belladonna/opium (B & O supprettes)

Introduction

DEA controlled substance, class II.

Indications

• treatment of moderate to severe rectal or bladder tenesmus
  • post-operative states
  • neoplasm
• pain associated with ureteral spasms
  • not responsive to non-narcotic analgesics
  • space intervals between opiate injections

Contraindications

• glaucoma
• severe renal or hepatic disease
• bronchial spasm
• respiratory depression
• convulsive disorders
• acute alcoholism
• premature labor

Dosage

• 1 suppository QD to QID

Store at 15-30 C, avoid freezing.

#15A: belladonna extract: 15 mg & powdered opium 30 mg (12s)

#16A: belladonna extract: 15 mg & powdered opium 30 mg (12s)

Adverse effects

• common (> 10%)
  • constipation
  • decreased sweating
  • dry mouth, nose, throat
  • irritation at the site of injection
• less common (1-10%)
  • decreased flow of breast milk, difficulty swallowing, increased sensitivity to light
• uncommon (< 1%)
  • skin rash, confusion, increased intraocular pain, orthostatic hypotension, bloated feeling, difficulty urinating, blurred vision, drowsiness, headache, loss of memory, nausea/vomiting, weakness, fatigue, tachycardia, palpitations, ventricular fibrillation, ataxia, CNS depression, antidiuretic hormone release, biliary or urinary tract spasm, urinary retention, respiratory depression, histamine release, physical & psychologic dependence, sweating

Overdose:

• ensure adequate respiratory exchange
• naloxone for reversal of opiate-induced effects
• physostigmine 1-2 mg IV/SC (0.02 mg/kg for children) to reverse effects of belladonna

Drug interactions

• phenothiazines decrease effect
• increased effect/toxicity with CNS depressant & tricyclic antidepressants (TCA)

More general terms

• analgesic combination

Components

• belladonna alkaloid
• opium