Priapism
A relatively rare side effect associated with trazodone is priapism, likely due to its antagonism at α-adrenergic receptors. More than 200 cases have been reported, and the manufacturer estimated that the incidence of any abnormal erectile function is about one in 6,000 male patients treated with trazodone. The risk for this side effect appears to be greatest during the first month of treatment at low dosages (i.e. <150 mg/day). Early recognition of any abnormal erectile function is important, including prolonged or inappropriate erections, and should prompt discontinuation of trazodone treatment. Spontaneous orgasms have also been reported with trazodone in men.Clinical reports have described trazodone-associated psychosexual side effects in women as well, including increased libido, priapism of the clitoris, and spontaneous orgasms. Others
Rare cases of liver toxicity have been observed, possibly due to the formation of reactive metabolites.Elevated prolactin concentrations have been observed in people taking trazodone. They appear to be increased by around 1.5- to 2-fold.Studies on trazodone and cognitive function are mixed, with some finding improvement, others finding no change, and some finding impairment.Trazodone does not seem to worsen periodic limb movements during sleep.Trazodone is associated with increased risk of falls in older adults. It has also been associated with increased risk of hip fractures in older adults. Pregnancy and lactation
Sufficient data in humans are lacking. Use should be justified by the severity of the condition to be treated. Overdose
There are reported cases of high doses of trazodone precipitating serotonin syndrome.
Nalbuphine HCL is currently available only as an injectable in the US and the European Union. Nubain, the Astra USA brand name for injectable nalbuphine HCL, was discontinued from being marketed in 2008 in the United States for commercial reasons (Federal Register 2008); however, other commercial suppliers now provide generic injection formulation nalbuphine for the market. Society and culture
Brand names
Nalbuphine is marketed primarily under the brand names Nubain, Nalpain, and Nalbuphin. It is also marketed under the brand name Nalufin in Egypt and Raltrox in Bangladesh by Opsonin Pharma Limited, under the brand name Rubuphine in India by Rusan Healthcare Pvt Ltd, under the brand name Kinz and Nalbin in Pakistan by Sami and Global Pharmaceuticals, under the brand name Analin by Medicaids in Pakistan, and under the brand name Exnal by Indus Pharma in Pakistan, among many others. Legal status
Unlike many other opioids, nalbuphine has a limited potential for euphoria, and in accordance, is rarely abused. This is because whereas MOR agonists produce euphoria, MOR antagonists do not, and KOR agonists like nalbuphine moreover actually produce dysphoria. Nalbuphine was initially designated as a Schedule II controlled substance in the United States along with other opioids upon the introduction of the 1970 Controlled Substances Act. However, its manufacturer, Endo Laboratories, Inc., petitioned the Food and Drug Administration to remove it from Schedule II in 1973, and after a medical and scientific review, nalbuphine was removed completely from the Controlled Substances Act in 1976 and is not a controlled substance in the United States today.