opium tincture: clinical use

Prescribing considerations

• Confirm and investigate the cause of severe diarrhoea before use; the product is reserved for inadequate response to initial anti-diarrhoea treatment.
• Initiation and supervision should be by an appropriate specialist.
• Assess respiratory, hepatic, renal, neurological and bowel-obstruction risks before prescribing.
• Assess personal and family substance-use history, mental-health risk factors and concurrent psychoactive medicines.
• Use particular caution in older people, especially those with falls or fractures.
• Consider the formulation's substantial ethanol content in alcohol dependence, hepatic disease, epilepsy and pregnancy.

Contraindications and cautions

• Hypersensitivity to opium, morphine or an excipient
• Opiate dependency
• Glaucoma
• Severe hepatic or renal impairment
• Delirium tremens
• Severe head trauma
• Risk of paralytic ileus
• Chronic obstructive pulmonary disease or acute asthma
• Severe respiratory depression with hypoxia or hypercapnia
• Cor pulmonale
• Breastfeeding

Monitoring

• Clinical response and continuing need after investigation of the underlying diarrhoea
• Sedation, respiratory function and concurrent central nervous system depressants
• Constipation, abdominal distension, vomiting and other signs of ileus or toxic megacolon
• Urinary retention, postural hypotension and falls
• Renal and hepatic status where impairment is present
• Tolerance, dependence, opioid-use disorder and early refill requests

Clinical pharmacology

Morphine and other opium alkaloids act at opioid receptors, particularly enteric μ-receptors. They reduce gastrointestinal propulsion and secretion while increasing fluid absorption. Morphine undergoes glucuronidation to metabolites including active morphine-6-glucuronide, with predominantly renal elimination.

Formulation and product differences

• The selected product is a dark reddish-brown oral-drop solution standardised by morphine content.
• It contains ethanol and purified water; this is clinically relevant to interactions and particular risk groups.
• It may be used undiluted or mixed with water immediately before administration.
• The bottle has a child-resistant closure, must not be refrigerated or frozen, and has a four-week in-use shelf life after opening.

Oral drops

Route: Oral

Strengths: 10 mg/mL