3.3.4.2 Sedation
Transitory sedation is common when opioid doses are increased substantially,
but tolerance usually develops rapidly. Persistent drug-induced sedation is
usually best treated by reducing the opioid in each dose and increasing the
dosage frequency. This strategy will decrease the peak concentrations in blood
(and brain) while maintaining the same total dose. In some patients, switching
to another opioid may reduce the sedative effects. CNS stimulants such as
caffeine, dextroamphetamine (2.5 to 7.5 mg twice daily, orally), pemoline (18.5
To 37 mg, orally), or methylphenidate (5 to 10 my, orally) (Bruera, Brenneis,
Paterson, et al., 1989) may be added to increase alertness if the above
approach is ineffective in reducing sedation (Forrest, Brown, Brown, et al.,
1977).
These agents also improve the cognitive function of patients on continuous
opioid infusion, most likely by counteracting the sedation. In these patients,
methylphenidate has been demonstrated to improve functioning on a number of
neuropsychological tests, including tests of memory, mental speed, and
concentration (Bruera, Miller, Macmillan, et al., 1992).
Transdermal
Management of Side Effects
Constipation
Nausea and Vomiting
Antidepressants
Hydroxyzine
General comments and cautions regarding the use of opioid analgesics
Drugs and routes of administration not recommended for treatment of cancer pain
Index