Not suitable as substitute in opioid-dependent patients. Discontinue use if serotonin syndrome is suspected. Patients at risk for resp depression eg, substantially decreased resp reserve, hypoxia, hypercapnia, pre-existing rep depression; head injury, increased ICP, patients prone to convulsive disorders or shock; history of epilepsy, patients susceptible to seizures; adrenal insufficiency; androgen deficiency. CYP2D6 ultra-rapid metabolisers. High-dose & long-term use. Concomitant use w/ drugs lowering seizure threshold; alcohol, other CNS depressants; benzodiazepines; serotonergic drugs. May affect ability to drive or operate heavy machinery. Severe hepatic & renal impairment; dialysis. May reduce fertility. Not recommended during pregnancy. Not to be used during lactation. Not recommended in childn <12 yr. Elderly >75 yr.
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