Side Effects of moxifloxacin injection: A Synthesis of Findings from 12 Studies

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Original Abstract of the Article

Main Research Findings

Opioid side effects can limit opioid dosage and reduce quality of life. 8 This systematic review assessed the management of opioid side effects in the context of cancer pain management or, in the event that no evidence was available for cancer pain, for chronic noncancer pain. 8 The side effects studied were constipation, pruritus, nausea and vomiting, myoclonus, sedation, respiratory depression, and delirium. 8 Opioid rotation to manage side effects was also studied. 8 For each side effect, MEDLINE and the Cochrane Controlled Trials Register were searched and 657 possible titles were identified for inclusion. 8 Of these, 67 studies met inclusion criteria for analysis. 8 The lack of well-designed, randomized controlled trials and the heterogeneity of populations and study designs made the drawing of firm conclusions difficult and precluded performance of meta-analysis. 8 The type, strength, and consistency of evidence for available interventions to manage opioid side effects vary from strong (eg, on the use of naloxone to reverse respiratory depression or constipation) to weak (eg, changing from the oral to epidural route of morphine administration to manage sedation). 8 Well-designed trials in the specified populations are required to furnish clinicians with secure evidence on managing opioid side effects successfully. 8

Reasons for Side Effects

Opioids are drugs used to relieve pain, but they can also cause side effects. 10 Opioid side effects vary depending on the type and dose of opioid, and the patient's condition. 10 Opioids work by binding to opioid receptors in the brain and spinal cord, blocking the transmission of pain signals to the brain. 10 However, opioids can also bind to other receptors, which can lead to side effects. 10

Common Side Effects

Constipation

Opioids can slow down bowel movements and cause constipation. 8 Constipation is one of the most common side effects of opioids. 8 Opioid antagonists, such as naloxone, can be effective in reversing constipation. 8

Pruritus

Opioids can act on histamine receptors in the skin and cause itching. 8 Pruritus is a common side effect of opioids. 8 Opioid antagonists, such as naloxone, can be effective in reducing itching. 8 Epidural naloxone reduced pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine. 5 Epidural naloxone is effective in treating pruritus induced by epidural morphine. 9

Nausea and Vomiting

Opioids can affect nerves in the digestive system and cause nausea and vomiting. 8 Nausea and vomiting are common side effects of opioids. 8 Opioid antagonists, such as naloxone, can be effective in reducing nausea and vomiting. 8 Epidural naloxone reduced pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine. 5 The addition of droperidol to morphine for patient-controlled analgesia reduces the incidence of nausea and vomiting, but may result in unwanted side effects. 2 Intravenous infusion of nalbuphine or naloxone is effective in preventing epidural morphine-related side effects. 3 Combining naloxone with morphine via patient-controlled analgesia decreased the incidence of side effects compared to morphine alone. 6 A small-dose naloxone infusion alleviates nausea and sedation without impacting analgesia via intravenous tramadol. 11

Myoclonus

Opioids can affect the central nervous system and cause myoclonus. 8 Myoclonus is a relatively rare side effect of opioids. 8

Sedation

Opioids can affect the central nervous system and cause sedation. 8 Sedation is a common side effect of opioids. 8 Changing from the oral to epidural route of morphine administration can be effective in managing sedation. 8 A small-dose naloxone infusion alleviates nausea and sedation without impacting analgesia via intravenous tramadol. 11

Respiratory Depression

Opioids can affect the respiratory center and cause respiratory depression. 8 Respiratory depression is a serious side effect of opioids. 8 Opioid antagonists, such as naloxone, can be effective in reversing respiratory depression. 8

Delirium

Opioids can affect the brain and cause delirium. 8 Delirium is a relatively rare side effect of opioids. 8

Side Effects Management

Constipation

Dietary and exercise modifications can be effective in preventing constipation. 8 Medications such as laxatives and enemas are used to treat constipation. 8 Opioid antagonists, such as naloxone, can be effective in reversing constipation. 8

