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Antipsychotics

enhanced hypotensive and sedative effects when opioid analgesics given with antipsychotics

Increased risk of toxicity with myelosuppressive drugs

Anxiolytics and Hypnotics

increased sedative effect when opioid analgesics given with anxiolytics and hypnotics

Cimetidine

metabolism of opioid analgesics inhibited by cimetidine (increased plasma concentration)

Ciprofloxacin

avoidance of premedication with opioid analgesics advised by manufacturer of ciprofloxacin (reduced plasma concentration of ciprofloxacin) when ciprofloxacin used for surgical prophylaxis

Domperidone

opioid analgesics antagonise effects of domperidone on gastro-intestinal activity

Dose:

By mouth, 30–60 mg every 4 hours when necessary, to a max. of 240 mg daily; child 1–12 years, 3 mg/kg daily in divided doses

By intramuscular injection, 30–60 mg every 4 hours when necessary

Compound analgesic agents by Alan McLeod

The compound agents are preparations that include paracetamol (or aspirin) and a weak opioid. Caffeine is sometimes added to increase effectiveness but has no proven effect and may actually worsen headache.

Disadvantages

No proven to reduce pain more than simple paracetamol

Reduce scope for titration of individual components

May get opioid side effects (e.g. constipation)

Complicate overdose

Co-proxamol has been withdrawn and should no longer be prescribed – patients should be switched to an alternative

Co-codamol tablets are used for the relief of mild/moderate (or in the case of 30/500mg - severe) pain.

Co-dydramol tablets are used for the relief of mild/moderate pain.

Combination agents

Content

Dose

Co-codamol 8/500

Codeine phosphate 8 mg; Paracetamol 500 mg

T-TT t/qds

Co-codamol 15/500

Codeine phosphate 15 mg; Paracetamol 500 mg

T-TT t/qds

Co-codamol 30/500

Codeine phosphate 30 mg; Paracetamol 500 mg

T-TT t/qds

Co-dydramol 10/500

Di-hydrocodeine tartrate 10 mg, Paracetamol 500 mg

TT qds

Co-dydramol 20/500

Di-hydrocodeine tartrate 20 mg, Paracetamol 500 mg

TT qds

Co-dydramol 30/500

Di-hydrocodeine tartrate 30 mg, Paracetamol 500 mg

TT qds

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