Select therapeutic use:
Indications for KADIAN:
Management of moderate-to-severe pain, when a continuous, around-the-clock opioid analgesic is needed for an extended period of time.
Limitations Of use:
Not for use as an as-needed (prn) analgesic, for pain that is mild or not expected to persist for an extended period of time, for acute pain, or for postoperative pain unless already receiving chronic opioid therapy prior to surgery or if the postoperative pain is expected to be moderate to severe and persist for an extended period of time
Swallow whole or may sprinkle contents on applesauce. May be given through 16 French gastrostomy tube. Do not give via NG tube. Individualize. May be given on 24hr or 12hr schedule. Usually not for initial therapy; begin with an immediate-release product and convert to an ext-rel product. Opioid non-tolerant: initially 30mg every 24hrs. Adjust dose at 1–2 day intervals. 100mg, 130mg, 150mg and 200mg caps: for use in opioid-tolerant patients only. Withdraw gradually; downward titration every 2–4 days. Conversion from other morphine formulations, other opioids: see full labeling.
<18yrs: not established.
Significant respiratory depression. Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment. Known or suspected paralytic ileus.
Increased risk of fatal respiratory depression (esp. when initiating therapy and during dose increases); monitor. Abuse potential (monitor routinely). Accidental exposure may result in fatal overdose (esp. children). Risk of neonatal opioid withdrawal syndrome. Pulmonary disease (eg, COPD, cor pulmonale); monitor for respiratory depression (esp. within the first 24–72hrs of initiating therapy and after dose increases); consider alternative non-opioid analgesic. Head injury. Increased intracranial pressure. Convulsive disorders. Brain tumors. CNS depression. Impaired consciousness, coma, shock, GI obstruction; avoid. Biliary tract disease. Acute pancreatitis. Drug abusers. Avoid abrupt cessation. Elderly. Cachectic. Debilitated. Pregnancy (Cat.C). Labor & delivery, nursing mothers: not recommended.
Potentiated by alcohol (potentially fatal overdose): not recommended. During or within 14 days of MAOIs: not recommended. Avoid mixed agonist/antagonist opioids (eg, butorphanol, nalbuphine, pentazocine) or partial agonist (eg, buprenorphine); may reduce effects and precipitate withdrawal symptoms. Increased risk of respiratory depression with other CNS depressants (eg, sedatives, hypnotics, anxiolytics, neuroleptics, general anesthetics, phenothiazines, tranquilizers, other opioids; reduce initial dose of either). Monitor for respiratory depression with muscle relaxants. Antagonizes diuretics. Paralytic ileus with anticholinergics; monitor. May be potentiated by P-gp inhibitors (eg, quinidine). Potentiated by cimetidine; monitor. May increase serum amylase.
Constipation, nausea, somnolence, dizziness, anxiety; respiratory or circulatory depression, orthostatic hypotension, syncope, neonatal opioid withdrawal syndrome.
20mg, 30mg, 50mg, 60mg, 80mg, 100mg (YES); 10mg, 40mg, 70mg, 130mg, 150mg, 200mg (NO)