| 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 if administered with full opioid agonist. |
| 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 cocktaila | No evidence of analgesic benefit in using Brompton's cocktail over single-opioid analgesics. |
| DPT (meperidine, promethazine, and chlorpromazine)b | Efficacy is poor compared with that of other analgesics. |
| High incidence of adverse effects. |
| Anxiolytics alone | benzodiazepines (e.g., alprazolam [Xanax]; clonazepam [Ceberclon]; 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 by facilitating the development of delirium. |
| Sedative/hypnotic drugs alone | barbiturates, benzodiazepines | Analgesic properties not demonstrated. |
| Added sedation from sedative/hypnotic drugs limits opioid dosing and may facilitate the development of delirium. |
