OPIUM, POWDERED OPIUM TINCTURE (LAUDANUM)

OPIUM, POWDERED OPIUM TINCTURE (LAUDANUM)
(oh'pee-um)
Deodorized Opium Tincture
Classifications: narcotic (opiate) agonist; narcotic analgesic; antidiarrheal;
Therapeutic: narcotic analgesic; antidiarrheal

Prototype: Morphine
Pregnancy Category: C
Controlled Substance: Schedule II

Availability

10%, 2 mg/5 mL liquid

Action

Is obtained from the unripe capsules of Papaver somniferum or Papaver album and contains several natural alkaloids including morphine, codeine, papaverine. Antidiarrheal due to inhibition of GI motility and propulsion; leads to prolonged transit of intestinal contents, desiccation of feces, and constipation.

Therapeutic Effect

Antidiarrheal activity due to inhibition of GI motility.

Uses

Symptomatic treatment of acute diarrhea and to treat severe withdrawal symptoms in neonates born to women addicted to opiates.

Contraindications

Diarrhea caused by poisoning (until poison is completely eliminated); pregnancy (category C).

Cautious Use

History of opiate agonist dependence; asthma; severe prostatic hypertrophy; hepatic disease; lactation.

Route & Dosage

Acute Diarrhea
Adult: PO 0.6 mL q.i.d. up to 1 mL q.i.d. (max: 6 mL/d)
Child: PO 0.005–0.01 mL/kg q3–4h (max: 6 doses/24 h)

Neonatal Withdrawal
Child: PO Make a 1:25 aqueous dilution, then give 3–6 drops q3–6h as needed or 0.2 mL q3h, may increase by 0.05 mL q3h until withdrawal symptoms are controlled, then gradually decrease dose after withdrawal symptoms have stabilized

Administration

Oral
  • Do not confuse this preparation with camphorated opium tincture (paregoric), which contains only 2 mg anhydrous morphine/5 mL, thus requiring a higher dose volume than that required for therapeutic dose of Deodorized Opium Tincture.
  • Give drug diluted with about one third glass of water to ensure passage of entire dose into stomach.
  • Store in tight, light-resistant containers.

Adverse Effects (≥1%)

GI: Nausea and other GI disturbances. CNS: Depression of CNS.

Interactions

Drug: Alcohol and other cns depressants add to CNS effects.

Pharmacokinetics

Absorption: Variable absorption from GI tract. Distribution: Crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: In urine.

Nursing Implications

Assessment & Drug Effects

  • Withhold medication and report to physician if respirations are 12/min or below or have changed in character and rate.
  • Discontinue as soon as diarrhea is controlled; note character and frequency of stools.
  • Offer small amounts of fluid frequently but attempt to maintain 3000–4000 mL fluid total in 24 h.
  • Monitor body weight, I&O ratio and pattern, and temperature. If patient develops fever of 38.8° C (102° F) or above, electrolyte and hydration levels may need to be evaluated. Consult physician.

Patient & Family Education

  • Be aware that constipation may be a consequence of antidiarrheal therapy but that normal habit pattern usually is reestablished with resumption of normal dietary intake.
  • Note: Addiction is possible with prolonged use or with drug abuse.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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