| Narcotic pain medications (opioid analgesics) include opiates
and synthetic opiates alike. These medications are extremely effective
at relieving all types and levels of pain, and function through
central nervous system (CNS) depressant activity. These medications
use the opioid receptor paths available for the body's natural opioids;
endorphins, dynorphins, and enkaphalin.
Conditions treated by various narcotic analgesics include:
- Analgesia (pain control) - All
- Cough suppression
- Diarrhea prevention
- Drug addiction - Methadone only
- Pulmonary edema - Morphine only
Opioid analgesics are typically only used for short-term acute
pain, such as surgical recovery, or in cases where other pain control
methods have failed. Doctors are also more willing to prescribe
them in cases of terminal illness. While these medications pose
an increased risk of dependence, and individuals may develop a tolerance
for them, moderate doses tend to pose a lower risk of major organ
damage with chronic use than certain other treatments.
Individuals with serious chronic pain conditions are generally
more likely to experience undemedication for their pain than to
have a problem with dependence. They are generally taking medication
in order to resume a normal level of activity, and use the minimum
amount necessary. This contrasts with a state of addiction where
greater amounts of a drug are sought after in order to avoid life
situations and responsibilities. While the use of these medications
should be considered carefully, and used when as seldom as possible,
it is important to recognize the quality of life disruption caused
by untreated pain.
General Side Effects
The most common side effects with narcotic medications are dry
mouth, drowsiness, faintness, lightheadedness, stomach upset, urinary
retention, and sometimes constipation (increased likelihood with
long-term use). Do not take narcotics before driving or performing
other potentially hazardous tasks.
Other side effects tend to be infrequent to rare, and are usually
dose related. Individuals with allergies to one opiate should avoid
all other opiates, as a serious reaction could occur with any dose.
Consult the warnings and instructions for your individual treatment
for a more complete list of possible side effects.
Cautions: Narcotic pain medications may not be right for
everyone. Some individuals may want to check with a doctor for safe
use guidelines with a particular condition, or may decide that another
treatment would be more appropriate. Be sure to give your prescribing
physician a complete medical history, being especially sure to mention
any of the following conditions.
- Acute Abdominal Conditions: Narcotics may interfere with
the diagnosis and treatment of these conditions. If you suspect
a serious abdominal condition, seek medical treatment, and allow
the attending medical personnel to manage your pain control.
- Alcohol or Drug Addiction: There is an increased risk
of chemical dependence with these medications, particularly for
addiction prone individuals. If an addiction is untreated, combining
alcohol or drugs with these medications poses a greatly increased
risk for organ damage and dangerous or fatal overdose.
- Allergies: An allergy to a narcotic medication in the
past would indicate that you should seek another type of treatment.
Allergies to NSAIDs or aspirin indicate that you should not use
narcotic medications combined with these drugs. Mention any other
food or drug allergies you may have experienced, to be sure that
your doctor can prescribe an appropriate medication.
- Asthma or Chronic Lung Disease: These medications may
increase the risk of respiratory depression, and should be used
with caution. If you have ever had an asthmatic reaction to aspirin,
or any NSAID, you should not use narcotic preparations containing
them for pain control. You are at increased risk of bronchospasm
or an anaphylactic reaction. Do not take opiates during an asthma
attack, this could cause dangerous respiratory depression.
- Bowel Disorder: Narcotics may worsen symptoms of constipation.
- Brain Disease or Head Injury: Narcotic medications may
increase pressure in the cerebral and spinal fluid, possibly interfering
with accurate diagnosis or treatment.
- Dependence: Physical dependence and withdrawal are known
risks for these drugs. While many medications can cause withdrawal
symptoms when use is stopped, opiates have a higher risk of actual
addiction. Addiction should be distinguished from physical dependence,
as it is a psychological need to seek out a drug even when there
is no compelling health need, to the point of decreasing the quality
of life. Addiction is rarely an issue in individuals who require
pain control, but the risk is there, and narcotic use should be
considered carefully.
