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oxymorphone

Pronunciation

Generic Name: oxymorphone (OX ee MOR fone)
Brand Name: Opana, Opana ER, Numorphan HCl

What is oxymorphone?

Oxymorphone is an opioid pain medication. An opioid is sometimes called a narcotic.

Oxymorphone is used to treat moderate to severe pain.

The extended-release form of this medicine is for around-the-clock treatment of pain. This form of oxymorphone is not for use on an as-needed basis for pain.

Oxymorphone may also be used for purposes not listed in this medication guide.

What is the most important information I should know about oxymorphone?

You should not use this medicine if you have severe asthma or breathing problems, a blockage in your stomach or intestines, or moderate to severe liver disease.

Oxymorphone can slow or stop your breathing. Never use this medicine in larger amounts, or for longer than prescribed. Do not crush, break, or open an extended-release pill. Swallow it whole to avoid exposure to a potentially fatal dose. Oxymorphone may be habit-forming, even at regular doses. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

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MISUSE OF NARCOTIC MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription.

Tell your doctor if you are pregnant. Oxymorphone may cause life-threatening withdrawal symptoms in your newborn if you use the medication during pregnancy.

Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with oxymorphone.

What should I discuss with my healthcare provider before using oxymorphone?

You should not take this medicine if you are allergic to oxymorphone, or if you have:

  • severe asthma or breathing problems;

  • a blockage in your stomach or intestines; or

  • moderate to severe liver disease.

To make sure oxymorphone is safe for you, tell your doctor if you have:

  • any type of breathing problem or lung disease;

  • a history of head injury, brain tumor, or seizures;

  • a history of drug abuse, alcohol addiction, or mental illness;

  • urination problems;

  • liver or kidney problems; or

  • problems with your gallbladder, pancreas, or thyroid.

It is not known whether this medicine will harm an unborn baby. If you use oxymorphone while you are pregnant, your baby could become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on habit-forming medicine may need medical treatment for several weeks. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether oxymorphone passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I use oxymorphone?

Follow all directions on your prescription label. Oxymorphone can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never use oxymorphone in larger amounts, or for longer than prescribed. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Oxymorphone may be habit-forming, even at regular doses. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. MISUSE OF NARCOTIC MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription. Selling or giving away oxymorphone is against the law.

Always check your bottle to make sure you have received the correct pills (same brand and type) of medicine prescribed by your doctor. Ask the pharmacist if you have any questions about the medicine you receive at the pharmacy.

Stop taking all other around-the-clock narcotic pain medications when you start taking oxymorphone.

Take oxymorphone on an empty stomach, at least 1 hour before or 2 hours after a meal.

Do not crush, break, or open an extended-release pill. Swallow it whole to avoid exposure to a potentially fatal dose.

Some forms of oxymorphone are made with ingredients that are not absorbed in the body. Part of the tablet may appear in your stool. This is a normal side effect of oxymorphone and will not make the medication less effective.

Do not stop using this medicine suddenly after long-term use, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using oxymorphone.

Never crush or break a oxymorphone pill to inhale the powder or mix it into a liquid to inject the drug into your vein. This practice has resulted in death with the misuse of oxymorphone and similar prescription drugs.

Store at room temperature away from moisture, heat, and light.

Keep track of the amount of medicine used from each new bottle. Oxymorphone is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

Do not keep leftover oxymorphone pills. Ask your pharmacist where to locate a drug take-back disposal program. If there is no take-back program, flush any unused pills down the toilet.

What happens if I miss a dose?

Since oxymorphone is used for pain, you are not likely to miss a dose. Skip any missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. A oxymorphone overdose can be fatal, especially in a child or other person using the medicine without a prescription.

Overdose symptoms may include extreme drowsiness, muscle weakness, confusion, cold and clammy skin, pinpoint pupils, shallow breathing, slow heart rate, fainting, or coma.

What should I avoid while using oxymorphone?

Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with oxymorphone. Check your food and medicine labels to be sure these products do not contain alcohol.

This medication may impair your thinking or reactions. Avoid driving or operating machinery until you know how oxymorphone will affect you. Dizziness or severe drowsiness can cause falls or other accidents.

Oxymorphone side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • a light-headed feeling, like you might pass out;

  • seizure (convulsions);

  • fever, chills, cough with yellow or green mucus;

  • stabbing chest pain, wheezing, feeling short of breath; or

  • severe vomiting.

Oxymorphone is more likely to cause breathing problems in older adults and people who are severely ill, malnourished, or otherwise debilitated.

Common side effects may include:

  • stomach pain, nausea, vomiting, loss of appetite, constipation, diarrhea;

  • dizziness, drowsiness, headache, tired feeling;

  • dry mouth, increased sweating;

  • sleep problems (insomnia); or

  • mild rash or itching.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Oxymorphone dosing information

Usual Adult Dose for Pain:

The following dosing recommendations can only be considered suggested approaches to what is actually a series of clinical decisions over time; each patient should be managed individually.

ORAL:
Patients Who Are Not Opioid-Experienced:
-Initial dose: 10 to 20 mg orally every 4 to 6 hours; may consider 5 mg orally every 4 to 6 hours if deemed necessary
-Maintenance dose: Titrate cautiously to an acceptable level of analgesia taking into account the pain intensity and side effects experienced.

