Paregoric

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# Overview
Paregoric is a antidiarrheal that is FDA approved for the treatment of diarrhea.   Common adverse reactions include apnea, drug withdrawal, hypotension, respiratory depression, seizure, tachycardia.

# Adult Indications and Dosage

## FDA-Labeled Indications and Dosage (Adult)
- Paregoric is useful for the treatment of diarrhea.
- 5 to 10 mL (1 to 2 teaspoonfuls) 1 to 4 times a day or as directed by a physician.

## Off-Label Use and Dosage (Adult)

### Guideline-Supported Use
There is limited information regarding Off-Label Guideline-Supported Use of Paregoric in adult patients.

### NonGuideline-Supported Use
There is limited information regarding Off-Label NonGuideline-Supported Use of Paregoric in adult patients.

# Pediatric Indications and Dosage

## FDA-Labeled Indications and Dosage (Pediatric)
- Paregoric is useful for the treatment of diarrhea.
- 0.25 to 0.5 mL/kg of body weight 1 to 4 times a day or as directed by a physician.

## Off-Label Use and Dosage (Pediatric)

### Guideline-Supported Use
There is limited information regarding Off-Label Guideline-Supported Use of Paregoric in pediatric patients.

### NonGuideline-Supported Use
There is limited information regarding Off-Label NonGuideline-Supported Use of Paregoric in pediatric patients.

# Contraindications
- Hypersensitivity to morphine. Because of its stimulating effect on the spinal cord, morphine should not be used in convulsive states, such as those occurring in status epilepticus, tetanus, and strychnine poisoning.
- This preparation should not be used in diarrhea caused by poisoning until the toxic material is eliminated from the gastrointestinal tract.

# Warnings

### Precautions
- Head Injury and Increased Intracranial Pressure
- The respiratory depressant effects of narcotics and their capacity to elevate cerebrospinal-fluid pressure may be markedly exaggerated in the presence of head injury, other intracranial lesions, or a preexisting increase in intracranial pressure. Furthermore, narcotics produce additional effects that may obscure the clinical course in patients with head injuries.
- Acute Abdominal Conditions
- The administration of morphine or other narcotics may obscure the diagnosis or clinical course in patients with acute abdominal conditions.
- Morphine should be given with caution to certain patients, such as the elderly or debilitated and those with severe impairment of hepatic or renal function, hypothyroidism, Addison's disease, and prostatic hypertrophy or urethral stricture.
- Morphine should be used with extreme caution in patients with disorders characterized by hypoxia, since even usual therapeutic doses of narcotics may decrease respiratory drive to the point of apnea while simultaneously increasing airway resistance.
- Hypotensive Effect
- The administration of morphine may result in severe hypotension in the postoperative patient or any individual whose ability to maintain blood pressure has been compromised by a depleted blood volume or the administration of such drugs as the phenothiazines or certain anesthetics.
- Supraventricular Tachycardias
- Because of a possible vagolytic action that may produce a significant increase in the ventricular response rate, morphine should be used with caution in patients with atrial flutter and other supraventricular tachycardias.
- Convulsions
- Morphine may aggravate preexisting convulsions in patients with convulsive disorders. If dosage is escalated substantially above recommended levels because of tolerance development, convulsions may occur in individuals without a history of convulsive disorders.

# Adverse Reactions

## Clinical Trials Experience
- The most frequent adverse reactions include lightheadedness, dizziness, sedation, nausea, and vomiting. These effects seem to be more prominent in ambulatory than in nonambulatory patients, and some of these adverse reactions may be alleviated if the patient lies down.
- Other adverse reactions include euphoria, dysphoria, constipation, and pruritus.

## Postmarketing Experience
There is limited information regarding Postmarketing Experience of Paregoric in the drug label.

# Drug Interactions
- Morphine in combination with other narcotic analgesics, general anesthetics, phenothiazines, tranquilizers, sedative/hypnotics, or other CNS depressants (including alcohol) has additive depressant effects, and the patient should be so advised. When such combination therapy is contemplated, the dosage of one or both agents should be reduced.

# Use in Specific Populations

### Pregnancy
Pregnancy Category (FDA): C
- Animal reproduction studies have not been conducted with morphine. It is not known whether morphine can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Paregoric should be given to a pregnant woman only if clearly needed.
Pregnancy Category (AUS): 
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Paregoric in women who are pregnant.

### Labor and Delivery
There is no FDA guidance on use of Paregoric during labor and delivery.

### Nursing Mothers
- Morphine appears in the milk of nursing mothers. Caution should be exercised when paregoric is administered to a nursing woman.

