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Always keep a current list of the drugs and supplements you take and review it with your health care providers and your pharmacist. If possible, use one pharmacy for all your prescription medications and over-the-counter products. This allows your pharmacist to keep a complete record of all your prescription drugs and to advise you about drug interactions and side effects.
Jennifer Carey, PharmD. Oxycodone OxyIR is an opioid analgesic used to treat moderate to severe pain. Oxycodone 5mg contains one medication; oxycodone at a dose of 5mg. Laura Cable, Pharm. Q: Is 40 mg of Oxycontin similar to 30 mg of oxycodone? A: Oxycodone is a medication that is used to treat moderate to severe pain. It is classified in the group of medications known as narcotic pain relievers that is similar to morphine.
Oxycodone comes in several different forms, reflecting the many different ways the drug can be used. Oxycodone 30 mg tablets would be the short-acting product, or immediate release form, that are most useful for treating temporary pain or breakthrough pain occasional pain that occurs despite treatment with longer-acting pain medications. Oxycontin oxycodone extended-release is a long-acting tablet that is usually used when continuous, around-the-clock use of potent opioid medications is necessary for an extended period of time for more than a few days.
Lori Poulin, PharmD. Q: What is the difference between oxycodone and Oxycontin? A: Oxycodone is a narcotic pain reliever, similar to morphine, that is used to treat moderate to severe pain. It is in many pain relievers Percocet, Endocet, Percodan as well as by itself as an immediate release or extended release form. Oxycodone is an immediate release form of the medication and is used to treat pain in the short-term. It works by binding to opioid receptors in the body and produces pain relief, cough suppression, decreased breathing, and slowing of digestion.
Oxycontin oxycodone ER is the extended-release formulation of oxycodone and works by releasing the medication slowly over 12 hours. It is a strong narcotic pain reliever that should not be used to treat mild or short-term pain. How long is oxycodone detectable in the body? MS Contin are formulated as long-acting products that are taken every 12 hours.
Swallow the MS Contin tablet whole and do not crush, chew or break the controlled-release tablets. Breaking the tablet could cause too much of the drug to be absorbed into the body at one time. Also, do not suddenly stop taking the MS Contin unless directed by the doctor. Abruptly stopping could cause withdrawal symptoms such as nausea, vomiting, cramps, fever, faintness, anorexia loss of appetite.
MS Contin can be taken with or without food about 12 hours apart. Common side effects of MS Contin include constipation, nausea, stomach pain, dizziness, headache, and drowsiness. MS Contin is distributed to the skeletal muscle, kidneys, liver, intestines, lungs, spleen, brain, and also crosses membrane into the breast milk. Almost all of the drug is converted into a major metabolite call morphineglucuronide. The elimination half-life of MS Contin is hours. Most MS Contin should be out of the body a day or two after the last dose. Oxy IR oxycodone is indicated for break-through pain.
Common side effects of Oxy IR include dry mouth, dizziness, constipation, and headache. Oxy IR is metabolized in the liver to the major metabolite noroxycodone and other metabolites xylophone and glucuronides. The elimination of the half-life is 0. Many factors may contribute to the elimination of drug. Factors may include the person's age, weight, dose, how long the drug has been taken and other factors.
Most prescription medications should not be a problem with drug screens as long as the drug is documented and taken under the supervision of a healthcare provider. Kimberly Hotz, PharmD. Q: Is oxycodone safe to take with cirrhosis?
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A: Oxycodone is in a class of drugs called opioid analgesics. Oxycodone is used to treat moderate to severe pain -- when the use of an opioid analgesic is appropriate. Oxycodone works by altering the way in which the brain and nervous system respond to pain. In a clinical study supporting the development of oxycodone, too few people with decreased liver function were included in the study to conclude if people with decreased liver function differ from people with normal liver function in regards to how their body handles oxycodone. However, according to oxycodone prescribing information, oxycodone is extensively metabolized cleared from the body by the liver.
The clearance of oxycodone from the body may decrease in people with liver failure. Thus, according to oxycodone prescribing information, the starting dose of oxycodone in people with liver impairment should be conservative; that is, on the lower side. And, dose adjustment should be evaluated on a case by case basis -- depending on various patient-specific factors. Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules lumps that occur as a result of a process in which damaged tissue is regenerated , leading to loss of liver function.
