Opium Tincture

Pronunciation

(OH pee um TING chur)

Synonyms

DTO; Opium Tincture, Deodorized

Generic Available

Yes

Use

Treatment of diarrhea or relief of pain

Restrictions

C-II

Pregnancy Risk Factor

B/D (prolonged use or high doses at term)

Lactation

Enters breast milk/use caution

Contraindications

Hypersensitivity to morphine sulfate or any component of the formulation; increased intracranial pressure; severe respiratory depression; severe hepatic or renal insufficiency; pregnancy (prolonged use or high dosages near term)

Warnings/Precautions

Opium shares the toxic potential of opiate agonists, and usual precautions of opiate agonist therapy should be observed; some preparations contain sulfites which may cause allergic reactions; infants <3 months of age are more susceptible to respiratory depression, use with caution and generally in reduced doses in this age group; this is not paregoric, dose accordingly

Adverse Reactions

Frequency not defined.

Cardiovascular: Palpitations, hypotension, bradycardia, peripheral vasodilation

Central nervous system: Drowsiness, dizziness, restlessness, headache, malaise, CNS depression, increased intracranial pressure, insomnia, mental depression

Gastrointestinal: Nausea, vomiting, constipation, anorexia, stomach cramps, biliary tract spasm

Genitourinary: Decreased urination, urinary tract spasm

Neuromuscular & skeletal: Weakness

Ocular: Miosis

Respiratory: Respiratory depression

Miscellaneous: Histamine release, physical and psychological dependence

Overdosage/Toxicology

Primary attention should be directed to ensuring adequate respiratory exchange. Naloxone, 2 mg I.V. with repeat administration as necessary up to a total of 10 mg, can also be used to reverse toxic effects of the opiate.

Drug Interactions

Increased toxicity: CNS depressants, MAO inhibitors, tricyclic antidepressants may potentiate the effects of opiate agonists; dextroamphetamine may enhance the analgesic effect of opiate agonists

Ethanol/Nutrition/Herb Interactions

Ethanol: Avoid ethanol (may increase CNS depression).

Stability

Protect from light

Mechanism of Action

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

Duration: 4-5 hours

Absorption: Variable

Metabolism: Hepatic

Excretion: Urine

Dosage

Oral:

Children:

Diarrhea: 0.005-0.01 mL/kg/dose every 3-4 hours for a maximum of 6 doses/24 hours

Analgesia: 0.01-0.02 mL/kg/dose every 3-4 hours

Adults:

Diarrhea: 0.3-1 mL/dose every 2-6 hours to maximum of 6 mL/24 hours

Analgesia: 0.6-1.5 mL/dose every 3-4 hours

Monitoring Parameters

Observe patient for excessive sedation, respiratory depression, implement safety measures, assist with ambulation

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) May cause hypotension, dizziness, drowsiness, impaired coordination, or blurred vision (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); or dry mouth (frequent mouth care, small, frequent meals, chewing gum, or sucking lozenges may help). Report slow or rapid heartbeat, acute dizziness, or persistent headache; changes in mental status; swelling of extremities or unusual weight gain; changes in urinary elimination or pain on urination; acute headache; trembling or muscle spasms; blurred vision; skin rash; or shortness of breath. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. If you are breast-feeding, take medication immediately after breast-feeding or 3-4 hours prior to next feeding.

Nursing Implications

Monitor patient for excessive sedation, respiratory depression, implement safety measures, assist with ambulation

Dental Health: Effects on Dental Treatment

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

Dizziness and drowsiness are common; may cause restlessness; may rarely cause insomnia or depression

Mental Health: Effects on Psychiatric Treatment

Concurrent use with psychotropics may alter the analgesic effects of opioids; monitor for altered response

Dosage Forms

Liquid: 10% (120 mL, 480 mL) [0.6 mL equivalent to morphine 6 mg; contains alcohol 19%]

References

Kraus DM and Hatzopoulos FK, "Neonatal Therapy," Applied Therapeutics: The Clinical Use of Drugs , 6th ed, Young LY and Koda-Kimble MA, eds, Vancouver, WA: Applied Therapeutics, Inc, 1995.

Levy M and Spino M, "Neonatal Withdrawal Syndrome: Associated Drugs and Pharmacologic Management," Pharmacotherapy , 1993, 13(3):202-11.

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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