- Emotional Problems: You are at an increased risk of side
effects and drug interactions with prescription treatments for
your condition.
- Gallbladder Disease: You are at an increased risk for
adverse side effects, and should only take these medications with
the consent of your physician.
- Heart Disease: You may be at an increased risk for adverse
side effects.
- Intracranial Lesion: Do not use narcotic analgesics.
- Kidney Disease: These medications may stress damaged
kidneys. Ask your doctor if this treatment is right for you, or
if there are dosing guidelines that would make it safe. Drink
6-8 glasses of water daily to reduce strain on the kidneys.
- Liver Disease: These medications may cause liver damage,
and stress damaged livers. Speak to your doctor about appropriate
dosage guidelines, or other available pain control methods. Do
not combine alcohol use with your treatment.
- Medical Emergencies: Inform medical personnel if you
have taken these medications recently, as they may interfere with
diagnosis of certain conditions or interact with some treatments.
Do not take these medications if you need to seek out emergency
services; instead allow the ambulance or hospital staff to manage
your pain control.
- Overdose: This may be indicated by cold or clammy skin,
exaggerated CNS depression (extreme weakness, dizziness, stupor,
or difficulty breathing), paradoxical restlessness, pinpoint puils,
seizure, or slowed heartbeat. If you suspect an overdose of these
medications, seek emergency medical treatment immediately.
To avoid, keep medication out of reach of children, follow maximum
dosing instructions, and do not mix with alcohol or other drugs
which may cause drowsiness.
- Pregnancy: Certain narcotics appear to increase the risk
of birth defects. There is a risk of fetal dependence and withdrawal
symptoms if the medications are used during pregnancy. Respiratory
depression and muscle weakness may also occur in newborns whose
mothers used opiates during pregnancy. While clinical trials have
not been conducted with each of these medications in pregnancy,
they are generally considered too risky to prescribe to pregnant
women and are not recommended for nursing mothers.
- Seizures: Some of these medications may increase the
risk of seizure. Discuss this with your prescribing physician
if you have a history of seizure or are taking medication that
makes seizure more likely.
- Surgery: Inform your doctor or dentist beforehand that
you use these medications, and follow any instructions they may
give you.
- Thyroid Problems: Narcotic medications should be prescribed
with caution and be attended by medical supervision.
- Urogenital Tract Problems: Narcotics may worsen these
conditions, particularly difficult urination, and should only
be undertaken with medical supervision. This also applies to individuals
with enlarged prostrates.
- Withdrawal: Long-term and frequent use of these medications
may result in withdrawal symptoms if treatment is stopped abruptly.
The severity of symptoms is usually dependent on dosage and length
of use. They may include aches, agitation, decreased appetite,
diarrhea, fever, gooseflesh, insomnia, large pupils, nausea or
vomiting, rapid heartbeat, shaking, stomach cramping, sweating,
weakness, or yawning. Your physician may be able to reduce the
severity of this condition by stepping you off your medication
gradually, or by other methods. Moderate, periodic use of these
medications will not generally cause withdrawal symptoms.
Interactions
Narcotics may interact with other medications you may be taking.
The following drugs are especially likely to interact with these
treatments, but you should always check the labels of each individual
medication you use to decrease the likelihood of undesirable side
effects. If medications increase each other's effects, or lead to
undesirable drug buildups in the body, your doctor may recommend
adjusting the dosages of one of the medications if it seems appropriate
to use both treatments.
Medications which increase central nervous system depression should
not generally be taken with narcotics, or within the time frame
that they are active in the body. If your doctor prescribes other
medications that have CNS depressant effects, be sure to work out
a medication schedule that won't leave you oversedated or increase
your risk for overdose.
If you are taking a narcotic preparation which is combined with
acetaminophen, aspirin, or ibuprofen, you will need to look into
potential drug interactions and warnings for those drugs as well.
