Emergency Medical Minute1 Dec 2020

Podcast 618: Treating Opiate Side Effects

Contributor: Don Stader, MD

Educational Pearls:

Majority of patients experience side effects while taking opioids
Most common include nausea/vomiting, puriitis, constipation; more severe and less common include respiratory depression, addiction and overdose
Opiates can cause nausea, but ondansetron (Zofran) is the wrong treatment because it's not antidopaminergic. Instead consider using metoclopramide (Reglan), olanzapine (Zyprexa), or haloperidol (Haldol)
Itching from opiates isn't histamine mediated so hydroxyzine (Atarax) and diphenhydramine (Benadryl) aren't effective - oddly ondansetron may help with itching.
Constipation is best treated with promotility agents like Senna, rather than stool softeners

References

Rogers E, Mehta S, Shengelia R, Reid MC. Four Strategies for Managing Opioid-Induced Side Effects in Older Adults. Clin Geriatr. 2013 Apr;21(4): PMID: 25949094; PMCID: PMC4418642.

Farmer AD, Holt CB, Downes TJ, Ruggeri E, Del Vecchio S, De Giorgio R. Pathophysiology, diagnosis, and management of opioid-induced constipation. Lancet Gastroenterol Hepatol. 2018 Mar;3(3):203-212. doi: 10.1016/S2468-1253(18)30008-6. PMID: 29870734.

Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD

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