NARCOTICANALGESICS For Pain Relief (Systemic)

Some commonly used brand names are:

In the U.S.?

• Astramorph PF ¹⁰
• AVINZA ¹⁰
• Buprenex ²
• Cotanal-65 ¹⁶
• Darvon ¹⁶
• Darvon-N ¹⁶
• Demerol ⁸
• Dilaudid ⁶
• Dilaudid-5 ⁶
• Dilaudid-HP ⁶
• Dolophine ⁹
• Duramorph ¹⁰
• Hydrostat IR ⁶
• Kadian ¹⁰
• Levo-Dromoran ⁷
• Methadose ⁹
• M S Contin ¹⁰
• MSIR ¹⁰
• MS/L ¹⁰
• MS/L Concentrate ¹⁰
• MS/S ¹⁰
• Nubain ¹¹
• Numorphan ¹⁴
• OMS Concentrate ¹⁰
• Oramorph SR ¹⁰
• OxyContin ¹³
• PP-Cap ¹⁶
• Rescudose ¹⁰
• RMS Uniserts ¹⁰
• Roxanol ¹⁰
• Roxanol 100 ¹⁰
• Roxanol UD ¹⁰
• Roxicodone ¹³
• Roxicodone Intensol ¹³
• Stadol ³
• Talwin ¹⁵
• Talwin-Nx ¹⁵

In Canada?

• Darvon-N ¹⁶
• Demerol ⁸
• Dilaudid ⁶
• Dilaudid-HP ⁶
• Epimorph ¹⁰
• Hycodan # ⁵
• Kadian ¹⁰
• Leritine ¹
• Levo-Dromoran ⁷
• M-Eslon ¹⁰
• Morphine Extra-Forte ¹⁰
• Morphine Forte ¹⁰
• Morphine H.P. ¹⁰
• Morphitec ¹⁰
• M.O.S. ¹⁰
• M.O.S.-S.R. ¹⁰
• M S Contin ¹⁰
• MS[dot ]IR ¹⁰
• Nubain ¹¹
• Numorphan ¹⁴
• Oramorph SR ¹⁰
• OxyContin ¹³
• Pantopon ¹²
• Paveral ⁴
• PMS-Hydromorphone ⁶
• PMS-Hydromorphone Syrup ⁶
• Robidone ⁵
• 642 ¹⁶
• Statex ¹⁰
• Statex Drops ¹⁰
• Supeudol ¹³
• Talwin ¹⁵

Other commonly used names are: dextropropoxyphene dihydromorphinone levorphan papaveretum pethidine

Category

• Analgesic?Anileridine; Buprenorphine; Butorphanol; Codeine; Hydrocodone; Hydromorphone; Levorphanol; Meperidine; Methadone; Morphine; Nalbuphine; Opium Injection; Oxycodone; Oxymorphone; Pentazocine; Propoxyphene
• Anesthesiaadjunct?Anileridine; Buprenorphine
• Anesthesia adjunct, opioid analgesic?Butorphanol; Hydromorphone; Levorphanol; Meperidine; Morphine; Nalbuphine; Oxymorphone; Pentazocine
• Antidiarrheal?Codeine; Morphine
• Antitussive?Codeine; Hydrocodone; Hydromorphone; Methadone; Morphine
• Pulmonary edema therapy adjunct?Morphine
• Suppressant, narcotic abstinencesyndrome?Methadone

Description

Narcotic (nar-KOT-ik) analgesics (an-al-JEE-zicks) are used to relievepain. Some of these medicines are also used just before or during an operationto help the anesthetic work better. Codeine and hydrocodone are also usedto relieve coughing. Methadone is also used to help some people control theirdependence on heroin or other narcotics. Narcotic analgesics may also be usedfor other conditions as determined by your doctor.

Narcotic analgesics act in the central nervous system (CNS) to relievepain. Some of their side effects are also caused by actions in the CNS.

If a narcotic is used for a long time, it may become habit-forming (causingmental or physical dependence). Physical dependence may lead to withdrawalside effects when you stop taking the medicine.

