drug adverse effects of opiates
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Adverse effects
- sedation, drowsiness
- level of arousal dose-dependent
- tolerance develops within a few days
- supression of the hypothalamic-pituitary axis
- decreased secretion of gonadotropins (LH, FSH)
- hypogonadism (both genders), erectile dysfunction[2]
- central origin; down regulation of GnRH[8]
- decreased secretion of ACTH[2]
- suboptimal morning cortisol in as many as 10%
- decreased secretion of gonadotropins (LH, FSH)
- nausea/vomiting (tolerance develops within a few days)
- constipation
- tolerance does NOT develop to constipating effects[3]
- stimulant laxative (senna) all patients[8]
- stool softener (dosusate) as needed
- bulk laxative such as fiber usually insufficient[3]
- methylnaltrexone may help relieve constipation in palliative care patients without negating analagesic effect of opioid[8][10]
- urinary retention[3]
- respiratory depression
- higher risk for invasive pneumococcal infection[11]
- hypotension
- hypothermia
- hyporeflexia
- pruritus, hives, flushing due to release of histamine from mast cells[1]
- no evidence that itching improves with continued use (no reference provided)
- miosis (usually)
- true allergy uncommon, generally adverse effect[1]
- cognitive slowing, hyperreflexia, myoclonus & hyperalgesia may result from long-term opioid use[8]
- increased risk of major depression & anxiety & stress-related disorders[12]
- xerostomia (tolerance develops within a few days)
- supportive measures
- maintenance of airway
- ventilatory support'
- avoid gastric lavage
- limit whole body irrigation to 'body packers'
- body packers rarely require surgery, except with intestinal obstruction
- avoid endoscopic attempts at removal (danger of rupture)
- antidotes
- use judiciously, so as not to precipitate pain crisis
- naloxone
- nalmefene
More general terms
References
- ↑ 1.0 1.1 1.2 Prescriber's Letter 13(2): 2006 Opioid Intolerance Decision Algorithm Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220201&pb=PRL
- ↑ 2.0 2.1 2.2 Prescriber's Letter 19(2): 2012 Hormonal Effects of Opioids Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=280205&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 3.0 3.1 3.2 3.3 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996 pg 535
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 682-683
- ↑ VA Greater Los Angeles Healthcare System
- ↑ 8.0 8.1 8.2 8.3 8.4 Medical Knowledge Self Assessment Program (MKSAP) 16, 18. American College of Physicians, Philadelphia 2012, 2018.
- ↑ Bliesener N, Albrecht S, Schwager A et al Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opioid dependence. J Clin Endocrinol Metab. 2005 Jan;90(1):203-6 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15483091
- ↑ 10.0 10.1 Thomas J et al, Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med 2008, 358:2332 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18509120
- ↑ 11.0 11.1 Wiese AD, Griffin MR, Schaffner W et al Opioid Analgesic Use and Risk for Invasive Pneumococcal Diseases: A Nested Case - Control Study. Ann Intern Med. 2018. Feb 13 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29435555 <Internet> http://annals.org/aim/article-abstract/2672601/opioid-analgesic-use-risk-invasive-pneumococcal-diseases-nested-case-control
Dublin S, Von Korff M. Prescription Opioids and Infection Risk: Research and Caution Needed. Ann Intern Med. 2018. Feb 13 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29435579 <Internet> http://annals.org/aim/article-abstract/2672606/prescription-opioids-infection-risk-research-caution-needed - ↑ 12.0 12.1 Brooks M New Risks of Prescription Opioids Discovered. Medscape - Nov 17, 2020. https://www.medscape.com/viewarticle/941170
Rosoff DB, Smith GD, Lohoff FW Prescription Opioid Use and Risk for Major Depressive Disorder and Anxiety and Stress-Related Disorders, A Multivariable Mendelian Randomization Analysis. JAMA Psychiatry. Published online November 11, 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33175090 PMCID: PMC7658804 Free PMC article https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2772881