b>Use of Oral Oxymorphone in the Elderly</b
To review the pharmacodynamics, pharmacokinetics, efficacy, tolerability, dosing, and role of oral oxymorphone immediate-release (IR) and extended-release (ER).
A MEDLINE/PUBMED search (1970 to September 2006) of English language studies. Additional references were obtained from their bibliographies.
All human studies of oxymorphone were reviewed.
Oral oxymorphone IR/ER tablet formulations were approved in June 2006. Oxymorphone, a semi-synthetic -opioid receptor agonist structurally similar to hydromorphone, has an oral bioavailability of approximately 10%. Oxymorphone is extensively metabolized to oxymorphone-3-glucuronide and the active 6-hydroxyoxymorphone. Rapid clearance mandates every four- to six-hour dosing (IR) and every 12-hour dosing (ER). Hepatic impairment, renal impairment, and aging enhance systemic exposure. Oxymorphone IR was superior to placebo and oxycodone IR (acute pain studies). Oxymorphone ER was superior to placebo and equivalent to oxycodone CR and morphine CR (one acute and five chronic pain studies). Oxymorphone exhibits the expected opioid side effects, being comparable to oxycodone and morphine in clinical trials. Coadministration with ethanol causes "dose-dumping" (ER) and increases intersubject variability in drug absorption. Oxymorphone IR is indicated for the relief of moderate-to-severe pain, while oxymorphone ER is indicated for persistent pain. Initial doses (opioid-naïve) are 10 mg to 20 mg every 4 to 6 hours (IR) and 5 mg every 12 hours (ER). Dosage adjustment is recommended in mild hepatic impairment (Child-Pugh class A), renal impairment (creatinine clearance below 50 mL/min), and in the elderly.
Oxymorphone is the newest oral opioid to enter a crowded marketplace now totaling 12 Schedule 2 opioids. It does not appear to have any unique assets or liabilities and should be considered as one of many oral opioids for the management of acute and persistent pain of moderate-to-severe intensity.
Available from: Diane Chau
- "Oral oxymorphone IR/ER tablet formulations are a semisynthetic opioid receptor agonist structurally similar to hydromorphone. Elderly patients can have increased plasma levels and systemic effects (Guay 2007 "
[Show abstract] [Hide abstract]
ABSTRACT: The evaluation of pain and the subsequent issue of pain control is a clinical challenge that all healthcare providers face. Pain in the elderly population is especially difficult given the myriad of physiological, pharmacological, and psychological aspects of caring for the geriatric patient. Opiates are the mainstay of pain treatment throughout all age groups but special attention must be paid to the efficacy and side effects of these powerful drugs when prescribing to a population with impaired metabolism, excretion and physical reserve. In a random chart review of 300 US veterans, 44% of those receiving an analgesic also received opioids. The increasing use of opiates for pain management by healthcare practitioners requires that those prescribing opioids be aware of the special considerations for treating the elderly. This article will address the precautions one must take when using opiates in the geriatric population, as well as the side effects and ways to minimize them.
[Show abstract] [Hide abstract]
ABSTRACT: Naturally occurring opioids have been used as analgesics for thousands of years. From these, semisynthetic and synthetic derivatives have emerged in the search for the 'perfect' opioid analgesic, without success. Weak opioid analgesics include codeine and propoxyphene, intermediate-strength opioid analgesics include the agonist-antagonists (e.g., pentazocine and butorphanol) and the partial agonist buprenorphine and the strong opioid analgesics include morphine, oxycodone, oxymorphone, hydrocodone, hydromorphone, fentanyl and meperidine. Propoxyphene, meperidine, agonist- antagonists and partial agonists should be avoided in most elderly patients owing to their unfavorable risk-benefit profiles. The other opioids can be recommended for use in the elderly and appear to be interchangeable (in equianalgesic doses) based upon similar efficacy and tolerability profiles. The aging process alters the pharmacokinetics of nearly all opioid analgesics, mainly due to alternations in the activity of excretory pathways (liver and kidneys). The need for frequent dosing of these drugs, due to their short terminal disposition half-lives, can be largely overcome by using oral or transdermal extended-release formulations that allow dosing as infrequently as every 3 days. Opioid side effects can be anticipated and, in virtually all cases, either tolerance develops or pre-emptive therapy can prevent the emergence of or minimize the impact of the side effect (e.g., laxative therapy prevents constipation). Opioid analgesics are effective for virtually all types of pain, including neuropathic pain (where chronic opioid therapy works, while 'as-needed' therapy does not). This review summarizes the evidence for and against the use of individual opioid analgesics in the elderly. This, in turn, should promote the safe and effective use of the preferred opioid analgesics in this patient population.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.