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Sedation
Transitory sedation is common when opioid doses are increased substantially, but tolerance usually develops rapidly. Persistent drug-induced sedation is usually best treated by reducing the opioid in each dose and increasing the dosage frequency. This strategy will decrease the peak concentrations in blood (and brain) while maintaining the same total dose. In some patients, switching to another opioid may reduce the sedative effects. CNS stimulants such as caffeine, dextroamphetamine (2.5 to 7.5 mg twice daily, orally), pemoline (18.5 To 37 mg, orally), or methylphenidate (5 to 10 my, orally) 70 may be added to increase alertness if the above approach is ineffective in reducing sedation.165
These agents also improve the cognitive function of patients on continuous opioid infusion, most likely by counteracting the sedation. In these patients, methylphenidate has been demonstrated to improve functioning on a number of neuropsychological tests, including tests of memory, mental speed, and concentration.73
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