Re: Dixie/All Medical Info on Oxycontin

July 16, 2004

Not only do we have the problem of not getting the truth about the meds we

take, we also have the problem that there is so much bad information out

there. I have read so many conflicting stories and it makes it hard to

decipher the truth from someone¹s opinion. I don¹t think anyone disputes

or doubts that you read what you read, however the author of the articles

could have an opinion of his own not based on medical research. I¹ve been

sending in medical articles to the group for many years, and many of them

conflict. Some are written by conventional doctors and some by alternative.

They view the same information much differently. I send in many different

views to show both sides of the story. Once someone is educated to the

various sides, only then can an educated decision be made.

I am the victim of narcophobic doctors. My rheumy had no problem

prescribing narcotic pain medicine to me for 15 years, but then all of a

sudden he stopped prescribing then to ANYONE. My pain has never been

adequately treated and I feel my quality of life suffers for it. I¹ve read

so many stories of people that take oxycontin and can work full time. If my

pain was treated, maybe I could return to work.

It is not fair that people that abuse drugs have made it impossible for

legitimate pain victims to get treatment. It is not fair that we are

labeled abusers because we want our pain treated. With the severe drug

problem we have in the country, the DEA should have it¹s hands full stopping

the illegal import of the drugs, NOT closing the pharmacy doors in the faces

of pain patients. Oxycontin has been a miracle for so many people but the

negative press fueled by the news media makes us all sound like addicts.

All information is welcome here, all sides and all opinions. But when a

statement is made of the medical effect such as rearranging our molecular

structure, we need to know the source of the information so that we can made

an educated decision about the information. Many times I¹ve read something

in the passed and have talked about it in general conversation, but I¹ll add

something like ³I once read that this could happen. I don¹t know if it¹s

true, but I remember reading it.² When and I read something like that,

we try our best to find out about it and post the links.

This is a very interesting view on oxycontin:

Oxycontin: The Politics, Science, and Sensationalization of an Abusable

Pharmaceutical

http://opioids.com/oxycodone/oxycontin.htm

a

> First of all I have to say that medical articles don't always include all of

> the truth about the drugs out there. The FDA doesn't even know or disclose

> half of the problems with the drugs until their out on the market for a few

> years.

>

> What I would like to say about oxycontin, once again, is that I KNOW what I

> read 2 years ago when I was on it which is what prompted me to get off of it

> quickly. I only WISH I had saved that article to share with this group.

> Hindsite is foresite.

>

> What I DON'T appreciate is being told directly or indirectly that I'm not

> telling the truth (ie: that I didn't read that oxycontin does what it does). I

> didn't pull this information out of thin air, nor am I a nut case. I simply

> believe in looking at both sides of all treatments that I need to utilize and

> then make my own informed choices from that. Again, I do no wish to impose my

> beliefs on anyone at all. I simply thought I was trying to be helpful in

> providing my experience with the drug.

>

> It IS known that oxycontin is a highly dangerous drug (as are many out there,

> cortisone included, which I'm currently on), and we should all look at both

> sides of the issue...not just assume " well I have to take it so I'm going to

> stick my head in the sand " , or not disclose ALL info to be politicially

> correct. Quite honestly, if that's the case I will not choose to be a part of

> a group that does that.

>

> Since reading this email this morning from Dixie, my first instinct was to be

> hurt at being indirectly called a liar by her saying that Oxycontin does NOT

> rearrange the molecules in your body (actually it does and it does so

> permanantly and I'm still going to continue to search for the articles). That

> was hurtful to me and I didn't appreciate that. As I said before, all medical

> articles are NOT required to disclose ALL information...if that were true

> there wouldn't be numerous lawsuits against oxycontin and other drugs (case in

> point Phen Phen...it was out on the market for years before they knew or

> disclosed what it really does to your body!). I, on the other hand, urge all

> of you as well as Dixie to be more open minded about the way you view the

> input of your group members as well as doing more research yourselves and not

> just stopping at the one article that doesn't say anything about negative side

> effects. Again, sticking our heads in the sand doesn't help any of us.