Cirrhosis is most commonly caused by alcoholism, hepatitis B and C, and fatty liver disease, but has many other possible causes. Cirrhosis is the twelfth leading cause of death by disease and affects men slightly more often than women. Derek Dore, PharmD. Q: How do you treat severe constipation from the use of oxycodone? A: Oxycodone is a narcotic pain reliever that is used for moderate to moderately severe pain. Oxycodone, like other narcotic pain relievers, can cause constipation by slowing down the propulsive movement of the colon to eliminate feces. There are a number of things patients can do to minimize the constipating effects of narcotics: 1 Drink plenty of fluids; 2 Eat foods high in fiber; and 3 Exercise if possible.
Over-the-counter stool softeners, like docusate, and laxatives are available to help make going to the bathroom a little easier. There are many laxatives to choose from, so it is important to talk to your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Bulk laxatives, like Metamucil or Fiberall, should only be used if you are able to drink plenty of water.
Senna derivatives may reverse the effects of narcotics, but they should not be used for too long. Another over-the-counter option for constipation due to oxycodone may be Miralax. There are also prescription medications that are used for the treatment of constipation due to narcotics. Please consult with your health care provider regarding the symptoms of constipation that you are experiencing and what treatment option may be most appropriate for you. Michelle McDermott, PharmD. Q: I took 25 mg tablets of oxycodone on Wednesday of last week.
This is Monday. Should the oxycodone be out of my system? A: Oxycodone is a narcotic pain reliever that is used to treat moderate to severe pain. This medication has a half-life of between 3 and 4. This means that half of the dosage is eliminated from the body after 4 hours, and for each consecutive 4 hours another half of what is left over will be eliminated. For example, you took 10mg of oxycodone, after 4 hours you have 5 mg in your system. After 8 hours you have 2. After 12 hours you have 1. After 16 hours you have 0. The entire dosage of oxycodone that you took should be out of the body around 3 days depending on your metabolism of the medication.
This is also dependent on if you have taken any more of the medication after that dosage or before the dosage on Wednesday. If you have been taking the medication for a while, it could take as long as a month for all of the medication to leave your system. Q: I had a knee replacement a few weeks back and I am still in pain.
However, the oxycodone, which are IR, are a little too strong.
Can I break the pill in half? A: Immediate-release oxycodone Oxy IR is classified as an analgesic opioid medication. Oxycodone is approved for the treatment of moderate to severe pain. The medication is often used in combination with non-opioid analgesic medications. It is important to take your medication exactly as prescribed by your physician. If you feel that the dosage is too strong for you, consult with your physician to discuss other treatment options.
Your physician is best able to make decisions regarding the dosage of your medication or possibly switching you to a different medication. If your physician recommends lowering the dosage of your medication, talk with your pharmacist about cutting the tablets. There are various formulations of oxycodone made by different drug companies. Your pharmacist can determine what form was dispensed to you and check the package insert to determine if it is safe to cut the tablet.
Jen Marsico, RPh. Q: I have been on oxycodone and OxyContin for 7 years. Now I have joint swelling and extreme pain in all my joints. Could this be related to these drugs? A: According to the prescribing information for oxycodone and OxyContin, joint pain and swelling are not listed as side effects of the medications.
Joint pain is listed as one of the withdrawal symptoms that may occur if a person is dependent on oxycodone and the medication is stopped or there is a significant dose reduction. However there can be many underlying causes of joint pain. Please consult with your health care provider in regards to the symptoms you are experiencing.
For more specific information, consult with your doctor for guidance based on your health status and current medications, particularly before taking any action. Kristen Dore, PharmD. Acetaminophen is primarily metabolized in the liver by first-order kinetics and involves three principal separate pathways: conjugation with glucuronide; conjugation with sulfate; and oxidation via the cytochrome, Pdependent, mixed-function oxidase enzyme pathway to form a reactive intermediate metabolite, which conjugates with glutathione and is then further metabolized to form cysteine and mercapturic acid conjugates.
