Opioid or Narcotic Analgesics
Complete list of drugs used to
treat arthritis.
Opioid analgesics, also known as narcotic analgesics, are pain relievers that act on
the central nervous system. Like all narcotics, they may become habit-forming if used over
long periods.
Purpose of Opioid or Narcotic Analgesics
Opioid analgesics are used to relieve pain from a variety of conditions. Some are used
before or during surgery (including dental surgery) both to relieve pain and to make
anesthetics work more effectively. They may also be used for the same purposes during
labor and delivery.
Description of Opioid or Narcotic Analgesics
Opioid analgesics relieve pain by acting directly on the central nervous system.
However, this can also lead to unwanted side effects, such as drowsiness, dizziness,
breathing problems, and physical or mental dependence.
Among the drugs in this category are codeine, propoxyphene (Darvon), propoxyphene and
acetaminophen (Darvocet N), meperidine (Demerol), hydromorphone (Dilaudid), morphine,
oxycodone, oxycodone and acetaminophen (Percocet, Roxicet), and hydrocodone and
acetaminophen (Lortab, Anexsia). These drugs come in many forms -- tablets, syrups,
suppositories, and injections, and are sold only by prescription. For some, a new
prescription is required for each new supply -- refills are prohibited according to
federal regulations.
Recommended dosage of Opioid or Narcotic Analgesics
Recommended doses vary, depending on the type of opioid analgesic and the form in which
it is being used. Doses may be different for different patients. Check with the physician
who prescribed the drug or the pharmacist who filled the prescription for correct dosages,
and make sure to understand how to take the drug.
Always take opioid analgesics exactly as directed. Never take larger or more frequent
doses, and do not take the drug for longer than directed. Do not stop taking the drug
suddenly without checking with the physician or dentist who prescribed it. Gradually
tapering the dose may the chance of withdrawal symptoms.
Precautions concerning Opioid or Narcotic Analgesics
Anyone who uses opioid analgesics -- or any narcotic -- over a long time may become
physically or mentally dependent on the drug. Physical dependence may lead to withdrawal
symptoms when the person stops taking the medicine. Building tolerance to these drugs is
also possible when they are used for a long period. Over time, the body needs larger and
larger doses to relieve pain.
Take these drugs exactly as directed. Never take more than the recommended dose, and do
not take the drugs more often than directed. If the drugs do not seem to be working,
consult your physician. Do not share these or any other prescription drugs with others
because the drug may have a completely different effect on the person for whom it was not
prescribed.
Children and older people are especially sensitive to opioid analgesics and may have
serious breathing problems after taking them. Children may also become unusually restless
or agitated when given these drugs.
Opioid analgesics increase the effects of alcohol. Anyone taking these drugs should not
drink alcoholic beverages.
Some of these drugs may also contain aspirin, caffeine, or acetaminophen. Refer to the
entries on each of these drugs for additional precautions.
Special conditions for Opioid or Narcotic Analgesics
People with certain medical conditions or who are taking certain other medicines can
have problems if they take opioid analgesics. Before taking these drugs, be sure to let
the physician know about any of these conditions.
Allergies
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.
Breast feeding
Some opioid analgesics can pass into breast milk. Women who are breast feeding 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.
Side effectsof Opioid or Narcotic Analgesics
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 machines, 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, check
with the physician or dentist who prescribed the medicine.
Dry mouth is another common side effect. Dry mouth 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, also may 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, check with the physician who prescribed the medicine.
Other side effects may be more serious and may require quick medical attention. These
symptoms could be signs of an overdose. Get emergency medical care immediately.
- 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.
In addition, these less common side effects do not require emergency medical care, but
should have medical attention as soon as possible:
- 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.
- 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).
Interactions of Opioid or Narcotic Analgesics
Anyone taking these drugs should notify his or her physician before taking opioid
analgesics:
- Central nervous system (CNS) depressants, such as antihistamines and other medicines for
allergies, hay fever, or colds; tranquilizers; some other prescription pain relievers;
seizure medicines; muscle relaxants; sleeping pills; some anesthetics (including dental
anesthetics).
- Monoamine oxidase (MAO) inhibitors, such as phenelzine (Nardil) and tranylcypromine
(Parnate). The combination of the opioid analgesic meperidine (Demerol) and MAO inhibitors
is especially dangerous.
- Tricyclic antidepressants, such as amitriptyline (Elavil).
- Anti-seizure medicines, such as carbamazepine (Tegretol). May lead to serious side
effects, including coma, when combined with propoxyphene and acetaminophen (Darvocet-N) or
propoxyphene (Darvon).
- Muscle relaxants, such as cyclobenzaprine (Flexeril)
- Sleeping pills, such as triazolam (Halcion)
- Blood-thinning drugs, such as warfarin (Coumadin)
- Naltrexone (Trexan, Revia). Cancels the effects of opioid analgesics.
- Rifampin (Rifadin)
- Zidovudine (AZT, Retrovir). Serious side effects when combined with morphine.
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