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Genotoxicity evaluation of morphine, buprenorphine, pentazocine and noscapine by micronucleus assay & comet assay in mice.
Opioids associated with the serotonin syndrome include meperidine, fentanyl, tramadol, and pentazocine.
Similarly, mixed agonist-antagonists like pentazocine or butorphanol (Stadol) have little use.
The list of potentially inappropriate drugs included: propoxyphene, indomethacin, pentazocine, methocarbamol, carisoprodol, oxybutynin, chlorzoxazone, metaxalone, cyclobenzaprine, flurazepam, amitriptyline, doxepin, meprobamate, lorazepam, oxazepam, alprazolam, temazepam, zolpidem, triazolain, chlordiazepoxide, diazepam, hydroxyzine, promethazine, all barbiturates (except phenobarbital), and meperidine.
We took morphine, diamorphine, cyclozine, codeine, temazepam, nitrezepam, phenobarbitone, sodium amytal dextropropoxyphene, methadone, nalbuphine, pethidine, pentazocine, buphrenorphine, dextromoramide chlormethiazole.
Drugs acting at [kappa]-receptor sites are known as "opioids with mixed actions" and include pentazocine (Talwin), butorphanol (Stadol), and nalbuphine (Nubain).
Typically, all partial agonists/agonist-antagonists (buprenorphine, nalbuphine, pentazocine, butorphanol), as well as codeine, meperidine, and prophoxyphene, are avoided because of toxic metabolites or inability to titrate to increasing doses.
CLASS B: Amphetamine Sulphate, Barbiturates, Cannabis, Codeine, Pentazocine
Codeine, propoxyphene, and mixed agonist-antagonist opioids, such as pentazocine and butorphanol, are not recommended because of their less-favorable analgesia-to-side-effect ratios and limited analgesia.