pentazocine/acetaminophen (Discontinued)

Brand and Other Names:Talacen
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

FDA is asking manufacturers to limit acetaminophen in prescription products to 325 mg/dosage unit; manufacturers have until January 14, 2014 to comply

pentazocine/acetaminophen

tablet: Schedule IV

  • 25mg/650mg

Pain

Dose determined by pain severity and patient response

1 tablet PO q4hr; not to exceed 6 tablets/day

Renal Impairment

Caution; may need to reduce either dose or frequency of administration

Hepatic Impairment

Caution; may need to reduce either dose or frequency of administration

Dosage Forms & Strengths

FDA is asking manufacturers to limit acetaminophen in prescription products to 325 mg/dosage unit; manufacturers have until January 14, 2014 to comply

pentazocine/acetaminophen

tablet: Schedule IV

  • 25mg/650mg

Pain

Dose determined by pain severity and patient response

<12 years: Safety & efficacy not established

12 years or older: 1 tablet PO q4hr; not to exceed 6 tablets/day

Use caution

Pain

Dose determined by pain severity and patient response

1 tablet PO q4hr; not to exceed 6 tablets/day

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Interactions

Interaction Checker

and pentazocine/acetaminophen

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            Contraindicated (1)

            • alvimopan

              alvimopan, pentazocine. receptor binding competition. Contraindicated. Alvimopan is contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea. No significant interaction is expected with concurrent use of opioid analgesics and alvimopan in patients who received opioid analgesics for 7 or fewer consecutive days prior to alvimopan.

            Serious - Use Alternative (45)

            • alfentanil

              pentazocine, alfentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • belladonna and opium

              pentazocine, belladonna and opium. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              pentazocine decreases effects of benzhydrocodone/acetaminophen by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone (benzhydrocodone prodrug of hydrocodone) and/or precipitate withdrawal symptoms in opioid tolerant patients.

            • bremelanotide

              bremelanotide will decrease the level or effect of pentazocine by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

            • buprenorphine

              buprenorphine, pentazocine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • buprenorphine buccal

              buprenorphine buccal, pentazocine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • butorphanol

              butorphanol, pentazocine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • calcium/magnesium/potassium/sodium oxybates

              pentazocine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • cimetidine

              cimetidine increases effects of pentazocine by decreasing metabolism. Avoid or Use Alternate Drug.

            • clonidine

              clonidine, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.

            • codeine

              pentazocine, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • desvenlafaxine

              pentazocine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

            • dextromoramide

              pentazocine, dextromoramide. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • diamorphine

              pentazocine, diamorphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • diazepam intranasal

              diazepam intranasal, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • difenoxin hcl

              pentazocine, difenoxin hcl. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • diphenoxylate hcl

              pentazocine, diphenoxylate hcl. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • dipipanone

              pentazocine, dipipanone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • eluxadoline

              pentazocine, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions. .

            • fentanyl

              fentanyl, pentazocine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              pentazocine decreases effects of fentanyl by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.

            • fentanyl intranasal

              fentanyl intranasal, pentazocine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              pentazocine decreases effects of fentanyl intranasal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.

            • fentanyl transdermal

              fentanyl transdermal, pentazocine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              pentazocine decreases effects of fentanyl transdermal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.

            • fentanyl transmucosal

              fentanyl transmucosal, pentazocine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              pentazocine decreases effects of fentanyl transmucosal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.

            • hydrocodone

              pentazocine decreases effects of hydrocodone by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone and/or precipitate withdrawal symptoms in opioid tolerant patients.

              hydrocodone, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • hydromorphone

              pentazocine, hydromorphone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • isocarboxazid

              isocarboxazid and pentazocine both increase serotonin levels. Avoid or Use Alternate Drug.

              isocarboxazid increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • levorphanol

              pentazocine, levorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • linezolid

              linezolid and pentazocine both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

              linezolid increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • lonafarnib

              acetaminophen will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

            • meperidine

              pentazocine, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • methadone

              pentazocine, methadone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • methylene blue

              methylene blue and pentazocine both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue pentazocine (if possible) and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

            • metoclopramide intranasal

              pentazocine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            • morphine

              pentazocine, morphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • nalbuphine

              nalbuphine, pentazocine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • oliceridine

              pentazocine, oliceridine. Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant use may reduce analgesic effect of oliceridine and/or precipitate withdrawal symptoms.

