What drugs interact with narcotic pain medications (opioids, analgesics)?
- phenelzine (Nardil),
- selegiline (Zelapar, Emsam, and Eldepryl),
- tranylcypromine (Parnate),
- procarbazine (Matulane),
- rasagiline (Azilect) and
- isocarboxazid (Marplan).
Therefore, the discontinuation and initiation of narcotic analgesics and MAO inhibitors should be separated by at least 14 days.
Narcotic analgesics should be used with caution with central nervous system depressant medications such as alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), zolpidem (Ambien), zaleplon (Sonata) and alcohol because of increased risks of respiratory depression, low blood pressure, sedation, and in severe cases, coma and death.
Narcotic analgesics should be used with caution with medications that alter liver enzymes that affect the elimination of narcotic analgesics because levels of narcotic analgesics can increase or decrease in the body and thereby affect their therapeutic effectiveness.
What formulations of narcotic pain medications (opioids, analgesics) are available?
- Codeine, oxycodone, hydromorphone, and methadone are available as immediate-release tablets.
- Oxycodone and morphine are available as extended-release tablets.
- Morphine and hydrocodone are available as extended-release capsules.
- Morphine also is available as intravenous, subcutaneous, and intramuscular injections.
- Fentanyl is available as an oral lozenge (Actiq) and topical patch (Duragesic).
What about taking narcotic pain medications (opioids, analgesics) during pregnancy or while breastfeeding?
There are no adequate studies of narcotic analgesics to determine if their use is safe and effective use in pregnant women. Narcotic analgesics may pass through breast milk and affect the baby; therefore, they should be avoided in females who are breastfeeding.
REFERENCE: FDA Prescribing Information.
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