- Alcohol - Narcotics and alcohol can accelerate central nervous
system depression. Avoid mixing the two, as this could result
in liver damage, or a dangerous and potentially fatal overdose.
- Antihistamines like Tavist or Benadryl may cause oversedation.
- Benzodiazepines (a class of antidepressants, anti-panic agents,
and muscle relaxants) such as Ativan
(lorazepam), Valium
(diazepam), Halcion (triazolam),
Restoril (temazepam),
Librium (chlordiazepoxide),
Xanax (alprazolam),
Tranxene-SD (clorazepate), Paxipam (halazepam), ProSom (estazolam),
Klonopin (clonazepam),
and others, may increase CNS depression in combination with narcotics.
Benzodiazepines may make narcotic pain medication less effective,
and may produce this effect for up to a full day depending on
how long-acting the particular medication is.
- Desyrel (trazodone) - Risk of
additive CNS depression.
- MAO inhibitors - Narcotics must not be mixed with MAO (monoamine
oxidase) inhibitors such as the antidepressants Nardil, Marplan,
or Parnate. They should not be used within 2 weeks of stopping
these medications.
- Narcotic pain medications should not be mixed with each other.
Brands like Tylenol with Codeine, Demerol (meperidine), Buprenex
(buprenorphine), Darvon (propoxyphene), Dilaudid (hydromorphone),
MS Contin or Kadian (morphine), nalbuphine, OxyContin (oxycodone),
Stadol (butorphanol), Talwin compound (pentazocine), Vicodin (hydrocodone,
acetaminophen), or Vicoprofen (hydrocodone, ibuprofen) should
not be mixed in treatment.
- Rifadin (Rifampin) - May decrease the effectiveness of methadone,
triggering withdrawal symptoms in individuals using it for addiction
treatment.
- Sedatives like Fioricet
(butalbital, acetaminophen, and caffeine), Fiorinal
(butalbital, aspirin, and caffeine), Phenobarbitol, Seconal, or
other barbiturates.
- Sleep medication like Ambien
(zolpidem), Sonata
(zaleplon), or over the counter sleeping pills should be used
with narcotics only as, and if, advised by your doctor.
- Skeletal muscle relaxants - such as Flexeril
(cyclobenzaprine), Norflex
(orphenadrine), Skelaxin
(metaxalone), Soma (carisoprodol),
or Robaxin (methocarbamol)
may increase respiratory depression when mixed with narcotics.
- Street drugs of any type must never be mixed with opiates as
this could result in a fatal overdose.
- Tegretol (carbamazepine) - May build up to toxic levels when
used with narcotics.
- Tranquilizers such as Haldol (haloperidol), Mellaril (thioridazine),
or Thorazine (chlorpromazine) may cause oversedation.
- Trexan (naltrexone) - Causes narcotic pain medication to be
ineffective.
- Tricyclic antidepressants such as Elavil
(amitriptyline), Asendin (amoxapine), Anafranil (clomipramine),
Pertofrane or Norpramin (desipramine), Sinequan
(doxepin), Tofranil (imipramine), Aventyl or Pamelor (nortriptyline),
Vivactil (protriptyline), and Surmontil (trimipramine), may increase
the central nervous system suppressant effects from either the
antidepressant, or the narcotic.
- Ultram (tramadol) - This
medication works partially by activating opiate receptors, and
increases central nervous system depression. Do not combine with
narcotics.
- Zidovudine (AZT, Retrovir) - Narcotic pain medication increases
blood levels of this drug, potentially making side effects more
severe.
For maximum safety and effectiveness, follow your
doctor's guidelines when using narcotic pain medications, and always
check the individual instructions for each medication you may take.
References:
This document is provided for information only; it is not intended
to diagnose symptoms, prescribe treatment, or to substitute for
consultation with a physician. While we have made every effort to
ensure that this information is accurate and extensive, only your
doctor can tell you if a medication, or drug combination, is safe
for you. Information intended for US residents only. |
