📋 Indications & Clinical Dosage
*Moderate to severe pain, Pre-and post-operative analgesia:*
BY IV, IM OR SC INJ: Adults: 10-20 mg.
*Pain in suspected myocardial infarction:*
BY SLOW IV INJ: Adults: 10-30 mg A repeat dose of 20 mg may be given within 30 min, if necessary.
Children: Not recommended.
⛔ Contraindications
Acute respiratory depression, comatose patients, head injury and raised intracranial pressure (opioid analgesics interfere with pupillary responses vital for neurological assessment), risk of paralytic ileus
⚠️ Precautions & Warnings
Renal or hepatic impairment, adrenocortical insufficiency and hypothyroidism (reduced dose), asthma (avoid during an acute attack), convulsive disorders, diseases of the biliary tract, hypotension, elderly and debilitated patients (reduced dose), impaired respiratory function (avoid in chronic obstructive pulmonary disease), inflammatory bowel disorders, myasthenia gravis, obstructive bowel disorders, prostatic hypertrophy, shock, urethral stenosis, history of opioid abuse.
🔄 Drug Interactions
CNS depressants.
⚠️ Adverse Reactions / Side Effects
Biliary spasm, bradycardia, confusion, constipation, dependence, difficulty with micturition, dizziness, drowsiness, dry mouth, dysphoria, euphoria, flushing, hallucinations, headache, hypotension and muscle rigidity (larger doses), miosis, nausea, oedema, palpitation, postural hypotension, pruritus, rash, respiratory depression (larger doses), sexual dysfunction, sleep disturbances, sweating, tachycardia, ureteric spasm, urinary retention, urticaria, vertigo, visual disturbances, vomiting, Adrenal insufficiency and hyperalgesia (long-term use), hypogonadism (long-termuse)
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Positive evidence of risk: Respiratory depression and withdrawal symptoms in the neonate; gastric stasis and inhalation pneumonia in the mother if opioid analgesics are used during labour and
Lactation / Breastfeeding:
Caution advised
🧪 Compatibility & Storage Stability
Compatibility: Dextrose 5% in NaCI 0.9%, Dextrose 5%, 0.9% NaCI, LR, incompatible with diazepam or pentobarbi-tal. Use separate IV line or flush line well before and after administration.
Stability & Storage: Stable for 48 hours when diluted in 1:1 and 1:2 ratios with diluents.
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.