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belladonna/opium (B & O supprettes)
DEA controlled substance, class II.
Indications:
1) treatment of moderate to severe rectal or bladder tenesmus
a) post-operative states
b) neoplasm
2) pain associated with ureteral spasms
a) not responsive to non-narcotic analgesics
b) space intervals between opiate injections
Contraindications:
1) glaucoma
2) severe renal or hepatic disease
3) bronchial spasm
4) respiratory depression
5) convulsive disorders
6) acute alcoholism
7) premature labor
Dosage:
- 1 suppository QD to QID
Store at 15-30 C, avoid freezing.
#15A: belladonna extract: 15 mg & powdered opium 30 mg (12s)
#16A: belladonna extract: 15 mg & powdered opium 30 mg (12s)
Adverse effects:
1) common (> 10%)
- constipation
- decreased sweating
- dry mouth, nose, throat
- irritation at the site of injection
2) less common (1-10%)
- decreased flow of breast milk, difficulty swallowing, increased sensitivity to light
3) uncommon (< 1%)
- skin rash, confusion, increased intraocular pain, orthostatic hypotension, bloated feeling, difficulty urinating, blurred vision, drowsiness, headache, loss of memory, nausea/vomiting, weakness, fatigue, tachycardia, palpitations, ventricular fibrillation, ataxia, CNS depression, antidiuretic hormone release, biliary or urinary tract spasm, urinary retention, respiratory depression, histamine release, physical & psychologic dependence, sweating
Overdose:
1) ensure adequate respiratory exchange
2) naloxone for reversal of opiate-induced effects
3) physostigmine 1-2 mg IV/SC (0.02 mg/kg for children) to reverse effects of belladonna
Drug interactions:
1) phenothiazines decrease effect
2) increased effect/toxicity with CNS depressant & tricyclic antidepressants (TCA)
General
analgesic combination
References
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Department of Veterans Affairs, VA National Formulary
Components
belladonna alkaloid
opium