Names and pronunciation
(ox-i-mor′fone)
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Drug reference
(ox-i-mor′fone)
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Func. class.: Opiate analgesic
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Chem. class.: Semisynthetic phenan- threne derivative Controlled Substance Schedule II
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Do not confuse: oxyMORphone/oxyCODONE
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ACTION: Inhibits ascending pain pathways in CNS, increases pain thresh- old, alters pain perception
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USES: Moderate to severe pain
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CONTRAINDICATIONS: Hypersen- sitivity, addiction (opiate), asthma, hepatic disease, ileus, intrathecal use, surgery
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Black Box Warning: Respiratory depres- sion Precautions: Pregnancy (short-term), breastfeeding, children <18 yr, addictive personality, increased intracranial pres- sure, MI (acute), severe heart disease, respiratory depression, renal/hepatic disease, bowel impaction Black Box Warning: Alcoholism, opioid- naive patients, substance abuse Black Box Warning: Increase: effects with other CNS depressants—alcohol, opiates, sedative/hypnotics, antipsychot- ics, skeletal muscle relaxants • Increase: unpredictable effects/reac- tions—MAOIs • Increase: serotonin syndrome SNRIs, SSRIs, tricyclics, MAOIs Drug/Herb Increase: sedative effect—kava, St. John’s wort, valerian Drug/Lab Test Increase: amylase Drug/Herb Increase: Serotonin syndrome—St. John's wort Black Box Warning: Respiratory dysfunc- tion: respiratory depression, character, rate, rhythm; notify prescriber if respirations are <10/min; dose may need to be decreased by 25%-50%; monitor B/P, pulse also Black Box Warning: Accidental ex- posure: dispose of properly, away from children/pets Black Box Warning: Overdose/poison- ing: avoid alcohol ingestion, do not crush, chew, snort, or inject tabs, high abuse potential, assess for abuse Black Box Warning: Opioid-naive pa- tients: ext rel tabs are not to be used im- mediately postop (12-24 hr after surgery) in these patients • Abrupt discontinuation: Taper after long-term use, assess for withdrawal: anxi- ety, restlessness, cramps, nausea/vomiting • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; neonatal opi- oid withdrawal syndrome may occur with extended use; avoid breastfeeding • Beers: avoid use in older adults; ataxia, impaired psychomotor function may occur
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SIDE EFFECTS CNS: Drowsiness, dizziness, confusion, headache, hallucinations, increased intracranial pressure, sedation, seizures, euphoria (geriatric patients) CV: Palpitations, bradycardia, change in B/P, hypotension EENT: Tinnitus, blurred vision, miosis, diplopia GI: Nausea, vomiting, anorexia, con- stipation, cramps GU: Dysuria, urinary retention INTEG: Rash, urticaria, bruising, flush- ing, diaphoresis, pruritus RESP: Respiratory depression
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INTERACTIONS
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TREATMENT OF OVERDOSE: Naloxone (Narcan) 0.2-0.8 mg IV (caution with patients physically dependent on opi- oids), O2, IV fluids, vasopressors HIGH ALERT
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DOSAGE AND ROUTES Acute pain • Adult: PO IR 5-10 mg q4-6hr prn (opioid naive) Chronic pain • Adult: PO ext rel 5 mg q12hr
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Available forms: Tabs 5, 10 mg; tabs ext rel 5, 7.5, 10, 15, 20, 30, 40 mg
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Administer: • 1 hr before or 2 hr after food (PO) • With antiemetic for nausea, vomiting • When pain is beginning to return; de- termine interval by response • Store in light-resistant area at room temperature
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Assess: • Pain: location, intensity, type, other characteristics before and after need for pain medication, physical dependence, give 25%-50% until pain reduction of 50% on pain rating scale, repeat dose may be given at time of peak if previous dose does not control pain and respira- tory depression has not occurred • I&O ratio for decreasing output; may indicate urinary retention • Bowel status: constipation; may need stimulative laxative if use ≥3 days; in- creased fluids, fiber for prevention • CNS changes: dizziness, drowsiness, hal- lucinations, euphoria, LOC, pupil reaction • Allergic reactions: rash, urticaria
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Evaluate: • Therapeutic response: decrease in pain
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report any symptoms of CNS changes, allergic reactions, serotonin syndrome • That physical dependency may result from extended use • That withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faint- ness, anorexia • Not to drive or operate machinery if drowsiness occurs • Not to use other CNS depressants, alcohol • To make position changes slowly to prevent orthostatic hypotension • To notify prescriber of all OTC, Rx, herbs, supplements being taken; not to take new products unless approved by prescriber • To notify health care professional if pregnancy is planned or suspected; avoid breastfeeding
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PHARMACOKINETICS Metabolized by liver, excreted in urine, crosses placenta, half-life: PO: 7-9 hr, ext rel: 9-11 hr PO: Peak 1 hr (fasting)
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• Adult: PO IR 5-10 mg q4-6hr prn (opioid naive) Chronic pain
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• Adult: PO ext rel 5 mg q12hr
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