belladonna and opium (Rx)

Brand and Other Names:B and O Suppositories
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

suppository: Schedule II

  • 16.2mg/30mg
  • 16.2mg/60mg

Ureteral Spasm Pain

Indicated for severe pain associated with ureteral spasm unresponsive to nonnarcotic analgesics or to space intervals between opiate injections

1 suppository PR qDay or q12hr

Not to exceed 4 doses/day

Dosage Forms & Strengths

suppository: Schedule II

  • 16.2mg/30mg
  • 16.2mg/60mg

Ureteral Spasm Pain

<12 years

  • Not recommended

>12 years

  • Indicated for severe pain associated with ureteral spasm unresponsive to nonnarcotic analgesics or to space intervals between opiate injections
  • 1 suppository PR qDay or q12hr
  • Not to exceed 4 doses/day

Ureteral Spasm Pain

Indicated for severe pain associated with ureteral spasm unresponsive to nonnarcotic analgesics or to space intervals between opiate injections

1 suppository PR qDay or q12hr

Not to exceed 4 doses/day

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Interactions

Interaction Checker

and belladonna and opium

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            Contraindicated (1)

            • alvimopan

              alvimopan, belladonna and opium. receptor binding competition. Contraindicated. Contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea.

            Serious - Use Alternative (20)

            • buprenorphine

              buprenorphine, belladonna and opium. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • buprenorphine buccal

              buprenorphine buccal, belladonna and opium. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • butorphanol

              butorphanol, belladonna and opium. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • calcium/magnesium/potassium/sodium oxybates

              belladonna and opium, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • cimetidine

              cimetidine increases effects of belladonna and opium by decreasing metabolism. Avoid or Use Alternate Drug.

            • diazepam intranasal

              diazepam intranasal, belladonna and opium. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • isocarboxazid

              isocarboxazid increases toxicity of belladonna and opium by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • linezolid

              linezolid increases toxicity of belladonna and opium by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • methylene blue

              methylene blue and belladonna and opium both increase serotonin levels. Avoid or Use Alternate Drug. If drug combination must be administered, monitor for evidence of serotonergic or opioid-related toxicities

            • metoclopramide intranasal

              belladonna and opium, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            • nalbuphine

              nalbuphine, belladonna and opium. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • oliceridine

              belladonna and opium, oliceridine. Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant use may reduce analgesic effect of oliceridine and/or precipitate withdrawal symptoms.

            • pentazocine

              pentazocine, belladonna and opium. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • phenelzine

              phenelzine increases toxicity of belladonna and opium by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • pramlintide

              pramlintide, belladonna and opium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • selegiline transdermal

              selegiline transdermal increases toxicity of belladonna and opium by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.

            • selinexor

              selinexor, belladonna and opium. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

            • sodium oxybate

              belladonna and opium, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • tramadol

              tramadol, belladonna and opium. Other (see comment). Avoid or Use Alternate Drug. Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

            • tranylcypromine

              tranylcypromine increases toxicity of belladonna and opium by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            Monitor Closely (229)

            • aclidinium

              belladonna and opium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • albuterol

              belladonna and opium increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alfentanil

              alfentanil and belladonna and opium both increase sedation. Use Caution/Monitor.

            • alprazolam

              alprazolam and belladonna and opium both increase sedation. Use Caution/Monitor.

            • amantadine

              belladonna and opium, amantadine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Potential for increased anticholinergic adverse effects.

            • amitriptyline

              belladonna and opium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium and amitriptyline both increase sedation. Use Caution/Monitor.

            • amobarbital

              amobarbital and belladonna and opium both increase sedation. Use Caution/Monitor.

            • amoxapine

              belladonna and opium and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium and amoxapine both increase sedation. Use Caution/Monitor.

            • anticholinergic/sedative combos

              anticholinergic/sedative combos and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • apomorphine

              belladonna and opium and apomorphine both increase sedation. Use Caution/Monitor.

