P, Inwood M "Hemolytic anemia associated with chlorpromazine therapy." Can J Psychiatry 25 (1980): 659-61
  14. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  15. Young A, Kehoe R "Two cases of agranulocytosis on addition of a butyrophenone to a long-standing course of phenothiazine treatment." Br J Psychiatry 154 (1989): 710-12
  16. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  17. Holt R "Neuroleptic drug-induced changes in platelet levels." J Clin Psychopharmacol 4 (1984): 130-2
  18. Zengotita H, Holt R "Neuroleptic drug-induced coagulopathy: mechanism of reaction and duration of effect." J Clin Psychiatry 47 (1986): 35-7
  19. Aram H "Henoch-Schonlein purpura induced by chlorpromazine." J Am Acad Dermatol 17 (1987): 139-40
  20. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  21. Ben-Yehuda A, Bloom A, Lijhovetzky G, et al "Chlorpromazine-induced liver and bone marrow granulomas associated with agranulocytosis." Isr J Med Sci 26 (1990): 449-51
View all 21 references
Moderate

Phenothiazines (Includes Mepergan) ↔ Liver Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease

Phenothiazines are extensively metabolized by the liver and may accumulate in patients with hepatic impairment. In addition, the use of some phenothiazines has been associated with adverse hepatic effects including cholestatic jaundice and elevated liver enzymes, generally within the first few months of therapy. Cholestatic jaundice usually occurs between the second and fourth weeks of therapy in approximately 0.1% to 4% of all patients. Therapy with phenothiazines should be administered cautiously in patients with preexisting liver disease, liver enzyme abnormalities, or hepatitis. Liver function and urine bilirubin tests should be performed periodically during prolonged therapy, and patients should be instructed to immediately report any signs or symptoms suggestive of cholestatic jaundice such as upper abdominal pain, nausea, yellow skin, influenza-like symptoms, rash, and fever. Phenothiazine therapy should be discontinued, preferably permanently, if jaundice occurs and is attributable to the drug. Clinical recovery is usually observed within a few weeks following withdrawal of therapy, although histopathologic changes may persist for longer periods.

References

  1. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  2. Barancik M, Brandborg LL, Albion MJ "Thioridazine-induced cholestasis." JAMA 200 (1967): 69-70
  3. Snyder S "Fluphenazine jaundice. Report of a case." Am J Gastroenterol 73 (1980): 336-40
  4. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  5. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  6. Maxwell JD, Carrella M, Parkes JD, et al "Plasma disappearance and cerebral effects of chlorpromazine in cirrhosis." Clin Sci 43 (1972): 143-51
  7. Dossing M, Andreasen B "Drug-induced liver disease in Denmark." Scand J Gastroenterol 17 (1982): 205-11
  8. Derby LE, Gutthann SP, Jick H, Dean AD "Liver disorders in patients receiving chlorpromazine or isoniazid." Pharmacotherapy 13 (1993): 353-8
  9. Lok AS, Ng IO "Prochlorperazine-induced chronic cholestasis." J Hepatol 6 (1988): 369-73
  10. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  11. Simpson GM, Yadalam KG, Levinson DF, et al "Single-dose pharmacokinetics of fluphenazine after fluphenazine decanoate administration." J Clin psychopharmacol 10 (1990): 417-21
  12. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  13. Taylor G, Houston JB, Shaffer J, Mawer G "Pharmacokinetics of promethazine and its sulphoxide metabolite after intravenous and oral administration to man." Br J Clin Pharmacol 15 (1983): 287-93
  14. Bach N, Thung S, Schaffner F, Tobias H "Exaggerated cholestasis and hepatic fibrosis following simultaneous administration of chlorpromazine and sodium valproate." Dig Dis Sci 34 (1989): 1303-7
  15. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  16. Chetty M, Moodley SV, Miller R "Important metabolites to measure in pharmacodynamic studies of chlorpromazine." Ther Drug Monit 16 (1994): 30-6
  17. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  18. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  19. Holt RJ "Fluphenazine decanoate-induced cholestatic jaundice and thrombocytopenia." Pharmacotherapy 4 (1984): 227-9
  20. Reinhart MJ, Benson RM, Kwass SK, Storey WF "Suggestive evidence of hepatotoxicity concomitant with thioridazine hydrochloride use." JAMA 197 (1966): 767-9
  21. Seeff L "Drug-induced chronic liver disease, with emphasis on chronic active hepatitis." Semin Liver Dis 1 (1981): 104-15
  22. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  23. Moradpour D, Altorfer J, Flury R, Greminger P, Meyenberger C, Jost R, Schmid M "Chlorpromazine-induced vanishing bile duct syndrome leading to biliary cirrhosis." Hepatology 20 (1994): 1437-41
  24. Podevin P, Biour M "Drug-induced ''allergic hepatitis''." Clin Rev Allergy Immunol 13 (1995): 223-44
  25. Hu OY, Tang H-S, Sheeng T-Y, et al "Pharmacokinetics of promazine I: disposition in patients with acute viral hepatitis B." Biopharm Drug Dispos 11 (1990): 557-68
  26. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  27. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  28. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  29. Whitfield LR, Kaul PN, Clark ML "Chlorpromazine metabolism IX: pharmacokinetics of chlorpromazine following oral administration in man." J Pharmacokinet Biopharm 6 (1978): 187-96
View all 29 references
Moderate