PERCOCET is indicated for the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate. Addiction can occur at recommended dosages and if the drug is misused or abused. Risks are increased in patients with a personal or family history of substance abuse including drug or alcohol abuse or addiction or mental illness e. The potential for these risks should not, however, prevent the proper management of pain in any given patient. Opioids are sought by drug abusers and people with addiction disorders and are subject to criminal diversion.
Contact local state professional licensing board or state controlled substances authority for information on how to prevent and detect abuse or diversion of this product. Healthcare providers are strongly encouraged to do all of the following:. The FDA Blueprint can be found at www. Serious, life-threatening, or fatal respiratory depression has been reported with the use of opioids, even when used as recommended.
Respiratory depression, if not immediately recognized and treated, may lead to respiratory arrest and death. Carbon dioxide CO 2 retention from opioid-induced respiratory depression can exacerbate the sedating effects of opioids. While serious, life-threatening, or fatal respiratory depression can occur at any time during the use of PERCOCET, the risk is greatest during the initiation of therapy or following a dosage increase.
Monitor patients closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy with and following dosage increases of PERCOCET. Neonatal opioid withdrawal syndrome, unlike opioid withdrawal syndrome in adults, may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts. Observe newborns for signs of neonatal opioid withdrawal syndrome and manage accordingly.
Concomitant use of PERCOCET with CYP3A4 inducers or discontinuation of an CYP3A4 inhibitor could decrease oxycodone hydrochloride plasma concentrations, decrease opioid efficacy or, possibly, lead to a withdrawal syndrome in a patient who had developed physical dependence to oxycodone hydrochloride. Because of these risks, reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioid analgesics alone.
If the decision is made to prescribe a benzodiazepine or other CNS depressant concomitantly with an opioid analgesic, prescribe the lowest effective dosages and minimum durations of concomitant use. In patients already receiving an opioid analgesic, prescribe a lower initial dose of the benzodiazepine or other CNS depressant than indicated in the absence of an opioid, and titrate based on clinical response. If an opioid analgesic is initiated in a patient already taking a benzodiazepine or other CNS depressant, prescribe a lower initial dose of the opioid analgesic, and titrate based on clinical response.
Follow patients closely for signs and symptoms of respiratory depression and sedation. Advise patients not to drive or operate heavy machinery until the effects of concomitant use of the benzodiazepine or other CNS depressant have been determined. Screen patients for risk of substance use disorders, including opioid abuse and misuse, and warn them of the risk for overdose and death associated with the use of additional CNS depressants including alcohol and illicit drugs.
The use of PERCOCET in patients with acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment is contraindicated. Elderly, Cachetic, or Debilitated Patients: Life-threatening respiratory depression is more likely to occur in elderly, cachectic, or debilitated patients because they may have altered pharmacokinetics or altered clearance compared to younger, healthier patients [see WARNINGS; Life Threatening Respiratory Depression ]. Alternatively, consider the use of non-opioid analgesics in these patients.
Cases of adrenal insufficiency have been reported with opioid use, more often following greater than one month of use. Presentation of adrenal insufficiency may include non-specific symptoms and signs including nausea, vomiting, anorexia, fatigue, weakness, dizziness, and low blood pressure. If adrenal insufficiency is suspected, confirm the diagnosis with diagnostic testing as soon as possible. If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids.
Wean the patient off of the opioid to allow adrenal function to recover and continue corticosteroid treatment until adrenal function recovers. Other opioids may be tried as some cases reported use of a different opioid without recurrence of adrenal insufficiency.
The information available does not identify any particular opioids as being more likely to be associated with adrenal insufficiency. There is increased risk in patients whose ability to maintain blood pressure has already been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs e.
Most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed milligrams per day, and often involve more than one acetaminophen-containing product. The excessive intake of acetaminophen may be intentional to cause self-harm or unintentional as patients attempt to obtain more pain relief or unknowingly take other acetaminophen-containing products.
The risk of acute liver failure is higher in individuals with underlying liver disease and in individuals who ingest alcohol while taking acetaminophen. Instruct patients to look for acetaminophen or APAP on package labels and not to use more than one product that contains acetaminophen. Instruct patients to seek medical attention immediately upon ingestion of more than milligrams of acetaminophen per day, even if they feel well.
Patients should be informed about the signs of serious skin reactions, and use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity. There have been post-marketing reports of hypersensitivity and anaphylaxis associated with use of acetaminophen.
