Constipation All opioids do this. Will be Encourage fibre intake (fruit, made worse by lack of cereals, vegetables), fluids, dietary fibre, fluid intake or and regular exercise. exercise. Stimulant laxatives if necessary. Weight gain, Fluid retention caused by Lower dose particularly for opioids more likely on – high doses Eating more while in Reduce fat and salt in diet, “ “ treatment; high salt exercise regimen intake Poor sleep Dose too low and Review maintenance dose causing withdrawal at and review other night medications Dose too late at night, Follow sleep hygiene “ “ causing stimulation at recommendations time of peak effects Other drugs (particularly stimulants in the evening, such as coffee, nicotine, amphetamines) General anxiety or irregular sleep pattern Depressive illness Central sleep apnoea Assess and consider referral “ “ Amenorrhoea or All opioids can do this Periods may return after oligomenorrhoea May be related to cessation of heroin use, lifestyle, stressors, poor or following withdrawal diet, and general poor from opioids. health Address other causes Lowered sex drive More common with a Review dose high dose through effect Consider investigation on sex hormones for opioid-induced Can be many other hypogonadism psychological factors (such as anxiety, poor relationship with partner, etc.) Dental problems All opioids reduce saliva Encourage oral hygiene, flow dental floss and use of sugar Poor diet, dental hygiene free gum. Dental check-up. Reduce intake of sugary drinks and sweet food.
Constipation All opioids do this. Will be made worse by lack of dietary fibre, fluid intake or exercise. Encourage fibre intake (fruit, cereals, vegetables), fluids, and regular exercise. Stimulant laxatives if necessary. Weight gain, particularly for Fluid retention caused by opioids – more likely on high doses Lower dose “ “ Eating more while in treatment; high salt intake Reduce fat and salt in diet, exercise regimen Poor sleep Dose too low and causing withdrawal at night Review maintenance dose and review other medications “ “ Dose too late at night, causing stimulation at time of peak effects Other drugs (particularly stimulants in the evening, such as coffee, nicotine, amphetamines) General anxiety or irregular sleep pattern Depressive illness Follow sleep hygiene recommendations “ “ Central sleep apnoea Assess and consider referral Amenorrhoea or oligomenorrhoea All opioids can do this May be related to lifestyle, stressors, poor diet, and general poor health Periods may return after cessation of heroin use, or following withdrawal from opioids. Address other causes Lowered sex drive More common with a high dose through effect on sex hormones Can be many other psychological factors (such as anxiety, poor relationship with partner, etc.) Review dose Consider investigation for opioid-induced hypogonadism Dental problems All opioids reduce saliva flow Poor diet, dental hygiene Encourage oral hygiene, dental floss and use of sugar free gum. Dental check-up. Reduce intake of sugary drinks and sweet food.
endorsed%20MATOD%20guidelines%20accessible%20Apr2014%20(D14-1005149).DOCX