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Managing Opiod Side Effects
2/6/2007
Opioids
Opioids are pain medications derived directly or indirectly from the opium poppy, sometimes called narcotics. They are used for acute and chronic pain. They come in various types of preparations including oral, suppositories, and injectables. Some are short acting and some are long acting.
Commonly used opioid preparations are:
- Morphine (MSContin, MSIR, Avinza, Kadian)
- Oxycodone (Percocet, OxyContin, OxyIR)
- Methadone
- Fentanyl (Duragesic Patch)
- Propoxyphene (Darvocet, Darvon)
- Hydromorphone (Diluadid)
- Hydrocodone (Vicodin)
- Codeine (Tylenol#3 or #4)
They come in many strengths and the strength that will be prescribed depends on the intensity and duration of pain. Some may cause an allergic reaction. Although they differ in many respects opioids do have many side effects in common.
Opioid Side Effects
The opioid side effects that occur most often when compared to placebo (an inactive substance) are:
- constipation
- nausea
- dizziness/vertigo
- somnolence/drowsiness
- vomiting
- dry skin/itching
These side effects are usually easily treated by the prescribing physician or healthcare practitioner so it is important to discuss any side effects as early as possible. Any unnecessary complications that may occur can then be avoided.
Common ways to treat opioid side effects with medications
Many opioid side effects are treated with additional medications. These medications may be taken on a daily basis or prn (as needed), depending on the severity of the side effects and how the patient tolerates the medications. Below is a list of common medications.
1. Nausea
- hydroxyzine hydrochloride (Atarax)
- metoclopramide (Reglan)
2. Constipation
- there are a wide variety of stool softeners and laxatives available; most physicians have their own preference
- docusate sodium-(Colace) and senna-(Senokot) are often used initially
3. Somnolence/drowsiness
- modafinil- (Provigil); caffeine
- dextroamphetamine-(Dexedrine)
- methylphenidate-(Adderal)
Other ways to treat opioid side effects
A patient may not wish to take additional medications to treat opioid side effects or side effects may persist despite the use of these medications to treat them. In these cases, the physician has many options available.
- Change the type of opioid used
- Change the dosing schedule (usually by taking a smaller dose more frequently, or giving a larger proportion of the dose at night)
- Change the way the medication is taken (from pill to patch, for example)
- Change the strength of the opioid
- Use different types of pain medications with the opioids
- End the use of opioids or lower the dose
A patient may try other methods besides medications to treat side effects.
Constipation may be treated by adding more fiber and fluid to the daily diet. Increased physical activities such as walking and exercise have been shown to decrease constipation.
Daytime drowsiness may be the result of sleep disturbance at night. This is a common occurrence for patients with pain. An evaluation of sleep patterns at home or overnight at a hospital may uncover additional causes such as sleep apnea. Eliminating napping during the day may also improve the quality of sleep at night.
Other medications instead of the opioids may be causing the side effects and should be considered. For example, opioid side effects are amplified by medications like benzodiazepines (like Valium or Ativan), by over-the-counter drugs like antihistamines (e.g. Benadryl), or alcohol. Undiagnosed medical conditions may also cause symptoms which can look like opioid side effects, such as thyroid conditions, infections, etc.
Opioids side effects are usually preventable or treatable. Many patients are reluctant to discuss side effects in order not to be a “complainer” or to risk that the doctor will no longer be willing to prescribe the pain medication. Discuss all symptoms with your physician or healthcare practitioner to determine what treatments are best for you.
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