Emergency Medical Minute 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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