Paregoric is a camphorated tincture of opium that was once one of the most widely used medicines in the Western world, prescribed for everything from diarrhea and coughs to teething pain in infants. Its active ingredient is morphine, present in a dilute form alongside camphor, anise oil, benzoic acid, and alcohol. Although it has been largely replaced by safer drugs, paregoric still exists in pharmacopoeias and occasionally surfaces in clinical discussions about severe, treatment-resistant diarrhea and, historically, neonatal opioid withdrawal. Understanding what paregoric actually is, how it was used, and why it fell from favor helps make sense of a medicine that shaped centuries of pain management and left a complicated legacy.
A Medicine Older Than Modern Pharmacy
Paregoric traces its origins to the early eighteenth century, when a chemist named Jakob Le Mort formulated it in the Netherlands. The name itself comes from the Greek paregorikon, meaning “soothing” or “consoling,” and for a long time, that is exactly what people believed it did. The preparation contained opium dissolved in alcohol with added camphor, anise oil, and benzoic acid. It was intended as a gentler alternative to laudanum, the much more concentrated opium tincture that was common at the time. Because paregoric contained far less morphine per dose than laudanum, it was considered safer for everyday complaints and was sold freely over the counter for most of its history.
By the nineteenth century, paregoric was a household staple across Europe and North America. It was given to colicky babies, fussy toddlers, and adults with stomach cramps alike. Opium-based remedies had been used for centuries before paregoric came along, and their dangers to infants were well documented even in antiquity. Thousands of cases of lethal opium poisoning in children had been reported long before the modern era.1PubMed. Lethal Lullabies: A History of Opium Use in Infants Despite this knowledge, the practice of dosing babies with opium preparations persisted for centuries, partly because infant mortality from other causes was so high that drug-related deaths blended into the background, and partly because there were few alternatives for exhausted parents dealing with inconsolable crying.
Paregoric remained available without a prescription in many places well into the twentieth century. In the United States, it was reclassified as a Schedule III controlled substance in 1970 under the Controlled Substances Act, meaning it required a prescription and carried legal restrictions on refills. That regulatory change, combined with the rise of newer antidiarrheal drugs and growing awareness of opioid risks, began its slow retreat from medicine cabinets.
How Paregoric Works in the Body
Paregoric’s effects come primarily from morphine, which acts on opioid receptors in the gut and central nervous system. In the gastrointestinal tract, opioid receptor activation slows the rhythmic contractions that push food and waste through the intestines. This is why opioids in general cause constipation as a side effect, and it is the same property that makes them useful against diarrhea when that effect is desired.
Research into paregoric’s pharmacology has shown that it produces a graduated reduction in gastrointestinal transit, meaning it slows the gut in a dose-dependent way. Interestingly, the preparation’s effects on the gut were not blocked by naloxone, a drug that reverses typical opioid actions, suggesting that some of paregoric’s intestinal effects may involve pathways beyond the classical opioid receptor system.2PubMed Central. Pharmacological analysis of paregoric elixir and its constituents: in vitro and in vivo studies The same research found that paregoric produced tolerance with repeated use but did not cause cross-tolerance with morphine’s pain-relieving effects, hinting that the mixture’s various ingredients may interact with the body in ways that pure morphine does not.2PubMed Central. Pharmacological analysis of paregoric elixir and its constituents: in vitro and in vivo studies
Beyond the morphine, paregoric’s other ingredients are not pharmacologically inert. Camphor has mild local analgesic and counterirritant properties. Anise oil was traditionally believed to ease gas and stomach upset. Benzoic acid served partly as a preservative. The high alcohol content, typically around 45%, was a solvent for the other ingredients but also carried its own sedative and caloric effects, which becomes especially problematic when the preparation is given to newborns.
Primary Uses Through the Centuries
Paregoric’s main clinical applications have always centered on two areas: controlling diarrhea and relieving pain. For most of its history, those two uses were not sharply separated in practice. A person with severe abdominal cramps and loose stools would take paregoric and get relief from both symptoms simultaneously, because opioids both slow the gut and blunt pain signals.
As an antidiarrheal, paregoric was used for acute watery diarrhea, chronic diarrhea from various causes, and the kind of cramping, urgent bowel movements associated with conditions like dysentery. In the pre-antibiotic era, when infections caused by contaminated water and food were rampant and could kill through dehydration, anything that slowed fluid loss from the gut was considered life-saving. Paregoric filled that role for generations.
Its use as a cough suppressant was also widespread. Morphine is an effective cough suppressant at doses lower than those needed for pain relief, and paregoric’s dilute morphine content made it a popular remedy for persistent coughs, especially in children. This application has been almost entirely abandoned in favor of non-opioid cough medications.