            • opium tincture

              pentazocine, opium tincture. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • oxycodone

              pentazocine, oxycodone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • oxymorphone

              pentazocine, oxymorphone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • ozanimod

              ozanimod and pentazocine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

            • papaveretum

              pentazocine, papaveretum. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • pexidartinib

              acetaminophen and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.

            • phenelzine

              phenelzine and pentazocine both increase serotonin levels. Avoid or Use Alternate Drug.

              phenelzine increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • pretomanid

              acetaminophen, pretomanid. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.

            • procarbazine

              procarbazine and pentazocine both increase serotonin levels. Avoid or Use Alternate Drug.

              procarbazine increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

            Monitor Closely (234)

            • 5-HTP

              5-HTP and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • albuterol

              pentazocine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alfentanil

              alfentanil and pentazocine both increase sedation. Use Caution/Monitor.

            • almotriptan

              almotriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • alprazolam

              alprazolam and pentazocine both increase sedation. Use Caution/Monitor.

            • amitriptyline

              pentazocine and amitriptyline both increase sedation. Use Caution/Monitor.

              amitriptyline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • amobarbital

              amobarbital and pentazocine both increase sedation. Use Caution/Monitor.

            • amoxapine

              pentazocine and amoxapine both increase sedation. Use Caution/Monitor.

              amoxapine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • apalutamide

              apalutamide will decrease the level or effect of acetaminophen by increasing elimination. Use Caution/Monitor. Apalutamide induces UGT and may decrease systemic exposure of drugs that are UGT substrates.

            • apomorphine

              pentazocine and apomorphine both increase sedation. Use Caution/Monitor.

            • arformoterol

              pentazocine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aripiprazole

              pentazocine and aripiprazole both increase sedation. Use Caution/Monitor.

            • armodafinil

              pentazocine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • avapritinib

              acetaminophen will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • axitinib

              acetaminophen increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • azelastine

              azelastine and pentazocine both increase sedation. Use Caution/Monitor.

            • baclofen

              baclofen and pentazocine both increase sedation. Use Caution/Monitor.

            • belladonna and opium

              belladonna and opium and pentazocine both increase sedation. Use Caution/Monitor.

            • benperidol

              pentazocine and benperidol both increase sedation. Use Caution/Monitor.

            • benzphetamine

              pentazocine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • brexanolone

              brexanolone, pentazocine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • brompheniramine

              brompheniramine and pentazocine both increase sedation. Use Caution/Monitor.

            • bupivacaine implant

              acetaminophen, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.

            • buprenorphine

              buprenorphine and pentazocine both increase sedation. Use Caution/Monitor.

            • buprenorphine buccal

              buprenorphine buccal and pentazocine both increase sedation. Use Caution/Monitor.

            • buprenorphine, long-acting injection

              pentazocine increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

            • buspirone

              buspirone and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • busulfan

              acetaminophen increases levels of busulfan by decreasing metabolism. Use Caution/Monitor. Use of acetaminophen prior to (< 72 hours) or concurrently with busulfan may result in decreased clearance of busulfan due to acetaminophen-induced decreases in glutathione levels.

            • butabarbital

              butabarbital and pentazocine both increase sedation. Use Caution/Monitor.

            • butalbital

              butalbital and pentazocine both increase sedation. Use Caution/Monitor.

            • butorphanol

              butorphanol and pentazocine both increase sedation. Use Caution/Monitor.

            • caffeine

              pentazocine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine and pentazocine both increase sedation. Use Caution/Monitor.

            • carisoprodol

              carisoprodol and pentazocine both increase sedation. Use Caution/Monitor.

            • cenobamate

              cenobamate, pentazocine. Either increases effects of the other by sedation. Use Caution/Monitor.

            • chloral hydrate

              chloral hydrate and pentazocine both increase sedation. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide and pentazocine both increase sedation. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine and pentazocine both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              pentazocine and chlorpromazine both increase sedation. Use Caution/Monitor.

