Adverse effects of<unk>  are similar to those of other potent opioid analgesics, such as morphine and heroin. The major hazards of<unk>  include dose-related respiratory depression, urinary retention, bronchospasm, and sometimes, circulatory depression. More common side effects include lightheadedness, dizziness, sedation, itching, constipation, nausea, vomiting, headache, perspiration, and hallucinations. These symptoms are common in ambulatory patients and in those not experiencing severe pain. Simultaneous use of<unk>  with other opioids, muscle relaxants, tranquilizers, sedatives, and general anesthetics may cause a significant increase in respiratory depression, progressing to coma or death. Taking benzodiazepines (such as diazepam) in conjunction with<unk>  may increase side effects such as dizziness and difficulty concentrating. If simultaneous use of these drugs is required, dose adjustment may be made. A particular problem that may occur with<unk>  is accidental administration in place of morphine due to a mix-up between the similar names, either at the time the prescription is written or when the drug is dispensed. This has led to several deaths and calls for<unk>  to be distributed in distinctly different packaging from morphine to avoid confusion. Massive overdoses are rarely observed in opioid-tolerant individuals, but when they occur, they may lead to circulatory system collapse. Symptoms of overdose include respiratory depression, drowsiness leading to coma and sometimes to death, drooping of skeletal muscles, low heart rate, and decreasing blood pressure. At the hospital, individuals with<unk>  overdose are provided supportive care, such as assisted ventilation to provide oxygen and gut decontamination using activated charcoal through a nasogastric tube. Opioid antagonists, such as naloxone, also may be administered concurrently with oxygen supplementation. Naloxone works by reversing the effects of<unk> , and only is administered in the presence of significant respiratory depression and circulatory depression. Sugar cravings associated with<unk>  use are the result of a glucose crash after transient hyperglycemia following injection, or a less profound lowering of blood sugar over a period of hours, in common with morphine, heroin, codeine, and other opiates. Hormone imbalance As with other opioids,<unk>  (particularly during heavy chronic use) often causes temporary hypogonadism or hormone imbalance. Neurotoxicity In the setting of prolonged use, high dosage, and/or kidney dysfunction,<unk>  has been associated with neuroexcitatory symptoms such as tremor, myoclonus, agitation, and cognitive dysfunction. This toxicity is less than that associated with other classes of opioids such as the pethidine class of synthetics in particular. Withdrawal Users of<unk>  may experience painful symptoms if the drug is suspended. Some people cannot tolerate the symptoms, which results in continuous drug use. Symptoms of opioid withdrawal are not easy to decipher, as there are differences between drug-seeking behaviors and true withdrawal effects. Symptoms associated with<unk>  withdrawal include: * Abdominal pain * Anxiety or panic attacks * Depression * Goose bump skin * Inability to enjoy daily activities * Muscle and joint pain * Nausea * Runny nose and excessive secretion of tears * Sweating * Vomiting In the clinical setting, excessive secretion of tears, yawning, and dilation of pupils are helpful presentations in diagnosing opioid withdrawal.<unk>  is a rapid acting pain killer; however, some formulations may last up to several hours. Patients who stop taking this drug abruptly may experience withdrawal symptoms, which may start within hours of taking the last dose of<unk> , and last up to several weeks. Withdrawal symptoms in people who stopped taking the opioid may be managed by using opioids or non-opioid adjuncts. Methadone is an opioid commonly used for this kind of therapy. However, the selection of therapy should be tailored to each specific person. Methadone also is used for detoxification in people who have opioid addiction, such as heroin or drugs similar to morphine. It may be given orally or intramuscularly. There is controversy regarding the use of opioids for people experiencing withdrawal symptoms, since these agents also may cause relapse on patients when they suspend therapy. Clonidine is a non-opioid adjunct, which may be used in situations where opioid use is not desired, such as in patients with high blood pressure.
Hydromorphone
Oxymorphone
Morphine
Nalorphine
Ropivacaine
Butorphanol
Oxymorphol
Sufentanil