Phenothiazines (Includes Mepergan) ↔ Nms

Moderate Potential Hazard, Moderate plausibility

Applies to: Neuroleptic Malignant Syndrome

The central dopaminergic blocking effects of phenothiazines may precipitate or aggravate a potentially fatal symptom complex known as Neuroleptic Malignant Syndrome (NMS). NMS is observed most frequently when high-potency neuroleptic agents like haloperidol or fluphenazine are administered intramuscularly but may occur with any agent possessing neuroleptic activity given for any length of time. Clinical manifestations of NMS include hyperpyrexia, muscle rigidity, altered mental status and autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac arrhythmias). Phenothiazine therapy should not be initiated in patients with active NMS and should be immediately discontinued if currently being administered in such patients. In patients with a history of NMS, introduction or reintroduction of phenothiazines should be carefully considered, since NMS may recur.

References

  1. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  2. Rampertaap MP "Neuroleptic malignant syndrome." South Med J 79 (1986): 331-6
  3. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  4. Grunhaus L, Sancovici S, Rimon R "Neuroleptic malignant syndrome due to depot fluphenazine." J Clin Psychiatry 40 (1979): 99-100
  5. Zubenko G, Pope HG, Jr "Management of a case of neuroleptic malignant syndrome with bromocriptine." Am J Psychiatry 140 (1983): 1619-20
  6. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  7. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  8. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  9. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  10. Morris H, McCormick W, Reinarz J "Neuroleptic malignant syndrome." Arch Neurol 37 (1980): 462-3
  11. Caroff SN "The neuroleptic malignant syndrome." J Clin Psychiatry 41 (1980): 79-83
  12. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  13. Tenenbein M "The neuroleptic malignant syndrome: occurrence in a 15-year-old boy and recovery with bromocriptine therapy." Pediatr Neurosci 12 (1985): 161-4
  14. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  15. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  16. Price W, Giannini A "A paradoxical response to chlorpromazine: a possible variant of the neuroleptic malignant syndrome." J Clin Pharmacol 23 (1983): 567-9
  17. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  18. Manser TJ, Warner JF "Neuroleptic malignant syndrome associated with prochlorperazine." South Med J 83 (1990): 73-4
  19. Dhib-Jalbut S, Hesselbrock R, Brott T, Silbergeld D "Treatment of the neuroleptic malignant syndrome with bromocriptine" JAMA 250 (1983): 484-5
  20. Caroff S, Rosenberg H, Gerber JC "Neuroleptic malignant syndrome and malignant hyperthermia" Lancet 1 (1983): 244
  21. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  22. West D "Dangers of fluphenazine." Br J Psychiatry 117 (1970): 718-9
  23. Granato JE, Stern BJ, Ringel A, Karim AH, Krumholz A, Coyle J, Adler S "Neuroleptic malignant syndrome: successful treatment with dantrolene and bromocriptine." Ann Neurol 14 (1983): 89-90
  24. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
View all 24 references
Moderate

