May cause CNS depression. Propoxyphene is major cause of drug-related deaths when given in excessive doses, either alone or in combination with other CNS depressants (including alcohol). May cause hypotension (use with caution in hypovolemia, cardiovascular disease (including acute myocardial infarction), or drugs which may exaggerate hypotensive effects (including phenothiazines or general anesthetics)). May obscure diagnosis or clinical course of acute abdominal conditions. Use with caution in adrenal insufficiency (including Addison’s disease), in biliary tract dysfunction (acute pancreatitis may cause constriction of sphincter of Oddi), and in CNS depression or coma. Should not be prescribed in severely depressed or suicidal patients. Use with caution in history of drug abuse or acute alcoholism (potential for drug dependency exists). Tolerance, psychological and physical dependence may occur with prolonged use. Use with extreme caution in head injury, intracranial lesions, or elevated intracranial pressure (exaggerated elevation of intracranial pressure may occur). Use with caution in hepatic impairment, in morbidly obese patients, in prostatic hyperplasia and/or urinary stricture, in renal impairment (avoid use in CrCl <10 mL/minute), and in thyroid dysfunction. Effects may be potentiated when used with other sedative drugs or ethanol. Use with caution in debilitated patients (greater potential for critical respiratory depression), and in the elderly (may be more sensitive to adverse effects). Optimal analgesic dose varies widely among patients. Concurrent use of agonist/antagonist analgesics may precipitate withdrawal symptoms and/or reduced analgesic efficacy in patients following prolonged therapy with μ-opioid agonists. Abrupt discontinuation following prolonged use may also lead to withdrawal symptoms.