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Pronunciation:

(bel a DON a & OH pee um)

U.S. Brand Names:

B&O Supprettes®

Synonyms:

Opium and Belladonna

Generic Available:

Yes

Use:

Relief of moderate to severe pain associated with rectal or bladder tenesmus that may occur in postoperative states and neoplastic situations; pain associated with ureteral spasms not responsive to non-narcotic analgesics and to space intervals between injections of opiates

Restrictions:

C-II

Pregnancy Risk Factor:

Lactation:

Excretion in breast milk unknown/use caution

Contraindications:

Glaucoma; severe renal or hepatic disease; bronchial asthma; respiratory depression; convulsive disorders; acute alcoholism; premature labor

Warnings/Precautions:

Usual precautions of opiate agonist therapy should be observed; infants <3 months of age are more susceptible to respiratory depression, use with caution and generally in reduced doses in this age group

Adverse Reactions:

>10%:

Dermatologic: Dry skin

Gastrointestinal: Constipation, dry throat, xerostomia

Respiratory: Dry nose

Miscellaneous: Diaphoresis (decreased)

1% to 10%:

Dermatologic: Increased sensitivity to light

Endocrine & metabolic: Decreased flow of breast milk

Gastrointestinal: Dysphagia

<1%: Orthostatic hypotension, ventricular fibrillation, tachycardia, palpitation, confusion, drowsiness, headache, loss of memory, fatigue, ataxia, CNS depression, rash, antidiuretic hormone release, bloated feeling, nausea, vomiting, constipation, biliary tract spasm, dysuria, urinary retention, urinary tract spasm, increased intraocular pain, blurred vision, weakness, respiratory depression, histamine release, physical and psychological dependence, diaphoresis

Overdosage/Toxicology:

Primary attention should be directed to ensuring adequate respiratory exchange. Opiate agonist-induced respiratory depression may be reversed with parenteral naloxone hydrochloride. Anticholinergic toxicity may be caused by strong binding of a belladonna alkaloid to cholinergic receptors. Physostigmine 1-2 mg given slowly SubQ or I.V. may be administered to reverse overdose with life-threatening effects.

Drug Interactions:

Decreased effect: Phenothiazines

Increased effect/toxicity: CNS depressants, tricyclic antidepressants

Ethanol/Nutrition/Herb Interactions:

Ethanol: Avoid ethanol (may increase sedation).

Stability:

Store at 15°C to 30°C (avoid freezing)

Mechanism of Action:

Anticholinergic alkaloids act primarily by competitive inhibition of the muscarinic actions of acetylcholine on structures innervated by postganglionic cholinergic neurons and on smooth muscle; resulting effects include antisecretory activity on exocrine glands and intestinal mucosa and smooth muscle relaxation. Contains many narcotic alkaloids including morphine; its mechanism for gastric motility inhibition is primarily due to this morphine content; it results in a decrease in digestive secretions, an increase in GI muscle tone, and therefore a reduction in GI propulsion.

Pharmacodynamics/Kinetics:

Opium:

Onset of action: Within 30 minutes

Metabolism: Hepatic, with formation of glucuronide metabolites

Dosage:

Rectal: Adults: 1 suppository 1-2 times/day, up to 4 doses/day

Test Interactions:

Increased aminotransferase [ALT (SGPT)/AST (SGOT)] (S)

Patient Education:

If self-administered, use exactly as directed; do not increase dose or frequency. Drug may cause physical and/or psychological dependence. While using this medication, do not use alcohol and other prescription or OTC medications (especially sedatives, tranquilizers, antihistamines, or pain medications) without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. May cause hypotension, dizziness, or drowsiness; use caution when driving, climbing stairs, or changing position (rising from sitting or lying to standing) or when engaging in tasks requiring alertness (until response to drug is known); dry mouth or throat (frequent mouth care, frequent sips of fluids, chewing gum, or sucking lozenges may help); constipation (increased exercise, fluids, fruit, or fiber may help; if unresolved, consult prescriber about use of stool softeners); photosensitivity (use sunscreen, wear protective clothing and eyewear, and avoid direct sunlight); or decreased perspiration (avoid extremes in temperature or excessive activity in hot environments). Report chest pain or palpitations; persistent dizziness; changes in mentation; changes in gait; blurred vision; shortness of breath or respiratory difficulty. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.

Dental Health: Effects on Dental Treatment:

Key adverse event(s) related to dental treatment: Xerostomia and changes in salivation (normal salivary flow resumes upon discontinuation), and dry throat and nose.

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

No information available to require special precautions

Mental Health: Effects on Mental Status:

None reported

Mental Health: Effects on Psychiatric Treatment:

Constipation and dry mouth are common; use with low potency antipsychotics and TCAs will likely result in additive effects

Dosage Forms:

Suppository:

#15 A: Belladonna extract 16.2 mg and opium 30 mg

#16 A: Belladonna extract 16.2 mg and opium 60 mg

References

Mokhlesi B, Leikin JB, Murray P, et al, "Adult Toxicology in Critical Care: Part II: Specific Poisonings,"Chest, 2003, 123(3):897-922.

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