Severe Diarrhea in Adults
While paregoric itself has largely disappeared from clinical practice, the broader class of opium-based antidiarrheals has not vanished entirely. Opium tincture, a more concentrated preparation, is still indicated for severe diarrhea in adults when first-line treatments fail to provide adequate control. A prospective observational study of patients treated with medicinal-grade opioid drops found a rapid and sustained improvement in fecal emptying control.3PubMed. Medicinal grade opium tincture for severe diarrhea: effect revisited in observational study The patients in that study had already tried other antidiarrheal medications without sufficient relief, placing opium preparations firmly in the category of last-resort treatments rather than first choices.
The conditions that might lead a doctor to consider opium-based antidiarrheals today include short bowel syndrome, severe inflammatory bowel disease flares unresponsive to standard therapy, and intractable diarrhea related to certain cancers or radiation treatment. In all of these cases, the goal is the same as it was two centuries ago: slow the gut enough to allow the body to absorb water and nutrients that would otherwise be lost.
Modern first-line antidiarrheals like loperamide work through the same opioid receptor mechanism in the gut but are designed not to cross into the brain in significant amounts, which means they control diarrhea without causing the sedation, euphoria, or dependence that come with drugs like morphine. This is exactly why loperamide replaced paregoric for the vast majority of patients. Opium preparations remain relevant only for the small fraction of people whose diarrhea does not respond to loperamide or similar agents.
Neonatal Abstinence Syndrome
One of paregoric’s more controversial applications was in treating newborns going through opioid withdrawal, a condition now commonly called neonatal abstinence syndrome. When a mother uses opioids during pregnancy, the baby is born physically dependent and can develop tremors, high-pitched crying, feeding difficulties, seizures, and other distressing symptoms within the first few days of life. For decades, paregoric was a go-to treatment for easing these withdrawal symptoms in neonatal intensive care units.
A retrospective chart review comparing paregoric to methadone in treating neonatal opioid withdrawal found no observed differences in outcome variables between the two treatment groups. The time it took for withdrawal symptoms to resolve, the rate at which symptom severity decreased, and the length of hospital stay were all similar. Side effect profiles were also comparable, and dosing regimens in both groups were consistent with American Academy of Pediatrics recommendations at the time.4PubMed. A chart review comparing paregoric to methadone in the treatment of neonatal opioid withdrawal
Despite those findings suggesting equivalent effectiveness, paregoric and tincture of opium have since been abandoned for neonatal abstinence syndrome because of safety concerns.5PubMed Central. Neonatal abstinence syndrome: essentials for the practitioner The concerns were not about whether paregoric could control withdrawal symptoms, because it clearly could. The problems were about the other ingredients in the mixture. Camphor can cause seizures in neonates. The high alcohol content exposes a fragile newborn to a significant dose of ethanol. And benzoic acid competes with bilirubin for binding sites in the blood, which can worsen jaundice, a condition that already puts newborns at risk for brain damage. In short, the morphine in paregoric did what it was supposed to do, but the rest of the formulation created unnecessary hazards for the most vulnerable patients imaginable.
Current protocols for neonatal abstinence syndrome favor oral morphine solutions, methadone, or buprenorphine, all of which deliver a controlled opioid dose without the problematic companion ingredients. Non-pharmacological approaches like swaddling, skin-to-skin contact, low-stimulation environments, and breastfeeding (when appropriate) have also gained much more emphasis in recent years, reducing the need for medication in many cases.
Dosing and the Danger of Confusion
One of the most hazardous aspects of paregoric’s history involves dosing errors caused by confusion between paregoric and opium tincture. The two preparations sound similar and were sometimes stored near each other in pharmacies, but their morphine concentrations are dramatically different. Paregoric contains roughly 0.4 mg of morphine per milliliter. Opium tincture, also called laudanum or deodorized tincture of opium, contains about 10 mg of morphine per milliliter, making it twenty-five times more concentrated.
Mix-ups between the two have caused deaths, particularly in neonates. If a pharmacist or nurse accidentally dispensed opium tincture when paregoric was prescribed, the infant would receive a dose of morphine far beyond what its body could handle. This risk was significant enough that the U.S. Food and Drug Administration and various pharmacy safety organizations issued repeated warnings over the years. Some hospitals eventually removed one or both preparations from their formularies specifically to eliminate the possibility of a switch.
When paregoric was in active clinical use, typical adult dosing for diarrhea was 5 to 10 milliliters taken one to four times daily, which delivered roughly 2 to 4 mg of morphine per dose. Neonatal doses were calculated by weight and were far smaller, usually in the range of fractions of a milliliter. The narrow margin between a therapeutic dose and a dangerous one in newborns made precise measurement critical, and the availability of standardized oral morphine solutions eventually made that precision much easier to achieve without the baggage of paregoric’s complex formulation.
Risks and Why Paregoric Fell Out of Use
Paregoric carries every risk associated with opioid medications: respiratory depression, sedation, constipation (an asset when treating diarrhea but a liability otherwise), physical dependence, and the potential for misuse. Because it contains morphine, chronic use leads to tolerance, requiring increasing doses to achieve the same effect, and abrupt discontinuation after prolonged use causes withdrawal symptoms.