These medicines are available only with your medical doctor's or dentist'sprescription. For some of them, prescriptions cannot be refilled and you mustobtain a new prescription from your medical doctor or dentist each time youneed the medicine. In addition, other rules and regulations may apply whenmethadone is used to treat narcotic dependence.

These medicines are available in the following dosage forms:

Oral
• Anileridine
  • Tablets (Canada)
• Codeine
  • Oral solution (U.S. and Canada)
  • Tablets (U.S. and Canada)
• Hydrocodone
  • Syrup (Canada)
  • Tablets (Canada)
• Hydromorphone
  • Extended-release capsule (U.S. and Canada)
  • Oral solution (U.S. and Canada)
  • Tablets (U.S. and Canada)
• Levorphanol
  • Tablets (U.S. and Canada)
• Meperidine
  • Syrup (U.S.)
  • Tablets (U.S. and Canada)
• Methadone
  • Oral concentrate (U.S.)
  • Oral solution (U.S.)
  • Tablets (U.S.)
  • Dispersible tablets (U.S.)
• Morphine
  • Capsules (U.S.)
  • Extended-release capsules (U.S. and Canada)
  • Oral solution (U.S. and Canada)
  • Syrup (Canada)
  • Tablets (U.S. and Canada)
  • Extended-release tablets (U.S. and Canada)
• Oxycodone
  • Oral solution (U.S.)
  • Tablets (U.S. and Canada)
  • Extended-release tablets (U.S. and Canada)
• Pentazocine
  • Tablets (Canada)
• Pentazocine and Naloxone
  • Tablets (U.S.)
• Propoxyphene
  • Capsules (U.S. and Canada)
  • Oral suspension (U.S.)
  • Tablets (U.S. and Canada)

Parenteral
• Buprenorphine
  • Injection (U.S.)
• Butorphanol
  • Injection (U.S.)
• Codeine
  • Injection (U.S. and Canada)
• Hydromorphone
  • Injection (U.S. and Canada)
• Levorphanol
  • Injection (U.S. and Canada)
• Meperidine
  • Injection (U.S. and Canada)
• Methadone
  • Injection (U.S.)
• Morphine
  • Injection (U.S. and Canada)
• Nalbuphine
  • Injection (U.S. and Canada)
• Opium
  • Injection (Canada)
• Oxymorphone
  • Injection (U.S. and Canada)
• Pentazocine
  • Injection (U.S. and Canada)

Rectal
• Hydromorphone
  • Suppositories (U.S. and Canada)
• Morphine
  • Suppositories (U.S. and Canada)
• Oxycodone
  • Suppositories (Canada)
• Oxymorphone
  • Suppositories (U.S. and Canada)

Before Using This Medicine

In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your doctor will make. For narcotic analgesics,the following should be considered:

Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to any of the narcotic analgesics. Also tell your healthcare professional if you are allergic to any other substances, such as foods,preservatives, or dyes.

Pregnancy?Although studies on birth defects with narcotic analgesicshave not been done in pregnant women, these medicines have not been reportedto cause birth defects. However, hydrocodone, hydromorphone, and morphinecaused birth defects in animals when given in very large doses. Buprenorphineand codeine did not cause birth defects in animal studies, but they causedother unwanted effects. Butorphanol, nalbuphine, pentazocine, and propoxyphenedid not cause birth defects in animals. There is no information about whetherother narcotic analgesics cause birth defects in animals.

Too much use of a narcotic during pregnancy may cause the baby to becomedependent on the medicine. This may lead to withdrawal side effects afterbirth. Also, some of these medicines may cause breathing problems in the newborninfant if taken just before delivery.

Breast-feeding?Most narcotic analgesics have not been reportedto cause problems in nursing babies. However, when the mother is taking largeamounts of methadone (in a methadone maintenance program), the nursing babymay become dependent on the medicine. Also, butorphanol, codeine, meperidine,morphine, opium, and propoxyphene pass into the breast milk.

