Morphine to Hydrocodone: Switching Between Two Extended-Release Pain Drugs
According to a study published in Pain Practice, patients with moderate-to-severe chronic pain who switch from morphine extended-release (ER) to once-daily hydrocodone bitartrate experienced maintained or improved pain relief without an increase in safety concerns.
Kathleen Broglio, DNP, from Columbia University Medical Center, and colleagues conducted a post-hoc analysis to examine the efficacy and safety of hydrocodone bitartrate in patients who were previously taking morphine ER for pain management. The open-label, 12-month study was conducted in 88 sites across the country.
Study patients were titrated to a once-daily dose of hydrocodone bitartrate 20mg, 40mg, 60mg, 80mg, or 120mg for 45 days. The subgroup of patients was taking morphine ER prior to study entry. Patients then entered a 12-month maintenance period once stabilized on a hydrocodone bitartrate daily dose, in which additional dose adjustments could be made and non-opioid or short-acting opioids could be received.
Pain over the last 24 hours was documented daily (scale of 0–10) and patients also completed the Brief Pain (BPI) short form every 4 weeks, which evaluated pain severity and the interference of pain in daily life.
Of the 26 patients who switched from morphine ER to hydrocodone bitartrate, 19 entered the maintenance period. The mean average pain over the last 24 hours reduced from 5.21 at study entry to 3.90 by the time patients entered the maintenance phase. This level was sustained over the 12-month period; 16 patients did not require further hydrocodone bitartrate dose adjustment. In addition, BPI scores decreased for both pain severity and pain interference during the maintenance period. Dr. Broglio added that hydrocodone bitartrate therapy was well tolerated.
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