Methadone and Stadol

[BBnurse34]

I have had two methadone dependant patients describe acute withdrawal after receiving Stadol while in labor.

I haven't been able to find anything about it in the drug book.

Anyone else seen or heard about this?

Any info would be much apreciated.

[SmilingBluEyes]

never heard this......hmmm. something to ponder and research.

[sunnygirl272]

stadol a narcotic antagonist....i think that's the right label....it blocks the receptors and will cause withdrawal...there is another med that does this and it is not commonly known,but i cannot remember which off the top of my head....watched a terminal pancreatic ca pt suffer terribly because someone other than the anesthesiologist wrote pain control orders..anesthesia had a morphone gtt...other doc wrote for something for BTP....could hear the poor soul screaming all the way down the hall...

[sunnygirl272]

Interaction between Naltrexone/Opioid Analgesics

Return to Drug Interactions

Severity

1-Contraindicated Drug Combination: This drug combination is clearly contraindicated in all cases and should not be dispensed or administered to the same patient.

Action

Naltrexone is an opioid antagonist and thus inhibits the effects of the opioid analgesics.(1)

Effect

Concurrent administration or the administration of naltrexone within 7-10 days of opioids may induce acute abstinence syndrome or exacerbate a pre-existing subclinical abstinence syndrome.(1)

Predisposing Factors

None determined.

Management

The manufacturer of naltrexone states that the administration of naltrexone concurrently with opioids or to patients dependent on opioids is contraindicated.

Discussion

Patients should be opioid-free for a minimum of seven to ten days before beginning naltrexone therapy. The manufacturer of naltrexone states that the naloxone challenge test, described in the naltrexone prescribing information, can be administered to determine if patients are opioid free.(1)

[SmilingBluEyes]

Sunny, well there ya go. Thankyou, I learned something new. I don't often see methadone-program pts and when I do, they have invariably chosen epidural anesthesia which, of course, does not include stadol use. thanks for the info. I am always willing to learn!

[BBnurse34]

Thanks for the information!

I am looking foreward to sharing it at work in the interest of safe patient care.

[mark_LD_RN]

there are several drugs that can cause this:

these drugs are classed as Narcotic agonist-antagonists they are:

1) nubain (NalbuphineHCL)

2)Stadol (Butorphanol Tartrate)

3) Buprenex (buprenorephine HCL)

these are not to be given with patients /c history of narcotic abuse

hope you find this info helpful

[sunnygirl272]

yeah!!! nubain....that's the one i was brainfarting on...thanks, mark!!!

[sbic56, BSN, RN]

mark_LD_RN

That is great information. Thanks!

[mark_LD_RN]

you're welcome

[Motivated, SN]

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.

[nursing rocks]

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.