Opioid analgesics

1.Introduction:

What are opioids?

Let’s get Creative,Picture your body as having tiny messengers that tell your brain about pain. Opioids trick these messages into thinking the pain is gone. This makes them very good at taking away pain from bad conditions like cancer, surgery and long-term health issues.

2. Alternative terms for opiates

These are also known as narcotic pain medications or drugs. Some opioids like morphine, tramadol and OxyContin , also have high-sounding scientific names like fentanyl, oxycodone and codeine.

3. The dosage:

Dosage varies for General Population.

Patients with kidney disease:

Mild to Moderate Loss: If the bad condition is serious, we might need different pain medicines. We often have to change how much of them are used too.

Severe Disability (Including Dialysis): Because medications break down and get out of the body differently, adjusting opioid doses is usually needed.

Receivers of Transplants:

After transplant: The effects of medicine that weaken the immune system and how well someone’s kidneys work may need changing the amount given for painkillers.

Opioids and Medication Interactions:

Opioids may interact with several medication types, which presents a significant danger because they may:

Exacerbate respiratory depression: Opioids already slow down breathing; some mixes can make this even worse, possibly causing problems with breath. Amplify central nervous system (CNS) depression: This can make you tired, confused and have trouble with balance. It also slows down your breathing in a dangerous way. When people take different medicines together, it can cause bad effects like sickness and vomiting. This may also lead to seizures or something called serotonin syndrome depending on the specific drugs.

4. Talking about how opioids affect kidneys and the right amount of usage .

Morphine:

The kidneys are mainly in charge of getting rid of morphine and its changes. Morphine changes can build up in people with weak kidneys, which could lead to bad results.

Dosage adjustments can be required.

Immediate-Release(Oral):

First Dosage: 10-30 mg every 4 hours, or use as needed to relieve pain.

Extended-Release (Oral):The starting dose is 15-30 mg once a day.

Oxycodone:

The liver processes oxycodone, and the kidneys get rid of its byproducts. Even though kidney problems don’t affect oxycodone directly, you still need to think about the patient’s overall health and any possible drug reactions.

Initial Dosage: Use 5-15 mg as needed every four to six hours.

Starting Dosage: 10 milligrams every twelve hours.

Tramadol:

The kidneys get rid of tramadol and its changes. People with kidney problems might take more time to get rid of tramadol. It might be important to change the amount or use other ways of dealing with pain.

Quick-Release Tramadol used orally:

Initial Dosage : 50-100 mg , every 4 to 6 hours.

Codeine:

Kidney problems can cause a change in how codeine is removed from the body. This might lead to more harmful effects happening. Dosage adjustments might be necessary.

Starting Dosage: Use 15-60 mg as required every 4 to 6 hours.

Fentanyl:

The liver breaks down fentanyl and the kidneys mostly get rid of its leftovers. 

Initial  Dose for Transdermal Fentanyl: considering patient’s past usage ; at first, patches usually taken 12-25 mcg/hour.

Tapentadol:

People with kidney failure might need to change their dose.

Quick-Release Tapentadol taken orally:

Initial Dosage: Use 50-100 mg , every 4 to 6 hours,as suggested.

5. Opioid interactions with other medications:

1. Sleep Aids and Relaxants:

These drugs also slow down the brain and nervous system. They include benzodiazepines (like Valium and Xanax), barbiturates (such as Luminal) along with sleep aids which help people sleep better at night. When used together with opioids, they greatly increase sleepiness and chance of breathing problems. Sometimes it can cause coma too.

2. few specific antidepressants

Special medicines for depression, like Prozac class drugs and some MAOIs can mix with opioids to dangerously increase the feel-good substance serotonin. This could cause a life threatening condition called Serotonin Syndrome.

3. Drugs that Impact Serotonin Levels:

Medicines such as triptans (for headaches) and St. John’s wort( for feeling down ) can work with opioids to make serotonin rise even more. This increases the chance of getting a condition called ‘serotonin syndrome’.

4. Anti-epilepsy Drugs:

Some medicines for seizures, like phenytoin and carbamazepine can quickly break down opioids. This might make them less effective and cause withdrawal symptoms.

5. Antibiotics

Medicines that slow down the breakdown of painkillers like opioids, such as erythromycin and clarithromycin, can make them stronger while also increasing their side effects.

