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Diamorphine is a pro-drug for morphine and apart from its greater water solubility, it has no advantages over morphine or oxycodone for injections. 5.3.3.4 Adverse effects of opioids: With all opioids, it is http://en.wikipedia.org/wiki/Methisazone important to offer the patient a laxative and to keep checking for the development of constipation. Transdermal fentanyl and buprenorphine are associated with reduced incidence of constipation (Clark et?al, 2004; Tassinari et?al, 2009). It is not necessary to routinely prescribe an anti-emetic with opioids, except for the first week when starting buprenorphine. Most opioids cause dose-related sedation; however, fentanyl and oxycodone are associated with reduced sedation compared to morphine (Ahmedzai & Brooks, 1997; Clark et?al, 2004; Reid et?al, 2006). Patients who experience intolerable sedation due to opioids (or other drugs, e.g. thalidomide) may be considered for a trial of a psychostimulant such as methylphenidate or modafanil; this should only be prescribed by a specialist in palliative medicine. (See sections 7.5 and 7.6) Respiratory depression is uncommon in patients treated chronically with opioids as long as dose increments are made carefully as outlined above. With the initiation of opioids, it is common to see a reduction in respiratory rate; however, this is usually balanced by changes in tidal volume so that minute ventilation initially remains steady. Care needs http://www.selleckchem.com/products/Roscovitine.html to be taken in patients with chronic obstructive pulmonary disorder or obstructive sleep apnoea, http://www.selleckchem.com/products/bay-57-1293.html in whom the respiratory depression can occur even with low doses of opioids. True respiratory depression caused by opioids is diagnosed by a reduction in oxygen saturation (SaO2?