Dosing and uses of Talwin (pentazocine)
Adult dosage forms and strengths
injectable solution: Schedule IV
- 30mg/mL
Treatment of Moderate to Severe Pain
30 mg IV/IM/SC q3-4hr (not to exceed 30 mg/dose IV or 60 mg/dose IM/SC)
Not to exceed 360 mg/day IV/IM/SC
Labor Pain
30mg IM once Or
20mg IV when contractions become regular; may give q2-3hr PRN; not to exceed 60 mg
Preoperative or Preanesthetic/Supplement to Surgical Anesthesia
30 mg IV/IM/SC q3-4hr (not to exceed 30 mg/dose IV or 60 mg/dose IM/SC)
Not to exceed 360 mg/day IV/IM/SC
Renal Impairment
CrCl 10-50 mL/min: 75% of regular dose
CrCl<10 mL/min: 50% of regular dose
Hepatic Impairment
Use lower dose or avoid in liver disease
See Also Combos With
Acetaminophen: Talacen
ASA: Talwin Compound (discontinued)
Naloxone (Talwin Nx)
Pentazocine HCl tablets (Talwin 50) (discontinued)
Pediatric dosage forms and strengths
injectable solution: Schedule IV
- 30mg/mL
Preoperative or Preanesthetic/Supplement to Surgical Anesthesia
>1 year: 0.5 mg/kg IM as a single dose
Analgesia (Off-label)
<5 years: Safety and efficacy not established
5-8 years: 15 mg Im
>8 years: 30 mg Im
Geriatric dosage forms and strengths
Treatment of moderate to severe pain
30 mg IV/IM/SC q3-4hr (not to exceed 30 mg/dose IV or 60 mg/dose IM/SC)
Not to exceed 360 mg/day IV/IM/SC
Preoperative or preanesthetic/supplement to surgical anesthesia
30 mg IV/IM/SC q3-4hr (not to exceed 30 mg/dose IV or 60 mg/dose IM/SC)
Not to exceed 360 mg/day IV/IM/SC
Talwin (pentazocine) adverse (side) effects
Frequency not defined
Nausea
Vomiting
Constipation
Abdominal distress
Cramps
Anorexia
Diarrhea
Diaphoresis, flushed skin (including plethora)
Rash, pruritus, urticaria
Edema of the face
Dizziness
Lightheadedness
Euphoria
Sedation
Nervousness
Apprehension
Depression
Floating feeling
Headache
Weakness or faintness
Disturbed dreams
Insomnia
Syncope
Tachycardia
Circulatory depression
Shock
Increased blood pressure
Stinging
Soft tissue induration, nodule
Cutaneous depression
Ulceration
Severe sclerosis of the skin
Depression of leukocytes (especially granulocytes)
Moderate transient eosinophilia
Blurred vision
Focusing difficulty
Nystagmus
Diplopia
Miosis
Warnings
Contraindications
Toxin-mediated diarrhea, pseudomembranous enterocolitis, respiratory depression
Cautions
Acute asthma, bradycardia, chronic respiratory disease, head injury, inflammatory bowel disease, intracranial HTN, acute abdominal pain, BPH, biliary spasm, cardiac conduction disorder, liver disease, drug dependence, epilepsy, gallbladder disease, hypotension, hypothyroidism, mood changes, urinary system procedure, renal disease, substance abuse, 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 pts
Pregnancy and lactation
Pregnancy category: 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.
Pharmacology of Talwin (pentazocine)
Mechanism of action
Opioid agonist; inhibits ascending pain pathways, which causes alteration in response to pain; produces analgesia, respiratory depression, and sedation
Pharmacokinetics
Half-life: 2-3 hr
Onset: IM 15-20 min; IV 2-3 min
Duration: IM 2 hr; IV 1 hr
Peak Plasma Time: IM 15-60 min; IV 15 min
Concentration: IM 140 ng/mL
Bioavailability: 60-70%
Protein Bound: 60%
Metabolism: liver, (oxidation of terminal methyl groups-dimethyl alkyl side chain); glucuronide conjugation
Metabolites: Alcoholic/carboxylic acid metabolites
Excretion: Urine (mainly); feces
Administration
IV Incompatibilities
Additive: aminophylline, amobarbital, pentobarbital, phenobarbital, sodium bicarbonate
Syringe: glycopyrrolate, heparin, pentobarbitaL
Y-site: nafcillin
IV Compatabilities
Syringe: atropine, butorphanol, chlorpromazine, cimetidine, dimenhydrinate, diphenhydramine, droperidol, fentanyl, glycopyrrolate, hydromorphone, hydroxyzine, meperidine, meperidine w/ perphenazine, metoclopramide, morphine, papaveretum, perphenazine, prochlorperazine, promazine, promethazine, ranitidine, scopolamine
Y-site: heparin, hydrocortisone Na-succinate, KCl, Vit B/C
IV/IM Administration
IM, SC, & IV
Constant rotation of injection site for IM necessary
Use SC route only when necessary due to tissue damage
Avoid intra-arterial injection
Storage
Store at room temp
Protect from heat & freezing
