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Download TOOL 4. Summary of Common Adverse Effects Associated - Med-IQ
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TOOL 4. Summary of Common Adverse Effects Associated With Chronic Opioid Therapy for Non-Cancer Pain SIDE EFFECT KEY PATIENT EDUCATION AND MANAGEMENT TIPS Constipation • Constipation does not diminish with time or resolve spontaneously • Advise patients to increase fluid and fiber intake to prevent constipation • Consider initiating a bowel regimen with a stool softener and/or laxative Nausea and vomiting • Nausea and vomiting tend to diminish with time, usually in a few days or weeks • May be due to constipation and improve with treatment for constipation • An oral or rectal antiemetic can be prescribed if nausea and/or vomiting are severe Sedation and cloudy thinking • These side effects tend to diminish with time, although they can return if the dose is increased • Instruct patients to evaluate how the medication makes them feel, both at the start of therapy and whenever the dose changes, before driving a car, going to work, or engaging in other activities that require mental alertness • Consider whether the patient engages in a profession that may be subject to additional regulations and laws regarding use of opioids, such as bus drivers and airline pilots • Educate patient that other drugs and substances, such as alcohol, antihistamines, or sleep medications can worsen the sedating effects of opioids Respiratory depression • Problems with breathing may occur if the initial dose is too high, if the dose is titrated too rapidly, or if chronic opioid therapy is combined with other respiratory-depressing drugs, such as benzodiazepines • Patients with sleep apnea or other respiratory conditions may be at higher risk; opioids should be carefully initiated and titrated Sexual dysfunction and/or fatigue • Chronic use of sustained-release opioids is associated with hypogonadism and decreased levels of dehydroepiandrosterone sulfate • Test patients with these symptoms for hormonal deficiencies Pruritus • A common adverse effect for which no standard treatment exists; can try an antihistamine or change to another opioid Myoclonus • A common adverse effect for which no standard treatment exists Derived from Chou R, Fanciullo GJ, Fine PG, et al; American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113-130.
