Situations where great caution should be used as regards opioid use:
i. Respiratory problems: asthma, emphysema
ii. Decreased blood volume (hypotension)
iii. Biliary colic
iv. Liver disease (increased bioavailability)*
v. Impaired kidney function (accumulation of metabolites)*
vi. Opioids may aggravate pre-existing convulsions in patients with convulsive disorders. If dosage is escalated substantially above recommended levels (because of tolerance) convulsions may occur in patients who have no previous history
*Opioids may have prolonged duration of action and possibly a cumulative effect in patients who have impaired liver or kidney function.
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