Side Effects of naratriptan: A Synthesis of Findings from 12 Studies

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Original Abstract of the Article

Major Research Findings

Opioids are effective medications for managing cancer-related pain and chronic non-cancer pain, but they can cause side effects such as constipation, pruritus, nausea and vomiting, myoclonus, sedation, respiratory depression, and delirium. These side effects can limit opioid dosage and reduce quality of life. 8 reviewed several studies to assess the management of opioid side effects but found that the lack of well-designed, randomized controlled trials and the heterogeneity of populations and study designs made it difficult to draw firm conclusions. The type, strength, and consistency of evidence for available interventions to manage opioid side effects vary widely.

Opioid antagonists like naloxone and nalbuphine have been used to reduce opioid-related side effects. 6 showed that naloxone infusion decreased the incidence of morphine-related side effects from intravenous patient-controlled analgesia (PCA). 3 compared intravenous infusions of nalbuphine or naloxone in the prevention of epidural morphine-related side effects and found that nalbuphine was effective. 11 showed that a small-dose naloxone infusion alleviates nausea and sedation without impacting analgesia via intravenous tramadol.

In addition to opioid antagonists, antiemetics such as droperidol have also been used to reduce opioid-related side effects. 2 showed that adding droperidol to morphine for PCA reduces the incidence of nausea and vomiting but may result in unwanted side effects. 1 investigated the use of butorphanol with epidural morphine to see if it would reduce the frequency of side effects caused by neuraxial opioids in pediatric patients.

Researchers have also explored the use of low-dose opioid antagonists, such as oral naltrexone, in combination with opioids. 12 aimed to assess the influence of ultra-low doses of opioid antagonists on the analgesic properties of opioids and their side effects. 4 determined the dose-response relation for nalmefene, a pure opioid antagonist with a longer duration of action, in the prevention of morphine-related side effects in patients receiving intravenous PCA.

Reasons for Side Effects

Opioid side effects occur because opioids bind to opioid receptors in the brain and spinal cord. Opioid receptors are involved in various physiological processes, and binding to them can lead to side effects such as pain relief, nausea, vomiting, and constipation.

Common Side Effects

Constipation

Opioids can slow down the movement of the muscles in the digestive tract, which can lead to constipation. 8 reported that naloxone may help relieve constipation.

Pruritus

Opioids can cause pruritus by releasing histamine. 9 found that epidural naloxone reduced pruritus induced by epidural morphine. 5 showed that epidural naloxone reduced pruritus and nausea without affecting analgesia by epidural morphine.

Nausea and Vomiting

Opioids can cause nausea and vomiting by stimulating the vomiting center in the brain. 8 reported that nausea and vomiting from opioids can be managed by changing the route of administration or using antiemetics.

Myoclonus

Opioids can cause myoclonus, which is a sudden, brief, involuntary muscle contraction. 10 examined the structure and predictive validity of somatic and cognitive/affective side-effect profiles of morphine and pentazocine.

Sedation

Opioids can cause sedation by depressing brain activity. 8 reported that changing the route of opioid administration may help manage sedation. 11 showed that naloxone alleviates sedation caused by intravenous tramadol.

Respiratory Depression

Opioids can cause respiratory depression by suppressing the respiratory center. 8 reported that naloxone is effective in reversing respiratory depression.

Delirium

Opioids can cause delirium. 8 noted that evidence for interventions to manage delirium is limited.

Side Effect Management

Constipation

To prevent constipation, it is important to drink plenty of fluids, eat a high-fiber diet, and exercise. If constipation does not improve, consult your doctor. You may need medication, such as a laxative. 8 reported that naloxone may help relieve constipation.

Pruritus

If pruritus is severe, consult your doctor. Antihistamines or pain relievers may be prescribed. 5 showed that epidural naloxone reduced pruritus caused by epidural morphine.

Nausea and Vomiting

If nausea and vomiting are severe, consult your doctor. Antiemetics may be prescribed. 3 found that nalbuphine was effective in preventing epidural morphine-related nausea and vomiting. 11 showed that naloxone alleviates nausea caused by tramadol. 2 showed that adding droperidol to morphine for PCA reduced the incidence of nausea and vomiting.

Myoclonus

If you are concerned about myoclonus, consult your doctor. Muscle relaxants may be prescribed.

Sedation

If sedation is severe, your opioid dosage may need to be adjusted. 11 showed that naloxone alleviates sedation caused by tramadol.

Respiratory Depression

If respiratory depression is suspected, contact your doctor immediately. Respiratory depression can be life-threatening. 8 reported that naloxone is effective in reversing respiratory depression.

Delirium

If delirium occurs, contact your doctor immediately. Delirium can be a sign of other problems.

Comparison of Studies

Commonalities

These studies found that opioid antagonists such as naloxone are effective in reducing opioid-related side effects. They explore various interventions to reduce side effects.

Differences

These studies differ in the type of opioid, route of administration, and type of side effect being investigated. Therefore, it is difficult to directly compare the results. The sample sizes and study designs also vary across studies.

Implications for Everyday Life

Opioids are effective medications for managing pain, but it is important to understand the risks of side effects. When using opioids, follow your doctor's instructions and contact your doctor immediately if you experience side effects. There are ways to manage opioid side effects. Your doctor can adjust your opioid dosage or use other medications to reduce side effects.

Limitations of Current Research

There are limited high-quality randomized controlled trials investigating interventions for managing opioid side effects. Therefore, there is insufficient evidence to evaluate the effectiveness of specific interventions. The sample sizes and study designs also vary, making it difficult to directly compare the results.

Directions for Future Research

Further high-quality randomized controlled trials are needed to develop safe and effective interventions for effectively managing opioid-related side effects. Additional research is needed on different types of opioids, routes of administration, and types of side effects.

Conclusion

Opioids are effective medications for pain management, but it is important to be aware of the risks of side effects. If you experience side effects, contact your doctor immediately. There are ways to manage opioid side effects. Your doctor can adjust your opioid dosage or use other medications to reduce side effects. Further research is needed to better understand and manage opioid side effects.

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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