### Pediatric Use
There is no FDA guidance on the use of Paregoric with respect to pediatric patients.

### Geriatic Use
There is no FDA guidance on the use of Paregoric with respect to geriatric patients.

### Gender
There is no FDA guidance on the use of Paregoric with respect to specific gender populations.

### Race
There is no FDA guidance on the use of Paregoric with respect to specific racial populations.

### Renal Impairment
There is no FDA guidance on the use of Paregoric in patients with renal impairment.

### Hepatic Impairment
There is no FDA guidance on the use of Paregoric in patients with hepatic impairment.

### Females of Reproductive Potential and Males
There is no FDA guidance on the use of Paregoric in women of reproductive potentials and males.

### Immunocompromised Patients
There is no FDA guidance one the use of Paregoric in patients who are immunocompromised.

# Administration and Monitoring

### Administration
- Oral

### Monitoring
There is limited information regarding Monitoring of Paregoric in the drug label.

# IV Compatibility
There is limited information regarding IV Compatibility of Paregoric in the drug label.

# Overdosage
- Paregoric is a Schedule III narcotic.
- Morphine can produce drug dependence and, therefore, has the potential for being abused. Patients receiving therapeutic dosage regimens of 10 mg every 4 hours for 1 to 2 weeks have exhibited mild withdrawal symptoms. Development of the dependent state is recognizable by an increased tolerance to the analgesic effect and the appearance of purposive phenomena (complaints, pleas, demands, or manipulative actions) shortly before the time of the next scheduled dose. A patient in withdrawal should be treated in a hospital environment. Usually, it is necessary only to provide supportive care with administration of a tranquilizer to suppress anxiety. Severe symptoms of withdrawal may require administration of a replacement narcotic.
- Serious overdosage of morphine is characterized by respiratory depression (a decrease in respiratory rate and/or tidal volume, Cheyne-Stokes respiration, cyanosis), extreme somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, and, sometimes, bradycardia and hypotension. In severe overdosage, apnea, circulatory collapse, cardiac arrest, and death may occur.
- Primary attention should be given to the reestablishment of adequate respiratory exchange through provision of a patent airway and institution of assisted or controlled ventilation. The narcotic antagonist naloxone hydrochloride is a specific antidote against the respiratory depression that may result from overdosage or unusual sensitivity to narcotics. Therefore, an appropriate dose of the antagonist should be administered, preferably by the intravenous route, simultaneously with efforts at respiratory resuscitation. Since the duration of action of morphine may exceed that of the antagonist, the patient should be kept under continued surveillance, and repeated doses of the antagonist should be administered as needed to maintain adequate respiration.
- Oxygen, intravenous fluids, vasopressors, and other supportive measures should be employed as indicated.

# Pharmacology
There is limited information regarding Paregoric Pharmacology in the drug label.

## Mechanism of Action
- Morphine produces its major effects on the central nervous system (CNS) and on the bowel.

## Structure
- Each 5 mL (teaspoonful) contains:
- Anhydrous Morphine . . . . . . . . . . . . . . . . . ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 mg (from opium tincture)
- Alcohol . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . not more than 47.0%
- Inactive Ingredients: anise oil, benzoic acid, camphor, alcohol, glycerin, and purified water.

## Pharmacodynamics
There is limited information regarding Pharmacodynamics of Paregoric in the drug label.

## Pharmacokinetics
There is limited information regarding Pharmacokinetics of Paregoric in the drug label.

## Nonclinical Toxicology
- Paregoric has no known carcinogenic or mutagenic potential. However, no long-term animal studies are available to support this observation.

# Clinical Studies
There is limited information regarding Clinical Studies of Paregoric in the drug label.

# How Supplied
- Paregoric, USP contains anhydrous morphine 2 mg/5 mL (from opium tincture); alcohol not more than 47.0% and is available in 16 fl. oz. (473 mL) bottles.
tore at controlled room temperature, 15-30C (59-86F) .
- PROTECT FROM LIGHT
- AVOID EXCESSIVE HEAT
- Dispense in a tight, light-resistant container as defined in the USP. Use safety closures when dispensing this product unless otherwise directed by a physician or requested by the purchaser.

## Storage
There is limited information regarding Paregoric Storage in the drug label.

# Images

## Drug Images

## Package and Label Display Panel

# Patient Counseling Information
- Information for Patients
- Morphine may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks, such as driving a car or operating machinery.

# Precautions with Alcohol
- Alcohol-Paregoric interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

# Brand Names
- OPIUM

# Look-Alike Drug Names
There is limited information regarding Paregoric Look-Alike Drug Names in the drug label.

# Drug Shortage Status

# Price