Opioids Tincture

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... 

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. 

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 These natural agents are still available for treating diarrhea, but they have essentially been replaced by newer opioids such as diphenoxylate and loperamide.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 The use of these formulations has largely been replaced by use of the purified compounds. 

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. 

Observational studies Tincture of opium is a preparation of powdered opium, which contains morphine, codeine, papaverine, and alcohol. It is used as an antidiarrheal agent, to treat neonatal abstinence syndrome, in the management of pain, and traditionally for the management of opioid dependency in some Asian countries. In an open study, opium-dependent subjects were allocated to three different doses of tincture of opium twice a day 10 ml (6.66 mg morphine equivalents n = 13), 20 ml (13.3 mg morphine equivalents n = 8), and 30 ml (20 mg morphine equivalents n = 11) [1 j. In all the subjects tincture of opium effectively suppressed withdrawal symptoms without causing significant adverse effects. 

Somogyi AA, Larsen M, Abadi RM, Jittiwutikarn J, All R, White JM. Flexible dosing of tincture of opium in the management of opioid withdrawal pharmacokinetics and pharmacodynamics. Br J Clin Pharmacol 2008 66(5) 640-7. 

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