What are codeine and percocet used for?


OpioidsDrug groupsPainkillers Opioids are natural drugs obtained from opium or (semi) synthetically produced drugs with analgesic, depressant, calming and psychotropic properties. The effects are based on the binding to endogenous opioid receptors. Opioids are administered in the form of tablets, drops, injections and transdermal patches and are mainly used for pain, coughing and anesthesia. They are potent active ingredients that must be used with caution. An overdose is life-threatening, and possible respiratory paralysis is particularly feared. Common side effects at therapeutic doses are constipation, nausea and fatigue. Opioids can be abused as intoxicants and lead to dependence and addiction.

synonymous: opiates, opium alkaloids, opioid pain relievers, opioid analgesics, opioid receptor agonists

background

Opioids have been used as pain relievers for thousands of years. First in the form of opium, the dried milk juice of the opium poppyPapaver somniferum L. (Papaveraceae). At the beginning of the 19th century, the pure opium alkaloid morphine was isolated for the first time and later administered with the newly invented injection needle.

In the 20th century, numerous derivatives and synthetic opioids were developed and made subject to the Narcotics Act. These include some active ingredients that are no longer derived from natural alkaloids. For example, pethidine, fentanyl and methadone are derived from the tropane alkaloid atropine from nightshade plants.

Opioids are the collective name for all active ingredients, natural ingredients such as morphine and codeine are called opiates. Opioid peptides like the endorphins and enkephalins are the natural ligands of the opioid receptors.

Effects

Opioids (ATC N02A) are primarily pain-relieving and pain-relieving. In contrast to other pain relievers such as the non-steroidal anti-inflammatory drugs, they have neither anti-inflammatory nor antipyretic properties. Opioids are also sedating (dampening), psychotropic (affecting the psyche), calming and cough-relieving, among other things.

The effects are based on the binding to endogenous opioid receptors, which occur in the brain, spinal cord and in the peripheral nervous system, among other things. These include the μ (mu), δ (delta) and κ (kappa) opioid receptors. The active ingredients have different affinities for the various receptors.

Indications

The areas of application for opioids include:

abuse

Opioids have two faces - on the one hand, they are essential and highly effective drugs for pain therapy. On the other hand, due to their psychotropic, euphoric and calming properties, they are abused as intoxicants. Typical examples are heroin, morphine, codeine and oxycodone - but in principle all opioids can be used as drugs. Due to the high potential for dependency and the life-threatening and destructive undesirable effects, abuse is urgently not recommended. Opioids can also be used as doping agents.

Active ingredients
  • Alfentanil (Rapifen®)
  • Benzhydrocodone (Apadaz®)
  • Buprenorphine (e.g. Temgesic®, Transtec®)
  • Carfentanil (veterinary drug)
  • Codeine (many medicines)
  • Dermorphine
  • Desomorphine (intoxicant)
  • Dextromoramide (Palfivet®)
  • Dextropropoxyphene (except for trade)
  • Dihydrocodeine (e.g. Codicontin®, Paracodin®)
  • Ethylmorphine (Phol-Tux®)
  • Fentanyl (e.g. Durogesic®, generics)
  • Heroin (Diaphin®, intoxicant)
  • Hydrocodone (Hydrocodone Streuli®, out of trade)
  • Hydromorphone (e.g. Palladon®)
  • Levomethadon (L-Polamidon®)
  • Levorphanol (not commercially available in Switzerland)
  • Methadone (e.g. Ketalgin®, magistral formulations)
  • Metopon (not on sale)
  • Morphine (e.g. MST Continus®, morphine drops)
  • Nalbuphine (Nalbuphine OrPha®)
  • Nicomorphine (Vilan®, out of trade)
  • Opium (magistral formulas)
  • Opium tincture (Dropizol®)
  • Oripavin (precursor)
  • Oxycodone and Naloxone (Targin®)
  • Oxycodone (Oxycontin®, Oxynorm®)
  • Oxymorphone (Opana®, generics)
  • Pentazocine (Fortalgesic®, out of trade)
  • Pethidine (various manufacturers)
  • Piritramid (Dipidolor®)
  • Remifentanil (Ultiva®, generics)
  • Sufentanil (Sufenta®, generics)
  • Tapentadol (Palexia®)
  • Tilidine (Valoron®)
  • Tramadol (Tramal®, generics)

Opioid antagonists are antagonists at opioid receptors and neutralize the effects of the opioids. They are used, among other things, for poisoning, detoxification, alcohol addiction, constipation and to end the opioid effects.

Contraindications

Numerous precautionary measures must be observed during use. The complete information can be found in the information for healthcare professionals. Contraindications include hypersensitivity, simultaneous therapy with MAO inhibitors, respiratory insufficiency, respiratory depression, intestinal obstruction, delayed gastric emptying, liver disease, increased intracranial pressure, traumatic brain injury and severe obstructive pulmonary disease.

Interactions Undesirable Effects

Opioids are potent drugs and must be administered with caution. An overdose is life-threatening and manifests itself in respiratory paralysis, low blood pressure, low pulse, circulatory failure and coma. The possible respiratory depression is particularly feared. Possible side effects that occur even at therapeutic doses include:

  • Constipation, nausea, vomiting, dry mouth, loss of appetite
  • Central and psychiatric disorders such as dizziness, headache, tiredness, drowsiness, confusion, anxiety, euphoria, dysphoria
  • Small pupils (miosis)
  • Respiratory depression
  • Itching, rash, reddening of the skin, sweating
  • Urinary retention
  • Hyperalgesia: paradoxically increased sensitivity to pain
  • Cardiovascular disorders such as low blood pressure, slow heartbeat
  • Development of tolerance, dependence and addiction, withdrawal syndrome after weaning

The advantage is that opioids do not cause organ damage like other pain relievers.

see also

Pain relievers, pain relievers, opioid antagonists

literature
  • Pharmaceutical product information (CH, USA)
  • Berland D., Rodgers P. Rational use of opioids for management of chronic nonterminal pain. Am Fam Physician, 2012, 86 (3), 252-8 Pubmed
  • De Leon-Casasola O.A. Opioids for chronic pain: new evidence, new strategies, safe prescribing. Am J Med, 2013, 126 (3 Suppl 1), S3-11 Pubmed
  • European Pharmacopoeia PhEur
  • Pharmacology textbooks
  • Manchikanti L., Benyamin R., Datta S., Vallejo R., Smith H. Opioids in chronic noncancer pain. Expert Rev Neurother, 2010, 10 (5), 775-89 Pubmed
  • Manchikanti L., Singh A. Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician, 2008, 11 (2 Suppl), S63-88 Pubmed
  • Marlowe K.F., Geiler R. Pharmacist's role in dispensing opioids for acute and chronic pain. J Pharm Pract, 2012, 25 (5), 497-502 Pubmed
  • Rosenblum A., Marsch L.A., Joseph H., Portenoy R.K. Opioids and the treatment of chronic pain: controversies, current status, and future directions. Exp Clin Psychopharmacol, 2008, 16 (5), 405-16 Pubmed
author

Conflicts of Interest: None / Independent. The author has no relationships with the manufacturers and is not involved in the sale of the products mentioned.


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This article was last changed on 3/18/2021.
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