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.

[kids]

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.

[Dave ARNP]

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

[jackstem]

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).