Phenothiazines (Includes Mepergan) ↔ Parkinsonism

Moderate Potential Hazard, Moderate plausibility

Applies to: Parkinsonism

The use of phenothiazines is associated with pseudo-parkinsonian symptoms such as akinesia, bradykinesia, tremors, pill-rolling motion, cogwheel rigidity, and postural abnormalities including stooped posture and shuffling gait. The onset is usually 1 to 2 weeks following initiation of therapy or an increase in dosage. Propylamino derivatives such as chlorpromazine, promazine, and triflupromazine may be more likely to induce these effects. Therapy with phenothiazines should be administered cautiously in patients with Parkinson's disease or parkinsonian symptoms.

References

  1. Schwinghammer TL, Kroboth FJ, Juhl RP "Extrapyramidal reaction secondary to oral promethazine." Clin Pharm 3 (1984): 83-5
  2. Edelstein H, Knight RT "Severe parkinsonism in two AIDS patients taking prochlorperazine." Lancet 2 (1987): 341-2
  3. Oyewumi LK, Lapierre YD, Gray R, Batth S, Gelfand R "Abnormal involuntary movements in patients on long-acting neuroleptics." Prog Neuropsychopharmacol Biol Psychiatry 7 (1983): 719-23
  4. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  5. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  7. Marcotte DB "Neuroleptics and neurologic reactions." South Med J 66 (1973): 321-4
  8. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  9. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  10. Baker FM, Cook P "Compazine complications: a review." J Natl Med Assoc 73 (1981): 409-12
  11. Sheppard C, Merlis S "Drug-induced extrapyramidal symptoms: their incidence and treatment." Am J Psychiatry 123 (1967): 886-9
  12. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  13. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  14. Lamb P, Mindham RH, Ezzat MA "Letter: Parkinsonism induced by fluphenazine decanoate." Lancet 1 (1976): 484
  15. Boston Collaborative Drug Surveillance Program "Drug-induced extrapyramidal symptoms." JAMA 224 (1973): 889-91
  16. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  17. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  18. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  19. Mariani P "Adverse reactions to chlorpromazine in the treatment of migraine." Ann Emerg Med 17 (1988): 380-1
  20. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  21. Curson DA, Barnes TR, Bamber RW, Platt SD, Hirsch SR, Duffy JC "Long-term depot maintenance of chronic schizophrenic out-patients: the seven year follow-up of the Medical Research Council fluphenazine/placebo trial. II. The incidence of compliance problems,side-effects, neurotic symptoms and depression" Br J Psychiatry 146 (1985): 469-74
  22. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  23. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  24. Rajput A, Rozdilsky B, Hornykiewicz O, et al "Reversible drug-induced parkinsonism." Arch Neurol 39 (1982): 6446
View all 24 references
Moderate

Phenothiazines (Includes Mepergan) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Phenothiazines and their metabolites are excreted by the kidney. There are very limited data concerning the use of phenothiazines in patients with renal disease. Therapy with phenothiazines should be administered cautiously in patients with significantly impaired renal function. The manufacturers recommend periodic renal function tests for all patients during prolonged therapy.

