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Table 5. Drugs To Be Avoided for Treatment of Cancer Pain

Class Drug Rationale for NOT Recommending 
Opioidsmeperidine (Demerol)Short duration (2–3 h) of analgesia.
Repeated administration may lead to CNS toxicity (tremor, confusion, or seizures).
Opioid agonist-antagonistspentazocine (Talwin), butorphanol (Stadol), nalbuphine (Nubain)Risk of precipitating withdrawal in opioid-dependent patients.
Analgesic ceiling.
Possible production of unpleasant psychotomimetic effects (e.g., dysphoria, delusions, hallucinations).
Partial agonistbuprenorphine (Buprenex)Analgesic ceiling.
May precipitate withdrawal if administered with full opioid agonist.
Antagonistsnaloxone (Narcan), naltrexone (ReVia)May precipitate withdrawal.
Limit use to treatment of life-threatening respiratory depression. Give in diluted form to opioid-tolerant patients.
Combination preparationsBrompton's cocktailaNo evidence of analgesic benefit in using Brompton's cocktail over single-opioid analgesics.
DPT (meperidine, promethazine, and chlorpromazine)bEfficacy is poor compared with that of other analgesics.
High incidence of adverse effects.
Anxiolytics alonebenzodiazepines (e.g., alprazolam [Xanax]; clonazepam [Ceberclon]; diazepam [Valium]; lorazepam [Ativan])Analgesic properties not demonstrated except for some instances of neuropathic pain.
Added sedation from anxiolytics may compromise neurologic assessment in patients receiving opioids by facilitating the development of delirium.
Sedative/hypnotic drugs alonebarbiturates, benzodiazepinesAnalgesic properties not demonstrated.
Added sedation from sedative/hypnotic drugs limits opioid dosing and may facilitate the development of delirium.

CNS = central nervous system.
aContains morphine, cocaine, ethanol, and, in some cases, chlorpromazine.
bMeperidine is the only analgesic in this combination.