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Before Using
Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Pediatric
Breathing problems may be especially likely to occur in children younger than 2 years of age. These children are usually more sensitive than adults to the effects of narcotic analgesics. Also, unusual excitement or restlessness may be more likely to occur in children receiving these medicines. Hydromorphone extended-release capsules should not be used in children younger than 18 years of age.
Geriatric
Elderly people are especially sensitive to the effects of narcotic analgesics. This may increase the chance of side effects, especially breathing problems, during treatment.
Pregnancy
Although studies on birth defects with narcotic analgesics have not been done in pregnant women, these medicines have not been reported to cause birth defects. However, hydrocodone, hydromorphone, and morphine caused birth defects in animals when given in very large doses. Buprenorphine and codeine did not cause birth defects in animal studies, but they caused other unwanted effects. Butorphanol, nalbuphine, pentazocine, and propoxyphene did not cause birth defects in animals. There is no information about whether other narcotic analgesics cause birth defects in animals.
Too much use of a narcotic during pregnancy may cause the baby to become dependent on the medicine. This may lead to withdrawal side effects after birth. Also, some of these medicines may cause breathing problems in the newborn infant if taken just before delivery.
Breastfeeding
Most narcotic analgesics have not been reported to cause problems in nursing babies.
- Codeine and other narcotic analgesics—Codeine is changed to morphine in the body. Some people change codeine to morphine more quickly than others. These individuals are called "ultra-rapid metabolizers of codeine". If a nursing mother is an ultra-rapid metabolizer of codeine, it could lead to a morphine overdose in the nursing baby and cause very serious side effects. A nursing mother should talk to her doctor if she has any questions about taking codeine or about how this medicine may affect her baby .
- Butorphanol, meperidine, morphine, opium, and propoxyphene—These medicines pass into the breast milk.
- Methadone—When a mother is taking large amounts of methadone (in a methadone maintenance program), the nursing baby may become dependent on the medicine.
Drug Interactions
Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.
- Acecainide
- Ajmaline
- Amiodarone
- Amisulpride
- Amitriptyline
- Amoxapine
- Aprindine
- Astemizole
- Azimilide
- Bepridil
- Bretylium
- Brofaromine
- Chloral Hydrate
- Chloroquine
- Chlorpromazine
- Cisapride
- Citalopram
- Clarithromycin
- Clorgyline
- Desipramine
- Dibenzepin
- Disopyramide
- Dofetilide
- Dolasetron
- Doxepin
- Dronedarone
- Droperidol
- Ebastine
- Encainide
- Erythromycin
- Flecainide
- Fluconazole
- Flucytosine
- Fluoxetine
- Fluvoxamine
- Foscarnet
- Furazolidone
- Halofantrine
- Haloperidol
- Hydroquinidine
- Ibutilide
- Imipramine
- Iproniazid
- Isocarboxazid
- Isradipine
- Itraconazole
- Lazabemide
- Lidoflazine
- Linezolid
- Lorcainide
- Mefloquine
- Mesoridazine
- Methdilazine
- Mexiletine
- Mibefradil
- Moclobemide
- Naltrexone
- Nialamide
- Nicardipine
- Nortriptyline
- Octreotide
- Olanzapine
- Pargyline
- Pentamidine
- Phenelzine
- Pimozide
- Pirmenol
- Prajmaline
- Primaquine
- Probucol
- Procainamide
- Procarbazine
- Propafenone
- Protriptyline
- Quinidine
- Rasagiline
- Risperidone
- Selegiline
- Sematilide
- Sertindole
- Sertraline
- Sotalol
- Spiramycin
- Sulfamethoxazole
- Sultopride
- Tedisamil
- Telavancin
- Terfenadine
- Thioridazine
- Tiapride
- Toloxatone
- Tranylcypromine
- Trimeprazine
- Trimethoprim
- Trimipramine
- Vasopressin
- Zimeldine
- Ziprasidone
- Zolmitriptan
- Zotepine
Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acebutolol
- Acetazolamide
- Acetophenazine
- Adinazolam
- Alfentanil
- Almotriptan
- Alphaprodine
- Alprazolam
- Alprenolol
- Amiloride
- Amiodarone
- Amitriptyline
- Amlodipine
- Amobarbital
- Amoxapine
- Amprenavir
- Anileridine
- Aprepitant
- Aprobarbital
- Arsenic Trioxide
- Asenapine
- Atenolol
- Azosemide
- Bemetizide
- Bendroflumethiazide
- Benzthiazide
- Bepridil
- Betaxolol
- Bevantolol
- Bisoprolol
- Brofaromine
- Bromazepam
- Bromperidol
- Brotizolam
- Bucindolol
- Bumetanide
- Buprenorphine
- Buspirone
- Butabarbital
- Butalbital
- Butorphanol
- Canrenoate
- Carbamazepine
