An acute hypertensive response after intravenous use of a new pentazocine formulation

We present the case of a 27-year-old woman with a history of drug abuse. Following her routine intravenous (IV) injection of solubilized pentazocine and tripelennamine tablets ("Ts and Blues"), the patient developed severe hypertension, a finding not characteristic of either drug alone or of the combination. The manufacturers of Talwin (pentazocine) recently have added naloxone to the tablets to discourage IV abuse of this oral preparation. Our patient unknowingly had injected the new pentazocine formulation, and she subsequently developed narcotic withdrawal symptoms. Her hypertension was treated, and she was discharged from the emergency department. We report the case as an "unusual reaction" that may develop in frequent abusers of pentazocine and its combinations.