            • arformoterol

              belladonna and opium increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aripiprazole

              belladonna and opium and aripiprazole both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of aripiprazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of aripiprazole by pharmacodynamic antagonism. Use Caution/Monitor.

              aripiprazole increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • armodafinil

              belladonna and opium increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • atracurium

              atracurium and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • atropine

              atropine and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • atropine IV/IM

              atropine IV/IM and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • azelastine

              azelastine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • baclofen

              baclofen and belladonna and opium both increase sedation. Use Caution/Monitor.

            • belladonna alkaloids

              belladonna alkaloids and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • benperidol

              belladonna and opium and benperidol both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of benperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of benperidol by pharmacodynamic antagonism. Use Caution/Monitor.

              benperidol increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • benzphetamine

              belladonna and opium increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • benztropine

              benztropine and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use.

            • bethanechol

              bethanechol increases and belladonna and opium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • brompheniramine

              brompheniramine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • buprenorphine

              buprenorphine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • buprenorphine buccal

              buprenorphine buccal and belladonna and opium both increase sedation. Use Caution/Monitor.

            • butabarbital

              butabarbital and belladonna and opium both increase sedation. Use Caution/Monitor.

            • butalbital

              butalbital and belladonna and opium both increase sedation. Use Caution/Monitor.

            • butorphanol

              butorphanol and belladonna and opium both increase sedation. Use Caution/Monitor.

            • caffeine

              belladonna and opium increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbachol

              carbachol increases and belladonna and opium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • carisoprodol

              carisoprodol and belladonna and opium both increase sedation. Use Caution/Monitor.

            • cenobamate

              cenobamate, belladonna and opium. Either increases effects of the other by sedation. Use Caution/Monitor.

            • cevimeline

              cevimeline increases and belladonna and opium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chloral hydrate

              chloral hydrate and belladonna and opium both increase sedation. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide and belladonna and opium both increase sedation. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              belladonna and opium and chlorpromazine both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor.

              chlorpromazine increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • chlorzoxazone

              chlorzoxazone and belladonna and opium both increase sedation. Use Caution/Monitor.

            • cinnarizine

              cinnarizine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • cisatracurium

              cisatracurium and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • clemastine

              clemastine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • clomipramine

              belladonna and opium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium and clomipramine both increase sedation. Use Caution/Monitor.

            • clonazepam

              clonazepam and belladonna and opium both increase sedation. Use Caution/Monitor.

            • clorazepate

              clorazepate and belladonna and opium both increase sedation. Use Caution/Monitor.

            • clozapine

              belladonna and opium and clozapine both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.

              clozapine increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • codeine

              codeine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • cyclizine

              cyclizine and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclizine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • cyclobenzaprine

              cyclobenzaprine and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclobenzaprine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • dantrolene

              dantrolene and belladonna and opium both increase sedation. Use Caution/Monitor.

            • daridorexant

              belladonna and opium and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

            • darifenacin

              darifenacin and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • desflurane

              desflurane and belladonna and opium both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.

            • desipramine

              belladonna and opium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium and desipramine both increase sedation. Use Caution/Monitor.

            • dexchlorpheniramine

              dexchlorpheniramine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • dexfenfluramine

              belladonna and opium increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmedetomidine

              dexmedetomidine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • dexmethylphenidate

              belladonna and opium increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextroamphetamine

              belladonna and opium increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextromoramide

              dextromoramide and belladonna and opium both increase sedation. Use Caution/Monitor.

            • diamorphine

              diamorphine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • diazepam

              diazepam and belladonna and opium both increase sedation. Use Caution/Monitor.

            • dicyclomine

              dicyclomine and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • diethylpropion

              belladonna and opium increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • difelikefalin

              difelikefalin and belladonna and opium both increase sedation. Use Caution/Monitor.

            • difenoxin hcl

              difenoxin hcl and belladonna and opium both increase sedation. Use Caution/Monitor.

