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Drilldown: Medicines

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Medicines > classes : Dissociative or Opioid or secondary amine)]]

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generic:
Codeine (2)
brand:
None (29) · (multiple, generic dominant) (1) · Alfenta (1) · Darvon (1) · Demerol (1) · Dilaudid (1) · Duragesic (1) · DXM (1) · DXO (1) · Heroin (1) · Krokodil (1) · Nubain (1) · Nucynta (1) · O-DSMT (1) · Opana (1) · Pamelor (US brand discontinued; generic widely available), Aventyl (1) · Spravato (1) · Stablon (1) · Stadol (1) · Sufenta (1) · Talwin (1) · Ultiva (1) · Vicodin (1)
classes: (Click arrow to add another value)
mechanism:
Potent mu-opioid receptor agonist (6) · Mu-opioid receptor agonist (4) · NMDA antagonist (3) · NMDA antagonist; sigma receptor agonist (2)
uses:
None (48) · Mild to moderate pain; cough suppression (low-dose). (1) · Treatment-resistant depression (TRD) in adults, as adjunct to oral antidepressant (FDA-approved March 2019). Depressive symptoms in adults with MDD with acute suicidal ideation or behavior (FDA-approved Aug 2020). (1) · '"`UNIQ--vote-0000001B-QINU`"', '"`UNIQ--vote-0000001C-QINU`"', '"`UNIQ--vote-0000001D-QINU`"', '"`UNIQ--vote-0000001E-QINU`"', '"`UNIQ--vote-0000001F-QINU`"' (1)
starting dose:
None (48) · Adult: 15–60 mg every 4 hours as needed. (1) · Depression: 25 mg PO TID-QID or 75 mg at bedtime, titrate to 75-150 mg/day. Neuropathic pain: 10-25 mg at bedtime, titrate to 50-100 mg/day. Elderly: 10 mg at bedtime (Beers-list cautions, though less than amitriptyline) (1) · Induction (TRD): 56 mg intranasal twice weekly × 4 weeks. Maintenance: 56-84 mg once weekly × 4 weeks, then 56-84 mg every 1-2 weeks. For acute suicidality: 84 mg twice weekly × 4 weeks. Administered under medical supervision in REMS-certified site. (1)
preparations:
None (48) · 28 mg/device (each dose uses 2 devices) (1) · Capsules 10, 25, 50, 75 mg; oral solution 10 mg/5 mL (1) · Tablet (15, 30, 60 mg); oral solution; combination products (with [[Acetaminophen|acetaminophen]] or ibuprofen). (1)
fda max:
None (48) · 150 mg/day; therapeutic plasma-level monitoring recommended (target 50-150 ng/mL window) (1) · 360 mg/day (1) · 84 mg per session (1)
routes:
None (48) · Intranasal (under direct medical supervision) (1) · Oral (1) · PO (only formulation marketed in the US). (1)
onset:
None (48) · 30–60 min (PO) (1) · Pain and migraine prophylaxis effect 1-4 weeks; antidepressant effect 4-6 weeks (1) · Within hours of first administration (1)
duration:
None (48) · 24 hours (HS dosing) (1) · 4–6 hours (1) · Acute effect ~24 hours; cumulative effect builds with repeated dosing (1)
halflife:
None (48) · 18-44 hours'"`UNIQ--ref-00000020-QINU`"' (1) · 2.5–3 hours (1) · ~7-12 hours (1)
bioavailability:
None (48) · ~48% intranasal (1) · ~50% (oral)'"`UNIQ--ref-00000021-QINU`"' (1) · ~50% (variable, CYP2D6-dependent for analgesic effect). (1)
pregnancy:
None (48) · Avoid; may cause fetal harm (1) · Avoid; risk of neonatal opioid withdrawal with chronic use; UM-mother breastfeeding contraindicated. (1) · TCA class signal; limited human data specific to nortriptyline.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)
legal:
None (48) · Rx, Schedule III (US). REMS program required. (1) · US Schedule II (single-entity); Schedule III–V (combination products by content). (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults'"`UNIQ--ref-00000022-QINU`"' (1)

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