Tincture of Opium (Opium Tincture) is a powdered formulation containing morphine, codeine, alcohol, and papaverine. It is used to treat diarrhea and pain in terminally ill patients.
Tincture of opium Uses:
-
Diarrhea:
- Used for the treatment of diarrhea in adults.
Tincture of Opium dose in Adults
Note: Opium tincture contains morphine 10 mg/mL. Use caution in ordering, dispensing, and/or administering. Doses may be expressed in mg (milligram) dosing units of morphine or as drops.
Tincture of Opium dose in the treatment of Diarrhea:
- Oral: 6 mg (0.6 mL) (undiluted opium tincture) (10 mg/mL) QID
Tincture of Opium dose in the treatment of Cancer treatment-induced diarrhea (off-label dosing):
- Oral: 10 to 15 drops (opium tincture [10 mg/mL]) in water every 3 to 4 hours
Use in Children:
Not indicated.
Pregnancy Risk Factor C
- Opium tincture contains 10 mg/mL of Morphine and 19% alcohol. The placenta can be crossed by Morphine.
- Birth defects, preterm births, poor fetal growth and stillbirth can all be caused by maternal use of opioids.
- The newborn may experience withdrawal if they are exposed to chronic opioids during pregnancy.
- An infant who is exposed to opium tincture in utero during pregnancy may experience opioid withdrawal that will require treatment.
- Consider also the alcohol content of pregnant women.
- For adults, Opium Tincture is approved for treatment of diarrhea. However, alternative agents should be used during pregnancy.
- For additional information refer to the Morphine (Systemic) monograph.
Use during breastfeeding:
- Opium tincture contains 10 mg/mL of Morphine and 19% alcohol.
- Breast milk secretes Morphine. Be aware of the alcohol content. If the medication is given to a woman who is breastfeeding, be cautious.
- For additional information refer to the Morphine (Systemic) monograph.
Dose in Kidney Disease:
No dosage adjustments provided in the manufacturer's labeling.
Dose in Liver disease:
No dosage adjustments provided in the manufacturer's labeling; use with caution.
Side effects of Tincture of opium:
-
Cardiovascular:
- Bradycardia
- Hypotension
- Palpitations
- Peripheral Vasodilation
-
Central Nervous System:
- Central Nervous System Depression
- Depression
- Dizziness
- Drowsiness
- Drug Dependence
- Headache
- Increased Intracranial Pressure
- Insomnia
- Malaise
- Restlessness
-
Gastrointestinal:
- Anorexia
- Biliary Tract Spasm
- Constipation
- Nausea
- Stomach Cramps
- Vomiting
-
Genitourinary:
- Decreased Urine Output
- Genitourinary Tract Spasm
-
Hypersensitivity:
- Histamine Release
-
Neuromuscular & Skeletal:
- Weakness
-
Ophthalmic:
- Miosis
-
Respiratory:
- Respiratory Depression
Contraindications to Tincture of opium:
- Use with children
- Diarrhea caused by poisoning that remains in the GI tract
- There is limited documentation on allergenic cross-reactivity with opioids.
- Cross-sensitivity is possible due to similarities in chemical structure or pharmacologic effects.
Warnings and precautions
-
CNS depression:
- CNS depression can cause impairment of mental or physical abilities.
- Patients should be cautious about driving or operating machinery that requires mental alertness.
-
Hypotension
- Hypotension can occur during use. Patients with hypovolemia, heart disease (including acute MI) or drugs that exaggerate hypotensive effects (including general anesthetics or phenothiazines) should be cautious.
-
Conditions abdominales:
- Patients with acute abdominal conditions can be difficult to diagnose or track.
-
Insufficiency of the adrenal glands:
- Patients with adrenal insufficiency (including Addison's) should be cautious.
- Long-term opioid use can lead to secondary hypogonadism, which can cause infertility, sexual dysfunction, mood disorders, and osteoporosis.
-
Insufficiency of the biliary tract:
- Patients with biliary dysfunction (including acute pancreatitis) should be cautious when using this product. This could cause constriction or Oddi's sphincter to become constricted.
-
CNS depression/coma:
- Patients with CNS depression and coma should not use this medication.
- These patients are more susceptible to the intracranial effects CO retention.
-
Use of drugs:
- Patients with a history or severe alcoholism should be cautious when using this product.
- The possibility of becoming drug dependent exists. Prolonged use may lead to tolerance, psychological reliance, and/or physical dependence.
-
GI Hemorrhage:
- Patients with GI hemorhage should be cautious.
-
Head trauma
- Patients with intracranial injuries, intracranial lesion or elevated intracranial pressure should be cautious. This could cause an exaggerated elevation in ICP.
-
Hepatic impairment
- Patients with hepatic dysfunction should be cautious when using this product.
-
Obesity:
- Patients who are obese or morbid should be cautious when using this product.
-
Prostatic hyperplasia/urinary restriction:
- Patients with urinary stricture or prostatic hyperplasia should be cautious.
-
Respiratory disease
- Patients should exercise caution if they have any pre-existing respiratory illnesses (hypoxia/hypercapnia, COPD, or other obstructive lung diseases), kyphoscoliosis, or other skeletal issues that may impact respiratory function. The medicine can have severe respiratory depression even at therapeutic levels.
-
Thyroid dysfunction:
- Patients with thyroid dysfunction should be cautious when using this product.
