Opioids

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Opioids

Opioids (OH pee awids) is the generic, all-inclusive term that refers to the group of medicines that includes these brand names:

  • hydrocodone (hi dro CO done)
  • oxycodone (oxy CO done)
  • morphine (MOR feen)
  • hydromorphone (hi dro MOR fone)
  • fentanyl (FIN tin il)
  • methadone (METH a done)
  • buprenorphine (bu PRENOR feen)
  • codeine (CO deen)
  • meperidine (me PER i deen)
  • propoxyphene (pro POXY feen)
  • Percocet® (PER co cet)
  • Norco® (NOR co)
  • Vicodin® (VI co din)
  • Dilaudid® (di LAU did)
  • Suboxone® (sub OX own)
  • Subutex® (SUB u tex)
  • Darvocet®(DAR vo set)
  • Demerol® (DIM er ol)

These medicines are used for pain control.            

Warnings

  • If your child is allergic to an ingredient in any medicine prescribed for him or her, the child should not take this medicine.
  • These medicines are opioids. They are controlled substances that the doctor has ordered for your child only. They should be taken only as directed by your child’s doctor or dentist because they can be habit-forming. Do not let anyone else take this medicine.
  • Tolerance (when your body gets used to this medicine) can develop very quickly. Check with your doctor if you feel the medicine is not working as well as it used to.
  • There is potential for abuse of these medicines. Opioid medicines should only be used when needed because they can be addictive. Opioid addiction can happen to anyone and can lead to permanent illness, injury and even death.
  • If a patient thinks she might be pregnant, she should tell the doctor before she begins taking this or any medicine. This medicine may cause problems such as low birth weight, miscarriage and possibly certain birth defects if taken during pregnancy.
  • If a patient is breast-feeding her baby, she should tell her doctor before she begins taking this or any medicine. This medicine can pass into breast milk and cause side effects in the baby.

How to give this medicine – (**NOTE TO PROVIDER: please check text lines that apply to the medicine you are prescribing.**)

  •  Sustained-release capsules and tablets allow the dose of medicine to be spread out through the day. Do not crush, break, or let your child chew them. This can cause the medicine not to work and may cause side effects.
  •  Read the label carefully. Make sure you are giving your child the right dose. It is easy to confuse the many different dosage forms and strengths.
  •  Stay with your child until he or she has swallowed the dose of medicine.
  •  Wash and dry your hands before and after giving the medicine.
  •  Ask your pharmacist, nurse, or doctor before crushing any medicine.
  •   If nausea occurs you may want to give this medicine with food.
  •   Your child should drink lots of liquids with this medicine. Drink at least _______ glass(es) per day.        
  •   It is important to keep a record of when the medicine is given. Use a calendar or Helping Hand HH-V-1, Medication RecordWeaning off opioids

The longer opioid medicines are used, the more a person needs them. This is because as one’s body gets used to these medicines, he or she needs more to control pain and chronic conditions. This occurs even when the medicines are used only as prescribed. If the medicines are stopped all at once, it can cause withdrawal. Signs of opioid withdrawal are

  • hot and cold flashes
  • sweating
  • goosebumps
  • agitation
  • fatigue
  • muscle aches
  • yawning
  • runny nose
  • fast heart rate
  • difficulty sleeping
  • abdominal pain
  • diarrhea
  • nausea
  • vomiting

Opioid withdrawal is not life-threatening; however, it can be very uncomfortable.

If you develop symptoms of opioid withdrawal (see above list), please contact your doctor
to tell you what to do.

If you forget to give a dose (**NOTE TO PROVIDER: select the appropriate directions**)

o  For SCHEDULED, IMMEDIATE RELEASE opioid medications: If you forget to
     give the medicine within 1 hour of the scheduled dose, call your child’s provider to tell
   you what to do. Do not double a dose to make up for a missed dose.

o  For SCHEDULED, SUSTAINED RELEASE opioid medications: If you forget to
     give the medicine within 3 hours of the scheduled dose, call your child’s provider to tell
     you what to do. Do not double a dose to make up for a missed dose.

o  For PRN (as needed) opioid medications: Follow dosing instructions on the label for
     how often to give a dose.

o  Other: ______________________________________________________

 

If a dose is vomited

o If the medicine is thrown up right after you give it, do not repeat the dose. The
     vomiting might be due to the strong taste of the medicine. For the next scheduled
     dose, try giving the medicine in applesauce or jelly. If the vomiting continues, call
     your child's doctor.

   Medicine storage

  • Keep this medicine in a locked cabinet or lock box AND out of the reach of children.
  • Always keep medicine in the original bottle from the pharmacy.
  • Do not use this medicine after the expiration date printed on the container.
  • Light, heat and moisture may cause this medicine not to work as well. Keep the bottle tightly closed.
  • Store it in a place that is cool (or room temperature) dark and dry (not
         in the bathroom or above the kitchen sink).
     

How to dispose of unused medicines – (**Note to provider: please check text lines that apply to the medicine you are prescribing.**)

Visit www.dea.gov or call DEA’s Registration Call Center at 1-800-882-9539 to find
       one of the following:

  • a nearby Drug Take-Back Event or
  • a mail-back authorized collector to get a preaddressed mail-back package and instructions.