            • chlorzoxazone

              chlorzoxazone and pentazocine both increase sedation. Use Caution/Monitor.

            • cigarette smoking

              cigarette smoking decreases effects of pentazocine by increasing metabolism. Use Caution/Monitor. Tobacco smoking may decrease the clinical effect of a standard pentazocine dose.

            • cinnarizine

              cinnarizine and pentazocine both increase sedation. Use Caution/Monitor.

            • citalopram

              citalopram and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • clemastine

              clemastine and pentazocine both increase sedation. Use Caution/Monitor.

            • clomipramine

              pentazocine and clomipramine both increase sedation. Use Caution/Monitor.

              clomipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • clonazepam

              clonazepam and pentazocine both increase sedation. Use Caution/Monitor.

            • clorazepate

              clorazepate and pentazocine both increase sedation. Use Caution/Monitor.

            • clozapine

              pentazocine and clozapine both increase sedation. Use Caution/Monitor.

            • cocaine

              cocaine and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • codeine

              codeine and pentazocine both increase sedation. Use Caution/Monitor.

            • cyclizine

              cyclizine and pentazocine both increase sedation. Use Caution/Monitor.

            • cyclobenzaprine

              cyclobenzaprine and pentazocine both increase sedation. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine and pentazocine both increase sedation. Use Caution/Monitor.

            • dantrolene

              dantrolene and pentazocine both increase sedation. Use Caution/Monitor.

            • dapsone topical

              acetaminophen increases toxicity of dapsone topical by altering metabolism. Modify Therapy/Monitor Closely. May induce methemoglobinemia .

            • desflurane

              desflurane and pentazocine both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.

            • desipramine

              pentazocine and desipramine both increase sedation. Use Caution/Monitor.

              desipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • deutetrabenazine

              pentazocine and deutetrabenazine both increase sedation. Use Caution/Monitor.

            • dexchlorpheniramine

              dexchlorpheniramine and pentazocine both increase sedation. Use Caution/Monitor.

            • dexfenfluramine

              pentazocine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              dexfenfluramine and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • dexmedetomidine

              dexmedetomidine and pentazocine both increase sedation. Use Caution/Monitor.

            • dexmethylphenidate

              pentazocine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextroamphetamine

              pentazocine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              dextroamphetamine and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • dextromethorphan

              dextromethorphan and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • dextromoramide

              dextromoramide and pentazocine both increase sedation. Use Caution/Monitor.

            • diamorphine

              diamorphine and pentazocine both increase sedation. Use Caution/Monitor.

            • diazepam

              diazepam and pentazocine both increase sedation. Use Caution/Monitor.

            • diethylpropion

              pentazocine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • difenoxin hcl

              difenoxin hcl and pentazocine both increase sedation. Use Caution/Monitor.

            • dihydroergotamine

              dihydroergotamine and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • dihydroergotamine intranasal

              dihydroergotamine intranasal and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • dimenhydrinate

              dimenhydrinate and pentazocine both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine and pentazocine both increase sedation. Use Caution/Monitor.

            • diphenoxylate hcl

              diphenoxylate hcl and pentazocine both increase sedation. Use Caution/Monitor.

            • dipipanone

              dipipanone and pentazocine both increase sedation. Use Caution/Monitor.

            • dobutamine

              pentazocine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopamine

              pentazocine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopexamine

              pentazocine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dosulepin

              pentazocine and dosulepin both increase sedation. Use Caution/Monitor.

            • doxepin

              pentazocine and doxepin both increase sedation. Use Caution/Monitor.

              doxepin and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • doxylamine

              doxylamine and pentazocine both increase sedation. Use Caution/Monitor.

            • droperidol

              pentazocine and droperidol both increase sedation. Use Caution/Monitor.

            • duloxetine

              duloxetine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • eletriptan

              eletriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • eltrombopag

              eltrombopag increases levels of acetaminophen by decreasing metabolism. Use Caution/Monitor. UGT inhibition; significance of interaction unclear.

            • ephedrine

              pentazocine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine

              pentazocine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine racemic

              pentazocine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ergotamine

              ergotamine and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • escitalopram

              escitalopram and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • esketamine intranasal

              esketamine intranasal, pentazocine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

            • estazolam

              estazolam and pentazocine both increase sedation. Use Caution/Monitor.

