Phenothiazines Narcotics

Estazolam potentiates the CNS depressant effects of phenothiazines, narcotics, antihistamines, MAOIs, barbiturates, alcohol, general anesthetics, and TCAs. Use with cimetidine, disulfiram, oral contraceptives, and isoniazid may diminish hepatic metabolism and result in increased plasma concentrations of estazolam and increased CNS depressant effects. Fleavy smoking (more than 20 cigarettes/day) accelerates estazolam s clearance. Theophylline antagonizes estazolam s pharmacological effects. 

Triazolam potentiates the CNS depressant effects of phenothiazines, narcotics, antihistamines, MAOIs, barbiturates, alcohol, general anesthetics, and antidepressants. Use with cimetidine and disulfiram may increase triazolam s plasma concentration. 

The sedatives and hypnotics have an additive effect when administered with alcohol, antidepressants, narcotic analgesics, antihistamines, or phenothiazines. 

Tranquillizing drugs based on the phenothiazine nucleus potentiate the action of narcotic analgesics [157] although there are some reports to the contrary [158] and certain derivatives, notably methotrimeprazine (levomepromazine, Levo-prome, Veractil) (—)-(LV), are claimed to have intrinsic analgesic activity. In mice, (-)-(LV) is more potent than morphine in a variety of tests [159, 160] for example hot-plate EDso value of 1.02 mg/kg, that of morphine 2.1 mg/kg. 

Hypotensive effect Narcotic analgesics may cause severe hypotension in individuals whose ability to maintain blood pressure has been compromised by a depleted blood volume, or coadministration of drugs such as phenothiazines or general anesthetics. Renal toxicity Avinza doses over 1,600 mg/day contain a quantity of fumaric acid that has not been demonstrated to be safe, which may result in serious renal toxicity. 

Hydromorphone (Dilaudid) [C-ll] [Narcotic Analgesic] Uses Pain Action Narcotic analgesic Dose 1-4 mg IV (onset w/in 10 min duration about 3 h) Caution [B (D if prolonged use or high doses near term), ] t resp depression and CNS t effects CNS depressants, phenothiazines, TCA Contra Component sensitivity Disp Tabs 2, 4 mg, 8 mg Liq 5 mg/5 mL or 1 mg/mL inj... 

Slows intestinal motihty Dose Adul. Initial 4 mg PO, then 2 mg aftCT each loose stool, up to 16 mg/d Feds. 2—5 y, 13—20 kg 1 mg PO tid 6-8 y, 20—30 kg 2 mg PO bid 8-12 y, >30 kg 2 mg PO tid Caution [B, +] Not for acute D caused by Salmonella sp, Shigella sp, or C. difficile Contra Pseudomembranous colitis, bloody D Disp Caps, tabs, Liq SE Constipation, sedation, dizziness Interactions t Effects W/ antihistamines, CNS depressants, phenothiazines, TCAs, EtOH EMS Use caution w/ narcotics, may T risk of constipation related to opioids OD May cause constipation and CNS depression activated charcoal may be effective, naloxone (Narcan) may be effective... 

Among the many toxicants that cause convulsions are chlorinated hydrocarbons, amphetamines, lead, organophosphates, and strychnine. There are several levels of coma, the term used to describe a lowered level of consciousness. At level 0, the subject may be awakened and will respond to questions. At level 1, withdrawal from painful stimuli is observed and all reflexes function. A subject at level 2 does not withdraw from painful stimuli, although most reflexes still function. Levels 3 and 4 are characterized by the absence of reflexes at level 4, respiratory action is depressed and the cardiovascular system fails. Among the many toxicants that cause coma are narcotic analgesics, alcohols, organophosphates, carbamates, lead, hydrocarbons, hydrogen sulfide, benzodiazepines, tricyclic antidepressants, isoniazid, phenothiazines, and opiates. 

Anesthetics, antihistamines, barbiturates, benzodiazepines, chloral hydrate, meprobamate, narcotics, phenothiazines, tricyclic antidepressants Phenothiazines Diazepam... 

The incidence of opioid-induced nausea and vomiting is markedly increased in ambulatory patients. If narcotic analgesic therapy must be continued, nausea and vomiting can be treated with hydroxyzine or a phenothiazine antiemetic. 

Thermoregulation Poor temperature-regulating mechanisms 1 shivering 1 metabolic rate i vasconstriction i thirst response i subjective awareness of temperature Medications affecting awareness, mobility, muscular activity, vasoconstrictor mechanisms CNS medications Phenothiazines Barbiturates Benzodiazepines Tricyclic antidepressants Narcotics Alcohol... 

Clinically important, potentially hazardous interactions with alcohol, anticholinergics, barbiturates, benzodiazepines, butabarbital, chloral hydrate, chlordiazepoxide, chlorpromazine, clonazepam, clorazepate, diazepam, ethchlorvynol, fluphenazine, flurazepam, hypnotics, lorazepam, MAO inhibitors, mephobarbital, mesoridazine, midazolam, narcotics, oxazepam, pentobarbital, phenobarbital, phenothiazines, phenylbutazone, primidone, prochlorperazine, promethazine, quazepam, secobarbital, sedatives, temazepam, thioridazine, tranquilizers, trifluoperazine, zolpidem... 

Clinically important, potentially hazardous interactions with alcohol, amprenavir, barbiturates, buprenorphine, chlorpheniramine, clarithromycin, CNS depressants, efavirenz, esomeprazole, eucalyptus, fluoroquinolones, imatinib, indinavir, ivermectin, macrolide antibiotics, MAO inhibitors, methadone, mianserin, nalbuphine, narcotics, nelfinavir, nilutamide, phenothiazines, ritonavir, SSRIs... 

---