Morphine side effects

Cancer l/6th as potent as morphine Side effects quantitatively similar to those of morphine some withdrawal phenomena 200... 

Hydromorphone is more soluble than morphine and approximately eight times more active upon parenteral administration. High solubility permits a lower volume of injected fluid, which is important if multiple injections are needed. It begins to work faster than morphine, but lasts for a shorter amount of time. It has a high sedative effect and a lessened capability of causing euphoria. Hydromorphone is used the same way as morphine. Side effects are analogous. Synonyms for this drug are dilaudid and others. 

Hydromorphone is more potent than morphine by weight and is believed to produce analgesic effects four to eight times greater than morphine. Side effects are comparable to morphine with the exception of vomiting, which tends to be less frequent with hydromorphone use. 

Marret E, Kurd O, Zufferey P, Bonnet E Effects of nonsteroidal antiinffammatory drugs on patient-controlled analgesia morphine side effects metaanalysis of randomized controlled trials. Anesthesiology 2005 102 1249-60. 

Marret E, Kurdi O, Zufferey P, Bonnet F. The effect of NSAIDS on PCA morphine side effects a meta-analysis. Anesthesiology 2005 102(6) 1249-1260. 

Poullis A, Foster R, Shetty A, Fagerhol MK, Mendall MA (2004) Bowel inflammation as measured by fecal calprotectin a link between lifestyle factors and colorectal cancer risk. Cancer Epidemiol Biomark Prev 13 279-284 Rabier D, Kamoun P (1995) Metabolism of citrulline in man. Amino Acids 9 299-316 Raehal KM, Walker JKL, Bohn LM (2005) Morphine side effects in p-arrestin 2 knockout mice. J Pharmacol Exp Ther 314(3) 1195-1201... 

Codeiae (2, R = CH3) occurs ia the opium poppy along with morphine (2, R = H) but usually ia much lower concentration. Because it is less toxic than morphine and because its side effects (including depression, etc) are less marked, it has found widespread use ia the treatment of minor pain and much of the morphine found ia cmde opium is converted to codeiae. The commercial coaversioa of morphine to codeiae makes use of a variety of methylating ageats, amoag which the most common are trimethylphenylammonium salts. Ia excess of two huadred toas of codeiae are coasumed anauaHy from productioa faciUties scattered arouad the world. 

The quest for compounds that combined the analgesic properties of morphine, were nonaddictive, and lacked the side effects of nalorphine, led to the development of the dmgs shown in Table 3. These compounds have both agonist and antagonist activities. Nalbuphine (14) (23) and buprenorphine... 

Morphine has certain undesirable side effects. Among these are respiratory depression, nausea, and vomiting, depression of the cough reflex, cardiovascular depression and hypotension, smooth muscle contraction (constipation), and histamine release (93). Morphine s onset of action, duration, and low therapeutic indices have prompted a search for a more effective opiate iv anesthetic. Extreme simplification of the complex morphine molecule has resulted in anilido —piperidines, the fentanyl class of extremely potent opiate iv anesthetics (118,119). 

Codeine, like morphine, is isolated from the opium poppy. However, the low yield of 0.7—2.5% does not provide sufficient material to meet commercial demands. The majority of marketed codeine is prepared by methylating the phenolic hydroxyl group of morphine. Morphine yields from opium poppy are 4—21%. When prescribed for cough, the usual oral dose is 10—20 mg, three to four times daily. At these doses, adverse side effects are very few. Although the abuse potential for codeine is relatively low, the compound can substitute for morphine in addicts (47). 

A not uncommon side effect observed with morphine and some of the other narcotic analgesics is constipation due to decreased motility of the gastrointestinal tract. It proved possible to so modify pethidine as to retain the side effect at the expense of analgesic activity. Relief of diarrhea, it will be realized, is a far from trivial indication. Alkylation of the anion from diphenylacetonitrile (95) with ethylene dibromide gives the intermediate, 96. Alkylation of normeperidine (81) with that halide... 

There are a number of side-effects of opiates that are due to their actions on opiate receptors outside the central nervous system. Opiates constrict the pupils by acting on the oculomotor nucleus and cause constipation by activating a maintained contraction of the smooth muscle of the gut which reduces motility. This diminished propulsion coupled with opiates reducing secretion in the gut underlie the anti-diarrhoeal effect. Opiates contract sphincters throughout the gastrointestinal tract. Although these effects are predominantly peripheral in origin there are central contributions as well. Morphine can also release histamine from mast cells and this can produce irritation and broncho-spasm in extreme cases. Opiates have minimal cardiovascular effects at therapeutic doses. 

Severe pain should be treated with an opioid such as morphine, hydromorphone, methadone, or fentanyl. Moderate pain can be treated effectively in most cases with a weak opioid such as codeine or hydrocodone, usually in combination with acetaminophen. Meperidine should be avoided owing to its relatively short analgesic effect and its toxic metabolite, normeperidine. Normeperidine may accumulate with repeated dosing and can lead to central nervous system side effects including seizures. 

Although placebo effects are generally referred to as nonspecific, there is also a sense in which they are very specific. The effect of the placebo is specific to the beliefs that people have about the substance they are ingesting. Placebo morphine, for example, reduces pain, whereas placebo antidepressants reduce depression. Even the side effects that people report when given a placebo tend to be the same side effects that are produced by the real drug.12 In other words, the effect of a placebo is specific to the effect that the person expects it to have. When given placebo stimulants like decaffeinated coffee (presented as regular coffee), people feel more alert, and their heart rate and... 

The history of this class of analgesics might have stopped there were it not for the manifold ancillary activities shown by that molecule. Although still one of the most widely used agents for treatment of severe pain, morphine is a drug that must be used with caution. Side effects include respiratory depression, induction of constipation, and sometimes marked sedation. The one property that most severely limits use of this drug is its propensity to induce physical dependence in patients subjected to more than casual exposure. 

It will be recalled that a common side effect of morphine is the induction of constipation. This property of the drug has often been exploited in the design of preparations used to control diarrhea. 

Opium and its derivatives have been employed for centuries for the treatment of pain. Morphine was first synthesized in 1805 and has proven to be one of the most effective analgesic agents available [1], Morphine and its analogs are particularly useful because they diminish pain sensation while maintaining consciousness. However, opiates induce severe side-effects including respiratory depression, nausea, bradycardia and constipation and long-term use of opiates can cause addiction [2]. 

A major side-effect of morphine is respiratory depression. Opiates are believed to cause this effect via actions in brainstem nuclei, fi receptor immunoreactivity and mRNA were detected in neurons of the nucleus of the solitary tract, nucleus ambiguous, and parabrachial nucleus. mRNA was detected in the bed nucleus of the stria terminalis which projects to the nucleus of the solitary tract, fi receptor immunoreactivity is found in the nucleus of the solitary tract and dorsal rhizotomy reduced receptor immunoreactivity in the nucleus suggesting a presynaptic localization of the receptor. 

Like <5 selective agonists, k agonists have few of the side effects of morphine and recent studies have suggested that k selective agonists may be effective analgesics [2]. However, a limitation to the clinical use of k agonists is tolerance development. 

Andersen G, Christrup L, Sjogren P. Relationships among morphine metabolism, pain and side effects during long-term treatment an update. J Pain Symptom Manage 2003 25(1 ) 74—91. 

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