            • ethanol

              pentazocine and ethanol both increase sedation. Use Caution/Monitor.

            • etomidate

              etomidate and pentazocine both increase sedation. Use Caution/Monitor.

            • exenatide injectable solution

              exenatide injectable solution will decrease the level or effect of acetaminophen by unspecified interaction mechanism. Use Caution/Monitor. To avoid potential interaction, give acetaminophen at least 1 hour before or 4 hours after exenatide injection.

            • exenatide injectable suspension

              exenatide injectable suspension will decrease the level or effect of acetaminophen by unspecified interaction mechanism. Use Caution/Monitor. To avoid potential interaction, give acetaminophen at least 1 hour before or 4 hours after exenatide injection.

            • fenfluramine

              pentazocine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              fenfluramine and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • finerenone

              acetaminophen will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or moderate CYP3A4 inhibitors. Adjust finererone dosage as needed.

            • flibanserin

              pentazocine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

              acetaminophen will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

            • fluoxetine

              fluoxetine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • imatinib

              imatinib decreases levels of acetaminophen by decreasing hepatic clearance. Modify Therapy/Monitor Closely. In vitro, imatinib was found to inhibit acetaminophen O-glucuronidation (Ki value of 58.5 micro-M) at therapeutic levels; avoid chronic acetaminophen therapy with imatinib; if occasional acetaminophen administered, do not exceed 1300 mg/day.

            • fluphenazine

              pentazocine and fluphenazine both increase sedation. Use Caution/Monitor.

            • flurazepam

              flurazepam and pentazocine both increase sedation. Use Caution/Monitor.

            • fluvoxamine

              fluvoxamine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • formoterol

              pentazocine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • frovatriptan

              frovatriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • gabapentin

              gabapentin, pentazocine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • gabapentin enacarbil

              gabapentin enacarbil, pentazocine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • haloperidol

              pentazocine and haloperidol both increase sedation. Use Caution/Monitor.

            • hydromorphone

              hydromorphone and pentazocine both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine and pentazocine both increase sedation. Use Caution/Monitor.

            • iloperidone

              pentazocine and iloperidone both increase sedation. Use Caution/Monitor.

            • imipramine

              pentazocine and imipramine both increase sedation. Use Caution/Monitor.

              imipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • isoniazid

              isoniazid and pentazocine both increase serotonin levels. Use Caution/Monitor.

              isoniazid will increase the level or effect of acetaminophen by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor.

            • isoproterenol

              pentazocine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ivacaftor

              acetaminophen increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .

            • ketamine

              ketamine and pentazocine both increase sedation. Use Caution/Monitor.

            • ketotifen, ophthalmic

              pentazocine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

            • L-tryptophan

              L-tryptophan and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • lasmiditan

              lasmiditan, pentazocine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

            • lemborexant

              lemborexant, pentazocine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

              acetaminophen will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

            • levalbuterol

              pentazocine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

              levonorgestrel oral/ethinylestradiol/ferrous bisglycinate will decrease the level or effect of acetaminophen by unknown mechanism. Use Caution/Monitor.

              acetaminophen increases levels of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by decreasing hepatic clearance. Use Caution/Monitor. Coadministration of ascorbic acid and certain combined hormonal contraceptives (CHCs) containing EE may increase plasma EE concentrations, possibly by inhibition of conjugation.

            • levomilnacipran

              levomilnacipran and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • levorphanol

              levorphanol and pentazocine both increase sedation. Use Caution/Monitor.

            • lisdexamfetamine

              pentazocine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lithium

              lithium and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • lixisenatide

              lixisenatide will decrease the level or effect of acetaminophen by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. GLP1 agonists delay gastric emptying, which may affect absorption of concomitantly administered oral medications. No effects on acetaminophen Cmax and Tmax were observed when acetaminophen was administered 1 hr before lixisenatide. When administered 1 or 4 hr after lixisenatide, acetaminophen Cmax was decreased by 29% and 31% respectively and median Tmax was delayed by 2 and 1.75 hr, respectively.