Clinical signs included swelling of the face, mouth, and throat, respiratory distress, urticaria, rash, pruritus, and vomiting. There were infrequent reports of life-threatening anaphylaxis requiring emergency medical attention. In patients who may be susceptible to the intracranial effects of CO 2 retention e. Opioids may also obscure the clinical course in a patient with a head injury. Opioids may cause increases in serum amylase. Monitor patients with biliary tract disease, including acute pancreatitis, for worsening symptoms.
The oxycodone in PERCOCET may increase the frequency of seizures in patients with seizure disorders, and may increase the risk of seizures occurring in other clinical settings associated with seizures. PERCOCET may impair the mental or physical abilities needed to perform potentially hazardous activities such as driving a car or operating machinery. Advise patients how to recognize respiratory depression and to seek medical attention if breathing difficulties develop.
In the case of accidental ingestions, emergency medical care should be sought immediately. Inform patients that opioids could cause a rare but potentially life-threatening condition resulting from concomitant administration of serotonergic drugs. Warn patients of the symptoms of serotonin syndrome and to seek medical attention right away if symptoms develop. Inform patients that opioids could cause adrenal insufficiency, a potentially life-threatening condition.
Adrenal insufficiency may present with non-specific symptoms and signs such as nausea, vomiting, anorexia, fatigue, weakness, dizziness, and low blood pressure. Advise patients not to adjust the medication dose themselves and to consult with their healthcare provider prior to any dosage adjustment. Advise patients to consult with their physician for a gradual discontinuation dose schedule to taper off the medication. Inform patients to not take more than milligrams of acetaminophen per day. Advise patients to call their prescriber if they take more than the recommended dose.
Instruct patients how to recognize symptoms of low blood pressure and how to reduce the risk of serious consequences should hypotension occur e. Advise nursing mothers to monitor infants for increased sleepiness more than usual , breathing difficulties, or limpness. Inform patients that chronic use of opioids may cause reduced fertility. Although oxycodone may cross-react with some drug urine tests, no available studies were found which determined the duration of detectability of oxycodone in urine drug screens.
However, based on pharmacokinetic data, the approximate duration of detectability for a single dose of oxycodone is roughly estimated to be one to two days following drug exposure. Urine testing for opiates may be performed to determine illicit drug use and for medical reasons such as evaluation of patients with altered states of consciousness or monitoring efficacy of drug rehabilitation efforts.
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The preliminary identification of opiates in urine involves the use of an immunoassay screening and thin-layer chromatography TLC. The identities of 6-keto opiates e. Monitor patients for respiratory depression and sedation at frequent intervals. Monitor for signs of opioid withdrawal.
Due to additive pharmacologic effect, the concomitant use of benzodiazepines and other CNS depressants such as benzodiazepines and other sedative hypnotics, anxiolytics, and tranquilizers, muscle relaxants, general anesthetics, antipsychotics, and other opioids, including alcohol, can increase the risk of hypotension, respiratory depression, profound sedation, coma, and death. Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate.
Limit dosages and durations to the minimum required. The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system, such as selective serotonin reuptake inhibitors SSRIs , serotonin and norepinephrine reuptake inhibitors SNRIs , tricyclic antidepressants TCAs , tryptans, 5-HT3 receptor antagonists, drugs that affect the serotonin neurotransmitter system e.
If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment. The concomitant use of opioids and MAOIs, such as phenelzine, tranylcypromine, linezolid, may manifest as serotonin syndrome or opioid toxicity e. If urgent use of an opioid is necessary, use test doses and frequent titration of small doses to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression.
PERCOCET may enhance the neuromuscular-blocking action of skeletal muscle relaxants and produce an increase in the degree of respiratory depression. Hepatotoxicity has occurred in chronic alcoholics following various dose levels moderate to excessive of acetaminophen. Increase in glucuronidation resulting in increased plasma clearance and a decreased half-life of acetaminophen. Propranolol appears to inhibit the enzyme systems responsible for the glucuronidation and oxidation of acetaminophen.
Therefore, the pharmacologic effects of acetaminophen may be increased. The effects of the loop diuretic may be decreased because acetaminophen may decrease renal prostaglandin excretion and decrease plasma renin activity. The pharmacologic effects of zidovudine may be decreased because of enhanced non-hepatic or renal clearance of zidovudine.
