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Metral has not been shown to cause histamine release. At therapeutic doses, Metral has no effect on heart rate, left-ventricular function or cardiac index.
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Metral may induce psychic and physical dependence of the morphine-type (?- opioid) (See WARNINGS).
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This indicates that Metral slightly decreases the precision of thermoregulatory control in addition to reducing the setpoint.
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Nalbuphine consumption in the first 24 h after operation was reduced by 35% in the Metral group.

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Metral 100 mg was statistically superior to placebo for TOTPAR, SPID, and time of remedication,
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Metral can increase the risk of seizure in epileptic patients, especially with simultaneous use of tricyclic antidepressants,
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the manufacturer-sponsored surveillance program's estimated rates of Metral abuse in a Metral-exposed population.

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A single i.m. dose of Metral is useful pre-treatment to minimize the risk of acid aspiration during operation,

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Intramuscular (i.m.) Metral increases gastric pH during anaesthesia similar to famotidine.
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Nonetheless, Metral nearly doubled the interthreshold range at a concentration near 200 ng/mL.
Respiratory depression should be treated as an overdose.
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which may affect the therapeutic response (see PRECAUTIONS - Drug Interactions).

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This effect may go away if you lie down forawile.
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Metral was not mutagenic in the following assays:
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Metral is extensively metabolized by a number of pathways, including CYP2D6 and CYP3A4, as well as by conjugation of parent and metabolites.
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