Adverse effects with short-term use of opioids
The spectrum and incidence of adverse effects associated with short-term use of opioids is similar for all opioids given in equianalgesic doses, but there can be significant variation in patient response. See Adverse effects with short-term use of opioids for adverse effects with short-term use of opioids.
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System |
Adverse effects with short-term use |
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respiratory |
opioid-induced ventilatory impairment—manifests as sedation or reduced respiratory rate; risk increases with concomitant administration of sedatives (eg benzodiazepines, sedating antihistamines, gabapentinoids, alcohol, cannabis) increased risk of sleep-disordered breathing (eg central sleep apnoea, obstructive sleep apnoea) cough suppression |
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cardiovascular |
bradycardia, vasodilation and hypotension (including postural hypotension)—usually only seen after the use of large intravenous doses during anaesthesia or if the patient is hypovolaemic dose-dependent QT-interval prolongation with methadone and to a lesser extent with buprenorphine and oxycodone |
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neurological |
sedation, impaired cognition, delirium, dysphoria, euphoria, miosis—monitor patients and caution them not to drive, especially when opioids have recently been initiated or opioid dose has been increased muscle rigidity, myoclonus or seizures can be idiosyncratic, or occur in patients taking a high dose of opioids or who have renal impairment, due to accumulation of neurotoxic metabolites |
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dermatological |
pruritus (not associated with a rash) [NB1] widespread urticaria suggests an allergic response, whereas localised urticaria (ie along the line of a vein into which an opioid is injected) is likely due to local histamine release |
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gastrointestinal |
nausea, vomiting, decreased gastric motility and emptying, prolonged large bowel transit time, constipation |
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urinary |
urinary retention |
Note:
NB1: If pruritus persists, consider changing to a different opioid.
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