>

> As far as some of the other side effects, ie: kicking oxycontin being harder

> then kicking heroin...yes, I know it first hand and there are tons of articles

> on that out there...here's an excerpt from one:

> " OxyContin Withdrawal

> OxyContin withdrawal symptoms are as serious as heroin withdrawal and are not

> to be taken lightly - they are chemically very similar. Just as with heroin

> addiction, OxyContin withdrawal is something very few people can get through

> without medical help and supervision. Those who have attempted, or perhapes

> eve succedeed in quitting, have experienced some or all of the following

> OxyContin withdrawal symptoms:

>

> muscle and bone pain

> restlessness

> diarrhea

> insomnia

> vomiting

> cold flashes

> involuntary leg movements

> These and other severe " flu " like symptoms can be minimized or avoided under

> proper medical supervision called detoxification. OxyContin withdrawal is not

> a process you can go through on you own easily, " sweating it out " in your

> bedroom over the weekend, and expect to be successful in beating your

> addiction. Very few people can manage, as it is a very individual and

> frightening experience. If you know or suspect that you might be an OxyContin

> addict, the Pharma-Help Team urges you to seek medical advice and assitance.

> It will be the best decision you ever take. "

>

> This is taken from http://shop.pharma-help.com/oxycontin/oxycontin-addiction-

> and-abuse.

>

> I was only on it for 2 months which is a very short period of time and had

> this happen to me. My husband can attest to it...it was a nightmare.

>

> Again...if we have to be on certain drugs and it IMPROVES the quality of our

> lives, then that's one thing. AGAIN...all I'm saying is BE AWARE of what

> you're putting in your body...not just the good side, but both sides of the

> story.

>

> Hugs-

> Ivy

>

> Quoting Dixie <dix7chix@...>:

>

>> >

>> > PLEASE NOTE: The following article is the medical information provided

>> > to medical professionals about OxyContin. There is NO indication that it

>> > rearranges molecules in the body. If that were something that happened

>> with

>> > this medication, it would be required by law to be included with this

>> > information.

>> >

>> > Also note: See section on abuse.

>> >

>> > Final Note: OxyContin is bsically the same drug as percocet - the

>> > difference is that Oxy is extended release over 12 hours, while Percocet

>> > (Lorcet & other names) works immediately, but lasts for about 4-6 hours.

>> >

>> > BOTH Oxy and Percocet are completely safe medications to use if taken

>> > exactly as prescribed. If the pain doesn't get to a tolerable level, it's

>> > generally advised to take an extra-strength Tylenol. In a double blind

>> > research study, patients who received Tylenol rated it's effectiveness as

>> > 8.5, while patients receiving Tylenol 3 (with codeine) rated its

>> > effectiveness 9.

>> >

>> > Dix

>> >

>> > NARCOTIC ANALGESICS

>> >

>> > OxyContin (oxycodone hydrochloride) C-II

>> >

>> > Tablets (controlled-release): 10, 20, 40, 80 mg

>> >

>> > Manufacturer: Purdue Pharma

>> >

>> ----------------------------------------------------------------------------

>> >

>> > Indications/Dosage/Administration

>> >

>> > Moderate to severe pain: In patients not already taking opioids, 10 mg

>> > q12h; a nonopioid analgesic or a NSAID may be continued. If the current

>> > nonopioid is discontinued, early upward dose titration may be needed. In

>> > patients taking fixed ratio opioid/nonopioid combination drugs, if patients

>> > are taking 1-5 tablets/capsules/caplets daily of a regular strength drug,

>> > 10-20 mg q12h. For patients taking 6-9 tablets/capsules/caplets daily of a

>> > regular strength drug, consider using 20-30 mg q12h. For those taking 10-12

>> > tablets/capsules/caplets daily, consider using 30-40 mg q12h. The nonopioid

>> > may be continued as a separate drug, or a different nonopioid may be

>> > selected. If the current nonopioid is discontinued, early upward dose

>> > titration may be needed.

>> >

>> > Drug is indicated for moderate to severe pain where use of an opioid

>> > analgesic is appropriate for more than a few days.

>> >

>> > Administration: Swallow tablets whole; do not break, chew, or crush.

>> > Using broken, chewed, or crushed tablets could lead to rapid release and

>> > absorption of a potentially toxic dose of oxycodone. Rectal administration

>> of

>> > tablets is not recommended.

>> >

>> > Initiation of therapy: When starting therapy, consider patient's

>> general

>> > condition and medical status; daily dose, potency, and type of analgesic(s)

>> > the patient has been taking; reliability of conversion estimate used to

>> > calculate oxycodone dose; patient's opioid exposure and tolerance (if any),

>> > and balance between pain control and adverse experiences.

