What Unani medicines contain opium?

Unani Medicines Containing Opium

Several Unani formulations contain opium as an active ingredient, most notably laudanum (deodorized tincture of opium), which contains approximately 10 mg/mL morphine equivalent and is used primarily for severe diarrhea. 1

Traditional Unani Medicine Background

Unani medicine (also known as Islamic medicine) is a traditional healing system established by Islamic physicians in the Middle East approximately 1,000 years ago, based on the teachings of Hippocrates and Galen 2. This system was widely practiced throughout the world, including Europe, until the 16th century and contributed significantly to the development of modern medicine.

Opium-Containing Unani Preparations

Pharmaceutical Preparations:

1. Laudanum (Deodorized Tincture of Opium)

   • Contains approximately 10 mg/mL morphine equivalent 1
   • Dosage: 10-15 drops in water every 3-4 hours for severe diarrhea
   • Used when first-line treatments like loperamide fail

2. Paregoric (Camphorated Tincture)

   • Less concentrated preparation containing approximately 0.4 mg/mL morphine equivalent 1
   • Dosage: 5 mL in water every 3-4 hours
   • Important: Do not confuse with deodorized tincture of opium to avoid 25-fold dosing error

Clinical Applications of Opium in Unani Medicine

Opium-containing Unani preparations are primarily used for:

1. Management of severe diarrhea - Particularly when other treatments have failed 1
2. Pain management - Opioids are effective analgesics for various pain syndromes 3

Pharmacology and Active Components

The primary active components in opium-containing Unani medicines include:

• Morphine - Principal alkaloid responsible for analgesic and antidiarrheal effects 3
• Codeine - Metabolized to morphine through CYP2D6 enzyme pathway 3

Safety Considerations and Precautions

When using opium-containing Unani preparations, consider:

• Respiratory depression risk - Monitor respiratory status, especially in elderly or those with respiratory conditions 1
• Contraindications - Avoid in intestinal obstruction 1
• Genetic variations - CYP2D6 enzyme exhibits polymorphism among various ethnic groups, affecting metabolism 3
• Renal function - Use with caution in patients with fluctuating renal function due to potential accumulation of renally cleared metabolites 3
• Dependence potential - Risk of physical dependence with prolonged use

Regulatory Status

Unlike many traditional Unani formulations that lack standardization, pharmaceutical opium preparations like laudanum contain standardized amounts of active ingredients with clear dosing guidelines 1. In India, Unani medicines are regulated under the Drugs and Cosmetics Act of 1940, with quality standards prescribed in the Unani Pharmacopoeia of India 4.

Clinical Decision-Making Algorithm

When considering opium-containing Unani medicines:

1. Confirm indication - Primarily for severe diarrhea or pain unresponsive to first-line treatments
2. Verify patient eligibility - Check for contraindications (intestinal obstruction, respiratory compromise)
3. Select appropriate formulation - Choose between laudanum or paregoric based on required potency
4. Start with lowest effective dose - Begin with 10 drops of laudanum or 5 mL of paregoric
5. Monitor for adverse effects - Watch for sedation, respiratory depression, constipation
6. Adjust dosing as needed - Titrate based on response while monitoring for side effects

Remember that while these traditional preparations have historical use in Unani medicine, modern standardized pharmaceutical preparations provide more consistent dosing and safety profiles.