Children?Breathing problems may be especially likely to occurin children younger than 2 years of age. These children are usually more sensitivethan adults to the effects of narcotic analgesics. Also, unusual excitementor restlessness may be more likely to occur in children receiving these medicines.Hydromorphone extended-release capsules should not be used in children youngerthan 18 years of age.

Older adults?Elderly people are especially sensitive to the effectsof narcotic analgesics. This may increase the chance of side effects, especiallybreathing problems, during treatment.

Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are takinga narcotic analgesic, it is especially important that your health care professionalknow if you are taking any of the following:

• Carbamazepine (e.g., Tegretol)?Propoxyphene may increase theblood levels of carbamazepine, which increases the chance of serious sideeffects

• Central nervous system (CNS) depressants or
• Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g.,Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], tranylcypromine[e.g., Parnate] (taken currently or within the past 2 weeks) or
• Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine[e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane],doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g.,Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil])?Thechance of side effects may be increased; the combination of meperidine (e.g.,Demerol) and MAO inhibitors is especially dangerous

• Naltrexone (e.g., Trexan)?Narcotics will not be effective inpeople taking naltrexone

• Rifampin (e.g., Rifadin)?Rifampin decreases the effects ofmethadone and may cause withdrawal symptoms in people who are dependent onmethadone

• Zidovudine (e.g., AZT, Retrovir)?Morphine may increase theblood levels of zidovudine and increase the chance of serious side effects

Other medical problems?The presence of other medicalproblems may affect the use of narcotic analgesics. Make sure you tell yourdoctor 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 isreplaced 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 effectsof 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 analgesicscan cause convulsions

Proper Use of This Medicine

Some narcoticanalgesics given by injection may be given at home to patients who do notneed to be in the hospital. If you are using an injection form of this medicineat home, make sure you clearly understand and carefullyfollow your doctor's instructions.

To take long-acting hydromorphone capsules:

• These capsules must be swallowed whole.Do not chew, crush or dissolve.
• If the capsules is not swallowed whole, you could overdose on thismedicine.
• Check with your doctor right away if you are not sure how to takeextended-release hydromorphone capsules.

To take the syrup form of meperidine:

• Unless otherwise directed by your medical doctor or dentist, take this medicine mixed with a half glass (4 ounces) of water to lessen the numbing effect of the medicine on your mouth and throat.

To take the oral liquid forms of methadone:

• This medicine may have to be mixed with wateror another liquid before you take it. Read the label carefully fordirections. If you have any questions about this, check with your health careprofessional.

To take the dispersible tablet form of methadone:

• These tablets must be stirred into water or fruitjuice just before each dose is taken. Read the label carefully for directions. If you have any questions about this, check with your health careprofessional.

To take oral liquid forms of morphine:

• This medicine may be mixed with a glass of fruit juice just beforeyou take it, if desired, to improve the taste.

To take long-acting morphine and oxycodone tablets:

• These tablets must be swallowed whole.Do not break, crush, or chew them before swallowing.

To take long-acting morphine capsules:

• These capsules must be swallowed whole.Do not chew, crush or dissolve.
• Or, the capsule can be opened and all of the beads inside sprinkledover applesauce and used right away. The beads must notbe chewed, crushed, or dissolved.
• If capsules or beads from the capsules are not swallowed whole, youcould overdose on this medicine.
• Check with your doctor right away if you are not sure how to takelong-acting morphine capsules.

To use suppositories:

• If the suppository is too soft to insert, chill it in the refrigeratorfor 30 minutes or run cold water over it before removing the foil wrapper.
• To insert the suppository: First remove the foil wrapper and moistenthe suppository with cold water. Lie down on your side and use your fingerto push the suppository well up into the rectum.

Take this medicine only as directed by your medicaldoctor or dentist. Do not take more of it, do not take it more often,and do not take it for a longer time than your medical doctor or dentist ordered.This is especially important for young children and elderly patients, whoare especially sensitive to the effects of narcotic analgesics. If too muchis taken, the medicine may become habit-forming (causing mental or physicaldependence) or lead to medical problems because of an overdose.

