5th January 2024

Common Opioid Adverse Effects

Drowsiness

Drowsiness is a common but transient adverse effect when starting or increasing a dose of opioid medications. It usually settles after 2-3 days, and if it doesn’t, reducing the dose may be indicated.

Nausea and Vomiting

This is also a transient issue that usually passes after the first week. Ongoing symptoms can be managed with an antiemetic.

Constipation

Constipation is an ongoing and common adverse effect of opioids. NICE suggests co-prescribing a stimulant and softener laxative to help manage this effect. In cases resistant to usual constipation management, naloxegol may be indicated. Naloxegol is a peripherally-acting opioid receptor antagonist that can manage constipation without altering opioid pain management.

Dry Mouth

Many common medications have anticholinergic activity that can also lead to dry mouth. It is worth considering de-prescribing medications appropriately to help alleviate this issue. Non-pharmacological management in the form of ice lollies, boiled sweets and small sips of fluid can all help manage dry mouth.