Visit www.rxdrugdropbox.org to find out how to find a nearby collection location.

If you are unable to use a method above in a timely manner, flush down the toilet.
         (NOTE to healthcare provider – recommended ONLY for these medicines and their
       brand name equivalents:

  • buprenorphine
  • diazepam
  • fentanyl
  • hydrocodone
  • hydromorphone
  • Meperidine
  • methadone
  • morphine
  • oxycodone
  • oxymorphone
  • methylphenidate
  • naloxone
  • naltrexone
  • sodium oxybate
  • tapentadol

For patches (buprenorphine or fentanyl patches), fold sticky side to itself, then flush.

Flushing is not recommended for all medicines. Please ask your pharmacist or doctor
     for advice regarding how to properly dispose of other medicines in the home.

Drug - nutrient interactions

Do not give this medicine with these foods, products, and/or medicines:

  • Your child should not smoke. Smoking increases the amount of acid in the stomach and will make your child feel worse.
  • Your child should not drink alcohol. Taking this medicine with alcohol can cause drowsiness and inadequate breathing and can be dangerous. Some cold medicines, cough syrups and mouthwashes contain alcohol. Check with your doctor or pharmacist before giving over-the-counter medicines.
  • Check with the doctor or pharmacist before you give your child acetaminophen, aspirin, antacids, or cold medicines.
  • If your child is taking any other medicine or herbal supplements, tell your doctor and pharmacist. Certain medicines should not be taken with opiates.

Possible side effects (from most common to least common)

  • Constipation
  • Nausea
  • Drowsiness
  • Itchiness
  • Vomiting

What to do about side effects

  • If a skin rash occurs, stop the medicine. Call your child's doctor.
  • If your child becomes drowsy or sleepy, do not let him ride a bike or operate machinery (such as a lawnmower or car), or take part in any activities where he must stay alert and awake.
  • Other: ________________

When to call for emergency help

Call for emergency help if:

  • Your child has any of these signs of an allergic reaction: Trouble breathing, swelling of the tongue, swelling of hands, feet, or ankles.
  • Your child becomes very sleepy and it is difficult to wake him or her.
  • Your child’s breathing slows or stops.
  • Other: ________________ 

When to call the doctor

Call your child's doctor if:

  • Your child is having any side effects that continue or are very bothersome.
  • Your child’s pain is not controlled despite using this medicine as directed.
  • Other: ____________________ 

Preventive measures

  • Immediately tell the person giving the medicine if your child feels any burning, stinging, or pain while it is being given.
  • Your child may need to take medicine to help control nausea and vomiting.
  • Other: ______________________ 

 

Miscellaneous

  • Ask your pharmacist for two labeled bottles if your daycare provider will be giving
    this medicine.
  • This medicine cannot be refilled. Your child’s doctor needs to write a new prescription each time you run out of medicine and need more.
  • Very important: ask for a new prescription at least 3 days before the last dose is given.
  • Make sure all refills are the same brand. Do not use the generic form of this medicine without checking with your doctor or pharmacist first. Some pharmacies may not have this medicine. Please ask your nurse to call your pharmacy before you leave the hospital to see if they have this medicine or can order it for you. You may also fill the prescription at the Nationwide Children's Hospital Pharmacy.
  • Ask your nurse for the marked Helping Hand(s):
  • HH-IV-28, Medications: How to Give By Mouth (if your child has trouble taking medicine)
  • HH-IV-169, Important Things to Know When Taking Opioids
  • HH-V-157, Medicine Safety
  • HH-I-4, Allergy to Medicines
  • Other Helping Hand(s)related to preparing, self-administering or using: 

Other advice about the medicine

  • Tell your child's doctor and pharmacist if your child has a strange or allergic reaction
    to any medicine.
  • Bring all your child's medicines with you in the original bottles whenever your child
    sees a doctor, goes to an emergency room, or is admitted to the hospital.
  • Learn the name, spelling, and dose of this medicine. Also, teach your child if he is
    old enough.
  • If your child takes too much of this medicine, or if someone else takes this medicine,
    call the Central Ohio Poison Center at 1-800-222-1222 (TTY 614-228-2272). They
    will tell you what to do.
  • Tell other doctors or dentists treating your child if (name of medicine) ___________
    has been taken in the past 2 months. This medicine can stay in the body for several months after you stop taking it.
  • When your child goes to the dentist, be sure to tell the dentist that your child is taking this medicine and why.
  • Tell your child's teacher, school nurse, coach, babysitter, and others that your child
    is taking this medicine. Tell them what side effects to watch for.
  • Your child's school will need a note from you and from the doctor if the medicine
    is to be given at school by the school nurse.
  • Your child should wear a medical ID bracelet or necklace (sold at many pharmacies).
    In an emergency, the doctor will need to know that your child takes this medicine.
  • Your child’s medicine comes with a Med Guide from the FDA. Make sure the pharmacist gives it to you and that you read it.
  • Other:_____________ 

 If you have any questions, be sure to ask your doctor, nurse, or pharmacist.

HH-V-270 Opioids (PDF) 12/16 Copyright 2016 Nationwide Children’s Hospital

Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000