Formulary
Opium: Indications, Dosing, Side Effects and Interactions
Opium is obtained from Papaver somniferum and contains various active alkaloids, mainly morphine.
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Opium: Indications, Dosing, Side Effects and Interactions
Opium is obtained from Papaver somniferum and contains various active alkaloids, mainly morphine.
Drug action
Opium is obtained from Papaver somniferum and contains various active alkaloids, mainly morphine.
Indications and dose
**Severe acute diarrhoea [when other treatments ineffective] (specialist use only)**
- **Adult** (By Mouth Using Oral Drops): Initially 5-10 drops 2-3 times a day (max. per dose 20 drops), adjust dose according to response; use the lowest effective dose for the shortest possible duration, a lower initial dose should be used for elderly patients; maximum 120 drops per day.
Cautions
Adrenocortical insufficiency (reduced dose is recommended); asthma (avoid during an acute attack); central sleep apnoea; convulsive disorders; current or history of mental health disorder; current or history of substance use disorder; debilitated patients (reduced dose is recommended); diseases of the biliary tract; elderly (reduced dose is recommended); hypotension; hypothyroidism (reduced dose is recommended); impaired respiratory function (avoid in chronic obstructive pulmonary disease); inflammatory bowel disorders; myasthenia gravis; obstructive bowel disorders; prostatic hypertrophy; shock; urethral stenosis Cautions, further information Dependence and addiction Prolonged use of opioid analgesics may lead to drug dependence and addiction, even at therapeutic doses. There is an increased risk in individuals with current or history of substance use disorder or mental health disorders. See also Important safety information . Central sleep apnoea Opioids cause a dose-dependent increased risk of central sleep apnoea, consider total opioid dose reduction. M Palliative care In the control of pain in terminal illness, the cautions listed should not necessarily be a deterrent to the use of opioid analgesics. M Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: if prescribed a strong , oral , or transdermal opioid (i.e. morphine, oxycodone, fentanyl, buprenorphine, diamorphine, methadone, tramadol, pethidine, pentazocine) as first-line therapy for mild pain (WHO analgesic ladder not observed) if used regularly without concomitant laxative (risk of severe constipation) if prescribed a long-acting (modified-release) opioid without a short-acting (immediate-release) opioid for breakthrough pain (risk of persistence of severe pain) Cautions For opium Gastrointestinal haemorrhage; pancreatitis
Contraindications
Acute respiratory depression; comatose patients; head injury (opioid analgesics interfere with pupillary responses vital for neurological assessment); raised intracranial pressure (opioid analgesics interfere with pupillary responses vital for neurological assessment); risk of paralytic ileus Contra-indications For opium Glaucoma; heart failure secondary to chronic lung disease (cor pulmonale)
Side effects
Common or very common Arrhythmias; confusion; constipation; dizziness; drowsiness; dry mouth; euphoric mood; flushing; hallucination; headache; hyperhidrosis; hypotension (with high doses); miosis; nausea (more common on initiation); palpitations; respiratory depression (with high doses); skin reactions; urinary retention; vertigo; visual impairment; vomiting (more common on initiation); withdrawal syndrome Uncommon Drug dependence; dysphoria; seizure Side-effects, further information Respiratory depression Respiratory depression is a major concern with opioid analgesics and it may be treated by artificial ventilation or be reversed by naloxone. Dependence, addiction, and withdrawal Long term use of opioids in non-malignant pain (longer than 3 months) carries an increased risk of dependence and addiction, even at therapeutic doses. At the end of treatment the dosage should be tapered slowly to reduce the risk of withdrawal effects; tapering from a high dose may take weeks or months. See also Important safety information . Overdose Opioids (narcotic analgesics) cause coma, respiratory depression, and pinpoint pupils. For details on the management of poisoning, see Opioids, under Emergency treatment of poisoning and consider the specific antidote, naloxone hydrochloride. Side-effects For opium Common or very common Appetite decreased; asthenia; bronchospasm; cough decreased; gastrointestinal discomfort; taste altered Uncommon Urethral spasm Rare or very rare Allodynia; amenorrhoea; biliary colic; chills; dyspnoea; hyperalgesia; ileus; malaise; muscle cramps; nystagmus; pancreatitis; peripheral oedema; renal colic; SIADH; vision disorders Frequency not known Addiction; adrenal insufficiency; hyperthermia; libido decreased; muscle contractions involuntary; restlessness
Pregnancy
Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour. Pregnancy For opium Avoid unless potential benefit outweighs risk-toxicity in animal studies; limited information available in pregnant women. M
Breast feeding
Avoid-present in milk in higher concentrations than maternal plasma. If use cannot be avoided, closely monitor infant for respiratory depression and sedation. M
Hepatic impairment
Caution in mild or moderate impairment (may precipitate coma); avoid in severe impairment M Dose adjustments Consider dose reduction in mild or moderate impairment. M
Renal impairment
Caution in mild or moderate impairment; avoid in severe impairment. M Dose adjustments Consider dose reduction in mild or moderate impairment. M
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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