Description

Paregoric

Paregoric, or camphorated tincture of opium, also known as tinctura opii camphorata, is a traditional patent medicine known for its antidiarrheal, antitussive, and analgesic properties.

According to Goodman and Gilman’s 1965 edition, “Paregoric is a 4% opium tincture in which there is also benzoic acid, camphor, and anise oil. … Paregoric by tradition is used especially for children.”

The name “paregoric” has also been used for a kind of boiled sweet, originally (and by some reports still currently) containing paregoric – in particular, the Army & Navy brand sweet produced by British confectioner Payne

Paregoric, U.S.P. formula

The principal active ingredient in Paregoric is powdered opium. In the United States the formula for Paregoric, U.S.P. is a tincture of opium 40 ml, anise oil 4 ml, benzoic acid 4 g, camphor 4 g, glycerin 40 ml, alcohol 450 ml, purified water 450 ml, diluted alcohol to 1000 ml, and contains the equivalent of 0.4 mg/ml of anhydrous morphine; one ounce of paregoric contains 129.6 mg (2 grains) of powdered opium or the equivalent of 13 mg of anhydrous morphine. The average adult dose is 4 ml by mouth which corresponds to 16 mg of opium, or 1.6 mg of anhydrous morphine.”

It is unclear when the current formula for Paregoric, U.S.P. was developed in the United States, and more research is needed. For example, one formula for “Camphorated Tincture of Opium (Paregoric Elixir)” attributed to the United States Pharmacopeia of 1863 is: “Macerate 1 drachm each powdered opium and benzoic acid, 1 fluid drachm of anise, 2 ounces clarified honey, and 2 scruples camphor, in 2 pints diluted alcohol for 7 days, and filter through paper.”[22] A slightly different formula is given in the 1926 pharmacopeia.

The current formula for Paregoric, U.S.P. should not be assumed to be universal. For example, in the United Kingdom the formula for Paregoric, B.P. is a tincture of opium 5 ml, benzoic acid 500 mg, camphor 300 mg, anise oil 0.3 ml, alcohol (60%) to 100 ml, and contains about 1/30th grain of anhydrous morphine in 60 minims, which is 25% stronger than Paregoric, U.S.P

Indications

The main effects of Paregoric are to increase the muscular tone of the intestine, to inhibit normal peristalsis, and as an expectorant; a peer-reviewed clinical study in 1944 reported “that all of [its] ingredients have been found to contribute toward the expectorant action of paregoric, and, further, that advantage is contained in the combination over the sum of the effects of the individual constituents,” that Paregoric “is expectorant by virtue of a reflex from the stomach,” and “preparations of paregoric which have aged for two or three years are superior as an expectorant to preparations aged for less time.”. Its main medical use is to control fulminant diarrhea, and as an antitussive (cough suppressant). Problems with its use include opiate dependency and analgesia which can mask symptoms of diseases that need treatment.

However, Paregoric was characterized as “a needlessly complex pharmacopeial mixture… of a former day” by a 1966 study. In the 21st century its two main uses have been largely supplanted by minimally psychoactive cough-suppressant drugs (such as dextromethorphan) and non-psychoactive antidiarrheal drugs (such as loperamide).