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Morphine also releases histamine from mast cells leading to local effects such as urticaria and pruritis at the site of injection or systemic effects such as bronchospasm and hypotension.

The immune system is depressed by long term opioid use.

Morphine is slowly and erratically absorbed.

Side effects:

nausea and vomiting (particularly in initial stages)

constipation

drowsiness

difficulty with micturition

ureteric or biliary spasm

dry mouth

sweating

headache

facial flushing

vertigo

bradycardia

pruritus

tachycardia

palpitation

postural hypotension

hypothermia

hallucinations

dysphoria

mood changes

dependence

miosis

decreased libido or potency

rashes

urticaria

larger doses produce respiratory depression, hypotension, and muscle rigidity

Opioids (narcotic analgesics) cause coma, respiratory depression, and pinpoint pupils in overdose. The specific antidote naloxone is indicated if there is coma or bradypnoea.

Contraindications:

Avoid in:

acute respiratory depression

acute alcoholism

risk of paralytic ileus

raised intracranial pressure or head injury (affects pupillary responses vital for neurological assessment)

avoid injection in phaeochromocytoma (risk of pressor response to histamine release)

Cautions:

pregnancy & breast-feeding

hypotension

hypothyroidism

asthma (avoid during attack) and decreased respiratory reserve

prostatic hypertrophy

convulsive disorders

may precipitate coma in hepatic impairment (reduce dose or avoid but many such patients tolerate well)

reduce dose or avoid in renal impairment, elderly and debilitated,

dependence (severe withdrawal symptoms if withdrawn abruptly)

use of cough suppressants containing opioid analgesics not generally recommended in children and should be avoided altogether in those under at least 1 year

NB. Palliative care: For the control of pain in terminal illness these cautions should not necessarily be a deterrent to the use of opioids

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