Obstructive resp disorders, reduced resp reserve (eg, kyphoscoliosis, emphysema or severe adiposis), anoxia, hypercapnia, resp insufficiency (patients may become comatose), pulmonary disorders; cor pulmonale; impaired conciousness, shock, CNS depression; known opioid dependency; post-surgery w/in the 1st 24 hr; hypovolemia; chronic kidney or liver diseases, pancreatits, myxoedema, adrenocortical insufficiency, hypothyroidism, pheochromocytoma, prostatic hypertrophy w/ residual urine (risk of bladder rupture secondary to urinary retention); fulminant ulcerative colitis; obstructive bile or urinary tract diseases or spasms of bile ducts & urinary tract secondary to stone formation; post-surgery affecting biliary system; epilepsy or increased propensity to seizures. Immediately discontinue when paralytic ileus is suspected or occurs during use. Obstructive bowel disorder, biliary colic, operations on the biliary tract, acute pancreatitis or prostatic hyperplasia. May be treated w/ appropriate laxatives if constipation occurs. Inflammatory bowel disease. May obscure the diagnosis or clinical course of patients w/ acute abdominal conditions & complications following abdominal surgery. Severe hypotension may occur; careful dosing is needed in the elderly, patients w/ heart insufficiency & w/ impaired liver or kidney function, respectively. Risk of physical &/or psychological dependence or tolerance. Monitor for reversible adrenal insufficiency. Monitor plasma cortisol conc in patients w/ pre-existing adrenocortical insufficiency (eg, Morbus Addison) & substitute corticoids if needed. Monitor for acute chest syndrome in patients w/ sickle cell disease. Risk of decreased sex hormones & increased prolactin w/ long-term use. Hyperalgesia. Concomitant use of sedative medicines eg, benzodiazepines; closely follow patients for signs & symptoms of resp depression & sedation. Concomitant use w/ rifampicin & P2Y12 inhibitor (eg, clopidogrel, prasugrel, ticagrelor). Interference w/ diagnostic determination of CSF pressure, plasma conc of amylase & lipase, SGPT, SGOT, serum bilirubin & alkaline phosphatase. May cause allergic reactions due to methyl & propyl parahydroxybenzoate. Not to be given to patients suffering from alcoholism; those w/ rare hereditary conditions of fructose/galactose intolerance, glucose-galactose malabsorption or sucrase isomaltase insufficiency. Diabetics. May have an impact on the capability to react to such an extent that the ability to drive or use machines is impaired. Renal & hepatic impairment. Only give to males w/ procreative potential & to females w/ childbearing potential if effective contraceptive measures are guaranteed. Elderly.
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