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Opiates

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Give IV doses slowly. Titrate to effects. The antidote is Naloxone.

Mode of action

Opiates act on central opioid mu receptors to cause usefully analgesia and Euphoria
Opiate effects can be quickly reversed with IV naloxone which must always be available where IV opiates are being administered.

Indications

Pain control, Peri operatively anaesthesia, Persistent cough - codeine used
Palliative care and Malignant disease - addiction is not an issue when opiates are used for pain control. One must be ready to increase the dose as tolerance occurs. One gives enough to render the patient comfortable.
Acute Myocardial Infarction

Contraindications

Respiratory failure, Cardiogenic shock
Cautions with other depressant drugs - Alcohol, Phenothiazine, Tricyclic antidepressants

Different Drugs

Morphine, Diamorphine - more potent and lipid-soluble metabolised to morphine
Fentanyl - used IV and also due to high lipid solubility as transdermal patches. However, the patches are highly potent and this is often not appreciated. It is wise to start on oral MST first and work up the dose and then convert to a patch if needed.
Oxycodone, Dihydrocodeine, Codeine - 10% metabolised to Morphine

Side effects

Depress respiration, Hypotension, Constipation, Nausea, vomiting
Cough suppression, Releases ADH - SIADH
Biliary spasm, Histamine release and bronchoconstriction
Vasodilatation, Itching, Tolerance and addiction

It can be important to switch the method of opiate delivery and between different formulations. To avoid over and underdosing the equivalent doses are shown here.

This is only an approximate guide (doses may not correspond with those given in clinical practice); patients should be carefully monitored after any change in medication and dose titration may be required
Analgesic	Route	Dose
Codeine	PO	100mg
Diamorphine	IM, IV, SC	3mg
Dihydrocodeine	PO	100mg
Morphine	PO	10mg
Morphine	IM, IV, SC	5mg
Oxycodone	PO	6.6mg
Tramadol	PO	100mg
PO = by mouth; IM = intramuscular, IV = intravenous, SC = subcutaneous

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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