Management of moderate-to-severe pain, when a continuous, around-the-clock opioid analgesic is needed for an extended period of time. 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. Individualize. Do not give via NG tube. Usually not for initial therapy; begin with an immediate-release product and convert to an ext-rel product. May be given on 24 hour or 12 hour schedule. Adjust dose at 1–2 day intervals. 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.
Abuse potential. Life-threatening respiratory depression; monitor first 24–72hrs after initiating therapy and during dose increases. Accidental ingestion may cause fatal overdose (esp. in children). 100mg, 130mg, 150mg and 200mg caps: for use in opioid-tolerant patients only. Head injury. Increased intracranial pressure. CNS depression. Coma. Convulsive disorders. Shock. Impaired renal, hepatic or pulmonary function. Prostatic hypertrophy. COPD. Cor pulmonale. GI or GU obstruction. Biliary tract disease. Acute pancreatitis. Drug abusers. Acute alcoholism. Avoid abrupt cessation. Elderly. Cachectic. Debilitated. Pregnancy (Cat.C). Labor & delivery, nursing mothers: not recommended.
During or within 14 days of MAOIs: not recommended. Potentiated by alcohol (potentially fatal overdose). CNS depression with other CNS depressants (eg, sedatives, hypnotics, general anesthetics, antiemetics, phenothiazines, tranquilizers; reduce initial dose of either). Avoid muscle relaxants. Antagonizes diuretics. Possible withdrawal symptoms with mixed agonist/antagonist opioids; avoid. Paralytic ileus with anticholinergics. May be potentiated by PGP inhibitors (eg, quinidine). Potentiated by cimetidine; monitor.
Drowsiness, constipation, nausea, dizziness, anxiety, asthenia, GI disturbances, respiratory depression or arrest, circulatory depression, cardiac arrest, hypotension, shock.
20mg, 30mg, 50mg, 60mg, 80mg, 100mg (YES); 10mg, 40mg, 70mg, 130mg, 150mg, 200mg (NO)