Clinical Findings of Opioid Toxicity in Patient Treated for Pain

Clinical findings of opioid toxicity while being treated for pain:

(1) hallucinations

(2) drowsiness

(3) confusion

(4) pinpoint pupils

(5) myoclonic jerks

(6) micro sleeps

Respiratory depression may occur, but this requires much higher doses than those usually given for pain control.

Management recommendations:

(1) Temporarily hold further doses of the opioid analgesic.

(2) Once signs of toxicity regress, restart analgesic dosing:

(2a) If there was good pain control with the original agent, then restart the same opioid at a lower dose.

(2b) If there was not good pain control with the original agent, then switch to another opioid at a lower equivalent dose.

(3) Administer naloxone if respiratory depression is present.