References

  1. Dorson P, Crismon M "Chlorpromazine accumulation and sudden death in a patient with renal insufficiency." Drug Intell Clin Pharm 22 (1988): 776-8
  2. McAllister CJ, Scowden EB, Stone WJ "Toxic psychosis induced by phenothiazine administration in patients with chronic renal failure." Clin Nephrol 10 (1978): 191-5
  3. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  4. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  5. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  6. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  7. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  8. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  9. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  10. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  11. Fabre J, Freudenreich J, de Duckert A, Pitton JS, Rudhardt M, Virieux C "Influence of renal insufficiency on the excretion of chloroquine, phenobarbital, phenothiazines and methacycline." Helv Med Acta 33 (1967): 307-16
  12. Taylor G, Houston JB, Shaffer J, Mawer G "Pharmacokinetics of promethazine and its sulphoxide metabolite after intravenous and oral administration to man." Br J Clin Pharmacol 15 (1983): 287-93
  13. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  14. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  15. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  16. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
View all 16 references
Moderate

Phenothiazines (Includes Mepergan) ↔ Seizure Disorders

Moderate Potential Hazard, Moderate plausibility

Applies to: CNS Disorder

Phenothiazines can lower the seizure threshold and induce seizures, particularly when dosages are high or increased rapidly and during the initiation of therapy. Of the phenothiazines used in the treatment of psychosis, chlorpromazine appears to have the greatest epileptogenic potential, while fluphenazine and thioridazine have the least. Therapy with phenothiazines should be administered cautiously in patients with a history of seizures or other factors predisposing to seizures such as abnormal EEG, preexisting CNS pathology, or head trauma. Adequate anticonvulsant therapy should be maintained during administration of phenothiazines.

References

  1. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  2. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  3. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  4. Markowitz J, Brown R "Seizures with neuroleptics and antidepressants." Gen Hosp Psychiatry 9 (1987): 135-41
  5. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  6. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  7. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  8. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  9. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  10. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  11. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  12. Waterhouse RG "Epileptiform convulsions in children following premedication with Pamergan SP100." Br J Anaesth 39 (1967): 268-70
  13. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  14. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  15. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  16. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  17. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  18. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
View all 18 references
Moderate

Phenothiazines (Includes Mepergan) ↔ Tardive Dyskinesia

Moderate Potential Hazard, Moderate plausibility

Applies to: Tardive Dyskinesia

Phenothiazines may commonly precipitate symptoms of tardive dyskinesia (TD), a syndrome consisting of rhythmic involuntary movements variously involving the tongue, face, mouth, lips, jaw, and/or trunk and extremities, following chronic use of at least several months but often years. Elderly patients, particularly women, are most susceptible. Also, propylpiperazine derivatives like fluphenazine, perphenazine, prochlorperazine, and trifluoperazine may be more likely to induce this syndrome. Both the risk of developing TD and the likelihood that it will become irreversible increase with the duration and total cumulative dose of phenothiazine therapy administered. However, patients may infrequently develop symptoms after relatively brief treatment periods at low dosages. If TD occurs during phenothiazine therapy, prompt withdrawal of the offending agent or at least a lowering of the dosage should be considered. TD symptoms usually become more severe after drug discontinuation or a dosage reduction, but may gradually improve over months to years. In patients with preexisting drug-induced TD, initiating or increasing the dosage of phenothiazine therapy may temporarily mask the symptoms of TD but may eventually worsen the condition. The newer, atypical neuroleptic agents (e.g., risperidone, quetiapine, olanzapine) tend to be associated with a substantially reduced risk of inducing TD and are considered the drugs of choice in patients being treated for psychosis.

