Clinical Effects of Parenteral Narcotics in Hospitalized Medical Patients

Abstract

Of 38,221 hospitalized medical patients monitored by a drug surveillance program, 1821 (4.8%) received morphine, 504 (1.3%) received codeine, 493 (1.3%) received papaveretum, 115 (0.3%) received hydromorphone and 101 (0.3%) received methadone parenterally. Hydromorphone had an unusually high adverse reaction rate (18%); it probably should not be used since other equally effective strong analgesics are available. Adverse reactions occurred in 2% of papaveretum recipients, in 4% of methadone and codeine recipients and in 6% of morphine recipients. Gastrointestinal reactions (primarily nausea, vomiting and constipation) were most common. CNS disturbances (primarily respiratory depression, drowsiness and confusion) were 2nd most common. Adverse reactions occurred more often with higher doses of morphine and codeine; the dose-response relationship could not be evaluated for the other 3 drugs. Life-threatening adverse reactions were reported in 28 patients. Respiratory depression was the most common life-threatening reaction. Most patients with these reactions were seriously ill, and many received other drugs that may have contributed to the event.