belladonna and opium (B and O Suppositories)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

Do I need a prescription for belladonna and opium?

Yes

Why is belladonna and opium prescribed to patients?

Belladonna/opium suppositories are used for the relief of moderate to severe pain caused by bladder spasms when non-narcotic pain medications are not effective. They are also used to space intervals between opiate injections.

What are the side effects of belladonna and opium?

Side effects of belladonna/opium are:

Belladonna/opium suppositories can be habit forming and has abuse potential because of its opium content.

What is the dosage for belladonna and opium?

Adults: Insert one suppository rectally once or twice daily. Not to exceed more than 4 suppositories per day or as directed by physician.

Belladonna/opium suppositories are not recommended for use in children 12 years of age and younger.

Quick GuideDigestive Disorders: Common Misconceptions

Digestive Disorders: Common Misconceptions

Which drugs or supplements interact with belladonna and opium?

Alvimopan (Entereg) and belladonna/opium suppositories should not be used together. Alvimopan significantly increases belladonna and opium levels in the body; opioid medications must be stopped 7 days prior to starting Alvimopan.

Belladonna/opium suppositories should not be used with MAO inhibitors like phenelzine (Nardil), selegiline (Zelapar, Emsam, Eldepryl), and isocarboxazid (Marplan) as well as linezolid (Zyvox) antibiotic. Combining these drugs with belladonna/opium may lead to serious changes in blood pressure, fever, sleepiness, agitation, confusion and in severe cases, death. These medications have to be stopped or separated by 14 days before administering belladonna/opium suppositories.

Belladonna/opium suppositories should not be used with naltrexone (Revia) because naltrexone decreases levels and therapeutic effects of belladonna/opium, leading to treatment failure.

Belladonna/opium suppositories should be used with caution with other narcotic analgesics because of increased risks of dizziness, sedation, and respiratory depression.

Individuals should check with their physicians before using this suppository.

Is belladonna and opium safe to use during pregnancy or while breastfeeding?

There are no adequate studies done on belladonna/opium suppositories to determine safe and effective use in pregnant women. They should be used only if clearly needed.

Opium is converted to morphine. Morphine is excreted in breast milk, however, the American Academy of Pediatrics committee states that it is safe to use while nursing.

What else should I know about belladonna and opium?

What preparations of belladonna and opium are available?

Belladonna/opium is available as rectal suppositories. Each package contains 12 suppositories. They are manufactured in two different strengths:

  • 16.2 mg of belladonna and 30 mg of opium in each suppository.
  • 16.2 mg of belladonna and 60 mg of opium in each suppository.
How should I keep belladonna and opium stored?

Store belladonna/opium suppositories at room temperature. Do not refrigerate the suppositories and protect them from moisture during storage.

How does belladonna and opium work?

Belladonna/opium is a man-made narcotic analgesic and anti-spasmodic combination medication. Belladonna relaxes smooth muscles and stops muscle spasms. Opium is converted to morphine which is an opioid pain reliever. Opioids can reduce gastrointestinal motility, propulsion, secretions, and increase gastrointestinal muscle tone. Opioids also stimulate receptors on nerves in the brain to increase the threshold to pain (increasing the amount of stimulation it takes to feel pain) and reduce the perception of pain (the perceived importance of the pain). These effects help in controlling pain and relieving spasms, especially bladder spasms. Belladonna/opium is a controlled substance.

REFERENCE: FDA Prescribing Information.

Quick GuideDigestive Disorders: Common Misconceptions

Digestive Disorders: Common Misconceptions

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Reviewed on 2/6/2017
References
REFERENCE: FDA Prescribing Information.

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