belladonna / opium
B&O Suppositories (belladonna / opium) is used to help ease severe pain from ureteral spasm in people ages 13 years and older. It's not a first-choice option for pain relief, but only prescribed when non-opioid medications haven't worked well. This medication contains belladonna, an anticholinergic that works by relaxing the bladder muscle. It also has opium, an opioid that blocks pain signals in the body. This rectal suppository is inserted into the rectum once or twice daily, as directed by the healthcare team. Some common side effects include drowsiness, dry mouth, and constipation. Brand name B&O Suppositories has been discontinued; it's only available as a generic.
What is B&O Suppositories (belladonna / opium)?
What is B&O Suppositories (belladonna / opium) used for?
Severe pain from ureteral spasm
How B&O Suppositories (belladonna / opium) works
B&O Suppositories (belladonna / opium) is an anticholinergic and opioid combination.
Belladonna is an anticholinergic. It's made up of two active ingredients: atropine and scopolamine. It relaxes the muscles in the ureter and bladder to ease spasms.
Opium is an opioid. The major active ingredient in opium is morphine. It works on opioid receptors in the brain to change how you respond to pain and provide pain relief.
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What are the risks and warnings for B&O Suppositories (belladonna / opium)?
B&O Suppositories (belladonna / opium) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Potential for misuse and addiction
Risk factors: Personal or family history of alcohol or substance use disorder | Personal or family history of mental health conditions
B&O Suppositories (belladonna / opium) is a controlled substance. It has a risk for misuse, addiction, and dependence, even at doses recommended by your healthcare team. To lower your risks, your healthcare team will prescribe the lowest dose of B&O Suppositories (belladonna / opium) that's necessary to manage your pain for the shortest period of time possible.
Life-threatening breathing problems
Risk factors: Children | Older adult | Serious illness | Brain-related injury | Sleep apnea or other health conditions that affect breathing | Drinking alcohol | Taking other medications that can slow breathing
B&O Suppositories (belladonna / opium) can cause dangerously slowed breathing. The risk is highest during the first 3 days after you start this medication or whenever your healthcare team raises your dose. To lower the risk of serious side effects, don't take more medication than what your healthcare professional (HCP) prescribed.
Make sure to take special precautions to store this medication in a safe place away from the reach of children. If a child accidentally uses this medication, they can also experience breathing problems, which can be life-threatening.
Your prescriber might write a prescription for naloxone (Narcan), a medication that can reverse slowed breathing from opioids. Your prescriber will instruct you to carry it with you at all times. Use naloxone, call 911, and get medical help right away if you or your loved one notices that you have trouble breathing or have bluish-colored lips, fingers, or toes.
Serious interactions with other medications and alcohol
Risk factors: Using with alcohol, opioids, muscle relaxants, anxiety medications, and sleeping pills
B&O Suppositories (belladonna / opium) can have serious interactions with drinks or other medications. For example, you should avoid taking it with alcohol or other medications that cause sleepiness (e.g., benzodiazepines, other opioid medications, sleep medications). In addition, don't use B&O Suppositories (belladonna / opium) while taking or within 2 weeks of taking a monoamine oxidase inhibitor (MAOI). These combinations can lead to life-threatening side effects, such as troubled breathing, extreme sleepiness, and confusion.
If your healthcare team thinks the benefits of taking some of these medications with B&O Suppositories (belladonna / opium) is greater than the risk for harm, they will prescribe the lowest doses needed for the shortest duration of time needed to treat your symptoms. They might also prescribe naloxone (Narcan) in case you accidentally take too much opioid medications.
Adrenal problems
Risk factors: Using B&O Suppositories (belladonna / opium) for more than a month
B&O Suppositories (belladonna / opium) can cause your adrenal glands to lower the production of essential hormones. Let your healthcare team know if you experience nausea, loss of appetite, weakness, or dizziness while using this medication. They might need to do tests to rule out adrenal problems. If necessary, they might ask you to stop B&O Suppositories (belladonna / opium) safely by lowering your dose slowly over time and consider safer options to treat your condition.
Risk of falls and injury
B&O Suppositories (belladonna / opium) can cause a sudden drop in your blood pressure, especially when you go from a sitting to a standing position. This can cause you to feel dizzy or lightheaded, which can raise your risk of falls and injuries. If you continue to feel dizzy while taking B&O Suppositories (belladonna / opium), let your healthcare team know. They can talk with you about other options to treat your pain.
B&O Suppositories (belladonna / opium) can also cause you to feel sleepy or slow your reactions, which can be dangerous. Don't drive or do anything that needs a lot of focus and attention when you first start taking B&O Suppositories (belladonna / opium), until you know how this medication makes you feel.
