How to Reverse Opioid Side Effects

Three Methods:Treating ConstipationTreating NauseaTreating Other Side Effects

Opioid medications are known to have a number of side effects. The most common are constipation, nausea, drowsiness, and itchiness. Fortunately, there are multiple medical strategies to reverse and treat opioid side effects.

Method 1
Treating Constipation

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    Be aware of the risk of constipationf.[1] Constipation is the number one most prevalent side effect of opioid medications, affecting 80% of people who are prescribed opioid drugs. It is for this reason that medical treatment is always offered for constipation upfront at the same time as the opioid prescription is initiated. It is also easier to treat potential constipation prophylactically (preventatively), as opposed to allowing it to develop into a serious problem which in turn can make it more difficult to resolve.
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    Take daily stool softeners.[2] Everyone offered an opioid medication will also be offered a daily stool softening regimen. An example would be taking Docusate twice daily and Senna once daily in order to maintain your normal bowels.
    • Your doctor will adjust the doses and choices of your stool softening medications depending on how they are working for you.
    • The goal ultimately is to maintain your bowels at the same frequency that you were having them prior to starting the opioid.
    • For example, if your normal is one bowel movement per day, the goal would be to maintain this even after starting the opioid,
    • Your doctor will tailor your stool softening medications to help you achieve this goal.
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    Practice lifestyle strategies to keep your stool loose.[3] In addition to medications, there are also a number of lifestyle strategies you can use to keep your bowels moving as easily as possible while on the opioid medication. These include:
    • Eating plenty of fibre. Fibre helps to bulk up your stool and allows it to pass more easily. The recommended daily amount is 20–35 g/day.
    • Drink plenty of fluids. Staying well-hydrated with at least eight to 10 8-oz glasses of water per day (and more with exercise) is key to helping your bowels stay soft and mobile.
    • Get regular exercise. Staying physically active with at least five exercise sessions of 30 minutes or more per week helps not only with your overall health, but also with passing your stools and keeping your gut healthy.
    • Try moving your bowels after a meal. There is a natural increase in colonic motility after meals, which may help. Colonic activity appears to be highest in the morning, so try going to the bathroom right after breakfast. Having a cup of coffee or other beverage with caffeine at breakfast may help with this.
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    Try other medical treatments if you continue to have problems.[4] If the first line stool softening methods and lifestyle strategies are insufficient to keep your bowels moving at a healthy pace, your doctor may suggest other medical alternatives to help treat your constipation. These may include:
    • Milk of Magnesia
    • The addition of an "osmotic laxative" such as Polyethylene glycol
    • A medication called Methylnaltrexone for severe constipation
    • Enemas and suppositories may be recommended as a last resort

Method 2
Treating Nausea

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    Understand that nausea is the second most bothersome side effect reported with opioid use.[5] It does not occur nearly as frequently as constipation, and hence does not require prophylactic (preventative) treatment; however, people who do get nausea with opioid use (approximately 25%) often find it the most challenging side effect to deal with.
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    Use an antipsychotic medication to combat nausea.[6] Although it may sound strange initially, the mechanism of action of antipsychotic medications actually works not only in psychotic patients, but also as a means to reduce opioid-induced nausea. Your doctor may suggest that you try haloperidol (an antipsychotic drug) as a treatment for opioid-induced nausea. Other options to try include prochlorperazine or promethazine.
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    Treat nausea related to the inner ear differently.[7] Some people on opioid medications get nausea that is directly associated to positional changes, or to certain motions that may throw off their equilibrium and balance. This type of nausea is specifically related to the inner ear (as opposed to other people who have constant nausea with opioid use that is not related to the inner ear). If you notice that your nausea comes and goes in relation to positional changes, ask your doctor to try an anticholinergic medication such as scopolamine. This has been shown to be most helpful in treating nausea related to the inner ear.
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    Use metoclopramide if your nausea is related to constipation.[8] The last subtype of opioid-induced nausea is nausea that comes and goes in relationship to your degree of constipation. If constipation is the triggering issue for your nausea, metoclopramide is the best choice of treatment as it specifically targets nausea related to the gut.
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    Opt for dexamethasone as a last resort.[9] Dexamethasone is a corticosteroid that has been shown to be effective in treating nausea; however, the mechanism of action (the way in which it works) is no completely understood, so it is generally not used as a first line treatment. Speak to your doctor about trying this as an option if other medical treatment has not been effective in alleviating your nausea.

