| Opioids |
meperidine (Demerol) |
Short duration (2–3 h) of analgesia. |
| Repeated administration may lead to CNS toxicity (tremor, confusion, or seizures). |
| Opioid agonist-antagonists |
pentazocine (Talwin), butorphanol (Stadol), nalbuphine (Nubain) |
Risk of precipitating withdrawal in opioid-dependent patients. |
| Analgesic ceiling. |
| Possible production of unpleasant psychotomimetic effects (e.g., dysphoria, delusions, hallucinations). |
| Partial agonist |
buprenorphine (Buprenex) |
Analgesic ceiling. |
| May precipitate withdrawal. |
| Antagonists |
naloxone (Narcan), naltrexone (ReVia) |
May precipitate withdrawal. |
| Limit use to treatment of life-threatening respiratory depression. Give in diluted form to opioid-tolerant patients. |
| Combination preparations |
Brompton's cocktail |
No evidence of analgesic benefit to using Brompton's cocktail over single-opioid analgesics. |
| DPT (meperidine, promethazine, and chlorpromazine) |
Efficacy is poor compared with that of other analgesics. |
| High incidence of adverse effects. |
| Anxiolytics alone |
benzodiazepine (e.g., alprazolam, Xanax; diazepam, Valium; lorazepam, Ativan) |
Analgesic properties not demonstrated except for some instances of neuropathic pain. |
| Added sedation from anxiolytics may compromise neurologic assessment in patients receiving opioids. |
| Sedative/hypnotic drugs alone |
barbiturates, benzodiazepine |
Analgesic properties not demonstrated. |
| Added sedation from sedative/hypnotic drugs limits opioid dosing. |