Digestive tract blockage
Risk factors: History of digestive tract problems
If you have certain stomach conditions or digestive tract blockages, don't use B&O Suppositories (belladonna / opium), because it can worsen your problems. Let your healthcare team know if you experience stomach pain, feeling of fullness in your stomach, or extreme constipation while using this medication.
Seizures
Risk factors: History of seizure conditions
B&O Suppositories (belladonna / opium) can raise the risk of having seizures more often in people who've had one before. This medication can also raise your risk of seizures in certain situations. Get medical help right away if you have a seizure while you're taking this medication.
Physical dependence and withdrawal
Risk factors: Using B&O Suppositories (belladonna / opium) over a longer period of time
B&O Suppositories (belladonna / opium) can cause physical dependence when it's taken for a long period of time. This means that your body starts to rely on the medication to function. You might experience withdrawal if you suddenly stop taking the medication or lower your dose too fast. Withdrawal symptoms can be bothersome and include anxiety, restlessness, irritability, runny nose, sweating, and chills.
Don't lower your dose or stop taking the medication suddenly without talking to your prescriber first. Your prescriber will slowly lower your dose to prevent withdrawal symptoms. Talk to your prescriber about alternative pain medications if you have concerns about the risk for dependence and withdrawal with B&O Suppositories (belladonna / opium).
Withdrawal in infants
Risk factors: Using B&O Suppositories (belladonna / opium) for a long period of time during pregnancy
Don't take B&O Suppositories (belladonna / opium) during pregnancy without first speaking to your healthcare team. This medication typically isn't recommended during pregnancy because there's a risk it can cause opioid withdrawal symptoms in newborns at birth, such as fever, trouble drinking milk or formula, or excessive crying. If you're pregnant or think you might be pregnant, discuss with your prescriber about all of the risks that are associated with this medication before starting it.
What are the side effects of B&O Suppositories (belladonna / opium)?
Common Side Effects
- Sleepiness
- Dizziness
- Dry mouth
- Light sensitivity
- Fast pulse
- Blurred vision
- Constipation
- Nausea
- Vomiting
- Trouble urinating
Other Side Effects
- Itching
- Hives
Serious Side Effects
- Breathing problems: troubled or slowed breathing
- Allergic reaction: swelling of your face, tongue, or throat
- Mental changes: confusion, irritability, anxiety
- Anticholinergic effects: sweating less, muscle cramps, fever
- Heart problems: chest pain, fast heartbeat
- Seizures
Source:Â DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Incidence not known
Decrease in the frequency of urination
decrease in urine volume
difficulty in passing urine (dribbling)
rapid pulse
Get emergency help immediately if any of the following symptoms of overdose occur:
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of B&O Suppositories (belladonna / opium)
Pros
Typically inserted once or twice a day
Inserted into the rectum, good option if you can't take medications by mouth
Two medications combined together to help relieve symptoms
Cons
Risk of dependence and addiction
Can cause withdrawal symptoms if stopped suddenly
Risk of seizures in people who have seizure disorders
Pharmacist tips for B&O Suppositories (belladonna / opium)
B&O Suppositories (belladonna / opium) is meant for rectal use only. Don't take it by mouth.
Don't suddenly stop using B&O Suppositories (belladonna / opium) if you've been using it regularly for a while. Doing so can lead to withdrawal symptoms, such as nausea, twitching, and diarrhea. If you want to stop this medication, talk with your healthcare team. They can help you do so safely by lowering your dose slowly over time.
B&O Suppositories (belladonna / opium) can cause drowsiness and dizziness. Until you know how B&O Suppositories (belladonna / opium) affects you, avoid driving and using machinery that requires you to be alert.
B&O Suppositories (belladonna / opium) can cause a sudden drop in blood pressure when changing positions, such as from sitting to standing. This is especially common when you first start B&O Suppositories (belladonna / opium) and when the dose is changed. Be careful when changing positions to avoid falling and hurting yourself.
You might experience constipation after starting B&O Suppositories (belladonna / opium). Make sure to drink enough fluids to stay hydrated and include enough fiber in your diet to avoid this problem.
It's best to avoid drinking alcohol or taking other medications that can cause drowsiness, like other opioid medications or benzodiazepines, while using B&O Suppositories (belladonna / opium). Doing so can raise the risk for serious side effects, such as extreme sleepiness and trouble breathing.
Only take B&O Suppositories (belladonna / opium) as prescribed by your healthcare team. It's best to use the lowest dose for the shortest period of time needed to treat your symptoms. This medication has a risk of dependence and addiction, even at recommended doses.
More tips for how to use B&O Suppositories (belladonna / opium):
Make sure to wash your hands well before and after using the B&O Suppositories (belladonna / opium).
