Converting to OPANA®
Converting to OPANA®
Converting from other short-acting oral opioids to OPANA1
| Opioid |
Approximate
Equivalent
Oral Dose |
Oral
Conversion
Ratioa |
a Ratio for conversion of oral opioid dose to approximate OPANA equivalent dose. Select opioid and multiply the dose by the conversion ratio to calculate the approximate oral oxymorphone equivalent.
b It is extremely important to monitor all patients closely when converting from methadone to other opioid agonists. The ratio between methadone and other opioid agonists may vary widely as a function of previous dose exposure. Methadone has a long half-life and tends to accumulate in the plasma.
The conversion ratios and approximate equivalent doses in this conversion table are only to be used for the conversion from current opioid therapy to OPANA.
|
| Oxymorphone |
10mg |
1 |
| Hydrocodone |
20mg |
0.5 |
| Oxycodone |
20mg |
0.5 |
| Methadoneb |
20mg |
0.5 |
| Morphine |
30mg |
0.333 |
Conversion steps
- Step 1: Use the conversion chart to calculate the total daily dose of OPANA
- Step 2: Administer this calculated total daily dose as equally divided doses every 4-6 hours as needed
- Step 3: Titrate as needed until adequate pain relief and acceptable side effects have been achieved
Vicodin® to OPANA sample calculation
A healthcare professional with a patient on a total daily dose of Vicodin 40 mg hydrocodone/4,000 mg APAP could do the following calculation:
- 40 mg hydrocodone x 0.5 = 20 mg (approximate oxymorphone total daily dose)
- Administer as 5 mg OPANA ER every 4-6 hours as needed
- Titrate as needed
Vicodin® is a registered trademark of Abbott Laboratories.
Learn about Converting from OPANA to OPANA ER
Additional Safety Information1
- OPANA TABLETS are to be swallowed whole and are not to be broken, chewed, dissolved, or crushed
- Patients must not consume alcoholic beverages, or prescription or nonprescription medications containing alcohol, while on OPANA therapy. The co-ingestion of alcohol with OPANA may result in increased plasma levels and a potentially fatal overdose of oxymorphone
- OPANA should be administered on an empty stomach, at least 1 hour prior to or 2 hours after eating
- Elderly patients, patients with mild hepatic impairment and patients with moderate or severe renal impairment should be started at the lowest dose and titrated slowly while carefully monitoring for side effects
- OPANA, like all opioid analgesics, should be started at 1/3 to 1/2 of the usual dose in patients who are concurrently receiving other CNS depressants
- Safety and effectiveness of OPANA in pediatric patients below the age of 18 years have not been established
Please see Important Safety Information, including boxed WARNING. Get the Full Prescribing Information for OPANA.
WARNING: OPANA ER contains oxymorphone, which is a morphine-like opioid agonist and a Schedule II
controlled substance, with an abuse liability similar to other opioid analgesics.
Oxymorphone can be abused in a manner similar to other opioid agonists, legal or illicit. This should be
considered when prescribing or dispensing OPANA ER in situations where the physician or pharmacist is
concerned about an increased risk of misuse, abuse, or diversion.
OPANA ER is an extended-release oral formulation of oxymorphone indicated for the management of
moderate to severe pain when a continuous, around-the-clock opioid analgesic is needed for an extended
period of time.
OPANA ER is NOT intended for use as an as needed analgesic.
OPANA ER TABLETS are to be swallowed whole and are not to be broken, chewed, dissolved, or crushed.
Taking broken, chewed, dissolved, or crushed OPANA ER TABLETS leads to rapid release and absorption of
a potentially fatal dose of oxymorphone.
Patients must not consume alcoholic beverages, or prescription or nonprescription medications containing
alcohol, while on OPANA ER therapy. The co-ingestion of alcohol with OPANA ER may result in increased
plasma levels and a potentially fatal overdose of oxymorphone.
OPANA, like OPANA ER, contains oxymorphone, an opioid agonist and Schedule II controlled substance with an abuse liability similar to morphine and can be abused in a manner similar to other opioid agonists, legal or illicit
OPANA and OPANA ER are contraindicated in patients with a known hypersensitivity to oxymorphone hydrochloride, morphine analogs such as codeine, or any of the other ingredients of OPANA and OPANA ER; in patients with moderate or severe hepatic impairment or in any situation where opioids are contraindicated such as: patients with respiratory depression (in the absence of resuscitative equipment or in unmonitored settings), acute or severe bronchial asthma, hypercarbia, and in any patient who has or is suspected of having paralytic ileus
OPANA ER is not indicated for pain in the immediate post-operative period (the first 12–24 hours following surgery), or if the pain is mild, or not expected to persist for an extended period of time. OPANA ER is only indicated for post-operative use if the patient is already receiving the drug prior to surgery or if the post-operative pain is expected to be moderate or severe and persist for an extended period of time. Physicians should individualize treatment, moving from parenteral to oral analgesics as appropriate (see American Pain Society guidelines)
Respiratory depression is the chief hazard of OPANA and OPANA ER, particularly in elderly or debilitated patients. OPANA and OPANA ER should be administered with extreme caution to patients with conditions accompanied by hypoxia, hypercapnia, or decreased respiratory reserve such as: asthma, chronic obstructive pulmonary disease or cor pulmonale, severe obesity, sleep apnea syndrome, myxedema, kyphoscoliosis, central nervous system (CNS) depression, or coma
Patients receiving other opioid analgesics, general anesthetics, phenothiazines or other tranquilizers, sedatives, hypnotics, or other CNS depressants (including alcohol) may experience additive effects resulting in respiratory depression, hypotension, profound sedation, or coma
OPANA and OPANA ER should be used with caution in elderly and debilitated patients and in patients who are known to be sensitive to CNS depressants, such as those with cardiovascular, pulmonary, renal, or hepatic disease. OPANA and OPANA ER should be used with caution in patients with mild hepatic impairment and in patients with moderate to severe renal impairment. These patients should be started cautiously with lower doses of OPANA or OPANA ER while carefully monitoring for side effects
OPANA ER is not indicated for preemptive analgesia (administration preoperatively for the management of postoperative pain)
The most common adverse drug reactions (≥10%) reported at least once by patients treated with OPANA in the clinical trials were nausea and pyrexia
The most common adverse drug reactions (≥10%) in clinical trials for OPANA ER were nausea, constipation, dizziness (excluding vertigo), vomiting, pruritus, somnolence, headache, increased sweating, and sedation
Patients and their families should be instructed to flush any OPANA and OPANA ER tablets that are no longer needed
Please see full Prescribing Information for OPANA and full Prescribing Information, including boxed WARNING for
OPANA ER
Vermont prescribers, please see additional information for OPANA and
OPANA ER
Oxymorphone is also available in injectable form. For more information, please see the full prescribing information for OPANA Injection
