Action

Binds with opiate receptors in the CNS, altering both perception of and emotional response to pain through and unknown mechanism.

Route

IV, IM, Nasal

Onset

IV 2-3 min, IM 10-15 min, Nasal - 15 min

Peak

IV - 30-60 min, IM 30-60 min, Nasal- 1-2 hours

Duration

IV - 3-4hrs, IM 3-4hrs, Nasal- 4-5hrs

Dosage

Adults

1 to 4mg IM every 3 to 4 hours, PRN or around the clock; or 0.5 to 2mg IV every 3-4 hrs PRN or around the clock. Not to exceed 4mg per dose. Alternatively, 1mg by nasal spray every 3-4 hours (1 spray in each nostril); repeated in 60 to 90 minutes if pain relief is inadequate.

Elderly

Use one-half of the usual dose or twice the interval for IV use; for nasal use, allow 1-2 hours to elapse before repeating dose.

confusion, nervousness, lethargy, headache, somnolence, dizziness, insomnia, anxiety, paresthesia, euphoria, hallucinations, flushing, increased intracranial pressure, palpitations, vasodilation, hypotension, blurred vision, nasal congestion (with nasal spray), tinnitus, unpleasant taste, nausea, vomiting, constipation, anorexia, respiratory depression, rash, hives, clamminess, excessive diaphoresis, sensation of heat.

Interactions

Drug-Drug

CNS depressants: additive effects. Use together cautiously.

Drug-Lifestyle

Alcohol use: additive effects. Avoid alcohol use.

Contraindications

Contraindicated in patients with narcotic addiction; may precipitate withdrawal syndrome. Also contraindicated in patient with hypersensitivity to drug or to preservative, benzethonium chloride.

~ Be aware that psychological and physical addiction may occur.

~ Use cautiously in patients with head injury, increased intracranial pressure, acute MI, ventricular dysfunction, coronary insufficiency, respiratory disease or depression, and renal or hepatic dysfunction.

~ Avoid driving or or activities that require mental alertness.