21 Cocaine Has demonstrated no efficacy as an analgesic or coanalgesic in combination with opioids. Can precipitate withdrawal. May precipitate withdrawal. Limit use to treatment of life-threatening respiratory depression. No evidence of analgesic benefit to using Brompton's cocktail over single opioid analgesics.
Efficacy is poor compared with that of other analgesics.
High incidence of adverse effects. Analgesic properties not demonstrated except for some instances of neuropathic pain. Added sedation from anxiolytics may limit opioid dosing. 21 Should not be used for children or patients prone to develop dependent edema or in patients with thrombocytopenia. The only drug approved by the FDA for transnasal administration at this time is butorphanol, an agonist-antagonist drug, which generally is not recommended.