If you think this medicine is not working properly after you have beentaking it for a few weeks, do not increase the dose.Instead, check with your doctor.

Dosing?The dose of these medicines will be differentfor different patients. Follow your doctor's orders orthe directions on the label. The following information includes onlythe average doses of these medicines. If your dose isdifferent, do not change it unless your doctor tells you to do so.

The number of capsules or tablets or teaspoonfuls of oral solution or syrupthat you take, or the amount of injection that you are directed to use, dependson the strength of the medicine. Also, the number ofdoses you take each day, the time allowed between doses, and the length oftime you take the medicine depend on the narcotic you are taking, whetheror not you are taking a long-acting form of the medicine, and the reason youare taking the medicine.

For anileridine
• For oral dosage form:
  • For pain
    • Adults and teenagers?25 to 50 milligrams (mg) every 6 hoursas needed.
    • Children up to 13 years of age?Dose must be determined by yourdoctor.

For buprenorphine
• For injection dosage form:
  • For pain:
    • Adults and teenagers?0.3 milligrams (mg), injected into a muscleor a vein every six hours as needed.
    • Children up to 2 years of age?Dose must be determined by yourdoctor.
    • Children 2 to 12 years of age?0.002 to 0.006 mg per kilogram(kg) (0.0008 to 0.0024 mg per pound) of body weight, injected into a muscleor a vein every four to six hours as needed.

For butorphanol
• For injection dosage form:
  • For pain:
    • Adults?1 to 4 milligrams (mg) (usually 2 mg), injected intoa muscle every three or four hours as needed. Some people may receive 0.5to 2 mg (usually 1 mg) injected into a vein every three or four hours as needed.
    • Children and teenagers?Dose must be determined by your doctor.

For codeine
• For oral dosage forms (oral solutionor tablets):
  • For pain:
    • Adults?15 to 60 milligrams (mg) (usually 30 mg) every threeto six hours as needed.
    • Children?0.5 mg per kilogram (kg) (0.2 mg per pound) of bodyweight every four to six hours as needed. Young children will probably takethe oral solution, rather than tablets. Small doses may need to be measuredby a special dropper instead of a teaspoon.
  • For cough:
    • Adults?10 to 20 mg every four to six hours.
    • Children up to 2 years of age?Use is not recommended.
    • Children 2 years of age?3 mg every four to six hours, up toa maximum of 12 mg a day. Children this young will probably take the oralsolution, rather than tablets. Small doses may need to be measured by a specialdropper instead of a teaspoon.
    • Children 3 years of age?3.5 mg every four to six hours, upto a maximum of 14 mg a day. Children this young will probably take the oralsolution, rather than tablets. Small doses may need to be measured by a specialdropper instead of a teaspoon.
    • Children 4 years of age?4 mg every four to six hours, up toa maximum of 16 mg a day. Children this young will probably take the oralsolution, rather than tablets. Small doses may need to be measured by a specialdropper instead of a teaspoon.
    • Children 5 years of age?4.5 mg every four to six hours, upto a maximum of 18 mg a day. Children this young will probably take the oralsolution, rather than tablets. Small doses may need to be measured by a specialdropper instead of a teaspoon.
    • Children 6 to 12 years of age?5 to 10 mg every four to sixhours, up to a maximum of 60 mg a day.
• For injection dosage form:
  • For pain:
    • Adults?15 to 60 mg (usually 30 mg), injected into a muscleor a vein or under the skin every four to six hours as needed.
    • Children?0.5 mg per kg (0.2 mg per pound) of body weight, injectedinto a muscle or under the skin every four to six hours as needed.

For hydrocodone
• For oral dosage form (syrup or tablets):
  • For pain:
    • Adults?5 to 10 milligrams (mg) every four to six hours as needed.
    • Children?0.15 mg per kilogram (kg) (0.06 mg per pound) of bodyweight every six hours as needed.
  • For cough:
    • Adults?5 mg every four to six hours as needed.
    • Children?Dose must be determined by your doctor.

