Methadone and Stadol

BBnurse 34:

I had methadone patient deliver yesterday. Doctor said her only options for pain were morphine or epidural because of interactions with other narcotics, Nubain, Stadol.

just worked with a mom on methadone who's baby is in the special care nursery. she described horrific immediate withdrawal symptoms after being given nubain in labor.

I was told I was defeating the purpose I tried alternating Ultram and ES Vicodin (at home) post op. Apparently it has some antagonist properties.

Please always scream at ANY practitioner that orders Stadol or Nubain for a recovering drug addict. These drugs will basically have the effect of Narcan for these types of pts.

Fentanyl, MSO4, Demerol... these are basically your options. And Demerol is one I would never use. I know only a few places that offer it for OB pts.


As far as Ultram and Vicodin. You simply prove one of the new studies correct. Ultram does have antagonist properties. I had a pt. who used some Ultram that we tried her on in the beginning of her therapy... in an attempt to avoid taking Oxy IR PRN. She got into a MAJOR pain crisis when she combined it with Oxycontin. Mixing Ultram and a narcotic is a quick way to enjoy a PCA w/ the narcotic of your choice for a few days.

Dave

Nubain and Stadol are agonist/antagonists. They act like narcan at the mu receptor (analgesia, euphoria, respiratory depression, itching are the main effects of activation of this receptor) while acting as an agonist at the kappa receptors (analgesia, sedation, occasional dysphoria). Most opioid addicts are using pure opioid agonists that act at both mu and kappa receptors. This is why opioid dependent patients experience immediate withdrawal when receiving nubain or stadol IV. This also explains why administering small doses of nubain after epidural or intrathecal fentanyl or morphine is more effective for the itching (a mu mediated effect) than benadryl (an antihistamine...the itching associated with opioids is rarely associated with histamine release).