            • lofepramine

              pentazocine and lofepramine both increase sedation. Use Caution/Monitor.

              lofepramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • lofexidine

              pentazocine and lofexidine both increase sedation. Use Caution/Monitor.

            • lomitapide

              acetaminophen increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

            • loprazolam

              loprazolam and pentazocine both increase sedation. Use Caution/Monitor.

            • lorazepam

              lorazepam and pentazocine both increase sedation. Use Caution/Monitor.

            • lormetazepam

              lormetazepam and pentazocine both increase sedation. Use Caution/Monitor.

            • loxapine

              pentazocine and loxapine both increase sedation. Use Caution/Monitor.

            • loxapine inhaled

              pentazocine and loxapine inhaled both increase sedation. Use Caution/Monitor.

            • lsd

              lsd and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • lurasidone

              lurasidone, pentazocine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

            • maprotiline

              pentazocine and maprotiline both increase sedation. Use Caution/Monitor.

              maprotiline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • marijuana

              pentazocine and marijuana both increase sedation. Use Caution/Monitor.

            • melatonin

              pentazocine and melatonin both increase sedation. Use Caution/Monitor.

            • meperidine

              meperidine and pentazocine both increase sedation. Use Caution/Monitor.

              meperidine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • meprobamate

              pentazocine and meprobamate both increase sedation. Use Caution/Monitor.

            • metaproterenol

              pentazocine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaxalone

              metaxalone and pentazocine both increase sedation. Use Caution/Monitor.

            • methadone

              methadone and pentazocine both increase sedation. Use Caution/Monitor.

            • methamphetamine

              pentazocine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methocarbamol

              methocarbamol and pentazocine both increase sedation. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              pentazocine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • midazolam

              midazolam and pentazocine both increase sedation. Use Caution/Monitor.

            • midazolam intranasal

              midazolam intranasal, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

              acetaminophen will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

            • midodrine

              pentazocine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mipomersen

              mipomersen, acetaminophen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

            • milnacipran

              milnacipran and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • mirtazapine

              pentazocine and mirtazapine both increase sedation. Use Caution/Monitor.

              mirtazapine and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • modafinil

              pentazocine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • morphine

              morphine and pentazocine both increase sedation. Use Caution/Monitor.

              morphine and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • motherwort

              pentazocine and motherwort both increase sedation. Use Caution/Monitor.

            • moxonidine

              pentazocine and moxonidine both increase sedation. Use Caution/Monitor.

            • nabilone

              pentazocine and nabilone both increase sedation. Use Caution/Monitor.

            • nalbuphine

              nalbuphine and pentazocine both increase sedation. Use Caution/Monitor.

            • naratriptan

              naratriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • nefazodone

              nefazodone and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • norepinephrine

              pentazocine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nortriptyline

              pentazocine and nortriptyline both increase sedation. Use Caution/Monitor.

              nortriptyline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • olanzapine

              pentazocine and olanzapine both increase sedation. Use Caution/Monitor.

            • oliceridine

              oliceridine, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • opium tincture

              opium tincture and pentazocine both increase sedation. Use Caution/Monitor.

            • orphenadrine

              orphenadrine and pentazocine both increase sedation. Use Caution/Monitor.

            • oxazepam

              oxazepam and pentazocine both increase sedation. Use Caution/Monitor.

            • oxycodone

              oxycodone and pentazocine both increase sedation. Use Caution/Monitor.

            • oxymorphone

              oxymorphone and pentazocine both increase sedation. Use Caution/Monitor.

            • paliperidone

              pentazocine and paliperidone both increase sedation. Use Caution/Monitor.

            • papaveretum

              papaveretum and pentazocine both increase sedation. Use Caution/Monitor.

            • papaverine

              pentazocine and papaverine both increase sedation. Use Caution/Monitor.

            • paroxetine

              paroxetine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • pegvisomant

              pentazocine decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.

            • pentobarbital

              pentobarbital and pentazocine both increase sedation. Use Caution/Monitor.

            • perphenazine

              pentazocine and perphenazine both increase sedation. Use Caution/Monitor.

            • phendimetrazine

              pentazocine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenobarbital

              phenobarbital and pentazocine both increase sedation. Use Caution/Monitor.