For hydromorphone
• For short-acting oral dosage form (oralsolution or tablets):
  • For pain:
    • Adults?2 or 2.5 milligrams (mg) every three to six hours asneeded.
    • Children?Dose must be determined by your doctor.
• For long-acting oral dosage forms (extended-releasecapsules):
  • For severe, chronic pain (severe pain that lasts a long time):
    • Adults?Long-acting forms of hydromorphone are usually usedfor patients who have already been receiving narcotics to relieve pain. Thestarting dose will depend on the amount of narcotic you have been receivingevery day. Your doctor will then adjust the dose according to your individualneeds. To be helpful, these medicines need to be taken at regularly scheduledtimes according to your doctor's instructions. It is important that you takethe dose at the time and as often as your doctor tells you.
    • Children?Dose must be determined by your doctor.
• For injection dosage form:
  • For pain:
    • Adults?1 or 2 mg, injected into a muscle or under the skinevery three to six hours as needed. Some people may receive 0.5 mg, injectedslowly into a vein every three hours as needed.
    • Children?Dose must be determined by your doctor.
• For rectal suppository dosage form:
  • For pain:
    • Adults?3 mg every four to eight hours as needed.
    • Children?Dose must be determined by your doctor.

For levorphanol
• For oral dosage form (tablets):
  • For pain:
    • Adults?2 milligrams (mg). Some people with severe pain mayneed 3 or 4 mg.
    • Children?Dose must be determined by your doctor.
• For injection dosage form:
  • For pain:
    • Adults?2 mg, injected under the skin or into a vein. Some peoplemay need 3 mg.
    • Children?Dose must be determined by your doctor.

For meperidine
• For oral dosage form (syrup or tablets):
  • For pain:
    • Adults?50 to 150 milligrams (mg) (usually 100 mg) every threeor four hours as needed.
    • Children?1.1 to 1.76 mg per kilogram (kg) (0.44 to 0.8 mg perpound) of body weight, up to a maximum of 100 mg, every three or four hoursas needed. Young children will probably take the syrup, rather than tablets.Small doses may need to be measured by a special dropper instead of a teaspoon.
• For injection dosage form:
  • For pain:
    • Adults?50 to 150 milligrams (mg) (usually 100 mg), injectedinto a muscle or under the skin every three or four hours as needed. The medicinemay also be injected continuously into a vein at a rate of 15 to 35 mg anhour.
    • Children?1.1 to 1.76 mg per kg (0.44 to 0.8 mg per pound) ofbody weight, up to a maximum of 100 mg, injected into a muscle or under theskin every three or four hours as needed.

For methadone
• For oral solution dosage form:
  • For pain:
    • Adults?5 to 20 mg every four to eight hours.
    • Children?Dose must be determined by your doctor.
  • For narcotic addiction:
    • Adults 18 years of age or older?
      • For detoxification: At first, 15 to 40 mg once a day. Your doctorwill gradually decrease the dose you take every day until you do not needthe medicine any more.
      • For maintenance: Dose must be determined by the needs of the individualpatient, up to a maximum of 120 mg a day.
    • Children up to 18 years of age?Special conditions must be metbefore methadone can be used for narcotic addiction in patients younger than18 years of age. Use and dose must be determined by your doctor.
• For oral tablet dosage form:
  • For pain:
    • Adults?2.5 to 10 mg every three or four hours as needed.
    • Children?Dose must be determined by your doctor.
  • For narcotic addiction:
    • Adults 18 years of age or older?
      • For detoxification: At first, 15 to 40 mg once a day. Your doctorwill gradually decrease the dose you take every day until you do not needthe medicine any more.
      • For maintenance: Dose must be determined by the needs of the individualpatient, up to a maximum of 120 mg a day.
    • Children up to 18 years of age?Special conditions must be metbefore methadone can be used for narcotic addiction in patients younger than18 years of age. Use and dose must be determined by your doctor.
• For injection dosage form:
  • For pain:
    • Adults?2.5 to 10 mg, injected into a muscle or under the skin,every three or four hours as needed.
    • Children?Dose must be determined by your doctor.
  • For narcotic addiction:
    • Adults 18 years of age and older?For detoxification only, inpatients unable to take medicine by mouth: At first, 15 to 40 mg a day. Yourdoctor will gradually decrease the dose you receive every day until you donot need the medicine any more.
    • Children younger than 18 years of age?Use and dose must bedetermined by your doctor.