Pruritus

Medications such as antihistamines and steroids are used to treat itching. 8 Opioid antagonists, such as naloxone, can be effective in reducing itching. 8 Epidural naloxone reduced pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine. 5 Epidural naloxone is effective in treating pruritus induced by epidural morphine. 9

Nausea and Vomiting

Medications such as antiemetics are used to treat nausea and vomiting. 8 Opioid antagonists, such as naloxone, can be effective in reducing nausea and vomiting. 8 Epidural naloxone reduced pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine. 5 The addition of droperidol to morphine for patient-controlled analgesia reduces the incidence of nausea and vomiting, but may result in unwanted side effects. 2 Intravenous infusion of nalbuphine or naloxone is effective in preventing epidural morphine-related side effects. 3 Combining naloxone with morphine via patient-controlled analgesia decreased the incidence of side effects compared to morphine alone. 6 A small-dose naloxone infusion alleviates nausea and sedation without impacting analgesia via intravenous tramadol. 11

Myoclonus

Medications such as anticonvulsants are used to treat myoclonus. 8

Sedation

Medications such as stimulants are used to treat sedation. 8 Changing from the oral to epidural route of morphine administration can be effective in managing sedation. 8 A small-dose naloxone infusion alleviates nausea and sedation without impacting analgesia via intravenous tramadol. 11

Respiratory Depression

Opioid antagonists, such as naloxone, are used to treat respiratory depression. 8

Delirium

Medications such as antipsychotics are used to treat delirium. 8

Comparison of Studies

Commonalities

Multiple studies have reported constipation, pruritus, nausea and vomiting, sedation, and respiratory depression as side effects of opioids. 8 It has also been shown that opioid antagonists, such as naloxone, are effective in reducing these side effects. 8

Differences

Studies have shown that the frequency and severity of side effects vary depending on the type and dose of opioid, and the patient's condition. 8 Study design and population heterogeneity may also have influenced the interpretation of results. 8

Real-Life Applications: Points to Consider

Opioids are effective drugs used to relieve pain, but it is important to be aware of the risk of side effects. 8 When using opioids, it is important to follow your doctor's instructions and monitor for side effects. 8 If side effects occur, talk to your doctor. 8

Current Research Limitations

Research on the management of opioid side effects has several limitations, including the lack of well-designed, randomized controlled trials and the heterogeneity of populations and study designs. 8

Future Research Directions

Well-designed trials in the specified populations are required to furnish clinicians with secure evidence on managing opioid side effects successfully. 8 In particular, research is needed to evaluate the effectiveness of opioid rotation in managing side effects. 8

Conclusion

Opioids are effective drugs used to relieve pain, but it is important to be aware of the risk of side effects. 8 When using opioids, it is important to follow your doctor's instructions and monitor for side effects. 8 If side effects occur, talk to your doctor. 8

Literature analysis of 12 papers
Positive Content
10
Neutral Content
0
Negative Content
2
Article Type
11
1
1
1
12
1.

Epidural morphine with butorphanol in pediatric patients.

Author: LawhornC D, BrownR E

Side effect reduction

Butorphanol 40 micrograms/kg added to epidural morphine 80 micrograms/kg was found to be effective in decreasing the occurrence of side effects caused by neuraxial opioids in pediatric patients. The study involved 20 children between the ages of 2 and 17 years undergoing spinal, abdominal, or thoracic procedures.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

2.

Patient-controlled analgesia with morphine and droperidol following caesarean section under spinal anaesthesia.

Author: RussellD, DuncanL A, FrameW T, HigginsS P, AsburyA J, MillarK

Reduced nausea
Reduced vomiting
Drowsiness

Droperidol, when added to morphine for patient-controlled analgesia (PCA) after caesarean section under spinal anesthesia, reduced the incidence of nausea and emesis. However, it also caused drowsiness in two patients, which limited the usefulness of the technique.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

3.

