methadone, fentanyl, oxycodone, hydromorphone, hydrocodone, codeine, and
||Opiate analgesic drugs include
drugs made from extracts of the opium poppy as well as synthetic drugs
which act like the naturally derived ones.
Opiate drugs include the following:
morphine (MS Contin, Oramorph, Roxanol,) methadone (Dolophine), oxycodone
(OxyContin, Percocet, Roxicet), hydrocodone (Vicodin, Lorcet, Lortab),
hydromorphone (Dilaudid), fentanyl (Duragesic, Actiq), codeine (Tylenol
#3, Tylenol #4, Fiornal #3) and many others.
||Opiates have been used for
serious painful conditions for many, many years.
The dosing of opiates depends
on a number of factors: the exact drug, whether or not it is a
long-acting preparation, the nature and severity of the pain, and the
patient's tolerance to the medication.
As opiates carry a risk of death if used
improperly, it is important to never deviate from the dosing guidelines
that are proposed by your healthcare provider.
Combined Opiates with
Several opiates are produced in combination
with acetaminophen (Tylenol). Hydrocodone (Lortab, Lorcet,
Vicodin,) oxycodone (Percocet, Roxicet), propoxyphene (Darvocett,) and
codeine (Tylenol #3, Tylenol #4) are all coformulated with
acetaminophen. Acetaminophen may add a small of
pain relief, but usually not a significant amount especially for people
with chronic pain or pain of an intensity anything more than mild.
However, the acetaminophen in these medications may limit the amount of opiate medication
that can be administered because it may be toxic to the liver to take
more than 3000 mg of acetaminophen per day on a sustained basis.
For example Vicodin 5/500 consists of 5 mg of hydrocodone mixed with 500
mg of acetaminophen. It would be unwise to take more than six of
these tablets a day as acetaminophen toxicity might be seen. If
pain control is inadequate with the acetaminophen combination drug, an
alternative pain medication that is available in pure form should be
considered (oxycodone, morphine, fentanyl).
to your willingness, ability, and actual performance in taking your
For further information and tips on adherence,
go to the
Adherence section of this site.
It is very important to take every dose
that is prescribed unless instructed by your healthcare provider or unless
you are limited by side effects.
If the medication is not taken correctly or
long enough, you may not get the benefits of this medication.
Do not adjust the amount of the dose or the frequency of
any opiate medication without speaking to your healthcare provider first.
Unless one has been taking an opiate pain reliever for a short period of
time (<72 hours), the dose of the opiate has been taken infrequently, or
the dose is relatively low, it is inadvisable to suddenly stop opiate
analgesics as there may be unpleasant "withdrawal" symptoms.
Withdrawal is characterized by diffuse body pain, an elevated heartrate,
elevated blood pressure, sweating, anxiety, restlessness, and diarrhea.
Withdrawal is a sign of physical dependence; withdrawal does not
necessarily indicate that addiction to opiates has developed.
Withdrawal may be prevented by tapering off of the opiate slowly.
If one reduces the dose of opiate by 50% every 2 days, the chance of
withdrawal is minimized. To avoid withdrawal and uncontrolled
pain, note carefully when you will run out of your opiate pain reliever
and plan ahead to get a refill from your healthcare provider on a timely
Possible Side Effects
The package insert for
most drugs including opiate medication is often overwhelming and scary with
perhaps an overemphasis on side effects. We have summarized the
important and more common problems here.
people take opiate
without any or very many side effects.
Opiate medication does not produce permanent side effects; any side effects
that occur with opiate medication will go away with dose reduction or
discontinuation of the medication.
Many side effects get
better with time.
The most frequent side
effects of opiate medications are nausea, itching, sleepiness, dry
mouth, constipation (which may be severe,) or feeling altered.
will experience jerking of their muscles (myoclonus) which may occur when they are
be severe with opiates and therefore it is STRONGLY recommended that
aggressive preventative measures should be employed. Use a
stool softener once or twice a day if you take opiates on a regular
basis. Drink plenty of fluids. Use an over-the-counter
laxative such as senna or Senokot once or twice a day if needed.
Take enough stool softener and/or laxative to keep your bowel habits
close to normal for you. If over the counter laxatives and stool
softeners do not work well enough, inform your healthcare provider
promptly for further advice.
If the dose is too high or the patient is taking
other drugs which act similarly on the brain ("CNS depressants") the
patient may experience intoxication with slurred speech, decreased
inhibitions, impaired walking, and sedation. If the patient
continues to take the pain medication while intoxicated or if too large
of a dose is taken too soon, the patient may go to sleep and experience
a decrease in respiratory function or stop breathing altogether.
This is called "respiratory depression" and it is a potentially deadly effect.
One definition of addiction is to use an opiate
drug for purposes other than for which it was intended, to use more and
more of the drug, and to suffer health consequences as a result.
Addiction is very unlikely to result from the use of opiates to treat
genuine pain. If addiction does develop, your healthcare provider
can provide the proper treatment for this problem.
This refers to the way that
opiate medication affects other
medications and how other medications might affect opiate medication.
Make sure that your healthcare provider
is aware of all the medications you are taking so that important and
possibly dangerous interactions are not overlooked.
Depression or Overdosage
Opiate medications can interact with
other medications that can cause sedation which can make the sedation
worse and produce intoxication and possibly even
death. These medications include the following:
Sleeping pills: temazepam (Restoril),
zolpidem (Ambien), flurazepam (Dalmane), and others
Muscle relaxers: cyclobenzaprine (Flexeril), carisprodal (Soma)
Anxiety medications: diazepam (Valium), lorazepam (Ativan) and
Older antidepressants: amitriptyline (Elavil) and others
Antihistamines: dipenhydramine (Benadryl)
Nausea mediations: promethazine (Phenergan), perchlorapazine (Compazine)
Barbiturates: meprobamate, secobarbital
Antagonism and Withdrawal
Avoid taking certain opiates such as propoxyphene (Darvon, Davocett)
or buprenorphene (Stadol, Suboxone) as these opiates block the receptors
that other opiates use and this may result in withdrawal.
Report to you healthcare
or go to an Emergency Room
if you have severe side effects,
increasing side effects, increasing shortness of breath, fever, eye pain or redness,
loss of vision, jaundice (eyes and skin turn yellow,) nausea and
vomiting (so that you cannot hold down your food and liquids) or rash.
If someone observes that you become intoxicated or unresponsive to
verbal or physical stimuli, they should be instructed to call for
immediate emergency help for you.
You can download this handout in PDF
format by clicking