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Strong Opioids +/- adjuvant therapy - page 19 / 38

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Contraindications:

Avoid in acute respiratory depression, acute alcoholism and where risk of paralytic ileus

Avoid in 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

Hepatic Failure (may ppt coma-reduce dose or avoid)

Renal Failure (reduce dose or avoid)

Elderly and debilitated (reduce dose)

Other cautions:

hypotension

hypothyroidism

asthma (avoid during attack) and decreased respiratory reserve

prostatic hypertrophy

convulsive disorders

dependence (severe withdrawal symptoms if withdrawn abruptly)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

Interactions:  No specific interaction information for Diamorphine, therefore taken from opioid analgesic interactions

Drug

Effect of interaction

Alcohol

Enhanced hypotensive and sedative effect

TCA

sedative effects possibly increased when opioid analgesics given with tricyclics

Antipsychotics

enhanced hypotensive and sedative effects when opioid analgesics given with antipsychotics

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

MAOIS

possible CNS excitation or depression (hypertension or hypotension) when opioid analgesics given with MAOIs —avoid concomitant use and for 2 weeks after stopping MAOIs

Metoclopramide

opioid analgesics antagonise effects of metoclopramide on gastro-intestinal activity

Mexiletine

opioid analgesics delay absorption of mexiletine

Moclebemide

possible CNS excitation or depression (hypertension or hypotension) when opioid analgesics given with moclobemide

Ritonavir

plasma concentration of opioid analgesics (except methadone) possibly increased by ritonavir

Monitoring:

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