Conversion from Injection to Oral:
-Administering 10 times the total daily parenteral dose in 4 to 6 equally divided oral oxymorphone doses.

Conversion from Other Oral Opioids to Oral Oxymorphone:
-Determine equipotent dose using published potency tables; it is safest to start therapy by administering one-half the calculated total daily oxymorphone requirement in 4 to 6 equally divided oral doses every 4 to 6 hours and gradually adjust dose as needed.

Comments:
-The oxymorphone 5 mg tablet strength is available as both immediate-release and extended-release; it is important to clarify which product is being used.
-Initiation of therapy with oral doses higher than 20 mg is not recommended because of potential serious side effects.
-Dose conversion should be done carefully and with close monitoring due to large patient variability in regards to opioid analgesic response.
-Upon cessation of therapy, taper gradually in physically dependent patient.

Use: For the relief of moderate to severe pain where the use of an opioid is appropriate.

PARENTERAL:
Initial dose: 0.5 mg IV or 1 mg to 1.5 mg IM/subcutaneously every 4 to 6 hours as needed
Maintenance dose: Titrate cautiously to an acceptable level of analgesia taking into account the pain intensity and side effects experienced.

Conversion from Oral to Injection
-Patients receiving oral oxymorphone may be converted to injection by administering one-tenth the total daily oral dose in 4 to 6 equally divided parenteral doses.

Comments:
-Doses are adjusted to an acceptable level of analgesia taking into account the pain intensity and side effects experienced.
-Dose conversion should be done carefully and with close monitoring due to large patient variability in regards to opioid analgesic response.

Uses:
-For the relief of moderate to severe pain where the use of an opioid is appropriate.
-For relief of anxiety in patients with dyspnea associated with pulmonary edema secondary to acute left ventricular dysfunction.

Usual Adult Dose for Labor Pain:

Initial dose: 0.5 mg to 1 mg intramuscularly

Comments: Use caution during labor as opioids are known to cross the placenta and may produce respiratory depression in neonates; monitor neonates closely for signs of respiratory depression.

Use: For obstetrical analgesia.

Usual Adult Dose for Chronic Pain:

The following dosing recommendations can only be considered suggested approaches to what is actually a series of clinical decisions over time; each patient should be managed individually.

Use as the First Opioid Analgesic or for those who are NOT Opioid Tolerant:
Initial dose: Extended-release tablets: 5 mg orally every 12 hours

CONVERSION DOSES:
Immediate-Release Oxymorphone to Extended-Release Oxymorphone Tablets:
-Administer one-half the patient's total daily immediate-release requirement as extended-release tablet taken orally every 12 hours

Parenteral Oxymorphone to Extended-Release Oxymorphone:
-Give 10 times the patient's total daily parenteral oxymorphone dose as extended-release tablet taken in 2 equally divided doses orally every 12 hours.

From Other Oral Opioids to Oxymorphone Extended-Release Tablets:
-Discontinue all other around-the-clock opioid drugs when oxymorphone extended-release therapy is initiated.
-Published potency tables can be used to estimate a patient's 24-hour oral oxymorphone requirement; however, due to substantial inter-patient variability, the conversion should then underestimate a patient's 24-hour requirement and provide rescue medication as the dose is titrated.
-Alternatively, the following conversion factors (CF) may be used to convert selected oral opioids to the extended-release oxymorphone tablet: Oxymorphone, CF=1; Hydrocodone, CF=0.5; Oxycodone, CF=0.5; Methadone, CF= 0.5, Morphine, CF=0.333
-As an example: Sum the total daily dose of prior oral opioid; multiply that sum by the CF to obtain 24-hour oral oxymorphone requirement; divide by 2 to calculate approximate starting dose to be given every 12 hours, round down, if necessary.
-These CFs cannot be used to convert from oxymorphone extended-release tablets to the selected oral opioid as doing so will result in overestimation of the oral opioid dose and may result in fatal respiratory depression

TITRATION AND MAINTENANCE:
Maintenance Dose: Individually titrate to a dose that provides adequate analgesia and minimizes adverse reactions; dose adjustments may be made in 5 to 10 mg increments every 12 hours, every 3 to 7 days.
Breakthrough Pain: If the level of pain increases after dose stabilization, attempt to identify the source before increasing dose; rescue medication with appropriate immediate-release analgesia may be helpful

Comments:
-An opioid tolerant patient is one who has been receiving for 1-week or longer at least: oral morphine 60 mg/day, fentanyl transdermal patch 25 mcg per hour, oral oxycodone 30 mg/day, oral hydromorphone 8 mg/day, oral oxymorphone 25 mg/day, or an equianalgesic dose of another opioid
-When converting from methadone, close monitoring is of particular importance due to methadone's long half-life.
-Dose conversion should be done carefully and with close monitoring due to large patient variability in regards to opioid analgesic response.
-Upon cessation of therapy, taper gradually in physically dependent patient.

Use: For the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.

What other drugs will affect oxymorphone?

Taking this medicine with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking oxymorphone with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Other drugs may interact with oxymorphone, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about oxymorphone.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 8.07. Revision Date: 2015-06-08, 1:38:17 PM.

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