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NERVOUS SYSTEM › ANALGESICS › OPIOIDS › Natural opium alkaloids
papaveretum
N02AA10
Forms & Strengths
- Injection solution: 1.55 mg to 20 mg per ampoule (mixtures of opium alkaloids equivalent to morphine)
- Oral solution/syrup: Variable concentrations containing anhydrous morphine, codeine, and papaverine hydrochlorides
Adult Dosing
- Subcutaneous or intramuscular injection: 10 mg to 20 mg every 4 hours as needed for severe pain
- Intravenous injection: 5 mg to 10 mg very slowly under close monitoring
Pediatric Dosing
- Not generally recommended for routine use in neonates and young children due to variable alkaloid pharmacokinetics
- If used off-label: 0.1 mg/kg to 0.2 mg/kg subcutaneously or intramuscularly under specialist supervision
Indications
- Management of moderate to severe acute pain
- Pre-operative sedation and adjunctive analgesia in anesthesia
- Palliative care for severe chronic pain
Mechanism of Action
- Acts primarily as an agonist at mu-opioid receptors in the central nervous system, inhibiting ascending pain pathways
- Contains purified alkaloids of opium (primarily morphine, with papaverine, codeine, and noscapine), providing combined analgesic, sedative, and mild smooth muscle relaxant properties
Contraindications
- Hypersensitivity to opium alkaloids or any component of the formulation
- Acute respiratory depression or severe chronic obstructive pulmonary disease
- Acute alcoholism and delirium tremens
- Risk of paralytic ileus
- Concurrent use with monoamine oxidase inhibitors (MAOIs) or within 14 days of cessation
Adverse Reactions
- Respiratory depression
- Sedation, dizziness, and drowsiness
- Constipation, nausea, and vomiting
- Urinary retention
- Hypotension and bradycardia
- Pruritus, flushing, and allergic reactions
- Physical dependence and risk of substance use disorder with prolonged use
Drug Interactions
- Central nervous system depressants (alcohol, benzodiazepines, general anesthetics): severe sedation, respiratory depression, and profound hypotension
- Monoamine oxidase inhibitors (MAOIs): risk of severe excitation, hyperpyrexia, or hypertensive/hypotensive crisis
- Potent CYP3A4 inhibitors/inducers may alter the metabolism of constituent alkaloids
- Mixed agonist-antagonist opioids (e.g., buprenorphine, pentazocine): may precipitate withdrawal symptoms or reduce analgesic efficacy
Curated Content: Needs Vetting Before Put to Clinical Use