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Anticipate and Warn Against Side Effects
- The most common side effects of opioids are constipation, nausea and drowsiness/sedation. Other side effects include urinary retention, itch, and rashes. Delirium/confusion myoclonus and hallucinations, as opposed to mild drowsiness alone, are generally a feature of opioid toxicity and these should be managed proactively.
- Warn against side effect of drowsiness – this generally diminishes over a few days.
- Chart a choice of PRN antiemetics e.g. Metoclopramide, Haloperidol, Cyclizine. See First-line Antiemetics Section.
- If there is a past history of nausea and vomiting or if the patient is concerned about these symptoms, antiemetics should be charted regularly – nausea usually subsides after 3-4 days and often the antiemetic can be discontinued.
- Regular laxatives (softener AND stimulant) e.g. Coloxyl and Senna™, must be charted. See Laxatives Section for guidance.
- Patients should be warned not to drive. See LTSA Medical Aspects of Fitness to Drive.
- Narcotic dependence is NOT a concern in acute, severe pain or in those with chronic /persistent cancer pain – patients who improve after anticancer treatment are often able to stop or reduce their Morphine.
Information regarding titration of Morphine follows.
Topic Code: 4049