Oxymorphone Hydrochloride

Indications

Oxymorphone Hydrochloride is used for: Moderate to severe pain, Maintain anesthesia

Adult Dose

Preoperative Anesthesia/Analgesia Also effective for relief of anxiety in patients with dyspnea associated with pulmonary edema secondary to acute left ventricular dysfunction 1-1.5 mg IM/SC q4-6hr PRN Analgesia during labor: 0.5-1 mg IM IV: 0.5 mg, increased PRN Moderate-to-Severe Pain Acute pain Immediate-release tablets indicated for acute moderate-to-severe pain where opioid use is appropriate Opioid-naive patients (immediate-release): 10-20 mg PO q4-6 hr PRN initially, then titrated as warranted (may start with 5-mg increments) Conversion from IV oxymorphone to PO: The absolute bioavailability of PO is ~10%, therefore conversion from 1 mg IV q4-6hr is equipotent to 10 mg PO q4-6hr Elderly patients or those with renal or hepatic impairment: 5 mg PO q4-6hr initially Hepatic impairment: Mild: Give the lowest dose w/ careful titration to pain control. Moderate to severe: Contraindicated.

Child Dose

Not recommended

Renal Dose

Renal impairment: Mild to moderate: Give the lowest dose w/ careful titration to pain control. Severe: Contraindicated.

Administration

Contra Indications

Significant respiratory depression Acute or severe bronchial asthma or hypercarbia Known or suspected paralytic ileus Moderate and severe hepatic impairment Hypersensitivity (e.g. anaphylaxis) to oxymorphone

Precautions

Do not stop abruptly; taper gradually to stop treatment. Use caution in patients with acute pancreatitis, Addison disease, benign prostatic hyperplasia, cardiac arrhythmias, central nervous system (CNS) depression, drug abuse or dependence, emotional lability, gallbladder disease, gastrointestinal (GI) disorder, pseudomembranous colitis, GI surgery, head injury, hypothyroidism or untreated myxedema, intracranial hypertension, brain tumor, toxic psychosis, urethral stricture, urinary tract surgery, seizures, acute alcoholism, delirium tremens, shock, cor pulmonale, chronic pulmonary disease, emphysema, kyphoscoliosis, severe obesity, renal or hepatic impairment, elderly or debilitated patients. Avoid alcohol. Reduce dosage if drug is coadministered with other CNS depressants. Thrombocytopenia purpura resulting in kidney failure or death has been reported when extended-release tablets are dissolved and injected IV. May obscure diagnosis of abdominal conditions. Addiction, abuse, and misuse Risk of opioid addiction, abuse, and misuse, which can lead to overdose and death Assess each patient’s risk prior to prescribing and monitor all patients regularly for the development of these behaviors or conditions Life-threatening respiratory depression Serious, life-threatening, or fatal respiratory depression may occur Monitor for respiratory depression, especially during initiation or following a dose increase Lactation: Unknown whether drug is excreted in breast milk; use caution

Pregnancy-Lactation

Interactions

Adverse Effects

Side effects of Oxymorphone Hydrochloride : >10% Dizziness (7-18%),Headache (7-12%),Fever (1-14%),Somnolence (9-19%),Pruritus (8-15%),Nausea (19-33%),Vomiting (9-16%),Constipation (4-28%),Agitation,Angina pectoris,Anticholinergic effects (dry mouth, palpitation, tachycardia),Bradycardia,Cardiac arrest,Coma,Constipation 1-10% Hypotension (<10%),Flushing (<10%),Hypertension (<10%),Edema (<10%),Sedation (1-10%),Nervousness (<10%),Insomnia (<4%),Confusion (3%),Depression (<10%),Disorientation (<10%),Lethargy (<10%),Dehydration (<10%),Flatulence (1-10%),Dyspepsia (<10%),Diarrhea (<4%),Decreased appetite (<3%),Hypoxia (<10%),Dyspnea (<10%),Diaphoresis (1-10%) <1% Agitation,Dermatitis,Bronchospasm,Miosis,Oliguria,Bradycardia,Apnea,Micturition difficulty,Palpitation,Euphoric mood,Urethral spasm,Urinary retention,Physical and psychological dependence,Hot flashes

Mechanism of Action

Opioid agonist; inhibits ascending pain pathways, thus altering response to pain; produces analgesia, respiratory depression, and sedation .