A more specific alternate chemical method must be used in order to obtain a confirmed analytical result. Moreover, clinical considerations and professional judgment should be applied to any drug-of-abuse test result, particularly when preliminary positive results are used. This effect appears to be drug, concentration and system dependent. Long-term studies to evaluate the carcinogenic potential of the combination of Oxycodone Hydrochloride and Acetaminophen have not been conducted.
Long-term studies in mice and rats have been completed by the National Toxicology Program to evaluate the carcinogenic potential of acetaminophen. Female rats demonstrated equivocal evidence of carcinogenic activity based on increased incidences of mononuclear cell leukemia at 0.
In contrast, there was no evidence of carcinogenic activity in male rats that received up to 0. The combination of Oxycodone Hydrochloride and Acetaminophen has not been evaluated for mutagenicity. Oxycodone alone was negative in a bacterial reverse mutation assay Ames , an in vitro chromosome aberration assay with human lymphocytes without metabolic activation and an in vivo mouse micronucleus assay. Oxycodone was clastogenic in the human lymphocyte chromosomal assay in the presence of metabolic activation and in the mouse lymphoma assay with or without metabolic activation.
In studies conducted by the National Toxicology Program, fertility assessments with acetaminophen have been completed in Swiss CD-1 mice via a continuous breeding study. There were no effects on fertility parameters in mice consuming up to 1. Although there was no effect on sperm motility or sperm density in the epididymis, there was a significant increase in the percentage of abnormal sperm in mice consuming 1. Published studies in rodents report that oral acetaminophen treatment of male animals at doses that are 1.
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These effects appear to increase with the duration of treatment. The clinical significance of these findings is not known. Chronic use of opioids may cause reduced fertility in females and males of reproductive potential. PERCOCET should not be given to a pregnant woman unless in the judgment of the physician, the potential benefits outweigh the possible hazards.
Prolonged use of opioid analgesics during pregnancy for medical or nonmedical purposes can result in physical dependence in the neonate and neonatal opioid withdrawal syndrome shortly after birth. Neonatal opioid withdrawal syndrome presents as irritability, hyperactivity and abnormal sleep pattern, high pitched cry, tremor, vomiting, diarrhea and failure to gain weight. The onset, duration, and severity of neonatal opioid withdrawal syndrome vary based on the specific opioid used, duration of use, timing and amount of last maternal use, and rate of elimination of the drug by the newborn.
Opioids cross the placenta and may produce respiratory depression and psycho-physiologic effects in neonates. An opioid antagonist, such as naloxone, must be available for reversal of opioid-induced respiratory depression in the neonate. PERCOCET is not recommended for use in pregnant women during or immediately prior to labor, when other analgesic techniques are more appropriate.
Opioid analgesics, including PERCOCET, can prolong labor through actions which temporarily reduce the strength, duration, and frequency of uterine contractions. However, this effect is not consistent and may be offset by an increased rate of cervical dilation, which tends to shorten labor. Monitor neonates exposed to opioid analgesics during labor for signs of excess sedation and respiratory depression. Withdrawal symptoms can occur in breastfed infants when maternal administration of an opioid analgesic is stopped, or when breast-feeding is stopped.
In general, use caution when selecting a dosage for an elderly patient, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy. Respiratory depression is the chief risk for elderly patients treated with opioids, and has occurred after large initial doses were administered to patients who were not opioid-tolerant or when opioids were co- administered with other agents that depress respiration.
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These drugs are known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. In a pharmacokinetic study of oxycodone in patients with end-stage liver disease, oxycodone plasma clearance decreased and the elimination half-life increased.
Because oxycodone is extensively metabolized in the liver, its clearance may decrease in patients with hepatic impairment. In a study of patients with end stage renal impairment, mean elimination half-life was prolonged in uremic patients due to increased volume of distribution and reduced clearance. Oxycodone should be used with caution in patients with renal impairment.
Because oxycodone is known to be substantially excreted by the kidney, its clearance may decrease in patients with renal impairment. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. The most frequently observed non-serious adverse reactions include lightheadedness, dizziness, drowsiness or sedation, nausea, and vomiting. These effects seem to be more prominent in ambulatory than in nonambulatory patients, and some of these adverse reactions may be alleviated if the patient lies down.