The specific risks of paregoric’s formulation go beyond generic opioid hazards. The camphor component can be toxic to the liver and nervous system, especially in children. Alcohol at 45% concentration is concerning in any medical preparation, but particularly so when given to infants or patients with liver disease. And the combination of multiple active and semi-active ingredients makes it harder to predict drug interactions compared to a single-agent preparation.
For adults, the practical risk of paregoric in its intended diarrhea-control role was modest when used short-term and at recommended doses. The real danger emerged with chronic use, unsupervised use, and use in populations where the formulation’s non-opioid ingredients posed outsized threats. The shift away from paregoric was not driven by any single dramatic event but by the gradual accumulation of safer alternatives and a growing recognition that a medicine containing five or six active compounds when only one was needed was an artifact of a less precise era.
The Difference Between Paregoric and Modern Opioid Antidiarrheals
If paregoric’s main job was to deliver morphine to the gut, you might wonder why it matters that other ingredients came along for the ride. The answer lies in the evolution of pharmaceutical thinking. In the eighteenth century, complex formulations were the norm. Apothecaries believed that mixtures of ingredients could balance and complement each other, and the concept of isolating a single active ingredient was still in its infancy. Paregoric was a product of that era: a polypharmacy in a bottle, each ingredient justified by the medical theories of the time.
Modern antidiarrheals take the opposite approach. Loperamide, the most commonly used over-the-counter option, was designed specifically to activate opioid receptors in the gut wall without crossing into the brain. It controls diarrhea through the same fundamental mechanism as paregoric but without causing sedation, euphoria, or respiratory depression at normal doses. This makes it vastly safer for general use and eliminates the dependence concerns that come with centrally acting opioids.
For patients who need something stronger than loperamide, doctors can prescribe diphenoxylate combined with atropine, another opioid-based antidiarrheal that has atropine added specifically to discourage misuse (taking too much causes unpleasant anticholinergic side effects). Beyond these, the opium tincture used in severe cases delivers morphine in a controlled, single-agent form without camphor, anise, or benzoic acid complicating the picture. Each of these modern options represents a refinement of the same principle paregoric was built on, just stripped of the unnecessary ingredients and dosed with far greater precision.
Paregoric in Popular Culture and Regulation
Paregoric occupies an odd place in cultural memory. People born before the mid-twentieth century often recall it as a common home remedy, something their mothers or grandmothers kept in the medicine cabinet and dispensed with a dropper. Its sweet, anise-flavored taste made it easy to give to children, which was both a practical advantage and a troubling one, since palatability in an opioid preparation encourages overuse.
In the United States, paregoric’s regulatory journey reflects the broader arc of opioid regulation. Before the Harrison Narcotics Tax Act of 1914, it was available without restriction. After 1914, it required a prescription in most contexts but remained accessible through various exemptions. The Controlled Substances Act of 1970 placed it in Schedule III, which is less restrictive than Schedule II (where pure morphine and opium tincture sit) but still requires a prescription and limits refills. Some states imposed additional restrictions, and many pharmacies simply stopped stocking it as demand dropped.
Today, paregoric is technically still a listed drug in the United States Pharmacopeia, but finding a pharmacy that carries it is difficult. Most pharmacists who trained after the 1990s have never dispensed it. Its main relevance in contemporary medicine is as a historical reference point and a cautionary example of how a once-universal remedy can become obsolete when its risks are better understood and its benefits can be achieved more safely through other means.
Camphor and the Forgotten Toxicity Problem
Camphor deserves special attention because its presence in paregoric is one of the clearest examples of an ingredient that persisted in medicine long after evidence showed it was harmful. Camphor is a waxy substance derived from the wood of the camphor laurel tree, and it has been used topically for centuries as a counterirritant and decongestant. When taken internally, however, camphor is a neurotoxin. Even small amounts can cause nausea, vomiting, and confusion. Larger amounts trigger seizures, and camphor poisoning can be fatal, particularly in children.
In paregoric, camphor was included based on the eighteenth-century belief that it had antispasmodic properties that complemented morphine’s pain-relieving effects. Whether camphor actually contributed meaningfully to paregoric’s clinical effects is debatable, and modern pharmacology has not found strong evidence that oral camphor adds therapeutic benefit for diarrhea or abdominal pain. What camphor clearly does is add toxicity risk, especially in the neonatal population where paregoric was used for withdrawal treatment. The presence of a known convulsant in a preparation given to seizure-prone, withdrawing newborns is, in hindsight, a remarkable oversight that persisted for decades.
The broader lesson from camphor’s role in paregoric applies to many older compound medications: ingredients added based on theoretical reasoning centuries ago were never subjected to the kind of rigorous testing that modern drug approval requires. When those formulations persisted through tradition, their unnecessary components carried forward as well, sometimes causing harm that a simpler, single-ingredient preparation would have avoided entirely.