            • dimenhydrinate

              dimenhydrinate and belladonna and opium both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              diphenhydramine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • diphenoxylate hcl

              diphenoxylate hcl and belladonna and opium both increase sedation. Use Caution/Monitor.

            • dipipanone

              dipipanone and belladonna and opium both increase sedation. Use Caution/Monitor.

            • dobutamine

              belladonna and opium increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • donepezil

              donepezil increases and belladonna and opium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopamine

              belladonna and opium increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopexamine

              belladonna and opium increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dosulepin

              belladonna and opium and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium and dosulepin both increase sedation. Use Caution/Monitor.

            • doxepin

              belladonna and opium and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium and doxepin both increase sedation. Use Caution/Monitor.

            • doxylamine

              doxylamine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • droperidol

              belladonna and opium and droperidol both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of droperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of droperidol by pharmacodynamic antagonism. Use Caution/Monitor.

              droperidol increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • echothiophate iodide

              echothiophate iodide increases and belladonna and opium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • eltrombopag

              eltrombopag increases levels of belladonna and opium by decreasing metabolism. Use Caution/Monitor. UGT inhibition; significance of interaction unclear.

            • ephedrine

              belladonna and opium increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine

              belladonna and opium increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine racemic

              belladonna and opium increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • esketamine intranasal

              esketamine intranasal, belladonna and opium. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

            • estazolam

              estazolam and belladonna and opium both increase sedation. Use Caution/Monitor.

            • ethanol

              belladonna and opium and ethanol both increase sedation. Use Caution/Monitor.

            • etomidate

              etomidate and belladonna and opium both increase sedation. Use Caution/Monitor.

            • fenfluramine

              belladonna and opium increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fesoterodine

              fesoterodine and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • flavoxate

              flavoxate and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • fluphenazine

              belladonna and opium and fluphenazine both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of fluphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of fluphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

              fluphenazine increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • flurazepam

              flurazepam and belladonna and opium both increase sedation. Use Caution/Monitor.

            • formoterol

              belladonna and opium increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • gabapentin

              gabapentin, belladonna and opium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • gabapentin enacarbil

              gabapentin enacarbil, belladonna and opium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • galantamine

              galantamine increases and belladonna and opium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • glycopyrrolate

              glycopyrrolate and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • glycopyrrolate inhaled

              glycopyrrolate inhaled and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • haloperidol

              belladonna and opium and haloperidol both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of haloperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of haloperidol by pharmacodynamic antagonism. Use Caution/Monitor.

              haloperidol increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • henbane

              henbane and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • homatropine

              homatropine and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • huperzine A

              huperzine A increases and belladonna and opium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hydromorphone

              hydromorphone and belladonna and opium both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • hyoscyamine

              hyoscyamine and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • hyoscyamine spray

              hyoscyamine spray and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • iloperidone

              belladonna and opium and iloperidone both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of iloperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of iloperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              iloperidone increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • imipramine

              belladonna and opium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium and imipramine both increase sedation. Use Caution/Monitor.

            • ipratropium

              ipratropium and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • isoproterenol

              belladonna and opium increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketamine

              ketamine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • ketotifen, ophthalmic

              belladonna and opium and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

            • levalbuterol

              belladonna and opium increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • levorphanol

              levorphanol and belladonna and opium both increase sedation. Use Caution/Monitor.

            • lisdexamfetamine

              belladonna and opium increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lofepramine

              belladonna and opium and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium and lofepramine both increase sedation. Use Caution/Monitor.

            • lofexidine

              belladonna and opium and lofexidine both increase sedation. Use Caution/Monitor.

            • loprazolam

              loprazolam and belladonna and opium both increase sedation. Use Caution/Monitor.

            • lorazepam

              lorazepam and belladonna and opium both increase sedation. Use Caution/Monitor.

