One aspect of opiates a lot of people don't know about is their effect on the GI. They slow gut motility, so opiate abusers often experience constipation (and diarrhea upon withdrawal). Opium used to be used medically as an antidiarrheal medication in a tincture with camphor - paregoric. Interestingly, opiates are still available OTC for the treatment of diarrhea.
Loperamide is unique among medically used opiates in that it isn't CNS-active - so you get the gut-slowing effects, without pain relief or addictive potential. It's the only opiate you can get OTC in most markets.
- Log in to post comments
More like this
I take care of my own patients in the hospital. I say that because it is not a given for internists. For a number of reasons, many having to do with time management and money, most internists utilize hospitalists, internal medicine docs who specialize in the care of hospitalized patients.…
Antidepressants are a very useful class of medications. With the introduction of the first modern antidepressant, fluoxetine (Prozac) in the U.S. in the late 1980's, the pharmacologic treatment of depression has undergone a revolution (and an enduring controversy). Older classes of…
This is an archived post from September, 2005, posted here and now because I am away on vacation.
As
I go about my days, I get the impression that there is a lot of
confusion out there about the treatment of opiate abuse and dependence.
Wes Clark (not that Wes Clark, the other
one) has written an…
Most people know of methadone as a long-term substitution therapy for people addicted to heroin, morphine, or other similar drugs called opiates or opioids. A good, free full-text description of methadone maintenance therapy (MMT) can be found in the 15 June 2001 issue of American Family Physician…
So...the use of loperamide in medicine has always made me wonder about the potential for an opioid antagonist that does not cross the BBB to treat constipation. I don't know if this is feasible... I am not sure to what extent the opioid peptides in the bowels control GI motility (and thus constipation) but it would be interesting to know!!
I read an anecdote from a pharmacy intern who expressed concern that her employers were using a bottle of paregoric as a doorstop. The pharmacist on duty said, "Oh, don't worry; nobody knows what paregoric is anymore." The intern said, "Anyone who's read William S. Burroughs knows what paregoric is." Five minutes later, a breeze blew the door closed, and the paregoric was nowhere to be found.
Yah, because Burroughs made opiate use sound sooooo much fun! But seriously....do they still make paregoric? (Literally, tummy opium)
Is that a methadone analogue then? The left side of the molecule certainly bears a superficial resemblance, while the right side is no doubt the functional group that keeps it from being psychoactive...