            • phentermine

              pentazocine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine

              pentazocine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine PO

              pentazocine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • pholcodine

              pentazocine and pholcodine both increase sedation. Use Caution/Monitor.

            • pimozide

              pentazocine and pimozide both increase sedation. Use Caution/Monitor.

            • pirbuterol

              pentazocine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pregabalin

              pregabalin, pentazocine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • primidone

              primidone and pentazocine both increase sedation. Use Caution/Monitor.

            • prochlorperazine

              pentazocine and prochlorperazine both increase sedation. Use Caution/Monitor.

            • promethazine

              promethazine and pentazocine both increase sedation. Use Caution/Monitor.

            • propofol

              propofol and pentazocine both increase sedation. Use Caution/Monitor.

            • propylhexedrine

              pentazocine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • protriptyline

              pentazocine and protriptyline both increase sedation. Use Caution/Monitor.

              protriptyline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • quazepam

              quazepam and pentazocine both increase sedation. Use Caution/Monitor.

            • quetiapine

              pentazocine and quetiapine both increase sedation. Use Caution/Monitor.

            • ramelteon

              pentazocine and ramelteon both increase sedation. Use Caution/Monitor.

            • remimazolam

              remimazolam, pentazocine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

            • risperidone

              pentazocine and risperidone both increase sedation. Use Caution/Monitor.

            • rizatriptan

              rizatriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • salmeterol

              pentazocine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • SAMe

              pentazocine and SAMe both increase serotonin levels. Use Caution/Monitor.

            • scullcap

              pentazocine and scullcap both increase sedation. Use Caution/Monitor.

            • secobarbital

              secobarbital and pentazocine both increase sedation. Use Caution/Monitor.

            • selegiline

              selegiline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely. Potential for increased CNS depression, drowsiness, dizziness or hypotension, so use with any MAOI should be cautious.

            • selegiline transdermal

              selegiline transdermal and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • sertraline

              sertraline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • sevoflurane

              sevoflurane and pentazocine both increase sedation. Use Caution/Monitor.

            • shepherd's purse

              pentazocine and shepherd's purse both increase sedation. Use Caution/Monitor.

            • St John's Wort

              pentazocine and St John's Wort both increase serotonin levels. Modify Therapy/Monitor Closely.

            • stiripentol

              stiripentol, pentazocine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

            • sufentanil

              pentazocine and sufentanil both increase sedation. Use Caution/Monitor.

            • sumatriptan

              sumatriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • sumatriptan intranasal

              sumatriptan intranasal and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • suvorexant

              suvorexant and pentazocine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

            • tapentadol

              pentazocine and tapentadol both increase sedation. Use Caution/Monitor.

            • tazemetostat

              acetaminophen will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • temazepam

              temazepam and pentazocine both increase sedation. Use Caution/Monitor.

            • terbutaline

              pentazocine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tetracaine

              tetracaine, acetaminophen. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.

            • thioridazine

              pentazocine and thioridazine both increase sedation. Use Caution/Monitor.

            • thiothixene

              pentazocine and thiothixene both increase sedation. Use Caution/Monitor.

            • tinidazole

              acetaminophen will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • topiramate

              pentazocine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

            • tramadol

              pentazocine and tramadol both increase sedation. Use Caution/Monitor.

              pentazocine and tramadol both increase serotonin levels. Use Caution/Monitor.

            • trazodone

              pentazocine and trazodone both increase sedation. Use Caution/Monitor.

              trazodone and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • triazolam

              triazolam and pentazocine both increase sedation. Use Caution/Monitor.

            • triclofos

              triclofos and pentazocine both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              pentazocine and trifluoperazine both increase sedation. Use Caution/Monitor.

            • trimipramine

              pentazocine and trimipramine both increase sedation. Use Caution/Monitor.

              trimipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • triprolidine

              triprolidine and pentazocine both increase sedation. Use Caution/Monitor.

            • venlafaxine

              venlafaxine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • warfarin

              acetaminophen increases effects of warfarin by unknown mechanism. Use Caution/Monitor.

            • xylometazoline

              pentazocine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            Minor (59)

            • acetazolamide

              acetazolamide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • albiglutide

              albiglutide decreases levels of acetaminophen by unspecified interaction mechanism. Minor/Significance Unknown.