For morphine
• For short-acting oral dosage forms (capsules,oral solution, syrup, or tablets):
  • For severe, chronic pain (severe pain that lasts a long time):
    • Adults?At first, 10 to 30 milligrams (mg) every four hours.Your doctor will then adjust the dose according to your individual needs.If you have already been taking other narcotics to relieve severe, chronicpain, your starting dose will depend on the amount of other narcotic you weretaking every day.
    • Children?Dose must be determined by your doctor.
• For long-acting oral dosage forms (extended-releasecapsules or tablets):
  • For severe, chronic pain (severe pain that lasts a long time):
    • Adults?Long-acting forms of morphine are usually used for patientswho have already been receiving narcotics to relieve pain. The starting dosewill depend on the amount of narcotic you have been receiving every day. Yourdoctor will then adjust the dose according to your individual needs. To behelpful, these medicines need to be taken at regularly scheduled times accordingto your doctor's instructions. It is important that you take the dose at thetime and as often as your doctor tells you. Some people may need to take ashort-acting form of morphine if breakthrough pain occurs between doses ofthe long-acting medicine.
    • Children?Dose must be determined by your doctor.
• For once daily long-acting oral dosageforms (extended-release capsules):
  • For severe, chronic pain (severe pain that lasts a long time):
    • Adults?Long-acting forms of morphine are usually used for patientswho have already been receiving narcotics to relieve pain. The starting dosewill depend on the amount of narcotic you have been receiving every day. Yourdoctor will then adjust the dose according to your individual needs. To behelpful, these medicines need to be taken once a day at regularly scheduledtimes according to your doctor's instructions. It is important that you takethe dose at the time and as often as your doctor tells you. Some people mayneed to take a short-acting form of morphine if breakthrough pain occurs betweendoses of the long-acting medicine.
    • Children?Dose must be determined by your doctor.
• For injection dosage form:
  • For pain:
    • Adults?5 to 20 mg (usually 10 mg), injected into a muscle orunder the skin every four hours as needed. Some people may receive 4 to 10mg, injected slowly into a vein. Morphine may also be injected continuouslyinto a vein or under the skin at a rate that depends on the needs of the patient.This medicine may also be injected into the spinal area. The dose will dependon where and how the medicine is injected into the spinal area and on theneeds of the patient.
    • Children?0.1 to 0.2 mg per kg (0.04 or 0.09 mg per pound) ofbody weight, up to a maximum of 15 mg, injected under the skin every fourhours as needed. Some patients may receive 0.05 to 0.1 mg per kg (0.02 to0.04 mg per pound) of body weight, injected slowly into a vein.
• For rectal suppository dosage form:
  • For pain:
    • Adults?10 to 30 mg every four to six hours as needed.
    • Children?Dose must be determined by your doctor.

For nalbuphine
• For injection dosage form:
  • For pain:
    • Adults?10 milligrams (mg) every three to six hours as needed,injected into a muscle or a vein or under the skin.
    • Children?Dose must be determined by your doctor.

For opium
• For injection dosage form:
  • For pain:
    • Adults?5 to 20 milligrams (mg), injected into a muscle or underthe skin every four to five hours as needed.
    • Children?Dose must be determined by your doctor.