>> >

>> > Titration of dosage: Titrate to mild or no pain with regular use of no

>> > more than 2 doses of supplemental analgesia/24h. Have rescue medication

>> > available. Because steady-state plasma concentrations are approximated

>> within

>> > 24-36 h, dosage may be adjusted every 1-2 days. It is appropriate to

>> increase

>> > the q12h dose, not the dosing frequency. There is no clinical information

>> on

>> > dosing intervals shorter than q12h. Except for increase from 10 mg to 20 mg

>> > q12h, the total daily oxycodone dose usually can be increased by 25-50% of

>> > the current dose at each increase. If signs of excessive adverse

>> experiences

>> > are seen, the next dose may be reduced. If this adjustment leads to

>> > inadequate analgesia, a supplemental dose of immediate-release oxycodone >>

may

>> > be given, or nonopioid analgesics may be used. Adjust dose to obtain an

>> > appropriate balance between pain relief and opioid-related adverse effects.

>> >

>> > Use of 80-mg controlled-release tablets: This dosage strength is for >>

use

>> > only in opioid-tolerant patients requiring daily oxycodone-equivalent

>> dosages

>> > of 160 mg or more; use caution. Advise patients against use by others than

>> > for whom it was prescribed; such inappropriate use may have severe medical

>> > consequences.

>> >

>> > Dosing intervals: While symmetric, around-the-clock, q12h dosing is

>> > appropriate for many patients, some patients may benefit from asymmetric

>> > dosing tailored to their pain pattern. It is usually appropriate to treat a

>> > patient with only one opioid for around-the-clock therapy.

>> >

>> > Elderly or debilitated patients: Reduce starting dose to 33-50% of

>> usual

>> > dose in debilitated, nontolerant patients.

>> >

>> > Hepatic impairment: Reduce starting dose to 33-50% of usual dose and

>> > carefully titrate dose.

>> >

>> > Renal impairment: In patients with Ccr < 60 ml/min, concentrations of

>> > oxycodone in plasma are ~ 50% higher than those with normal function.

>> > Conservatively start therapy, and adjust dosage according to clinical

>> > situation.

>> >

>> > Gender differences: In pharmacokinetic studies, opioid-naive females

>> > demonstrated up to 25% higher average plasma concentrations and greater

>> > frequency of adverse events than males, even after adjustment for body

>> > weight; clinical relevance is low.

>> >

>> > Patients currently on opioid therapy: If a patient has been receiving

>> > opioid-containing medications before controlled-release oxycodone therapy,

>> > determine total daily dose of other opioids. Using standard conversion

>> ratio

>> > estimates, multiply mg/day of previous opioids by appropriate

>> multiplication

>> > factors to obtain the equivalent total daily dose of oral oxycodone.

>> >

>> > Multiplication Factors for Converting the Daily Dose

>> >

>> > of Prior Opioids to the Daily Dose of Oral Oxycodone*

>> >

>> > Mg/Day Prior Opioid × Factor = Mg/day Oral Oxycodone

>> >

>> > Drug Oral Prior Opioid Parenteral Prior Opioid Transdermal Prior

>> > Opioid

>> >

>> > Oxycodone 1 - -

>> >

>> > Codeine 0.15 - -

>> >

>> > Fentanyl TTS - - 18 h after removal of transdermal fentanyl

>> patch,

>> > approximately 10 mg of oxycodone q12h can be substituted for each 25 µg/h

>> of

>> > transdermal fentanyl to start. Follow patient closely.

>> >

>> > Hydrocodone 0.9 - -

>> >

>> > Hydromorphone 4 20 -

>> >

>> > Levorphanol 7.5 15 -

>> >

>> > Meperidine 0.1 0.4 -

>> >

>> > Methadone 1.5 3 -

>> >

>> > Morphine 0.5 3 -

>> >

>> > * To be used for converting to oral oxycodone only. For patients

>> > receiving high-dose parenteral opioids, a more conservative conversion

>> should

>> > be used. For example, for high-dose parenteral morphine, use 1.5 instead of

3

>> > as a multiplication factor.