            • antithrombin alfa

              acetaminophen increases effects of antithrombin alfa by unknown mechanism. Minor/Significance Unknown.

            • antithrombin III

              acetaminophen increases effects of antithrombin III by unknown mechanism. Minor/Significance Unknown.

            • argatroban

              acetaminophen increases effects of argatroban by unknown mechanism. Minor/Significance Unknown.

            • aspirin

              aspirin, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Possible risk of renal papillary necrosis w/chronic Tx.

            • aspirin rectal

              aspirin rectal, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Possible risk of renal papillary necrosis w/chronic Tx.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Possible risk of renal papillary necrosis w/chronic Tx.

            • bemiparin

              acetaminophen increases effects of bemiparin by unknown mechanism. Minor/Significance Unknown.

            • bivalirudin

              acetaminophen increases effects of bivalirudin by unknown mechanism. Minor/Significance Unknown.

            • brimonidine

              brimonidine increases effects of pentazocine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • carbamazepine

              carbamazepine decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • cholestyramine

              cholestyramine decreases levels of acetaminophen by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • clonazepam

              clonazepam decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • colestipol

              colestipol decreases levels of acetaminophen by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • dalteparin

              acetaminophen increases effects of dalteparin by unknown mechanism. Minor/Significance Unknown.

            • dextroamphetamine

              dextroamphetamine increases effects of pentazocine by unspecified interaction mechanism. Minor/Significance Unknown.

            • diazepam

              diazepam decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • disulfiram

              disulfiram will increase the level or effect of acetaminophen by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.

            • enoxaparin

              acetaminophen increases effects of enoxaparin by unknown mechanism. Minor/Significance Unknown.

            • ethanol

              ethanol will decrease the level or effect of acetaminophen by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.

              ethanol increases toxicity of acetaminophen by decreasing metabolism. Minor/Significance Unknown.

            • ethosuximide

              ethosuximide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • eucalyptus

              pentazocine and eucalyptus both increase sedation. Minor/Significance Unknown.

            • felbamate

              felbamate decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • fondaparinux

              acetaminophen increases effects of fondaparinux by unknown mechanism. Minor/Significance Unknown.

            • fosphenytoin

              fosphenytoin decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • gabapentin

              gabapentin decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • gabapentin enacarbil

              gabapentin enacarbil decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • green tea

              green tea increases effects of acetaminophen by pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical, due to caffeine content).

            • heparin

              acetaminophen increases effects of heparin by unknown mechanism. Minor/Significance Unknown.

            • isoniazid

              isoniazid increases toxicity of acetaminophen by unknown mechanism. Minor/Significance Unknown.

            • lacosamide

              lacosamide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • lamotrigine

              lamotrigine decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • levetiracetam

              levetiracetam decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • lidocaine

              lidocaine increases toxicity of pentazocine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.

            • liraglutide

              liraglutide decreases levels of acetaminophen by unspecified interaction mechanism. Minor/Significance Unknown.

            • lorazepam

              lorazepam decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • methsuximide

              methsuximide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • metoclopramide

              metoclopramide increases levels of acetaminophen by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • metronidazole

              metronidazole will increase the level or effect of acetaminophen by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.

            • oxcarbazepine

              oxcarbazepine decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • oxybutynin

              oxybutynin decreases levels of acetaminophen by unspecified interaction mechanism. Minor/Significance Unknown.

            • oxybutynin topical

              oxybutynin topical decreases levels of acetaminophen by unspecified interaction mechanism. Minor/Significance Unknown.

            • oxybutynin transdermal

              oxybutynin transdermal decreases levels of acetaminophen by unspecified interaction mechanism. Minor/Significance Unknown.

            • phenindione

              acetaminophen increases effects of phenindione by unknown mechanism. Minor/Significance Unknown.

            • phenobarbital

              phenobarbital decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • phenytoin

              phenytoin decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • primidone

              primidone decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • protamine

              acetaminophen increases effects of protamine by unknown mechanism. Minor/Significance Unknown.

