Opioids paregoric

Opioids. Activation of opioid receptors in the enteric nerve plexus results in inhibition of propulsive motor activity and enhancement of segmentation activity. This antidiarrheal effect was formerly induced by application of opium tincture (paregoric) containing morphine. Because of the CNS effects (sedation, respiratory depression, physical dependence), derivatives with peripheral actions have been developed. Whereas diphenoxylate can still produce clear CNS effects, loperamide does not Lullmann, Color Atlas of Pharmacology... 

Babies bom to opioid-addicted women also exhibit withdrawal signs, but because of the slower metabolism of opioids in the newborn, the withdrawal signs are more protracted. The babies are often treated with the opium preparation paregoric to reduce withdrawal signs. 

The use of opium dates to 4,000 b.c. At that time it was used for medicinal and recreational purposes mainly via inhalation. Today few opium-containing preparations are used, since the activity of opium is largely attributed to its morphine content. The preparations in use today are those that have constipative effects useful for the treatment of diarrhea. Preparations include pantopon, an injectable hydrochloride of opium alkaloids, and paregoric, a camphorated tincture of opium. Paregoric can be used to treat infants with opioid withdrawal signs following in utero exposure to opioids. 

Diarrhea from almost any cause can be controlled with the opioid analgesics, but if diarrhea is associated with infection such use must not substitute for appropriate chemotherapy. Crude opium preparations (eg, paregoric) were used in the past to control diarrhea, but now synthetic surrogates with more selective gastrointestinal effects and few or no CNS effects, eg, diphenoxylate or loperamide, are used. Several preparations are available specifically for this purpose (see Chapter 62). 

Opioid derivatives used to treat diarrhea are listed in Table 27-3. Opium tincture (laudanum) and camphorated opium tincture (paregoric) are naturally occurring opiates that are very potent inhibitors of peristalsis. These natural agents are still available for treating diarrhea, but they have essentially been replaced by newer opioids such as diphenoxylate and loperamide. These newer opioids are somewhat less potent but may produce fewer side effects. 

Natural opioids, that is, opioids extracted directly from opium include codeine—used for dental and other postoperative pain laudanum, paregoric—a mild tincture of opium mixed with camphor and used primarily for control of diarrhea and morphine. Heroin is a partial synthetic that combines morphine and diacetyl... 

Papaver somniferum (opium poppy) contains a variety of opioid and related alkaloids, including codeine, morphine, noscapine, papaverine, and thebaine. Crude opium is the air-dried latex obtained by incising the unripe capsules of P. somniferum. Paregoric is ammoniated tincture of opium (Scotch paregoric) or camphorated tincture of opium (English paregoric). The use of these formulations has largely been replaced by use of the purified compounds. 

Paregoric affects the gastrointestinal tract by inhibiting motility and propulsion and increasing smooth muscle tone. Thus, it has been used to treat diarrhea, opioid addiction, and neonatal abstinence syndrome. 

Opium tincture/paregoric is an opioid analgesic that enhances tone in long segments of longitudinal muscle and inhibits propulsive contraction of both circular and longitudinal muscles. Opium tincture is used in acute and nonspecific diarrhea. 

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