            • lormetazepam

              lormetazepam and belladonna and opium both increase sedation. Use Caution/Monitor.

            • loxapine

              belladonna and opium and loxapine both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of loxapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of loxapine by pharmacodynamic antagonism. Use Caution/Monitor.

              loxapine increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • loxapine inhaled

              loxapine inhaled increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              belladonna and opium and loxapine inhaled both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.

            • lurasidone

              lurasidone, belladonna and opium. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

            • maprotiline

              belladonna and opium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium and maprotiline both increase sedation. Use Caution/Monitor.

            • marijuana

              belladonna and opium and marijuana both increase sedation. Use Caution/Monitor.

            • meclizine

              meclizine and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • melatonin

              belladonna and opium and melatonin both increase sedation. Use Caution/Monitor.

            • meperidine

              meperidine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • meprobamate

              belladonna and opium and meprobamate both increase sedation. Use Caution/Monitor.

            • metaproterenol

              belladonna and opium increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaxalone

              metaxalone and belladonna and opium both increase sedation. Use Caution/Monitor.

            • methadone

              methadone and belladonna and opium both increase sedation. Use Caution/Monitor.

            • methamphetamine

              belladonna and opium increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methocarbamol

              methocarbamol and belladonna and opium both increase sedation. Use Caution/Monitor.

            • methscopolamine

              methscopolamine and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              belladonna and opium increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • midazolam

              midazolam and belladonna and opium both increase sedation. Use Caution/Monitor.

            • midazolam intranasal

              midazolam intranasal, belladonna and opium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

            • midodrine

              belladonna and opium increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mirtazapine

              belladonna and opium and mirtazapine both increase sedation. Use Caution/Monitor.

            • modafinil

              belladonna and opium increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • morphine

              morphine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • motherwort

              belladonna and opium and motherwort both increase sedation. Use Caution/Monitor.

            • moxonidine

              belladonna and opium and moxonidine both increase sedation. Use Caution/Monitor.

            • nabilone

              belladonna and opium and nabilone both increase sedation. Use Caution/Monitor.

            • nalbuphine

              nalbuphine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • neostigmine

              neostigmine increases and belladonna and opium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • norepinephrine

              belladonna and opium increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nortriptyline

              belladonna and opium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium and nortriptyline both increase sedation. Use Caution/Monitor.

            • olanzapine

              belladonna and opium and olanzapine both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor.

              olanzapine increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • onabotulinumtoxinA

              onabotulinumtoxinA and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • opium tincture

              belladonna and opium and opium tincture both increase sedation. Use Caution/Monitor.

            • orphenadrine

              belladonna and opium and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              orphenadrine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • oxazepam

              oxazepam and belladonna and opium both increase sedation. Use Caution/Monitor.

            • oxybutynin

              belladonna and opium and oxybutynin both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • oxybutynin topical

              belladonna and opium and oxybutynin topical both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • oxybutynin transdermal

              belladonna and opium and oxybutynin transdermal both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • oxycodone

              belladonna and opium and oxycodone both increase sedation. Use Caution/Monitor.

            • oxymorphone

              belladonna and opium and oxymorphone both increase sedation. Use Caution/Monitor.

            • paliperidone

              belladonna and opium and paliperidone both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              paliperidone increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • pancuronium

              belladonna and opium and pancuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • papaveretum

              belladonna and opium and papaveretum both increase sedation. Use Caution/Monitor.

            • papaverine

              belladonna and opium and papaverine both increase sedation. Use Caution/Monitor.

            • pegvisomant

              belladonna and opium decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.

            • pentazocine

              belladonna and opium and pentazocine both increase sedation. Use Caution/Monitor.

            • pentobarbital

              pentobarbital and belladonna and opium both increase sedation. Use Caution/Monitor.

            • perphenazine

              belladonna and opium and perphenazine both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

              perphenazine increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • phendimetrazine

              belladonna and opium increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenobarbital

              phenobarbital and belladonna and opium both increase sedation. Use Caution/Monitor.