            • rifabutin

              rifabutin decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • rifampin

              rifampin decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • rufinamide

              rufinamide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • ruxolitinib

              acetaminophen will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • sage

              pentazocine and sage both increase sedation. Minor/Significance Unknown.

            • tiagabine

              tiagabine decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • topiramate

              topiramate decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • valproic acid

              valproic acid decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • ziconotide

              ziconotide, pentazocine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.

            • zonisamide

              zonisamide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism increase levels of hepatotoxic metabolites.

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            Adverse Effects

            Frequency Not Defined

            Pentazocine

            • Circulatory depression, increased blood pressure, shock, tachycardia
            • Apprehension, confusion and hallucinations (especially in elderly), depression, disturbed dreams, dizziness, euphoria, floating feeling, headache, insomnia lightheadedness, nervousness, sedation, syncope, weakness or faintness
            • Diaphoresis, flushed skin (including plethora), rash, pruritus, urticaria, edema of the face
            • Abdominal distress, anorexia, constipation, cramps, diarrhea, nausea, vomiting
            • Depression of leukocytes (especially granulocytes), moderate transient eosinophilia
            • Cutaneous depression, stinging, soft tissue induration, nodules, , ulceration, severe sclerosis of the skin
            • Blurred vision, focusing difficulty, nystagmus, diplopia, miosis

            Acetaminophen

            • Laryngeal edema
            • Angioedema
            • Pruritic maculopapular, rash, urticaria
            • Agranulocytosis, leukopenia, neutropenia, pancytopenia, thrombocytopenia, thrombocytopenic purpura
            • Hepatotoxicity
            • Anaphylactoid reaction
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            Warnings

            Black Box Warnings

            Contains acetaminophen

            Hepatotoxicity may occur with acetaminophen doses that exceed 4 grams/day (ie, 4,000 mg/day)

            Acetaminophen associated with cases of acute liver failure, at times resulting in liver transplant and death

            Most cases of liver injury are associated with the use of acetaminophen at doses that exceed 4 grams/day, and often involve more than 1 acetaminophen-containing product

            New dosage limit allows no more than 325 mg/dosage unit for prescription medications that contain acetaminophen

            Healthcare professionals can direct patients to take 1 or 2 tablets, capsules or other dosage units of a prescription product containing 325 mg of acetaminophen up to 6 times a day (12 dosage units) and still not exceed the maximum daily dose of acetaminophen (ie, 4000 mg/day)

            Contraindications

            Hypersensitivity

            Hepatitis or severe hepatic/renal impairment

            Toxin-mediated diarrhea

            Pseudomembranous enterocolitis

            Respiratory depression

            Cautions

            May cause physical and psychological dependence

            Acetaminophen associated with cases of acute liver failure, at times resulting in liver transplant and death; risk increases in individuals with underlying liver disease, alcohol ingestion, and/or use of more than 1 acetaminophen-containing product (see Black Box Warnings)

            Acetaminophen: Risk for rare, but serious skin reactions that can be fatal; these reactions include Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP); symptoms may include skin redness, blisters and rash

            G6PD deficiency

            Acute asthma

            Bradycardia

            Chronic respiratory disease, cardiac conduction disorder

            Head injury, intracranial hypertension

            Inflammatory bowel disease, acute abdominal pain

            Benign prostatic hypertrophy

            Biliary spasm

            Liver disease

            Drug dependence, substance abuse

            Epilepsy

            Gallbladder disease

            Hypotension

            Hypothyroidism

            Mood changes

            Urinary system procedure

            Renal disease

            Urethral stricture

            Less risk of respiratory sedation than with pure opioid agonist (dose dependent); highest incidence of psychotomimetic effects of all opioid agonist/antagonists

            May produce withdrawal in opioid dependent patients

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            Pregnancy & Lactation

            Pregnancy category: (pentazocine) C; D if used for prolonged periods or near term

            Lactation: Unknown if excreted in breast milk, use caution

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Pentazocine: Opioid agonist; inhibits ascending pain pathways, which causes alteration in response to pain; produces analgesia, respiratory depression, and sedation

            Acetaminophen: Nonopiate, nonsalicylate analgesic: may work peripherally to block pain impulse generation; acts on hypothalamus to produce antipyresis

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            Images

            No images available for this drug.
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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.