Contraindicated in:
- Hypersensitivity
- Significant respiratory depression in unmonitored settings or where resuscitative equipment is not readily available
- Paralytic ileus
- Severe renal impairment
- Severe hepatic impairment
- Concurrent use of MAO inhibitors or use of MAO inhibitors in the preceding 2 wk
- Acute or severe bronchial asthma
- Acute, mild, intermittent, or postoperative pain (extended-release only)
- OB: Not recommended for use during labor and delivery
- Pedi: Children
6 yr and 40 kg with renal or hepatic impairment.
Use Cautiously in:
- Conditions associated with hypoxia, hypercapnea, or ↓ respiratory reserve, including asthma, chronic obstructive pulmonary disease, cor pulmonale, extreme obesity, sleep apnea syndrome, myxedema, kyphoscoliosis, CNS depression, use of other CNS depressants, or coma (↑ risk of further respiratory depression); use smallest effective dose
- History of substance abuse or addiction disorder
- Seizure disorders
- Moderate hepatic impairment
- OB: Prolonged use of opioids during pregnancy can result in neonatal opioid withdrawal syndrome
- Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant
- Pedi: Safety and effectiveness not established in children <18 yr (extended release) or <6 yr and <(immediate release)
- Geri: ↑risk of respiratory depression in older adults (dose ↓ suggested).