Names and pronunciation
(oh′li-ser′i-deen) Olinvyk
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Drug reference
(oh′li-ser′i-deen) Olinvyk
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Func. class.: Opioid analgesic Controlled Substance II
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ACTION: Binds to the opioid mu receptor to produce analgesia
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USES: Acute pain
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CONTRAINDICATIONS: Hypersensitivity, severe respiratory depression, GI obstruction, asthma Precautions: Pregnancy, breastfeeding, abuse, neonatal opioid withdrawal syn- drome, use with benzodiazepine or other CNS depressants, QT prolongation, chronic pulmonary disease, adrenal insuf- ficiency, hypotension, GI disease, seizures
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SIDE EFFECTS CNS: Dizziness, somnolence, sedation, headache, flushing GI: Nausea, vomiting, constipation INTEG: Pruritus RESP: Respiratory depression, decreased O2 saturation MS: Back pain
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INTERACTIONS Increase: Oliceridine effect—moderate- strong inhibitors of CYP3A4 (macrolides, azoles, protease inhibitors); moderate- strong CYP2D6 inhibitors (fluoxetine, quinidine, bupropion); benzodiazepines, other CNS depressants; monitor for respiratory depression/sedation Increase: Serotonin effects—SSRIs, SNRIs, tricyclic antidepressants, triptans, 5-HT3 receptor antagonists, mirtazapine, trazodone, tramadol, cyclobenzaprine, metaxalone, MAOIs, linezolid, IV methylene blue; observe for serotonin symptoms Increase: Respiratory depression— muscle relaxants; monitor for respiratory depression Increase: Urinary retention, paralytic ileus—anticholinergics; monitor for uri- nary retention, paralytic ileus Decrease: Oliceridine effect—CYP3A4 inducers (rifampin, carbamazepine, phenytoin), mixed agonist/antagonists, partial agonist opioids; monitor for signs of opioid withdrawal Decrease: Diuretic effect—diuretics, monitor B/P, urinary output NURSING CONSIDERATIONS Assess • Pain: Location, intensity, type, charac- ter; check for pain relief 20 min follow- ing • IV, to relieve pain; give dose before pain becomes severe • Bowel status; constipation is com- mon, use stimulant laxative if needed; provide increased bulk, fluids in diet • B/P, pulse, respirations (character, depth, rate) • CNS changes: Dizziness, drowsiness, euphoria, LOC, pupil reaction • Abrupt discontinuation: Gradually taper to prevent withdrawal symptoms • Respiratory dysfunction: Depression, character, rate, rhythm; notify prescriber if respirations are <12/min • Pregnancy/breastfeeding: Use only if benefits outweigh risk to fetus; longer use can result in neonatal opioid with- drawal syndrome; do not breastfeed Evaluate • Therapeutic response: Control of pain without adverse reactions Teach patient/family • To report change in pain control • To report constipation, as other prod- ucts will need to be used • To change position slowly; orthostatic hypotension may occur • To report any symptoms of CNS changes, allergic reactions • That physical dependency may result from long-term use • That withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faint- ness, anorexia • To report serotonin syndrome Treatment of overdose • Naloxone (Narcan), O2, IV fluids, va- sopressors
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DOSAGE AND ROUTES Acute pain Adult IV bolus 1.5 mg; may give another 0.75 mg after 1 hr; doses may be repeated ≥1 hr and titrated based on tolerability and response; max single supplemental dose: 3 mg; max total daily dose: 27 mg Adult: PCA: 1.5 mg (given by provider); demand dose: range: 0.35-0.5 mg; lock- out interval: 6 min; supplemental dose (administered by health care provider): 0.75 mg; may be administered beginning 1 hr after the initial dose and repeated hourly as needed; may be used in addi- tion to the demand dose if needed for adequate response Max cumulative daily dose: 27 mg; an initial dose of oliceridine 1 mg = morphine 5 mg
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Available forms: IV solution (preserva- tive free): 1 mg/mL (1 mL); 2 mg/2 mL (2 mL); 30 mg/30 mL (30 mL)
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Administer: IV direct route • No dilution needed • Use the 1 mg/mL and 2 mg/2 mL single-dose vials for direct use only • PCA: Withdraw directly into a PCA sy- ringe or IV bag; no dilution needed; 30 mg/30 mL vial is for PCA only • Store at room temperature, do not freeze, protect from light
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PHARMACOKINETICS O Onset <5 min, half-life 1.3-3 hr, metabo- lite 44 hr, protein binding 77%
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