For oxycodone
• For oral dosage form (oral solution ortablets):
  • For pain:
    • Adults?5-15 milligrams (mg) every 4-6 hours asneeded.
    • Children?Dose must be determined by your doctor. Children upto 6 years of age will probably take the oral solution, rather than tablets.Small doses may need to be measured by a special dropper instead of a teaspoon.
• For long-acting oral dosage form (extended-releasetablets):
  • For pain (continuous and lasts a long time):
    • Adults?Your doctor will determine the dose according to yourindividual needs. To be helpful, these medicines need to be taken two timesa day at regularly scheduled times.
    • Children?Use and dose must be determined by your doctor.
• For rectal suppository dosage form:
  • For pain:
    • Adults?10 to 40 mg three or four times a day.
    • Children?Dose must be determined by your doctor.

For oxymorphone
• For injection dosage form:
  • For pain:
    • Adults?1 to 1.5 milligrams (mg), injected into a muscle orunder the skin every three to six hours as needed. Some patients may receive0.5 mg, injected into a vein.
    • Children?Dose must be determined by your doctor.
• For rectal suppository dosage form:
  • For pain:
    • Adults?5 mg every four to six hours as needed.
    • Children?Dose must be determined by your doctor.

For pentazocine
• For oral dosage form (tablets):
  • For pain:
    • Adults?50 mg every three to four hours as needed. Some patientsmay need 100 mg every three to four hours. The usual maximum dose is 600 mga day.
    • Children?Dose must be determined by your doctor.
• For injection dosage form:
  • For pain:
    • Adults?30 mg, injected into a muscle or a vein or under theskin every three to four hours as needed.
    • Children?Dose must be determined by your doctor.

For propoxyphene
• For oral dosage form (capsules, oralsuspension, or tablets):
  • For pain:
    • Adults?Propoxyphene comes in two different forms, propoxyphenehydrochloride and propoxyphene napsylate. 100 mg of propoxyphene napsylateprovides the same amount of pain relief as 65 mg of propoxyphene hydrochloride.The dose of propoxyphene hydrochloride is 65 milligrams (mg) every four hoursas needed, up to a maximum of 390 mg a day. The dose of propoxyphene napsylateis 100 mg every four hours as needed, up to a maximum of 600 mg a day.
    • Children?Dose must be determined by your doctor.

Missed dose?If your medical doctor or dentist has ordered youto take this medicine according to a regular schedule and you miss a dose,take it as soon as you remember. However, if it is almost time for your nextdose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage?To store this medicine:

• Keep out of the reach of children. Overdose is very dangerous inyoung children.
• Store away from heat and direct light.
• Do not store tablets or capsules in the bathroom, near the kitchensink, or in other damp places. Heat or moisture may cause the medicine tobreak down.
• Store hydromorphone, oxycodone, or oxymorphone suppositories in therefrigerator.
• Keep liquid (including injections) and suppository forms of the medicinefrom freezing.
• Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

If youwill be taking this medicine for a long time (for example, for several monthsat a time), your doctor should check your progress at regular visits.

Narcotic analgesics will add to the effects of alcohol and other CNS depressants(medicines that slow down the nervous system, possibly causing drowsiness).Some examples of CNS depressants are antihistamines or medicine for hay fever,other allergies, or colds; sedatives, tranquilizers, or sleeping medicine;other prescription pain medicines including other narcotics; barbiturates;medicine for seizures; muscle relaxants; or anesthetics, including some dentalanesthetics. Do not drink alcoholic beverages, and checkwith your medical doctor or dentist before taking any of the medicines listedabove, while you are using this medicine.

This medicine may cause some people to become drowsy, dizzy, or lightheaded,or to feel a false sense of well-being. Make sure you know how you react to this medicine before you drive, usemachines, or do anything else that could be dangerous if you are dizzy orare not alert and clearheaded.

Dizziness, light-headedness, or fainting may occur, especially when youget up suddenly from a lying or sitting position. Getting up slowly may helplessen this problem.

Nausea or vomiting may occur, especially after the first couple of doses.This effect may go away if you lie down for a while. However, if nausea orvomiting continues, check with your medical doctor or dentist. Lying downfor a while may also help relieve some other side effects, such as dizzinessor light-headedness, that may occur.