- Carisoprodol
- Carteolol
- Carvedilol
- Castor Oil
- Celiprolol
- Chloral Hydrate
- Chlordiazepoxide
- Chlorpromazine
- Chlorprothixene
- Chlorthalidone
- Chlorzoxazone
- Cimetidine
- Citalopram
- Clarithromycin
- Clobazam
- Clomipramine
- Clonazepam
- Clopamide
- Clorazepate
- Clorgyline
- Clovoxamine
- Clozapine
- Codeine
- Cyclobenzaprine
- Cyclothiazide
- Dantrolene
- Desipramine
- Desvenlafaxine
- Dexmedetomidine
- Dezocine
- Diazepam
- Difenoxin
- Digoxin
- Dihydrocodeine
- Diltiazem
- Diphenhydramine
- Diphenoxylate
- Docusate
- Dofetilide
- Dothiepin
- Doxepin
- Doxylamine
- Droperidol
- Duloxetine
- Eletriptan
- Enflurane
- Erythromycin
- Escitalopram
- Esmolol
- Estazolam
- Eszopiclone
- Ethacrynic Acid
- Ethchlorvynol
- Ethopropazine
- Etozolin
- Felodipine
- Femoxetine
- Fenquizone
- Fentanyl
- Fluconazole
- Flumazenil
- Flunitrazepam
- Fluoxetine
- Flupenthixol
- Fluphenazine
- Flurazepam
- Fluvoxamine
- Fosamprenavir
- Fospropofol
- Frovatriptan
- Furazolidone
- Furosemide
- Gatifloxacin
- Gemifloxacin
- Halazepam
- Halofantrine
- Haloperidol
- Halothane
- Hydrochlorothiazide
- Hydrocodone
- Hydroflumethiazide
- Hydromorphone
- Hydroxyzine
- Ibutilide
- Iloperidone
- Imipramine
- Indapamide
- Iproniazid
- Isocarboxazid
- Isoflurane
- Isradipine
- Itraconazole
- Ketamine
- Ketazolam
- Ketoconazole
- Labetalol
- Lactulose
- Lapatinib
- Lazabemide
- Levobunolol
- Levofloxacin
- Levomethadyl
- Levorphanol
- Linezolid
- Lofepramine
- Lorazepam
- Lormetazepam
- Loxapine
- Magnesium
- Mannitol
- Medazepam
- Melperone
- Meperidine
- Mephenesin
- Mephobarbital
- Mepindolol
- Meprobamate
- Mesoridazine
- Metaxalone
- Methadone
- Methocarbamol
- Methohexital
- Methotrimeprazine
- Metipranolol
- Metolazone
- Metoprolol
- Midazolam
- Milnacipran
- Mirtazapine
- Moclobemide
- Molindone
- Morphine
- Morphine Sulfate Liposome
- Moxifloxacin
- Nadolol
- Nalbuphine
- Naratriptan
- Nebivolol
- Nefazodone
- Nelfinavir
- Nialamide
- Nicardipine
- Nifedipine
- Nilotinib
- Nimodipine
- Nisoldipine
- Nitrazepam
- Nordazepam
- Nortriptyline
- Olanzapine
- Opium
- Oxazepam
- Oxprenolol
- Oxycodone
- Oxymorphone
- Paliperidone
- Pargyline
- Paroxetine
- Penbutolol
- Penfluridol
- Pentazocine
- Pentobarbital
- Perphenazine
- Phenelzine
- Phenobarbital
- Pimozide
- Pindolol
- Pipotiazine
- Piretanide
- Polythiazide
- Prazepam
- Procarbazine
- Prochlorperazine
- Promazine
- Promethazine
- Propiomazine
- Propofol
- Propoxyphene
- Propranolol
- Protriptyline
- Quazepam
- Quinethazone
- Quinidine
- Quinine
- Ramelteon
- Ranolazine
- Rasagiline
- Remifentanil
- Remoxipride
- Risperidone
- Ritonavir
- Rizatriptan
- Secobarbital
- Selegiline
- Sertraline
- Sibutramine
- Sildenafil
- Sodium Oxybate
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Sorbitol
- Sotalol
- Spironolactone
- Sufentanil
- Sulpiride
- Sumatriptan
- Sunitinib
- Talinolol
- Tapentadol
- Telavancin
- Telithromycin
- Temazepam
- Tertatolol
- Tetrabenazine
- Thiethylperazine
- Thiopental
- Thioridazine
- Thiothixene
- Ticrynafen
- Timolol
- Toloxatone
- Torsemide
- Tramadol
- Tranylcypromine
- Triamterene
- Triazolam
- Trichlormethiazide
- Trifluoperazine
- Triflupromazine
- Trimeprazine
- Trimipramine
- Troleandomycin
- Urea
- Vardenafil
- Venlafaxine
- Verapamil
- Xipamide
- Zaleplon
- Zolmitriptan
- Zolpidem
- Zuclopenthixol
Other Interactions
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using medicines in this class with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use your medicine, or give you special instructions about the use of food, alcohol, or tobacco.
- Ethanol
Other Medical Problems
The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:
- Alcohol abuse, or history of, or
- Drug dependence, especially narcotic abuse, or history of, or
- Emotional problems—The chance of side effects may be increased; also, withdrawal symptoms may occur if a narcotic you are dependent on is replaced by buprenorphine, butorphanol, nalbuphine, or pentazocine.
- Brain disease or head injury or
- Emphysema, asthma, or other chronic lung disease or
- Enlarged prostate or problems with urination or
- Gallbladder disease or gallstones—Some of the side effects of narcotic analgesics can be dangerous if these conditions are present.
- Colitis or
- Heart disease or
- Kidney disease or
- Liver disease or
- Underactive thyroid—The chance of side effects may be increased.
- Convulsions (seizures), history of—Some of the narcotic analgesics can cause convulsions.
