Narcotic Analgesic

Generic and Trade Names

Alfentanil			Alfenta
Codeine		Codeine
Fentanyl		Fentanyl
Hydrocodone		Vicodin
Hydromorphone		Dilaudid
Meperidine		Demerol
Methadone		Dolophine
Morphine		Morphine, MS Contin, MSIR, Astramorph
Oxycodone		Oxycodone
Oxymorphone		Numorphan
Propoxyphene		Darvon, Darvocet
Sufentanil		Sufenta

Description:

These agents work in different ways to block or control pain impulses to the brain and spinal cord. They have either agonist, agonist-antagonist or partial agonistic activity for the opiod receptors. The five known receptors are: mu, kappa, sigma, delta, and epsilon. These agents all act on the mu, kappa and delta receptors. All are habit forming with long term use. (Facts and Comparisons 1999)

Nutritional Considerations:

Monitor caloric intake (drug delays digestion, may cause constipation). (Pronsky 1999)

Hydration: insure adequate fluid intake unless directed otherwise. (Pronsky 1999)

Electrolytes should be maintained.

Avoid alcohol. (Facts and Comparisons 1999)

Herbal Considerations:

Herbs with sedative properties like: Calamus, Calendula, California poppy, Catnip, Capsicum, Celery, Couch grass, Elecampane, Siberian ginseng, German chamomile, Goldenseal, Gotu kola, Hops, Jamaican dogwood, Kava, Lemon balm, Sage, St. John's wort, Sassafras, Scullcap, Shepherd's purse, Stinging nettle, Valerian, Wild carrot, Wild lettuce, Withania, and Yerba mansa may increase the effects or side effects of these agents. (Brinker 1998)(Newall 1996)

The hypotensive property of: Astragalus, Or Barberry, Black Haw, Cleavers, Dong Quai, European Mistletoe, Fo-Ti, Kelp Plant, Motherwort, Osha, Parsley Plant, Psyllium, Sage, Skullcap, Squill or Yohimbe - may be additive with the some of these analgesics Morphine ,Sufentanil , etc. (Blumenthal 1998)(Newall 1996)

Silymarin (milk thistle) may protect the liver from damage caused by acetaminophen-containing products. (Brinker 1998)

References

Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.

Brinker, F Herb Contraindications and Drug Interactions, Eclectic Medical Publications, 1998.

Campos R, Garrido A, Guerra R, Valenzuela A. Silybin dihemisuccinate protects against glutathione depletion and lipid peroxidation induced by acetaminophen on rat liver. Planta Med 1989;55:417-19.

Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 1999.

Griffith, H. W. 1983. Complete Guide to Prescription and Non-Prescription. Fisher Publishing, Inc., Tucson.

Levine DF: Hypocalcemia increases the narcotic effect of codeine. Postgrad Med J 1980; 56:736-737.

Linnoila M & Hakkinen S: Effects of diazepam and codeine, alone and in combination with alcohol, on simulated driving. Clin Pharmacol Ther 1974; 15:368.

Matzke GR, Chan GLC & Abraham PA: Codeine dosage in renal failure. Clin Pharm 1986; 5:15-16.

Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996.

Parke TJ, Nandi PR, Bird KJ et al: Profound hypotension following intravenous codeine phosphate. Anaesthesia 1992; 47:852-854.

Product Information: Codeine. Wyeth Laboratories Inc, Philadelphia, PA, 1993.

Pronsky, Zaneta. Food Medication Interactions. 11th edition. 1999.

Threlkeld DS, ed. Central Nervous System Drugs, Acetaminophen. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1997.