When you're ready to use the B&O Suppositories (belladonna / opium), remove the foil wrapper. Before inserting the suppository, you should moisten your finger and the suppository with water.
Lie down on your side and use your finger to push the B&O Suppositories (belladonna / opium) well up into the rectum. Keep lying down for several minutes to keep the suppository from coming out before it melts.
Frequently asked questions about B&O Suppositories (belladonna / opium)
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B&O Suppositories (belladonna / opium) dosage forms
Typical dosing for B&O Suppositories (belladonna / opium)
Each suppository contains 16.2 mg of belladonna and 30 mg or 60 mg of opium.
Adults and children age 13 years or older: The typical dose is to unwrap and insert 1 suppository into the rectum once or twice a day, or as directed by your healthcare team.
Interactions between B&O Suppositories (belladonna / opium) and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Nalmefene
- Naltrexone
- Potassium
- Safinamide
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alfentanil
- Alprazolam
- Amphetamine
- Benzhydrocodone
- Benzphetamine
- Bromazepam
- Bromopride
- Buprenorphine
- Butorphanol
- Calcium Oxybate
- Cannabidiol
- Carbinoxamine
- Cetirizine
- Clobazam
- Clopidogrel
- Clozapine
- Codeine
- Desmopressin
- Desvenlafaxine
- Dextroamphetamine
- Dihydrocodeine
- Doxylamine
- Duloxetine
- Escitalopram
- Esketamine
- Fenfluramine
- Fentanyl
- Flibanserin
- Gabapentin
- Gabapentin Enacarbil
- Glucagon
- Glycopyrrolate
- Glycopyrronium Tosylate
- Granisetron
- Hydrocodone
- Hydromorphone
- Ketamine
- Lasmiditan
- Lemborexant
- Levocetirizine
- Levorphanol
- Lisdexamfetamine
- Lithium
- Lofexidine
- Lorazepam
- Loxapine
- Magnesium Oxybate
- Meclizine
- Meperidine
- Metaxalone
- Methacholine
- Methadone
- Methamphetamine
- Metoclopramide
- Midazolam
- Mirtazapine
- Morphine
- Morphine Sulfate Liposome
- Nalbuphine
- Ondansetron
- Oxycodone
- Oxymorphone
- Ozanimod
- Pentazocine
- Periciazine
- Potassium Oxybate
- Pregabalin
- Quetiapine
- Remifentanil
- Remimazolam
- Revefenacin
- Scopolamine
- Secretin Human
- Sertraline
- Sodium Oxybate
- Sufentanil
- Tapentadol
- Tiotropium
- Tramadol
- Trazodone
- Vortioxetine
- Zolpidem
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acetophenazine
- Chlorpromazine
- Dixyrazine
- Ethopropazine
- Fluphenazine
- Mesoridazine
- Methdilazine
- Methotrimeprazine
- Perazine
- Periciazine
- Perphenazine
- Pipotiazine
- Prochlorperazine
- Promazine
- Promethazine
- Propiomazine
- Thiethylperazine
- Thioridazine
- Trifluoperazine
- Triflupromazine
How much does B&O Suppositories (belladonna / opium) cost?
B&O Suppositories (belladonna / opium) contraindications
Extremely slowed breathing
Active asthma attack or severe asthma with no access to resuscitative equipment
Currently taking or have recently taken (in the past 14 days) monoamine oxidase inhibitors (MAOIs)
Digestive tract blockage
Glaucoma
Severe liver or kidney problems
Seizure conditions
Alcoholism
Delirium
Premature labor
What are alternatives to B&O Suppositories (belladonna / opium)?
Severe pain from ureteral spasm
Relieves urinary symptoms, such as painful urination, urinary urgency, frequency, loss of bladder control, frequent urination at night, and lower stomach pain, that you experience with urinary and prostate infections
Overactive bladder
Incontinence in children due to a neurologic (brain) condition, such as spina bifida
B&O Suppositories (belladonna / opium) images
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References
Best studies we foundCole, L., et al. (1990). Review of the rectal use of opioids. Journal of Pain and Symptom Management.
Lee, F. C., et al. (2017). Preoperative belladonna and opium suppository for ureteral stent pain: A randomized, double-blinded, placebo-controlled study. Urology.
MedlinePlus. (2023). Belladonna.
MedlinePlus. (2023). Neonatal abstinence syndrome.
Padagis US LLC. (2023). Belladona and opium- atropa belladona and opium suppository [package insert]. DailyMed.
Padagis US LLC. (2023). Morphine sulfate suppository [package insert]. DailyMed.
Patti, L., et al. (2024). Acute renal colic. StatPearls.
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