            • phentermine

              belladonna and opium increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine

              belladonna and opium increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine PO

              belladonna and opium increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • pholcodine

              belladonna and opium and pholcodine both increase sedation. Use Caution/Monitor.

            • physostigmine

              physostigmine increases and belladonna and opium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pilocarpine

              pilocarpine increases and belladonna and opium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pimozide

              belladonna and opium and pimozide both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.

              pimozide increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • pirbuterol

              belladonna and opium increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pralidoxime

              belladonna and opium and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • pregabalin

              pregabalin, belladonna and opium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • primidone

              primidone and belladonna and opium both increase sedation. Use Caution/Monitor.

            • procarbazine

              procarbazine increases toxicity of belladonna and opium by unknown mechanism. Use Caution/Monitor. Potential for increased CNS depression. Use caution during coadministration.

            • prochlorperazine

              belladonna and opium and prochlorperazine both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of prochlorperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor.

              prochlorperazine increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • promethazine

              promethazine and belladonna and opium both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of promethazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor.

              promethazine increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • propantheline

              belladonna and opium and propantheline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • propofol

              propofol and belladonna and opium both increase sedation. Use Caution/Monitor.

            • propylhexedrine

              belladonna and opium increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • protriptyline

              belladonna and opium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium and protriptyline both increase sedation. Use Caution/Monitor.

            • pyridostigmine

              pyridostigmine increases and belladonna and opium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • quazepam

              quazepam and belladonna and opium both increase sedation. Use Caution/Monitor.

            • quetiapine

              belladonna and opium and quetiapine both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of quetiapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor.

              quetiapine increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • ramelteon

              belladonna and opium and ramelteon both increase sedation. Use Caution/Monitor.

            • rapacuronium

              belladonna and opium and rapacuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • risperidone

              belladonna and opium and risperidone both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • rocuronium

              belladonna and opium and rocuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • salmeterol

              belladonna and opium increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • scopolamine

              belladonna and opium and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • scullcap

              belladonna and opium and scullcap both increase sedation. Use Caution/Monitor.

            • secobarbital

              secobarbital and belladonna and opium both increase sedation. Use Caution/Monitor.

            • selegiline

              selegiline increases toxicity of belladonna and opium by unknown mechanism. Use Caution/Monitor. Risk of hypotension, hyperpyrexia, somnolence, or death.

            • sevoflurane

              sevoflurane and belladonna and opium both increase sedation. Use Caution/Monitor.

            • shepherd's purse

              belladonna and opium and shepherd's purse both increase sedation. Use Caution/Monitor.

            • solifenacin

              belladonna and opium and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • succinylcholine

              succinylcholine increases and belladonna and opium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sufentanil

              belladonna and opium and sufentanil both increase sedation. Use Caution/Monitor.

            • tapentadol

              belladonna and opium and tapentadol both increase sedation. Use Caution/Monitor.

            • temazepam

              temazepam and belladonna and opium both increase sedation. Use Caution/Monitor.

            • terbutaline

              belladonna and opium increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • thioridazine

              belladonna and opium and thioridazine both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of thioridazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor.

              thioridazine increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • thiothixene

              belladonna and opium and thiothixene both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor.

              thiothixene increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • tiotropium

              belladonna and opium and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • tolterodine

              belladonna and opium and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • topiramate

              belladonna and opium and topiramate both increase sedation. Modify Therapy/Monitor Closely.

            • tramadol

              belladonna and opium and tramadol both increase sedation. Use Caution/Monitor.

            • trazodone

              belladonna and opium and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium and trazodone both increase sedation. Use Caution/Monitor.

            • triazolam

              triazolam and belladonna and opium both increase sedation. Use Caution/Monitor.

            • triclofos

              triclofos and belladonna and opium both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              belladonna and opium and trifluoperazine both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor.

              trifluoperazine increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • trihexyphenidyl

              belladonna and opium and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.

