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Moderate-to-Severe Pain

Acute pain

• Buy Opana ER 7.5mg Online, Immediate-release tablets are indicated for acute moderate-to-severe pain where pain is severe enough to require an opioid analgesic and for which alternative therapies are inadequate
• Opioid-naive patients (immediate-release): 10-20 mg PO q4-6 hr PRN initially, then titrated as warranted (may start with 5-mg increments)

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Extended-release oxymorphone is indicated 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

Extended-release tablet initial dosing

• Patients who are opioid-naive or not opioid-tolerant

  • 5 mg PO q12hr initially, then titrated in increments of 5-10 mg q12hr every 3-7 days to level that provides adequate analgesia and minimizes side effects

• Patients who are opioid-tolerant

  • Buy Opana ER 7.5mg Online, Opioid-tolerant definition: Patients who are receiving, for 1 week or longer, at least 60 mg/day PO morphine, 25 mcg/hr transdermal fentanyl, 30 mg/day PO oxycodone, 8 mg/day PO hydromorphone, 25 mg/day PO oxymorphone, or an equianalgesic dose of another opioid
  • Conversion from immediate-release to extended-release oxymorphone: Administer one-half of total immediate-release daily dose as extended-release q12hr
  • Conversion from other opioids: Refer to equianalgesic recommendations within the prescribing information

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Renal impairment

• Immediate-release tablet; CrCl <50 mL/min: Initiate therapy at lowest dose (eg, 5 mg); titrate to effect slowly; monitor

• Extended-release tablet

  • CrCl <50 mL/min (opioid-naïve): Initiate with 5 mg PO q12hr
  • CrCl <50 mL/min (prior opioid therapy): Initiate at 50% lower than the starting dose for a patient with normal hepatic function and titrate slowly

Hepatic impairment

• Mild; immediate-release or injection: Initiate therapy at lowest dose; titrate to effect slowly; monitor
• Moderate to severe: Contraindicated

• Extended-release

  • Mild (opioid-naïve): Initiate with 5 mg PO q12hr
  • Mild (prior opioid therapy): Initiate at 50% lower than the starting dose for a patient with normal hepatic function and titrate slowly
  • Moderate or severe: Contraindicated

Dosing Considerations

Immediate-release tablets

• Limitations of use

  • Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, reserve use when alternative treatment options (eg, nonopioid analgesics, opioid/opioid antagonist combination products) have not been tolerated, or are not expected to be tolerated, or have not provided adequate analgesia, or are not expected to provide adequate analgesia

Extended-release tablets

• Limitations of use

  • Because of risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because the greater risks of overdose and death with extended-release formulations, reserve for use in patients for whom alternative treatment options (eg, nonopioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient pain management
  • Extended-release formulations are not indicated as an as-needed (prn) analgesic

Access to naloxone for opioid overdose

• Assess need for naloxone upon initiating and renewing treatment

• Consider prescribing naloxone

  • Based on patient’s risk factors for overdose (eg, concomitant use of CNS depressants, a history of opioid use disorder, prior opioid overdose); presence of risk factors should not prevent proper pain management
  • Household members (including children) or other close contacts at risk for accidental ingestion or overdose

• Consult patients and caregivers on the following:

  • Availability of naloxone for emergency treatment of opioid overdose
  • Ways differ on how to obtain naloxone as permitted by individual state dispensing and prescribing requirements or guidelines (eg, by prescription, directly from a pharmacist, as part of a community-based program)