6. Best-known names for pain medicines in India.

1. Methadone:

– Brand Names: Oramorph, Zomorph, MST Continus and Kadian are medicines to treat pain. Morcontin is also used for this purpose.

2. Oxycodone:

– Brand Names: OxyIR, Oxycod, quick-acting Oxycontin and Oxynorm are forms of the medicine oxycodone.

3. Tramadol:

– Brand Names: These include Tramazac, Ultram, Tramacip and Tramjet.

4. Codeine:

– Brand Names: Codistar, Toseina, Codeine Phosphate but only common word 2000 in English. Also important names and medicine like Codomolindon are present here too. A strong drug to help make you feel better when sick or has a code name called “Code Contin.”

5. Fentanyl:

– Trade Names: Fent, Fentanyl Transdermal or Durogesic

6. Tapentadol:

– Trademarks: Zydol, Tapal, Tapenta, Nucynta

7. Side effects specifically on kidneys patients

Urinating may be a problem because of reduced pee production caused by opioids. People who already have kidney issues might find this effect really scary.

Using opiates for a long time can alter the body’s balance of electrolytes, especially if  not consuming enough amounts of  water or liquids. This rather creates certain problems with electrolytes like potassium, sodium and other types of ions. These could then affect how well your kidneys work.

Opioids can alter the blood pressure levels and sometimes make it drop too low causing hypotension. When blood flow to the kidneys is less than normal because of low pressure, it can change about how well the kidneys work.

Often, opioids are used with other medicines. Sometimes these drugs can directly or indirectly harm kidney function. It’s very important to remember any drug interactions that can affect kidney health.

Common Side effects 

Temporary Adverse Reactions:

Vomiting and Nausea

Constipation

Drowsiness and Sedation

Itching and Rash

Long-Term Adverse Reactions:

Tolerance: If you use pain medicines called opioids for a long time, your body might become used to them. Then it would need more of the medicine over time so that it still works just as well on reducing pain.

Physical Dependency: Sudden cessation  might lead to withdrawal signs, while continued use can cause physical dependence.

Opioid Use Disorder (OUD): inappropriate usage of opioid.

Hormonal Imbalances:opioid usage can lead to decreased testosterone levels.

Respiratory Distress:

The slowing of breathing, called respiratory depression, is a very bad side effect of drugs like opioids. People with breathing problems or those who take high doses are more likely to feel this.

Effects on cognition:

Opioids, particularly in older people, can affect thinking skills. This includes memory and :

decision-making.

Enhanced Pain Sensitivity

Using opioids for a long time might actually make people feel more pain; this is called hyperalgesia.

Digestive Disorders:

Using opioids can also cause other stomach problems like bloating and tummy pain, not just making you go to the bathroom less often.

Sleep disturbances:

Opioids can make it hard to sleep, leading to not sleeping well or having restless nights.

8. Advantages

Effective pain management: Pills like morphine and oxycodone help ease really bad pain from cancer, illnesses that last for a long time or after surgeries. They also make life better in these situations.

Targeted action: They act right on pain sensors and copy the body’s own natural chemicals that help with pain.

9. Negative effects

Decreased urine production: This could cause infections and stones because it makes getting rid of waste harder.

Constipation: The kidneys work hard because food is not being digested quickly.

High blood pressure: Some opioids can increase blood pressure, making kidney function worse.

10. Precautions

Dosage is important. People who use dialysis or have kidney problems need less drug doses because drugs stay in their body longer. A wrong dose could be harmful.

Worry about taking opiates for a long time, especially when large amounts are used.

Additional bad effects can include sleepiness, becoming addicted, feeling sick and throwing up.

Doctors might need to change the amount given or do adjustments for people with kidney problems, those getting dialysis treatment and also organ transplant patients. This will depend on how well their kidneys work and their general health state. If a doctor gives you medicine, always listen and tell them how your health is doing or if the drug helps.

People who use medicine for pain must take it as the rules say, tell doctors if they feel bad effects and be watched by healthy people all the time. Because opioids can make you addicted and cause bad things, they should only be taken very little. This is best under the care of a doctor or health expert who has permission to do so. To make it safer to use opioids for a long time, looking at other pain treatment methods and choices that are not-opioid might be needed.

11. Frequently Asked questions