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What to expect

Side effects

Constipation, nausea, and drowsiness are common. Slowed breathing is the effect that can kill.

Common

  • Constipation — almost everyone; a stool plan should start on day one
  • Nausea and vomiting
  • Drowsiness, dizziness, lightheadedness
  • Dry mouth
  • Itching, flushing
  • Urinary retention
  • Low blood pressure, especially when standing up
  • Confusion, especially in older adults

Serious

  • Slow or stopped breathing — the main cause of death
  • Overdose, coma, cardiac arrest
  • Severe drop in blood pressure
  • Adrenal insufficiency after long-term use (fatigue, nausea, low blood pressure)
  • Worsening of gallbladder or biliary pain (sphincter of Oddi spasm)
  • Opioid-induced hyperalgesia — paradoxically more pain with long, high-dose use