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Trade Names:
Opium Tincture, Deodorized
- Liquid 10 mg anhydrous morphine equiv./mL

Trade Names:
Paregoric
- Liquid 2 mg anhydrous morphine equiv./5 mL

Mechanism of Action

Pharmacology

Enhances tone in long segments of longitudinal muscle and inhibits propulsive contraction of both circular and longitudinal muscles.

Pharmacokinetics

Absorption

Morphine content well absorbed from GI tract.

Metabolism

Rapidly metabolized in the liver following oral administration. Morphine content undergoes conjugation with glucuronic acid.

Elimination

Approximately 75% is excreted in the urine within 48 hr.

Indications and Usage

Treatment of diarrhea.

Contraindications

Children (opium tincture); diarrhea caused by poisoning until toxic material is eliminated from GI tract.

Dosage and Administration

PO Opium tincture : 0.6 mL qid. Paregoric : 1 to 2 teaspoonfuls (5 to 10 mL) 1 to 4 times/day.

PO Paregoric : 0.25 to 0.5 mL per kg of body weight 1 to 4 times/day.

General Advice

• Use caution when selecting product. Do not confuse opium tincture with paregoric. Opium tincture contains 25 times more morphine than paregoric and if given in equivalent mL doses may result in a potentially fatal overdose.
• To reduce risk of dosing error, consider diluting opium tincture (10 mg morphine/mL) so that morphine concentration is equivalent to that in paregoric (0.4 mg morphine/mL)
• Administer without regard to meals. Administer with food if GI upset occurs.
• Measure and administer prescribed dose of opium tincture using dosing syringe.
• Measure and administer prescribed dose of paregoric or diluted opium tincture using dosing syringe, dosing spoon, or dosing cup.

Storage/Stability

Store opium tincture and paregoric at controlled room temperature (59° to 86°F). Protect paregoric from light and excessive heat.

Drug Interactions

Because of additive effects, dosage reduction may be indicated.

Monitor for increased respiratory and CNS depression. Coadministration of cimetidine and morphine has been reported to cause apnea, confusion, and muscle twitching.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Dermatologic

Pruritus; urticaria.

GI

Constipation; nausea; vomiting.

Precautions

Pregnancy

Category C .

Lactation

Use with caution.

Children

Opium tincture is contraindicated.

Special Risk Patients

Use with caution in the elderly, in debilitated individuals, and in patients with increased intracranial pressure, cerebral arteriosclerosis, hepatic cirrhosis or liver insufficiency, GI hemorrhage, myxedema, emphysema, and bronchial asthma.

Drug dependence

Has abuse potential; addiction may result.

Overdosage

Symptoms

Nausea, vomiting, miosis, cool and clammy skin, respiratory and CNS depression, bradycardia, hypotension, skeletal muscle flaccidity, noncardiogenic pulmonary edema, hypoglycemia, apnea, circulatory collapse, cardiac arrest, death.

Patient Information

• Explain name, dose, action, and potential side effects of drug.
• Advise patient medication may be habit forming and to take as prescribed and not to increase the dose or frequency of use unless advised by health care provider.
• Advise patient or caregiver to take, or administer, prescribed dose up to qid as needed to control diarrhea.
• Advise patient or caregiver to take, or administer, each dose without regard to meals but to take, or administer, with meals if stomach upset occurs.
• Advise patient or caregiver using paregoric to measure and administer prescribed dose using dosing syringe, dosing spoon, or dosing cup.
• Advise patient using opium tincture to measure and administer prescribed dose using dosing syringe.
• Advise patient if a dose is missed to skip that dose and take the next dose at the regularly scheduled time. Caution patient not to double the dose to catch up.
• Advise patient if diarrhea is not controlled, not to increase the dose or frequency of administration of medication but to inform health care provider.
• Advise patient to discontinue therapy when diarrhea resolves. Caution patient that continued use may cause severe constipation.
• Caution patient to avoid alcohol and other CNS depressants while using this medication.
• Caution patient drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness or coordination until tolerance is determined.
• Advise women to notify health care provider if pregnant, planning to become pregnant, or breastfeeding.
• Caution patient not to take any prescription or OTC medications, herbal preparations, or dietary supplements unless advised by health care provider.