Opioids are associated with a variety of side effects. The management of opioid side effects should be viewed as a fundamental aspect of opioid therapy. Because opioid responsiveness is determined by the balance between analgesia and side effects, effective management of problematic side effects will increase the likelihood of successful therapy.
JCAHO recommendations
The JCAHO recommends the following to control opioid side effects:1
- Use preventive measures, especially in populations at high risk
- Titrate doses slowly
- If a symptom occurs, verify its cause (i.e., opioid side effect or another problem)
- If opioid-related side effects occur, consider changing the dosing regimen or route of administration to obtain relatively constant blood levels
- Whenever possible, add (or increase dose of) non-opioid adjuvant analgesic for opioid-sparing effect
- Consider switching to another opioid
- Add another drug that counteracts the effect
- Assume constipation will develop, and treat it preemptively
