Tincture Of Opium

(tink-chur, oh-pee-um)

Trade/other name(s): deodorized tincture of opium, DTO, laudanum, deodorized opium tincture

Why would this drug be used?

Tincture of opium is used to control severe diarrhea.

How does this drug work?

Tincture of opium slows or stops the normal movement of the intestine (peristalsis) so that stool moves more slowly. Water is then absorbed from the liquid stool, lessening diarrhea.

Before taking this medicine

Tell your doctor…

• If you are allergic to anything, including medicines, dyes, additives, or foods.
• If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, diabetes, underactive thyroid, adrenal problems (Addison's disease), gallstones or gallbladder problems. These conditions may require that your medicine dose, regimen, or timing be changed.
• If you have brain disease, recent head injury, or if you have ever had seizures. Opium medicines can worsen these problems and cause or raise your risk of seizures.
• If you have gallstones, gallbladder disease, or pancreatitis. Tincture of opium can sometimes worsen these problems.
• If you have had abdominal pain or any disorder involving slowed or blocked intestines, such as paralytic ileus. Tincture of opium can worsen this problem.
• If you use alcohol, opioid pain medicines, muscle relaxers, tranquilizers, sleeping medicines, antihistamines, barbiturates, anti-seizure medicines or other substances that can cause sleepiness. This medicine may add to its effects and cause unconsciousness or even death.
• If you have asthma, emphysema, bronchitis, sleep apnea, or other breathing problems or lung disease. This medicine can worsen breathing.
• If you have trouble passing urine or an enlarged prostate. Tincture of opium can worsen this problem.
• If you have low blood pressure. Tincture of opium can worsen this.
• If you have trouble with addiction, alcohol, or drug abuse now or have had one in the past. Tincture of opium can be habit forming, especially for those who have had problems before.
• If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. There may be an increased risk of harm to the fetus if a woman takes this drug during pregnancy.
• If you are breast-feeding. This medicine may appear in breast milk, and can affect the baby.
• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Medicines or substances that slow down the brain or nervous system, such as these, can cause worse side effects if taken with tincture of opium:

• anti-anxiety drugs (tranquilizers or sedatives)
• sleeping pills
• muscle relaxers
• barbiturates
• anti-seizure medicines
• other opioid drugs
• anesthetics
• antidepressants such as amitriptyline, desipramine, doxepin, imipramine, nortriptyline
• anti-psychotic drugs (drugs for mental illness)
• certain anti-nausea medicines
• alcohol

Some of these can cause slowed breathing, low blood pressure, extreme sleepiness, coma, or even death if taken with tincture of opium.

Diuretics ("water pills") may worsen dizziness and low blood pressure while you are taking tincture of opium.

Buprenorphine (Subutex, Suboxone), butorphanol (Stadol), nalbuphine (Nubain), or pentazocine (Talwin, Talacen) may decrease the effects of tincture of opium or stop its action altogether. This can cause withdrawal symptoms if you have taken the tincture of opium for some time.

Check with your doctor, nurse, or pharmacist about whether other medicines, vitamins, herbs, and supplements can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Tincture of opium is taken by mouth as a liquid. It must be measured using a medicine dropper (even for adults), and mixed in water or juice. Your doctor will tell you how often to take it, (usually 1 to 4 times a day or after each loose bowel movement, but not more than 6 times a day). Do not take more than your doctor tells you.

Take this drug exactly as directed by your doctor. If you do not understand the instructions, ask your doctor or nurse to explain them to you. Store the medicine in a closed container and protect it from light, heat, and moisture. Keep it away from children and pets. Do not share your medicine with others.

Safety note: this drug is not the same as paregoric, which is a different opium tincture also used to treat diarrhea. People have accidentally overdosed and died when they took concentrated tincture of opium instead of paregoric. Unlike paregoric, this drug is never measured with a spoon.

Precautions

Diarrhea can cause dehydration and deplete important minerals in the body. It is very important to drink plenty of liquids while you are being treated for diarrhea. Try to drink 2 to 3 quarts of fluid a day. Check with your doctor if your diarrhea does not stop after two days or if you notice dizziness, lightheadedness, low urine output, dry mouth, unusual thirst, or dry, loose skin.

This medicine can cause drowsiness and lightheadedness. Do not drive, operate machinery, or perform other activities that require alertness until you know how you react to this medicine.

Tincture of opium can make you feel dizzy or faint, and increase your risk of falling. Be careful getting up, changing position, or walking. Get up slowly and hold onto something or someone to keep you steady. If you feel dizzy or lightheaded, it may help to lie down. Have a responsible adult with you until you have adjusted to the medicine.

To help decrease the diarrhea, try to eat small, frequent meals that are warm or at room temperature. Avoid foods that cause gas (such as broccoli or beans), fatty foods (such as bacon or cheeses), citrus fruits and juices. Avoid high-lactose foods (such as milk or ice cream) if they upset your stomach or make diarrhea worse. Eat foods high in sodium and potassium (such as soups, sports drinks, and bananas). Eat foods high in soluble fiber (such as rice or bananas). Avoid foods high in insoluble fiber (such as cereal or nuts). To add calories without worsening diarrhea, mix water with fruit juice.

Call your doctor or nurse if you notice bloating, constipation, stomach pain or cramping, nausea or vomiting, loss of appetite.

If you think you or someone else may have taken an overdose, get emergency help right away. Symptoms of overdose may include seizures, confusion, severe nervousness or restlessness, extreme dizziness, severe weakness, extreme drowsiness, slow heart beat, or slow or irregular breathing.

This is a controlled substance, and may be habit-forming. Do not allow others to take your medicine.

If tincture of opium is used for a long time, physical dependence may develop and the body will go into withdrawal if the drug is stopped suddenly. (This happens normally when an opioid drug is taken over a long while, and is not the same as addiction.) If you have been taking it for several weeks or more, do not stop taking it without checking with your doctor. Find out how to to gradually cut down the amount you are using, to reduce the chance of withdrawal effects. Check with your doctor if you notice fever, shivering or trembling, trouble sleeping, or severe weakness when you stop taking the drug.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

• nausea
• constipation*

Less common

• vomiting*
• itching
• drowsiness*
• dry mouth

Rare

• trouble urinating
• dizziness*
• slowed breathing
• blurred vision
• low blood pressure
• confusion, seizures, extreme sleepiness, severe nervousness (usually with high doses or overdose)*
• withdrawal symptoms when drug is stopped if taken for several weeks or more*
• allergic reaction with fast heartbeat, sweating, shortness of breath, skin rash, or hives (skin welts)

*See "Precautions" section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

This drug appears to pre-date the FDA approval process, which would mean it was not required to get formal FDA approval.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.