References

  1. Oyewumi LK, Lapierre YD, Gray R, Batth S, Gelfand R "Abnormal involuntary movements in patients on long-acting neuroleptics." Prog Neuropsychopharmacol Biol Psychiatry 7 (1983): 719-23
  2. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  3. Schwinghammer TL, Kroboth FJ, Juhl RP "Extrapyramidal reaction secondary to oral promethazine." Clin Pharm 3 (1984): 83-5
  4. Mukherjee S, Rosen AM, Cardenas C, Varia V, Olarte S "Tardive dyskinesia in psychiatric outpatients: a study of prevalence and association with demographic, clinical, and drug history variables." Arch Gen Psychiatry 39 (1982): 466-9
  5. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  6. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  7. Yesavage JA, Tanke ED, Sheikh JI "Tardive dyskinesia and steady-state serum levels of thiothixene." Arch Gen Psychiatry 44 (1987): 913-5
  8. Boston Collaborative Drug Surveillance Program "Drug-induced extrapyramidal symptoms." JAMA 224 (1973): 889-91
  9. Csernansky JG, Grabowski K, Cervantes J, Kaplan J, Yesavage JA "Fluphenazine decanoate and tardive dyskinesia: a possible association." Am J Psychiatry 138 (1981): 1362-5
  10. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  11. Yassa R, Iskandar H, Ally J "The prevalence of tardive dyskinesia in fluphenazine-treated patients." J Clin Psychopharmacol 8 (1988): 17S-20S
  12. Baker FM, Cook P "Compazine complications: a review." J Natl Med Assoc 73 (1981): 409-12
  13. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  14. Sheppard C, Merlis S "Drug-induced extrapyramidal symptoms: their incidence and treatment." Am J Psychiatry 123 (1967): 886-9
  15. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  16. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  17. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  18. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  19. Curson DA, Barnes TR, Bamber RW, Platt SD, Hirsch SR, Duffy JC "Long-term depot maintenance of chronic schizophrenic out-patients: the seven year follow-up of the Medical Research Council fluphenazine/placebo trial. II. The incidence of compliance problems,side-effects, neurotic symptoms and depression" Br J Psychiatry 146 (1985): 469-74
  20. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  21. Perenyi A, Arato M "Fluphenazine and tardive dyskinesia" Arch Gen Psychiatry 41 (1984): 727
  22. Yassa R, Dimitry R "Single phenothiazines and tardive dyskinesia." J Clin Psychiatry 44 (1983): 233-4
  23. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  24. Glazer WM, Moore DC "The diagnosis of rapid abnormal involuntary movements associated with fluphenazine decanoate." J Nerv Ment Dis 168 (1980): 439-41
  25. McClelland HA, Metcalfe AV, Kerr TA, Dutta D, Watson P "Facial dyskinesia: a 16-year follow-up study" Br J Psychiatry 158 (1991): 691-6
  26. Mariani P "Adverse reactions to chlorpromazine in the treatment of migraine." Ann Emerg Med 17 (1988): 380-1
  27. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  28. Marcotte DB "Neuroleptics and neurologic reactions." South Med J 66 (1973): 321-4
  29. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  30. Kolakowska T, Williams AO, Ardern M "Tardive dyskinesia and current dose of neuroleptic drugs" Arch Gen Psychiatry 42 (1985): 925
View all 30 references
Moderate

Promethazine (Includes Mepergan) ↔ Antidopaminergic Effects 2

Moderate Potential Hazard, Low plausibility

Applies to: Parkinsonism

Promethazine has weak central antidopaminergic activity. While its use is rarely associated with adverse effects secondary to dopaminergic blockade, large doses have produced extrapyramidal reactions. During chronic administration and/or high-dose therapy, the usual contraindications, warnings and precautions applicable to phenothiazines should be observed with promethazine.

References

  1. Schwinghammer TL, Kroboth FJ, Juhl RP "Extrapyramidal reaction secondary to oral promethazine." Clin Pharm 3 (1984): 83-5
  2. Nicholson AN "Central effects of H1 and H2 antihistamines." Aviat Space Environ Med 56 (1985): 293-8
  3. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.

Mepergan (meperidine / promethazine) drug Interactions

There are 1224 drug interactions with Mepergan (meperidine / promethazine)

Mepergan (meperidine / promethazine) alcohol/food Interactions

There is 1 alcohol/food interaction with Mepergan (meperidine / promethazine)

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.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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