>> >

>> > Divide 24-h dose in half to obtain q12h dose; round down to a dose

>> > appropriate for tablet strengths; and discontinue all other

>> around-the-clock

>> > opioid drugs when oxycodone is initiated. In all cases, immediate-release

>> > oral oxycodone or another suitable short-acting analgesic should be made

>> > available. If pain recurs, dose can be incrementally increased to

>> reestablish

>> > pain control.

>> >

>> > Supplemental analgesia: Most cancer patients given around-the-clock

>> > therapy with controlled-release opioid need to have immediate-release

>> > medication available for rescue from breakthrough pain or to prevent pain

>> > that occurs predictably during certain patient activities.

>> Immediate-release

>> > oxycodone may be use alone or with acetaminophen, aspirin, or other NSAIDs

>> as

>> > a supplemental analgesic. Prescribe the supplemental analgesic at 25-33% of

>> > the 12-h controlled-release oxycodone dose shown below.

>> >

>> > Table of Appropriate Supplemental Analgesia

>> >

>> > OxyContin q12h dose (mg) prn Rescue dose of immediate-release

>> > oxycodone (mg)

>> >

>> > 10 (1×10 mg) 5

>> >

>> > 20 (2×10 mg) 5

>> >

>> > 30 (3×10 mg) 10

>> >

>> > 40 (2×20 mg) 10

>> >

>> > 60 (3×20 mg) 15

>> >

>> > 80 (2×40 mg) 20

>> >

>> > 120 (3×40 mg) 30

>> >

>> > 160 (2×80 mg) 40

>> >

>> > 240 (3×80 mg) 60

>> >

>> > Use rescue medication as needed for breakthrough pain and 1 h before

>> > anticipated pain. If more than 2 doses of rescue medication are needed

>> within

>> > 24 h, titrate dose of controlled-release oxycodone upward.

>> >

>> > Discontinuation: When patient no longer requires controlled-release

>> > oxycodone, patients receiving doses of 20-60 mg/day can usually have

>> therapy

>> > stopped abruptly without incident; taper higher doses over several days to

>> > prevent signs and symptoms of withdrawal in physically dependent patients.

>> > Reduce daily dose by ~ 50% for the first 2 days and then by 25% every 2

>> days

>> > thereafter until total dose reaches 10 or 20 mg q12h. Therapy can then be

>> > discontinued. If signs of withdrawal appear, stop tapering, and slightly

>> > increase dose until signs and symptoms of opioid withdrawal disappear;

>> begin

>> > tapering again, but with longer time periods between each dose reduction.

>> >

>> > Conversion to parenteral opioids: To avoid overdose, follow

>> conservative

>> > dose conversion ratios. Initiate therapy with ~ 50% of estimated

>> > equianalgesic daily dose of parenteral opioid divided into suitable

>> > individual doses based on appropriate dosing interval, and titrate based

>> upon

>> > patient's response.

>> >

>> ----------------------------------------------------------------------------

>> >

>> > Patient Monitoring

>> >

>> > General: Reassess need for around-the-clock opioid therapy every 6-12

>> mo,

>> > as appropriate. Regularly and systematically assess patient, considering

>> > patient's own reports of pain and side effects. Advise patient to report

>> > breakthrough pain and adverse experiences. Advise women of childbearing

>> > potential to consult their physician before becoming pregnant.

>> >

>> > Blood: Plasma oxycodone measurements usually are not helpful in

>> clinical

>> > management. Plasma concentrations of active drug may be of value in

>> selected,

>> > unusual, or complex cases.

>> >

>> ----------------------------------------------------------------------------

>> >

>> > General Considerations

>> >

>> > Hypersensitivity: Contraindicated in patient with known

>> hypersensitivity

>> > to oxycodone.

>> >

>> > Inappropriate uses: Contraindicated in any situation where opioids are

>> > contraindicated. Drug is not indicated for managing addictive disorders.

>> >

>> > Respiratory impairment: Contraindicated in patients with significant

>> > respiratory depression in unmonitored settings or in the absence of

>> > resuscitative equipment and in those with acute or severe bronchial asthma

>> or

>> > hypercarbia. Respiratory depression is the chief hazard of all opioid

>> > agonists and occurs most frequently in elderly or debilitated patients,

>> > usually following large initial doses in nontolerant patients, or when

>> > opioids are given with other agents that depress respiration. Use extreme

>> > caution in patients with significant COPD or cor pulmonale and in patients

>> > with a substantially decreased respiratory reserve, hypoxia, hypercapnia,

>> or

>> > preexisting respiratory depression. In such patients, even usual

>> therapeutic

>> > doses of morphine may increase airway resistance and decrease respiratory

>> > drive to the point of apnea; consider use of alternative opioid analgesics,

>> > and use only under careful supervision at lowest effective dose.

