Talwin Overdose

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Talwin is a combination medication of pentazocine and naloxone. Pentazocine is a narcotic opioid pain reliever that’s prescribed to treat moderate to severe pain. Unlike most opioids, pentazocine produces what’s known as a “ceiling effect.”

At higher doses, the drug’s effects eventually reach a plateau to have a reduced impact on both pain relief and respiratory depression. This phenomenon makes it significantly more difficult to experience a fatal overdose while taking Talwin. The ceiling effect is a result of pentazocine being a mixed opioid agonist/antagonist. It blocks the activity of certain opioid receptors while activating others.

Naloxone is a powerful opioid antagonist, meaning it can rapidly reverse the effects of opioids such as pentazocine. Naloxone only functions when injected into the body. Talwin is intended for oral administration only. Naloxone was added to prevent people who take drugs recreationally from misusing the drug via crushing, dissolving, and injecting the substance.

Talwin does cause some degree of respiratory depression. However, due to its ceiling effect, catastrophic complications from severe respiratory depression are not as great a concern as they are with most other opioids. Talwin has rarely been associated with epidermal necrolysis, erythema multiform, and agranulocytosis.

Cardiovascular side effects may include hypotension (low blood pressure, hypertension (high blood pressure), tachycardia (rapid heart rate), syncope (fainting), and circulatory depression. Talwin use should be avoided following a myocardial infarction (heart attack).

Other possible side effects of Talwin include diarrhea, dry mouth, abdominal distress, nausea, vomiting, anorexia, and constipation. Visual hallucinations, confusion, and disorientation may also occur.

Talwin Overdose
The primary symptoms of Talwin overdose include psychotomimetic effects which mimic symptoms of psychosis. These may include nightmares, hallucinations, anxiety, and strange thoughts.

Clinically significant respiratory depression is unlikely to be an issue unless Talwin is mixed with other central nervous system depressants such as benzodiazepines, non-benzodiazepine sedative/hypnotics, muscle relaxants, tranquilizers, alcohol, and other opioids. Circulatory depression leading to deepening coma may occur when Talwin is combined with these substances.

Other signs of Talwin overdose may include seizures, dizziness, lethargy, somnolence, hypertension, tachycardia, nausea, vomiting, and paresthesia. Individuals who are allergic to the ingredients in Talwin may present with dermatitis, flushed skin, itching, pruritis, swelling of the face, anaphylactic shock, rash, and urticaria. Rash and urticaria are significantly less common symptoms. Visual blurring and difficulty focusing vision may also occur. In the rare case in which depression of white blood cells occurs, it is usually reversible.
Overdose symptoms can begin to present themselves in pentazocine doses exceeding 60 mg. Talwin is manufactured to contain 50 mg of pentazocine hydrochloride and 0.5 mg of naloxone hydrochloride per tablet. Doses greater than 600 mg of pentazocine should not be exceeded within a 24-hour period.

The standard adult dose of Talwin is one tablet every three to four hours. This may be increased to two tablets if the prescribing physician deems that the patient is tolerant of higher doses. The total daily limit should never exceed 12 tablets. Pain relieving effects can begin to take effect between 15 and 30 minutes following oral administration and typically last three to four hours.

The priorities for treating Talwin overdose are to ensure adequate ventilation and to provide circulatory support. Clinically significant respiratory depression is most likely to occur when Talwin is mixed with other central nervous system depressants such as other opioids, benzodiazepines, and alcohol. Breathing may be assisted with a bag-valve mask or controlled through the insertion of an endotracheal tube in unconscious patients.
Oxygen therapy, intravenous fluids, and vasopressors may also be employed to support respiration and circulation. It is possible that gastric aspiration, gastric lavage, and seizures may also need to be addressed. Seizures can be treated with anticonvulsant therapy.

In the event of severe respiratory depression, the administration of intravenous naloxone may be necessary. Naloxone rapidly reverses the effects of opioids like pentazocine by forcing them to break their bonds with opioid receptors in the body. Naloxone should only be administered in the presence of clinically significant respiratory depression.

The premature administration of naloxone can lead to a worsening of the patient’s symptoms. Initial doses should range between 0.4 mg and 2.0 mg of naloxone. Additional doses may be given at two to three minute intervals.

If you or someone you love is struggling with opioid misuse, The Recovery Village is available to answer any questions you may have. Visit us online at www.TheRecoveryVillage.com or call our toll-free hotline at 855-548-9825 for more information. We are available 24 hours per day to assist you on the road to recovery.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.