Before having any kind of surgery (including dental surgery) or emergencytreatment, tell the medical doctor or dentist in charge that you are takingthis medicine.

Narcotic analgesics may cause dryness of the mouth. For temporary relief,use sugarless candy or gum, melt bits of ice in your mouth, or use a salivasubstitute. However, if dry mouth continues for more than 2 weeks, check withyour dentist. Continuing dryness of the mouth may increase the chance of dentaldisease, including tooth decay, gum disease, and fungus infections.

If you have been taking this medicine regularly for several weeks or more, do not suddenly stop using it without first checkingwith your doctor. Your doctor may want you to reduce gradually theamount you are taking before stopping completely, in order to lessen the chanceof withdrawal side effects.

If you think you or someone else may have taken anoverdose, get emergency help at once. Taking an overdose of this medicineor taking alcohol or CNS depressants with this medicine may lead to unconsciousnessor death. Signs of overdose include convulsions (seizures), confusion, severenervousness or restlessness, severe dizziness, severe drowsiness, slow ortroubled breathing, and severe weakness.

Side Effects of This Medicine

Along with its needed effects,a medicine may cause some unwanted effects. Although not all of these sideeffects may occur, if they do occur they may need medical attention.

Get emergency help immediatelyif any of the following symptoms of overdose occur:

Cold, clammy skin; confusion; convulsions (seizures); dizziness (severe); drowsiness (severe); low blood pressure; nervousness or restlessness (severe); pinpoint pupils of eyes; slow heartbeat; slow or troubled breathing; weakness (severe)

Also, check with your doctor as soon as possible if any of thefollowing side effects occur:

Less common or rare

Dark urine (for propoxyphene only); fast, slow, or pounding heartbeat; feelings of unreality; hallucinations (seeing, hearing, or feeling thingsthat are not there); hives, itching, or skin rash; increased sweating (more common with hydrocodone,meperidine, and methadone); irregular breathing; mental depression or other mood or mental changes; pale stools (for propoxyphene only); redness or flushing of face (more common with hydrocodone, meperidine, andmethadone); ringing or buzzing in the ears; shortness of breath, wheezing, or troubled breathing; swelling of face; trembling or uncontrolledmuscle movements; unusual excitement or restlessness(especially in children); yellow eyes or skin (forpropoxyphene only)

Other side effects may occur that usually do not need medicalattention. These side effects may go away during treatment as your body adjuststo the medicine. However, check with your doctor if any of the following sideeffects continue or are bothersome:

More common

Dizziness, light-headedness, or feeling faint; drowsiness; nausea or vomiting

Less common or rare

Blurred or double vision or other changes in vision; constipation (more common with long-term use and with codeine); decrease in amount of urine; difficult or painful urination; dry mouth; false sense of well-being; frequenturge to urinate; general feeling of discomfort orillness; headache; lossof appetite; nervousness or restlessness; nightmares or unusual dreams; redness,swelling, pain, or burning at place of injection; stomach cramps or pain; trouble in sleeping; unusual tiredness or weakness

After you stop using thismedicine, your body may need time to adjust. The length of time this takesdepends on the amount of medicine you were using and how long you used it.During this period of time check with your doctor if you notice any of thefollowing side effects:

Body aches; diarrhea; fast heartbeat; fever, runny nose, or sneezing; gooseflesh; increased sweating; increased yawning; loss of appetite; nausea or vomiting; nervousness,restlessness, or irritability; shivering or trembling; stomach cramps; troublein sleeping; unusually large pupils of eyes; weakness

Other side effectsnot listed above may also occur in some patients. If you notice any othereffects, check with your doctor.

Additional Information

Once a medicine has been approved for marketingfor a certain use, experience may show that it is also useful for other medicalproblems. Although not specifically included in product labeling, morphineby injection is used in certain pediatric patients with the following medicalconditions:

• Pain, during mechanical ventilation, neonatal
• Pain, postoperative, neonatal

Other than the above information, there is no additional information relatingto proper use, precautions, or side effects for these uses.