>> >

>> > Patient selection: Opioids given on a fixed-dosage level have a narrow

>> > therapeutic index in certain populations, especially when combined with

>> other

>> > drugs; reserve for cases where benefits outweigh risks. Use caution in

>> > patients with acute alcoholism, adrenocortical insufficiency (eg, 's

>> > disease), CNS depression or coma, delirium tremens, debilitation,

>> > kyphoscoliosis associated with respiratory depression, myxedema or

>> > hypothyroidism, prostatic hypertrophy or urethral stricture, severe

>> hepatic,

>> > pulmonary, or renal dysfunction, and toxic psychosis.

>> >

>> > Head injury, increased intracranial pressure: Respiratory depressant

>> > effects of opioids with carbon dioxide retention and secondary elevation of

>> > CSF pressure may be markedly exaggerated in the presence of head injury,

>> > intracranial lesions, or a preexisting increase in intracranial pressure.

>> > Neurologic signs of further increases in pressure in patients with head

>> > injuries may be obscured.

>> >

>> > Postoperative use: Morphine and other opioids may decrease bowel

>> > motility. Ileus commonly occurs postoperatively, especially following

>> > intra-abdominal surgery with opioid analgesia. Cautiously monitor patient

>> > postoperatively for decreased bowel motility during opioid use. Institutte

>> > standard supportive therapy.

>> >

>> > Hypotension: Severe hypotension may occur in patients with compromised

>> > ability to maintain blood pressure because of depleted blood volume or

>> > concurrent use of drugs such as phenothiazines or other agents that

>> > compromise vasomotor tone. Orthostatic hypotension may occur in ambulatory

>> > patients. Use caution in patients with circulatory shock.

>> >

>> > Abdominal conditions: Administration may obscure diagnosis or clinical

>> > course in patients with acute abdominal conditions.

>> >

>> > Paralytic ileus: Contraindicated in any patient who has or is suspected

>> > of having paralytic ileus.

>> >

>> > Convulsive disorders: Drug may aggravate preexisting conditions in

>> > patients with convulsive disorders; all opioids may induce or aggravate

>> > seizures in some clinical settings.

>> >

>> > Ambulatory surgery: Use of this drug is not recommended preoperatively

>> or

>> > for management of pain in the first 12-24 h postsurgery in patients not

>> > previously taking the drug. Patients already receiving this product as part

>> > of ongoing analgesia may be safely continued if appropriate adjustments are

>> > made considering procedure, other drugs given, and temporary changes in

>> > physiology caused by the surgical intervention.

>> >

>> > Pancreatic/biliary tract disease: Drug may cause spasm of sphincter of

>> > Oddi; use caution in patients with biliary tract disease, including acute

>> > pancreatitis. Drug may cause increased serum amylase level.

>> >

>> > Tolerance: Significant tolerance should not occur in most patients

>> given

>> > lowest oxycodone doses. A fraction of cancer patients develop some degree

>> of

>> > tolerance and require progressively higher doses. Dosages can usually be

>> > increased safely to maintain an acceptable balance between pain relief and

>> > side effects. Tolerance to analgesia is usually paralleled by tolerance to

>> > side effects, except for constipation.

>> >

>> > Physical dependence: Dependence results in withdrawal symptoms in

>> > patients who abruptly discontinue the drug or may be precipitated through

>> use

>> > of drugs with opioid antagonist activity.

>> >

>> > Abstinence syndrome: If drug is abruptly discontinued in a physically

>> > dependent patient, an abstinence syndrome may occur, characterized by

>> > restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills,

>> > myalgia, and/or mydriasis; other symptoms may develop, including

>> > irritability, anxiety, backache, joint pain, weakness, abdominal cramps,

>> > insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood

>> pressure,

>> > respiratory rate, or heart rate. Reinstitute opioid use followed by

>> gradual,

>> > tapered dose reduction and symptomatic support.