Other adverse reactions include euphoria, dysphoria, constipation, and pruritus. Hypersensitivity reactions may include: Skin eruptions, urticarial, erythematous skin reactions. Hematologic reactions may include: thrombocytopenia, neutropenia, pancytopenia, hemolytic anemia. Rare cases of agranulocytosis has likewise been associated with acetaminophen use. In high doses, the most serious adverse effect is a dose-dependent, potentially fatal hepatic necrosis.
Renal tubular necrosis and hypoglycemic coma also may occur. Body as a Whole: Anaphylactoid reaction, allergic reaction, malaise, asthenia, fatigue, chest pain, fever, hypothermia, thirst, headache, increased sweating, accidental overdose, non-accidental overdose. Cardiovascular: Hypotension, hypertension, tachycardia, orthostatic hypotension, bradycardia, palpitations, dysrhythmias. Central and Peripheral Nervous System: Stupor, tremor, paraesthesia, hypoaesthesia, lethargy, seizures, anxiety, mental impairment, agitation, cerebral edema, confusion, dizziness. Fluid and Electrolyte: Dehydration, hyperkalemia, metabolic acidosis, respiratory alkalosis.
Gastrointestinal: Dyspepsia, taste disturbances, abdominal pain, abdominal distention, sweating increased, diarrhea, dry mouth, flatulence, gastrointestinal disorder, nausea, vomiting, pancreatitis, intestinal obstruction, ileus. Hepatic: Transient elevations of hepatic enzymes, increase in bilirubin, hepatitis, hepatic failure, jaundice, hepatotoxicity, hepatic disorder. Hypersensitivity: Acute anaphylaxis, angioedema, asthma, bronchospasm, laryngeal edema, urticaria, anaphylactoid reaction. Metabolic and Nutritional: Hypoglycemia, hyperglycemia, acidosis, alkalosis.
Psychiatric: Drug dependence, drug abuse, insomnia, confusion, anxiety, agitation, depressed level of consciousness, nervousness, hallucination, somnolence, depression, suicide. Respiratory System: Bronchospasm, dyspnea, hyperpnea, pulmonary edema, tachypnea, aspiration, hypoventilation, laryngeal edema. Urogenital: Interstitial nephritis, papillary necrosis, proteinuria, renal insufficiency and failure, urinary retention. All patients treated with opioids require careful monitoring for signs of abuse and addiction, since use of opioid analgesic products carries the risk of addiction even under appropriate medical use.
Prescription drug abuse is the intentional non-therapeutic use of a prescription drug, even once, for its rewarding psychological or physiological effects. Drug addiction is a cluster of behavioral, cognitive, and physiological phenomena that develop after repeated substance use and includes: a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal.
Preoccupation with achieving adequate pain relief can be appropriate behavior in a patient with poor pain control. Abuse and addiction are separate and distinct from physical dependence and tolerance. Health care providers should be aware that addiction may not be accompanied by concurrent tolerance and symptoms of physical dependence in all addicts. In addition, abuse of opioids can occur in the absence of true addiction. Careful record-keeping of prescribing information, including quantity, frequency, and renewal requests, as required by state and federal law, is strongly advised.
Proper assessment of the patient, proper prescribing practices, periodic re-evaluation of therapy, and proper dispensing and storage are appropriate measures that help to limit abuse of opioid drugs. Parenteral drug abuse is commonly associated with transmission of infectious diseases such as hepatitis and HIV. Both tolerance and physical dependence can develop during chronic opioid therapy. Tolerance is the need for increasing doses of opioids to maintain a defined effect such as analgesia in the absence of disease progression or other external factors. Tolerance may occur to both the desired and undesired effects of drugs, and may develop at different rates for different effects.
Physical dependence results in withdrawal symptoms after abrupt discontinuation or a significant dosage reduction of a drug. Withdrawal also may be precipitated through the administration of drugs with opioid antagonist activity e. Physical dependence may not occur to a clinically significant degree until after several days to weeks of continued opioid usage.
Some or all of the following can characterize this syndrome: restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills, myalgia, and mydriasis.