Analgesics, Opioid Health Article

Special conditions

People with certain medical conditions or who are taking certain other medicines can have problems if they take opioid analgesics. Before prescribing these drugs, the physician should be informed of any of these conditions.

ALLERGIES. The patient should let the physician know about any allergies to foods, dyes, preservatives, or other substances, and about any previous reactions to opioid analgesics.

PREGNANCY. Women who are pregnant or plan to become pregnant while taking opioid analgesics should let their physicians know. No evidence exists that these drugs cause birth defects in people, but some do cause birth defects and other problems when given to pregnant animals in experiments. Babies can become dependent on opioid analgesics if their mothers use too much during pregnancy. This can cause the baby to go through withdrawal symptoms after birth. If taken just before delivery, some opioid analgesics may cause serious breathing problems in the newborn.

BREASTFEEDING. Some opioid analgesics can pass into breast milk. Women who are breastfeeding should check with their physicians about the safety of taking these drugs.

OTHER MEDICAL CONDITIONS. These conditions may influence the effects of opioid analgesics:

• head injury (The effects of some opioid analgesics may be stronger and may interfere with recovery in people with head injuries.)
• history of convulsions (Some of these drugs may trigger convulsions.)
• asthma, emphysema, or any chronic lung disease
• heart disease
• kidney disease
• liver disease
• underactive thyroid (The chance of side effects may be greater.)
• Addison's disease (a disease of the adrenal glands)
• colitis
• gallbladder disease or gallstones (Side effects can be dangerous in people with these conditions.)
• enlarged prostate or other urinary problems
• current or past alcohol abuse
• current or past drug abuse, especially narcotic abuse
• current or past emotional problems (The chance of side effects may be greater.)

USE OF CERTAIN MEDICINES. Taking opioid narcotics with certain other drugs may increase the chances of serious side effects. In some cases, the physician may combine narcotic analgesics with other drugs that increase the activity of the analgesic. These include some sedatives, tranquilizers, and antihistamines. When these drugs are used together with narcotic analgesics, it may be possible to get the same pain relief with a lower dose of narcotic.

Side effects

Some people experience drowsiness, dizziness, lightheadedness, or a false sense of well-being after taking opioid analgesics. Anyone who takes these drugs should not drive, use machinery, or do anything else that might be dangerous until they know how the drug affects them. Nausea and vomiting are common side effects, especially when first beginning to take the medicine. If these symptoms do not go away after the first few doses, the person should check with the physician or dentist who prescribed the medicine.

Dry mouth is another common side effect, which can be relieved by sucking on sugarless hard candy or ice chips or by chewing sugarless gum. Saliva substitutes, which come in liquid or tablet forms, may also help. Patients who must use opioid analgesics over long periods and who have dry mouth should see their dentists, as the problem can lead to tooth decay and other dental problems.

The following side effects are less common. They usually do not need medical attention and will go away after the first few doses. If they continue or interfere with normal activity, the patient should check with the physician who prescribed the medicine for:

• headache
• loss of appetite
• restlessness or nervousness
• nightmares, unusual dreams, or problems sleeping
• weakness or tiredness
• mental sluggishness
• stomach pain or cramps
• blurred or double vision or other vision problems
• problems urinating such as pain, difficulty urinating, frequent urge to urinate, or decreased amount of urine
• constipation

Other side effects may be more serious and may require quick medical attention. These symptoms could be signs of an overdose. The person should get emergency medical care immediately:

• cold, clammy skin
• bluish discoloration of the skin
• extremely small pupils
• serious difficulty breathing or extremely slow breathing
• extreme sleepiness or unresponsiveness
• severe weakness
• confusion
• severe dizziness
• severe drowsiness
• slow heartbeat
• low blood pressure
• severe nervousness or restlessness

In addition, the following less-common side effects do not require emergency medical care, but should have medical attention as soon as possible, and include:

• hallucinations, or a sense of unreality
• depression or other mood changes
• ringing or buzzing in the ears
• pounding or unusually fast heartbeat
• itching, hives, or rash
• facial swelling
• trembling or twitching
• dark urine, pale stools, or yellow eyes or skin (after taking propoxyphene)
• increased sweating, red or flushed face (more common after taking hydrocodone and meperidine)