must be anticipated and prevented in all patients on weak or strong opioids. Regular stimulant laxatives must be commenced at the same time as weak or strong opioids. The dose of laxative should increase as the dose of opioid increases
constipation may be less severe in some patients with transdermal fentanyl.
may occur with the first few doses, but then lessens
is a common problem during the first few days of treatment. If it occurs, haloperidol, domperidone, cyclizine or metoclopramide are useful
dry mouth, itching, sweating, hallucinations and myoclonic jerks
does not occur in patients taking opioids for their analgesic effects
may occasionally occur, but an increase in dose requirement usually reflects an increase in pain due to advancing disease. Some patients may exhibit tolerance or intolerance (excessive side effects), to a particular strong opioid and switching to another strong opioid might be helpful. Seek specialist advice
is not a risk when doses are increased by appropriate amounts
if pain is relieved by alternative methods e.g. radiotherapy or nerve block, a reduction in opioid dose will be required
West Midlands Palliative Care Physicians (2007). Palliative care - guidelines for the use of drugs in symptom control.