>> >

>> > Opioid adverse experiences: Side effects from oxycodone are transient

>> but

>> > may require evaluation and management; if significant adverse events occur

>> > before mild or no pain is achieved, aggressively treat events and, when

>> > events are under control, continue upward titration to an acceptable level

>> of

>> > pain control. Adverse effects such as constipation should be anticipated >>

and

>> > treated aggressively and prophylactically with a stimulant laxative and/or

>> > stool softener. Patients do not usually become tolerant to constipating

>> > effects of opioids. Other side effects, such as sedation and nausea, are

>> > usually self-limited and often do not persist beyond the first few days. If

>> > nausea persists and is unacceptable, consider treatment with antiemetics or

>> > other modalities. Patients receiving drug may pass an intact matrix " ghost "

>> > in the stool or via colostomy; these ghosts contain little or no residual

>> > drug and are of no clinical consequence.

>> >

>> > Mental and/or physical impairment: Caution ambulatory patients that

>> their

>> > ability to drive and/or perform potentially hazardous activities may be

>> > impaired.

>> >

>> > Pregnancy: Neonates of mothers who have used oxycodone chronically may

>> > exhibit respiratory depression and/or withdrawal symptoms, either at birth

>> > and/or in the nursery. Use only if clearly needed (Pregnancy Category .

>> >

>> > Labor and delivery: Not recommended immediately before labor and

>> delivery

>> > because drug may cause respiratory depression in the newborn.

>> >

>> > Breast-feeding: Do not use in nursing mothers.

>> >

>> > Pediatric use: Safety and effectiveness in children under 18 yr of age

>> > not established with this dosage form.

>> >

>> ----------------------------------------------------------------------------

>> >

>> > Adverse Reactions

>> >

>> > Most frequent reactions are italicized.

>> >

>> > Digestive: Constipation and nausea (23%), vomiting (12%), dry mouth

>> (6%);

>> > diarrhea, anorexia, abdominal pain, dyspepsia, and gastritis (1-5%);

>> > dysphagia, eructation, flatulence, GI disorder, increased appetite, nausea

>> > and vomiting, taste perversion, and stomatitis (< 1%).

>> >

>> > Genitourinary: Dysuria, hematuria, impotence, polyuria, urinary

>> > retention, and impaired urination (< 1%).

>> >

>> > Neurologic: Somnolence (23%), dizziness (13%), headache (7%), asthenia

>> > (6%); nervousness, insomnia, confusion, anxiety, euphoria, twitching,

>> > abnormal dreams, and thought abnormalities (1-5%); abnormal gait,

>> agitation,

>> > amnesia, depersonalization, depression, emotional lability, hallucination,

>> > hyperkinesia, hypesthesia, hypotonia, malaise, paresthesia, seizures,

>> speech

>> > disorder, stupor, tinnitus, tremor, vertigo, and withdrawal syndrome with

>> or

>> > without seizures (< 1%).

>> >

>> > Miscellaneous: Pruritus (13%), sweating (5%); rash, dyspnea, chills,

>> > hiccups, postural hypotension, and fever (1-5%); accidental injury, chest

>> > pain, facial edema, malaise, neck pain, pain, migraine, syncope,

>> > vasodilation, ST depression, lymphadenopathy, dehydration, edema,

>> > hyponatremia, syndrome of inappropriate ADH secretion, peripheral edema,

>> > thirst, cough increased, pharyngitis, voice alteration, dry skin,

>> exfoliative

>> > dermatitis, and abnormal vision (< 1%).

>> >

>> ----------------------------------------------------------------------------

>> >

>> > Drug Interactions

>> >

>> > Other CNS depressants: Respiratory depression, hypotension, profound

>> > sedation, or coma. Use caution and at reduced dosage (33-50% of usual

>> dosage)

>> > in patients concurrently receiving sedatives or hypnotics, general

>> > anesthetics, phenothiazines, other tranquilizers, and alcohol.

>> >

>> > MAO inhibitors: Use caution.

>> >

>> > Mixed agonist/antagonist opioid analgesics: Decreased analgesic effect

>> > and/or precipitation of withdrawal symptoms. Use caution in using

>> > pentazocine, nalbuphine, butorphanol, buprenorphine, or other

>> > agonist/antagonist analgesics concurrently.

>> >

>> > Skeletal muscle relaxants: Increased neuromuscular blocking action.

>> > Increased respiratory depression.

>> >

>> ----------------------------------------------------------------------------

>> >

>> > HOME

>> >

>> > HedWeb

>> >

>> > BLTC Research

>> >

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