However, the patient was receiving several concomitant medications during the second episode and a causal relationship cannot be established. Flushing of the face, chills, tachycardia, bradyrardia, palpitation, faintness, syncope, hypotension and hypertension have been reported. Bronchospasm and laryngospasm have been known to occur. Pruritis, urticaria, other skin rashes, wheal and flare over the vein with intravenous injection, and diaphoresis have been reported with narcotic analgesics. However, local irritation and induration have been seen following parenteral injection of other narcotic drug products.
Physical dependence results in withdrawal symptoms in patients who abruptly discontinue the drug.
Physical dependence usually does not occur to a clinically significant degree until after several weeks of continued narcotic usage. Tolerance in which increasingly large doses are required in order to produce the same degree of analgesia, is initially manifested by a shortened duration of analgesic effect, and subsequently by decreases in the intensity of analgesia. This may be similar to the abstinence syndrome noted in patients who withdraw from heroin. These symptoms may increase in severity and over the next 72 hours may be accompanied by increasing irritability, anxiety, weakness, twitching and spasms of muscles, kicking movements, severe backache, abdominal and leg pains, abdominal and muscle cramps, hot and cold flashes, insomnia, nausea anorexia, vomiting, intestinal spasm, diarrhea, coryza and repetitive sneezing, increase in body temperature, blood pressure, respiratory rate and heart rate. Because of excessive loss of fluids through sweating, or vomiting and diarrhea, there is usually marked weight loss, dehydration, ketosis,and disturbances in acid-base balance.