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Palliative cancer care - pain - Management
How should I manage the common adverse effects of opioids?
- Exclude any underlying illness or other drugs (such as antipsychotics) that may mimic opioid-induced adverse effects (such as dehydration).
- Drowsiness is common at the start of treatment or after dose increases. Warn people to avoid activities (such as driving) in which drowsiness may be detrimental. Most people develop tolerance to drowsiness within a few days. Persistent sedation can usually be resolved by dose reduction.
- Nausea and vomiting subside after the first few days in many people but can be an ongoing problem for others. An anti-emetic (for example, metoclopramide if the problem is gastric stasis, otherwise low-dose haloperidol) should be prescribed [Twycross and Wilcock, 2007]:
- Constipation — tolerance does not develop, but constipation can usually be treated [Twycross and Wilcock, 2007]. To prevent constipation, prescribe a stimulant laxative (such as senna or bisacodyl) and a softening laxative (such as docusate):
- A laxative with both properties (for example, co-danthramer or co-danthrusate) is also an option. Some people taking dantron-containing laxatives may experience a chemical burn (reddening) of the perianal area; these agents are therefore unsuitable for incontinent people. Dantron can also colour the urine red and alarm the person.
- For more information, see the CKS topic on Palliative cancer care - constipation.
- Dry mouth can be troublesome. Consider reducing the dose of, or stopping, any drugs that also cause dry mouth. People should be encouraged to use simple measures first [Fallon and O'Neill, 1997; Doyle et al, 2004; Regnard and Hockley, 2004b; WeMeReC, 2006]:
- Cold, unsweetened drinks.
- Frequent sips or sprays of cold water.
- Ice cubes, crushed ice, or ice lollies.
- Lubricant on the lips.
- Sugar-free products — chewing gum, mints, boiled sweets, or pastilles.
- For more information, and what to do if simple measures are not adequate, see the CKS topic on Palliative cancer care - oral.
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