Method 3
Treating Other Side Effects

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    Be aware of other potential side effects of opioid medications.[10] Opioids can lead to a variety of different side effects. Although constipation and nausea tend to be the two greatest concerns, other side effects to be aware of include:
    • Drowsiness and reduced focus and mental alertness
    • Respiratory depression (a decreased drive to breathe due to the effect that opioids can have on the brain; this can be lead to death if the patient overdoses on his opioid medication)
    • Itchiness
    • Decreased libido and difficulty with orgasm
    • The possibility of becoming addicted to the medication
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    Use an antihistamine to treat itchiness.[11] About 10% of people taking opioids suffer from itchiness as a side effect. Trying an antihistamine medication such as Benadryl can help to alleviate the itch, but it can have a sedating effect. You may also want to try cetirizine, which is usually used in for chronic itchiness and has less sedating effects. Speak to your doctor about this if itchiness is a problem for you.
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    Try dose reduction.[12] If side effects such as drowsiness are bothering you, reducing the dose of opioid medication you are taking may be your best bet. Doctors tend not to use stimulant medications to combat opioid-induced drowsiness, except in palliative (end of life) situations. The general approach is to see if the drowsiness subsides as your body gets used to the opioid medication and, if not, to reduce the dose.
    • Note that this is another reason that your doctor will start you on a low dose of opioid medication, and gradually increase the dose as needed. This gives your body time to slowly adapt to the medication, as many of the opioid side effects decrease with time as your body gets used to it.
    • Doctors also start with a low dose of opioid in order to prevent respiratory depression. They will monitor you at a low dose and ensure that your breathing is not negatively affected before increasing the dose, in order to ensure that you are not at risk of respiratory complications.
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    Opt for a different opioid medication.[13] Another way to combat the side effects of opioids is to rotate through different drugs. There are many different opioid medications available, so switching to another one (and rotating which one you take) can help to decrease the side effects you are suffering from. Your doctor can also vary the route of administration of the medication, such as switching it from an oral pill to a transdermal skin patch; varying the route of administration can also help to diminish side effects.
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    Speak to your physician if you are suffering from sexual side effects.[14] Because opioid medications may lead to decreased libido and difficulty with orgasm, it is important to seek help from your physician if you are finding that your sex life is negatively affected. Dose reduction or switching opioids may be enough to reduce the problem; if not, your doctor or a sex therapist may be able to help you in other ways to reclaim your sex life.
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    Know that there is the possibility of addiction.[15] Addiction to opioid medication is rare in people who have not suffered from other addictions in their lives; however, for those who have a history of street drug abuse or other addictions, the possibility is there. The greatest risk factors for developing a dependency on opioid drugs is having a personal history of addiction or a family history of addictive behaviors.
    • Speak to your doctor about the possibility of addiction or drug dependency if this is a concern for you.
    • Know that everyone develops "tolerance" to opioid medications, meaning that the effectiveness of the drug gradually reduces with time as your body gets used to it.
    • However, developing tolerance with time is not the same as developing an addiction.
    • Addiction is when your ability to regulate your own behavior with regards to obtaining higher doses of the drug gets out of control.
    • Do not use opioids chronically. Use pain pills only for short periods to control pain or relieve discomfort and use them as directed by your doctor.
    • If you do become addicted to opioid pills, reach out to a loved one, friend, or doctor. This intervention may get you the help that you need to recover from using these powerful drugs.

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Categories: Taking Pills and Medicine