Khansari MahmoudReza, Sohrabi MasourReza, Zamani Farhad
Gastrointestinal and Liver Disease Research Center, Firoozgar Hospital, Tehran University of Medical Sciencse, Tehran, Iran.
Middle East J Dig Dis. 2013 Jan;5(1):5-16.
Opium is one of the oldest herbal medicines currently used as an analgesic, sedative and antidiarrheal treatment. The effects of opium are principally mediated by the μ-, κ- and δ-opioid receptors. Opioid substances consist of all natural and synthetic alkaloids that are derived from opium. Most of their effects on gastrointestinal motility and secretion result from suppression of neural activity. Inhibition of gastric emptying, increase in sphincter tone, changes in motor patterns, and blockage of peristalsis result from opioid use. Common adverse effects of opioid administration include sedation, dizziness, nausea, vomiting, constipation, dependency and tolerance, and respiratory depression. The most common adverse effect of opioid use is constipation. Although stool softeners are frequently used to decrease opioid-induced bowel dysfunction, however they are not efficacious. Possibly, the use of specific opioid receptor antagonists is a more suitable approach. Opioid antagonists, both central and peripheral, could affect gastrointestinal function and visceromotor sensitivity, which suggests an important role for endogenous opioid peptides in the control of gastrointestinal physiology. Underlying diseases or medications known to influence the central nervous system (CNS) often accelerate the opioid's adverse effects. However, changing the opioid and/or route of administration could also decrease their adverse effects. Appropriate patient selection, patient education and discussion regarding potential adverse effects may assist physicians in maximizing the effectiveness of opioids, while reducing the number and severity of adverse effects.
鸦片是目前用作镇痛药、镇静剂和止泻药的最古老的草药之一。鸦片的作用主要由μ-、κ-和δ-阿片受体介导。阿片类物质包括所有天然和合成的源自鸦片的生物碱。它们对胃肠蠕动和分泌的大多数作用是由神经活动的抑制引起的。使用阿片类药物会导致胃排空抑制、括约肌张力增加、运动模式改变和蠕动受阻。阿片类药物给药的常见不良反应包括镇静、头晕、恶心、呕吐、便秘、依赖性和耐受性以及呼吸抑制。使用阿片类药物最常见的不良反应是便秘。尽管经常使用大便软化剂来减少阿片类药物引起的肠道功能障碍，但它们并不有效。可能，使用特定的阿片受体拮抗剂是一种更合适的方法。中枢和外周的阿片受体拮抗剂都可能影响胃肠功能和内脏运动敏感性，这表明内源性阿片肽在胃肠生理学控制中起重要作用。已知影响中枢神经系统（CNS）的基础疾病或药物通常会加速阿片类药物的不良反应。然而，改变阿片类药物和/或给药途径也可能减少它们的不良反应。适当的患者选择、患者教育以及关于潜在不良反应的讨论可能有助于医生在最大化阿片类药物有效性的同时，减少不良反应的数量和严重程度。
