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Classification: Analgesic, Opiates

Action: Centrally acting analgesic not chemically related to opioids but binds to mu-opioid receptors and inhibits reuptake of norepinephrine and serotonin.

Indication: Moderate to severe pain.

Adverse Reactions: Vasodilation; dizziness vertigo, headache, somnolence, stimulation, anxiety, confusion, coordination disturbances, euphoria, nervousness, Visual disturbances, dry mouth. Nausea, diarrhea, constipation,  vomiting, abdominal pain, flatulence. Urinary retention.

Nursing Considerations


  • Assess patient’s pain before therapy and regularly thereafter to monitor drug effectiveness (give before pain become extreme)
  • Assess for hypersensitivity reactions
  • Monitor for possible drug induced adverse reactions
  • Monitor for CNS changes
  • Monitor input-output ratio and check for decreasing output which may indicate retention
  • Assess changes in bowel pattern. Increase diet bulk and oral fluids and to prevent constipation
  • Assess patient’s and family’s knowledge on drug therapy


  • Give with antiemetic for nausea and vomiting
  • Administer when pain is beginning to return; determine dosage interval by patient response
  • Store in cool environment, protect from sunlight


  • Instruct patient to take drug only as prescribed and not to increase dosage or interval without medical advice
  • Advice patient to avoid alcohol and OTC medication without medical advice
  • Warn ambulatory patients to be careful (call for assistance) when getting out of bed or walking and to refrain from performing activities that require alertness until CNS effects are known
  • Instruct patient to change positions slowly to prevent orthostatic hypotension
  • Instruct patient to monitor for and report occurrence of drug induced adverse reactions


  • Patient is relieved of pain
  • Patient does not sustain injury related to drug induced adverse reactions
  • Patient and family state understanding of drug therapy