Tincture of opium: Drug Interaction
|
Alizapride |
May enhance the CNS depressant effect of CNS Depressants. |
|
Amphetamines |
May enhance the analgesic effect of Opioid Agonists. |
|
Anticholinergic Agents |
May enhance the adverse/toxic effect of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination. |
|
Brimonidine (Topical) |
|
|
Bromopride |
May enhance the CNS depressant effect of CNS Depressants. |
|
Cannabidiol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Cannabis |
May enhance the CNS depressant effect of CNS Depressants. |
|
Chlorphenesin Carbamate |
May enhance the adverse/toxic effect of CNS Depressants. |
|
Desmopressin |
Opioid Agonists may enhance the adverse/toxic effect of Desmopressin. |
|
Dimethindene (Topical) |
May enhance the CNS depressant effect of CNS Depressants. |
|
Diuretics |
Opioid Agonists may enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics. |
|
Dronabinol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Gastrointestinal Agents (Prokinetic) |
Opioid Agonists may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). |
|
Kava Kava |
May enhance the adverse/toxic effect of CNS Depressants. |
|
Lofexidine |
May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs. |
|
Magnesium Sulfate |
May enhance the CNS depressant effect of CNS Depressants. |
|
MetyroSINE |
CNS Depressants may enhance the sedative effect of MetyroSINE. |
|
Minocycline |
May enhance the CNS depressant effect of CNS Depressants. |
|
Nabilone |
May enhance the CNS depressant effect of CNS Depressants. |
|
Pegvisomant |
Opioid Agonists may diminish the therapeutic effect of Pegvisomant. |
|
Piribedil |
CNS Depressants may enhance the CNS depressant effect of Piribedil. |
|
Pramipexole |
CNS Depressants may enhance the sedative effect of Pramipexole. |
|
Ramosetron |
Opioid Agonists may enhance the constipating effect of Ramosetron. |
|
ROPINIRole |
CNS Depressants may enhance the sedative effect of ROPINIRole. |
|
Rotigotine |
CNS Depressants may enhance the sedative effect of Rotigotine. |
|
Rufinamide |
May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. |
|
Selective Serotonin Reuptake Inhibitors |
CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. |
|
Serotonin Modulators |
Opioid Agonists may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Exceptions: Nicergoline. |
|
Succinylcholine |
May enhance the bradycardic effect of Opioid Agonists. |
|
Tetrahydrocannabinol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Tetrahydrocannabinol and Cannabidiol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Risk Factor D (Consider therapy modification) |
|
|
Alvimopan |
Opioid Agonists may enhance the adverse/toxic effect of Alvimopan. This is most notable for patients receiving long-term (i.e., more than 7 days) opiates prior to alvimopan initiation. Management: Alvimopan is contraindicated in patients receiving therapeutic doses of opioids for more than 7 consecutive days immediately prior to alvimopan initiation. |
|
Blonanserin |
CNS Depressants may enhance the CNS depressant effect of Blonanserin. |
|
Chlormethiazole |
May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. |
|
CNS Depressants |
May enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Droperidol |
May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs. |
|
Flunitrazepam |
CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. |
|
HYDROcodone |
CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Methotrimeprazine |
CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established. |
|
Nalmefene |
May diminish the therapeutic effect of Opioid Agonists. Management: Avoid the concomitant use of nalmefene and opioid agonists. Discontinue nalmefene 1 week prior to any anticipated use of opioid agonistss. If combined, larger doses of opioid agonists will likely be required. |
|
Naltrexone |
May diminish the therapeutic effect of Opioid Agonists. Management: Seek therapeutic alternatives to opioids. See full drug interaction monograph for detailed recommendations. |
|
Opioid Agonists |
CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
OxyCODONE |
CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Perampanel |
May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. |
|
Sincalide |
Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. |
|
Sodium Oxybate |
May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated. |
|
Suvorexant |
CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. |
|
Tapentadol |
May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Zolpidem |
CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. |
|
Risk Factor X (Avoid combination) |
|
|
Azelastine (Nasal) |
CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). |
|
Bromperidol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Eluxadoline |
Opioid Agonists may enhance the constipating effect of Eluxadoline. |
|
Opioids (Mixed Agonist / Antagonist) |
May diminish the analgesic effect of Opioid Agonists. Management: Seek alternatives to mixed agonist/antagonist opioids in patients receiving pure opioid agonists, and monitor for symptoms of therapeutic failure/high dose requirements (or withdrawal in opioid-dependent patients) if patients receive these combinations. |
|
Orphenadrine |
CNS Depressants may enhance the CNS depressant effect of Orphenadrine. |
|
Oxomemazine |
May enhance the CNS depressant effect of CNS Depressants. |
|
Paraldehyde |
CNS Depressants may enhance the CNS depressant effect of Paraldehyde. |
|
Thalidomide |
CNS Depressants may enhance the CNS depressant effect of Thalidomide. |
Monitoring parameters:
- Observe patient for excessive sedation, respiratory depression, constipation, nausea, vomiting, and lightheadedness
- Signs or symptoms of hypogonadism or hypoadrenalism in patients with chronic use
How to administer the Tincture of opium?
Oral: Cancer treatment-induced diarrhea: Before administration, add drops to water
Mechanism of action of Tincture of opium:
- There are many opioid alkaloids, including morphine.
- The mechanism of gastric motility inhibition is primarily mediated by morphine.
- It causes a decrease or digestive secretions, an increase or tone in the GI muscles, and therefore a decrease in GI propulsion.
Duration of action: 4 to 5 hours
Absorption is Variable
Metabolism: Takes place in Liver
Excretion: Via urine [/bg_collapse]
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