pentazocine/naloxone (Rx)

Brand and Other Names:Talwin NX
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

pentazocine/naloxone

tablet: Schedule IV

  • 50mg/0.5mg

Moderate-to-Severe Pain

1 tablet PO q3-4hr, may increase to 2 tablets q3-4hr PRN; not to exceed 12 tablets/day

Renal Impairment

CrCl 10-50 mL/min: 75% regular adult dose

CrCl <10 mL/min: 50% regular adult dose

Hepatic Impairment

Use caution

Dosage Forms & Strengths

pentazocine/naloxone

tablet: Schedule IV

  • 50mg/0.5mg

Moderate-to-Severe Pain

<12 years: Safety and efficacy not established

>12 years: As adults; tablet PO q3-4hr, may increase to 2 tablets q3-4hr PRN; not to exceed 12 tablets/day

Use caution; monitor closely

Moderate-to-Severe Pain

1 tablet PO q3-4hr, may increase to 2 tablets q3-4hr PRN; not to exceed 12 tablets/day

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Interactions

Interaction Checker

and pentazocine/naloxone

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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 (37)

            • 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.

            • 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.

            • naldemedine

              naldemedine, naloxone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for additive opioid receptor anatagonism and increased risk of opioid withdrawal.

            • naloxegol

              naloxegol, naloxone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration; potential for additive effect of opioid receptor anatagonism and increased risk of opioid withdrawal.

            • 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.

            Monitor Closely (219)

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • flibanserin

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

            • fluoxetine

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

            • 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.

            • isoproterenol

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

            • 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.

            • levalbuterol

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

            • 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.

            • 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.

            • 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.

            • midodrine

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

            • 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.

            • 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.

            • thioridazine

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

            • thiothixene

              pentazocine and thiothixene both increase sedation. 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.

            • xylometazoline

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

            • yohimbine

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

            • ziconotide

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

            • ziprasidone

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

            • zolmitriptan

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

            • zotepine

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

            Minor (7)

            • 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.

            • brimonidine

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

            • dextroamphetamine

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

            • elvitegravir

              elvitegravir decreases levels of naloxone by unknown mechanism. Minor/Significance Unknown. No dose adjustment of buprenorphine/naloxone is required upon coadministration with VITEKTA. Patients should be closely monitored for sedation and cognitive effects.

            • eucalyptus

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

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            Warnings

            Black Box Warnings

            Talwin Nx is intended for oral administration only. Severe vascular reactions have resulted from misuse by injection

            Contraindications

            Hypersensitivity

            Do not inject dissolved tablets

            If prescribed for long-term use, take precautions to avoid increases in dose by the patient

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: 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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            Patient Handout

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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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.