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This medication carries a risk of misuse and dependence, which can result in overdose and potentially fatal outcomes. It may also lead to severe, possibly life-threatening breathing difficulties. To minimize these risks, your healthcare provider should prescribe the lowest effective dose for the shortest duration necessary.

• The likelihood of experiencing severe breathing issues is increased at the beginning of treatment, if the incorrect dose is used, or if more medication is taken than prescribed.
• Combining this medication with alcohol or other substances that induce drowsiness or respiratory depression can lead to serious, potentially deadly side effects.
• Certain medications may interfere with how this drug is eliminated from your body, impacting its effectiveness. Ensure you understand the proper use of this medication and identify any drugs to avoid while taking it.
• Seek immediate medical attention if you experience serious side effects such as slow or shallow breathing, unusual lightheadedness, severe drowsiness or dizziness, or difficulty waking up.
• Store this medicine securely to prevent theft, misuse, or abuse. In case of accidental ingestion, seek medical help without delay.

For women of childbearing potential, it is essential to discuss the risks and benefits of this medication with your doctor. Inform your doctor if you are pregnant or suspect you might be. This medication is generally not recommended during pregnancy, as it may slightly increase the risk of birth defects during the first two months. Prolonged use or high doses near the time of delivery may harm the unborn child. To mitigate risks, use the smallest effective dose for the briefest time necessary. Infants born to mothers who have used this medication long-term may suffer from severe, possibly fatal, withdrawal symptoms. Notify your healthcare provider immediately if your newborn exhibits symptoms such as persistent crying, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or trouble gaining weight.

Common side effects:

• Nausea
• Lightheadedness
• Dizziness
• Drowsiness
• Vomiting
• Constipation

Less common but important to monitor:

• Sleep apnea
• Stomach or abdominal pain
• Changes in mental state (agitation or confusion)

Serious side effects:

• Eye pain
• Vision changes
• Irregular breathing
• Severe drowsiness
• Seizures
• Fainting
• Allergic reactions (rash, severe dizziness, trouble breathing, swelling of face, tongue, or throat)

Interactions with high risk of serious adverse effects and should be avoided:

• butorphanol
• nalbuphine
• pentazocine
• naltrexone
• pramlintide
• samidorphan
• codeine
• hydromorphone
• alcohol
• marijuana (cannabis)
• alprazolam
• lorazepam
• zolpidem
• carisoprodol
• cyclobenzaprine
• cetirizine
• diphenhydramine

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• potassium tablets/capsules
• ketoconazole
• erythromycin
• mifepristone
• tipranavir
• rifabutin
• rifampin
• ritonavir
• carbamazepine
• phenytoin