Paregoric is seldom prescribed due to its abusive potential

Dear Dr. Roach: Could you kindly tell me about the current status of paregoric? Has it been banned by the Food and Drug Administration? Is it available anywhere in the United States? I remember using this product occasionally as a teenager back in the 1960s. It was a miracle drug for stopping diarrhea, and it was available over the counter. Mothers would rub a little on their teething babies' gums to ease their pain.Nowadays, I do not see paregoric mentioned on any schedules of drugs. Many pharmacists have never heard of it, although it appears to be available in other countries. I don't understand why this drug that helped so many people is taken off the market. It certainly couldn't be any more addictive than codeine, which is still widely available.I'm 74 now and would like to have some paregoric on hand when I get diarrhea. — N.W.Answer: Paregoric is a derivative of opium, sometimes referred to as the camphorated tincture of opium. It's an extract of opium, along with some other traditional ingredients (anise oil, benzoic acid, camphor and glycerin), in a base of alcohol and water. Because of abuse, it was made a controlled substance in 1970. Although manufacturing stopped briefly, it is still available, and I suppose your pharmacist would get it if your physician ordered it. However, there are more effective and safer drugs for diarrhea (like loperamide and diphenoxylate-atropine), so paregoric is seldom prescribed.Even when I was a medical student and resident, some of the old-time physicians still prescribed paregoric or a tincture of belladonna and opium for diarrhea or bladder spasms. Other historical opium products include the alcoholic tincture of opium ("laudanum"), which is much more potent and dangerous than paregoric. They have a greater addictive potential than codeine, which is only 1% as potent as morphine.Although they are reasonably safe and effective when used exactly as directed, these medicines can be deliberately abused and inadvertently given in excess, causing overdoses. Finally, the additional ingredients in paregoric, although traditional, probably don't add any useful pharmacologic effects. The alcohol can even be harmful for some. Still, they are effective drugs and are occasionally used in unusual circumstances.Dear Dr. Roach: I am leaving for Ireland to visit friends and family. Should I get my flu vaccine before or after I travel? — R.C.Answer: The flu vaccine takes about two weeks to start working, so you want to have gotten the vaccine well before the expected start of the flu season. However, the vaccine is most effective in the body for about six months, after which protection wanes, so you don't want to get the vaccine too early that you are vulnerable at the end of the flu season.In the United States, flu season tends to begin earlier in the Southern states and later in the Northern states. In Ireland, the flu season tends to mirror the Northern U.S., beginning in October, reaching epidemic proportions in late November to early December, and peaking in late January to early February. The ideal time to get vaccinated would be anywhere from late September through the end of October. However, it's still worthwhile to get the vaccine as long as the virus is still circulating, which is usually until April.For people who haven't gotten your flu vaccine, I'd recommend getting one as soon as possible — like today.Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.