Which opioids should be avoided in renal impairment? Morphine especially should be avoided in the setting of renal impairment. This is because about 75% of morphine is metabolized to morphine-3-glucuronide, which is inactive in the sense that it does not act on the mu receptor; however, it may be neurotoxic. Neurotoxic effects such as myoclonus …
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Which opioid should be avoided in mothers who are breastfeeding their babies? Codeine is a prodrug that is metabolized extensively to morphine. The parent compound codeine and its morphine metabolite are readily excreted into breast milk. Respiratory depression and death have occurred in children who received codeine and morphine through the breast milk but in …
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Can tramadol and other opioids be used in combination with selective serotonin reuptake inhibitors? Tramadol, like selective serotonin reuptake inhibitors (SSRIs), inhibits reuptake of serotonin. Therefore, tramadol carries a risk for serotonin syndrome. Unlike tramadol, which inhibits reuptake of both norepinephrine and serotonin, tapentadol has limited interaction with serotonin transporter proteins and minimal effect upon …
Is there a validated and accepted schematic to determine morphine daily equivalent dose? No. The concept of morphine equivalents was employed because the daily dose of various opioids may not reflect their clinical potencies. However, the daily dose of one opioid does not necessarily exhibit the same effects of the daily dose of another opioid. …
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Is methadone considered an extended release opioid? Indications of methadone FDA-Approved Indications Off-Label Use Sources
Can Suboxone and methadone be legally prescribed for pain, and if so, is this considered off label? Methadone carries two FDA labeled indications: (1) chronic pain and (2) detoxification. Initial inpatient detoxification of opioids by a licensed trained provider with methadone and supportive care is appropriate. A methadone maintenance provider must have special credentialing and …
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What buprenorphine products are FDA approved specifically as an analgesic? Butrans is a transdermal patch formulation, and Belbuca is a twice-daily buccal formulation. Butrans and Belbuca are FDA approved for the management of chronic “pain requiring around-the-clock, long-term opioid treatment not adequately controlled by alternatives.” Buprenex is the IV or intramuscular (IM) formulation of buprenorphine …
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