            • trimipramine

              belladonna and opium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium and trimipramine both increase sedation. Use Caution/Monitor.

            • triprolidine

              triprolidine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • trospium chloride

              belladonna and opium and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • vecuronium

              belladonna and opium and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • xylometazoline

              belladonna and opium increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • yohimbine

              belladonna and opium increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziconotide

              belladonna and opium and ziconotide both increase sedation. Use Caution/Monitor.

            • ziprasidone

              belladonna and opium and ziprasidone both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.

              ziprasidone increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • zotepine

              belladonna and opium and zotepine both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of zotepine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor.

            Minor (10)

            • brimonidine

              brimonidine increases effects of belladonna and opium by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • dextroamphetamine

              dextroamphetamine increases effects of belladonna and opium by unspecified interaction mechanism. Minor/Significance Unknown.

            • dimenhydrinate

              dimenhydrinate increases toxicity of belladonna and opium by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

            • donepezil

              donepezil decreases effects of belladonna and opium by pharmacodynamic antagonism. Minor/Significance Unknown.

            • eucalyptus

              belladonna and opium and eucalyptus both increase sedation. Minor/Significance Unknown.

            • galantamine

              galantamine decreases effects of belladonna and opium by pharmacodynamic antagonism. Minor/Significance Unknown.

            • levodopa

              belladonna and opium, levodopa. Other (see comment). Minor/Significance Unknown. Comment: Anticholinergic agents may enhance the therapeutic effects of levodopa; however, anticholinergic agents can exacerbate tardive dyskinesia. In high dosage, anticholinergics may decrease the effects of levodopa by delaying its GI absorption. .

            • lidocaine

              lidocaine increases toxicity of belladonna and opium by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.

            • sage

              belladonna and opium and sage both increase sedation. Minor/Significance Unknown.

            • ziconotide

              ziconotide, belladonna and opium. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.

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            Adverse Effects

            Frequency Not Defined

            Pruritus

            Urticaria

            Nausea

            Vomiting

            Photophobia

            Anticholinergic

            • Dizziness
            • Sedation
            • Urticaria
            • Constipation
            • Dry mouth
            • Blurred vision
            • Urinary retention
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            Warnings

            Contraindications

            Hypersensitivity

            Respiratory disease/depression, acute or severe bronchial asthma in unmonitored setting or absence of resuscitative equipment, convulsive disorders, GI obstruction including paralytic ileus, glaucoma, severe renal or hepatic disease, within 14 days of taking a monoamine oxidase inhibitor, acute alcoholism, delirium tremens, premature labor

            Cautions

            Use caution in patients with head trauma, including injury, intracranial lesions, or elevated intracranial pressure (ICP); significant ICP may occur

            Use caution in patients with toxic psychosis; may exacerbate symptoms

            Use caution in prostatic hyperplasia; may cause urinary retention

            Use caution in cardiovascular disease or with thyroid dysfunction resulting in myxedema; may exacerbate symptoms

            Use caution in patients with seizure disorders; may cause or exacerbate preexisting seizures

            Use caution in patients with biliary tract impairment, including acute pancreatitis, may cause constriction of sphincter of Oddi

            Serious life-threatening or fatal respiratory depression may occur monitor closely for respiratory depression, especially during initiation or dose escalation; carbon dioxide retention resulting from respiratory depression can exacerbate sedating effects of opioids; educate patients and caregivers about how to recognize respiratory depression and getting emergency assistance immediately in the event of an overdose

            May cause severe hypotension, including syncope and orthostatic hypotension; use caution in patients with cardiovascular disease, hypovolemia, circulatory shock, or therapeutic agents that may significantly decrease blood pressure, including anesthetics or phenothiazines; monitor for hypotension upon initiating or titrating dose; avoid use in patients with circulatory shock