Comparison of intravenous nalbuphine infusion versus naloxone in the prevention of epidural morphine-related side effects.

Author: WangJ J, HoS T, TzengJ I

Postoperative pain management
Nausea and vomiting
Pruritus

This study compared the efficacy of nalbuphine and naloxone intravenous infusions in preventing epidural morphine-related side effects, such as nausea, vomiting, and pruritus.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

4.

Effects of prophylactic nalmefene on the incidence of morphine-related side effects in patients receiving intravenous patient-controlled analgesia.

Author: JoshiG P, DuffyL, ChehadeJ, WesevichJ, GajrajN, JohnsonE R

Reduces opioid-related side effects

This study was designed to determine the dose-response relation for nalmefene for the prevention of morphine-related side effects in patients receiving intravenous patient-controlled analgesia.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

5.

Epidural naloxone reduces pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine.

Author: ChoiJ H, LeeJ, BishopM J

Preserved analgesia
Reduced side effects
None reported

Epidural naloxone reduced morphine-induced side effects in a dose-dependent fashion without reversal of the analgesic effect.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

6.

Effect of combining naloxone and morphine for intravenous patient-controlled analgesia.

Author: SartainJames B, BarryJohn J, RichardsonChristopher A, BranaganHelen C

Reduced morphine side effects

This study investigated the effects of combining morphine and naloxone via patient-controlled analgesia (PCA) on morphine-related side effects. The combination of morphine and naloxone via PCA was found to decrease the incidence of side effects compared to morphine alone.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

7.

[Patient-controlled analgesia with lornoxicam in patients undergoing gynecological surgery].

Author: GongZ Y, YeT H, QinX T, YuG X, GuoX Y, LuoA L

Effective pain relief
Fewer adverse events

Lornoxicam provides an alternative to morphine or tramadol for the treatment of postoperative pain, with fewer adverse events.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : Chinese

8.

Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review.

Author: McNicolEwan, Horowicz-MehlerNathalie, FiskRuth A, BennettKyle, Gialeli-GoudasMaria, ChewPriscilla W, LauJoseph, CarrDaniel,

Constipation
Delirium
Myoclonus
Nausea
Pruritus
Respiratory depression
Sedation
Vomiting

This systematic review assessed the management of opioid side effects in cancer pain management and chronic noncancer pain. Well-designed trials are needed to provide evidence-based guidelines for managing opioid side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

9.

Effects of epidural naloxone on pruritus induced by epidural morphine: a randomized controlled trial.

Author: JeonY, HwangJ, KangJ, HanS, RheeK, OhY

Reduced pruritus severity

Continuous epidural infusion of naloxone combined with morphine is effective in reducing the incidence and severity of pruritus induced by epidural morphine.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

10.

Cognitive-affective and somatic side effects of morphine and pentazocine: side-effect profiles in healthy adults.

Author: RileyJoseph L, HastieBarbara A, GloverToni L, FillingimRoger B, StaudRoland, CampbellClaudia M

Cognitive side effects
Somatic side effects

This study examined the subjective effects of morphine and pentazocine on somatic and cognitive/affective side effects using questionnaires.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

11.

A small-dose naloxone infusion alleviates nausea and sedation without impacting analgesia via intravenous tramadol.

Author: JiaDong-Lin, NiCheng, XuTing, ZhangLi-Ping, GuoXiang-Yang

Reduced nausea
Reduced sedation
Reduced vomiting

A small dose of naloxone infusion reduced tramadol-induced side effects without reversing its analgesic effects in patients undergoing cervical vertebrae surgery.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

12.

Does adding low doses of oral naltrexone to morphine alter the subsequent opioid requirements and side effects in trauma patients?

Author: FarahmandShervin, AhmadiOmid, DehpourAhmadreza, KhashayarPatricia

Reduced nausea

Ultra-low-dose naltrexone combined with morphine does not alter opioid requirements in patients with extremity trauma but may reduce the risk of nausea.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

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