            In patients with significant COPD or cor pulmonale or patients with significant reduction in respiratory reserve, hypercapnia, hypoxia, or preexisting respiratory depression, especially when initiating and titrating therapy; significant respiratory depression may occur, including at therapeutic dosages; consider using nonopioid analgesics in these patients

            Use caution in patients with adrenal insufficiency, including Addison disease; long-term opioid use of one or more months may cause secondary hypogonadism, with may lead to osteoporosis and mood disorders

            Patients with history of opioid abuse or alcoholism are at greater risk for drug dependency; psychological, physical dependence, and tolerance may occur with prolonged use

            May cause CNS depression, impairing physical or mental abilities; caution patients about performing tasks requiring mental alertness or operating heavy machinery

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            Pregnancy & Lactation

            Pregnancy

            Prolonged use of opioid analgesics during pregnancy may cause neonatal opioid withdrawal syndrome; there are no available data on belladonna and opium suppositories in pregnant women to inform a drug-associated risk for major birth defects and miscarriage

            Chronic use of opioids may cause reduced fertility in females and males of reproductive potential; not known whether effects on fertility are reversible

            Fetal/Neonatal Adverse Reactions

            • Prolonged use of opioid analgesics during pregnancy for medical or nonmedical purposes can result in physical dependence in neonate and neonatal opioid withdrawal syndrome shortly after birth
            • Neonatal opioid withdrawal syndrome presents as irritability, hyperactivity and abnormal sleep pattern, high pitched cry, tremor, vomiting, diarrhea, and failure to gain weight
            • The onset, duration, and severity of neonatal opioid withdrawal syndrome vary based on specific opioid used, duration of use, timing and amount of last maternal use, and rate of elimination of the drug by the newborn; observe newborns for symptoms of neonatal opioid withdrawal syndrome and manage accordingly

            Labor or delivery

            • Opioids cross the placenta and may produce respiratory depression and psycho-physiologic effects in neonates; an opioid antagonist, such as naloxone, must be available for reversal of opioid-induced respiratory depression in the neonate
            • Belladonna and opium suppositories is not recommended for use in pregnant women during or immediately prior to labor when other analgesic techniques are more appropriate; opioid analgesics, including belladonna and opium suppositories, can prolong labor through actions that temporarily reduce strength, duration, and frequency of uterine contractions
            • However, this effect is not consistent and may be offset by increased rate of cervical dilation, which tends to shorten labor; monitor neonates exposed to opioid analgesics during labor for signs of excess sedation and respiratory depression

            Lactation

            Developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for belladonna and opium suppositories and any potential adverse effects on breastfed infant from belladonna and opium suppositories or from underlying maternal condition

            Infants exposed to belladonna and opium suppositories through breast milk should be monitored for excess sedation and respiratory depression; withdrawal symptoms can occur in breastfed infants when maternal administration of an opioid analgesic is stopped, or when breast-feeding is stopped

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Opium: analgesic, antispasmodic, antimuscarinic; because of its morphine content, inhibits GI motility and propulsion, diminishes digestive secretion

            Belladonna: anticholinergic alkaloids; competitively inhibit Ach actions at muscarinic receptors

            Pharmacokinetics

            Onset: Opium: 30 min, Belladonna: 1-2 hr

            Metabolism: opium: extensively in liver, undergoes conjugation with glucuronic acid; belladonna: no data

            Metabolites: opium: morphine-3-glucuronide, morphine-3-6-diglucuronide; belladonna: no data

            Excretion: opium: mainly by kidney, little amount in bile; belladonna: urine

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            belladonna alkaloids-opium rectal
            -
            16.2-30 mg suppos
            belladonna alkaloids-opium rectal
            -
            16.2-30 mg suppos
            belladonna alkaloids-opium rectal
            -
            16.2-60 mg suppos
            belladonna alkaloids-opium rectal
            -
            16.2-60 mg suppos

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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            Formulary

            FormularyPatient Discounts

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            Tier Description
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.