Managing the complexities of moderate to severe pain?

OPANA ER

OPANA ER tablets

Tablets shown are not actual size

Think OPANA® ER - for your appropriate
patients with moderate to severe
chronic pain

  • No known CYP450 PK drug-drug interactions
    at clinically relevant doses1
  • True 12-hour dosing that lasts2
  • Minimal increase in pain scores (VAS) with
    a stable dose over a full 12 weeks in
    clinical trials3,4
  • Less supplemental rescue medication use than the allowable maximum in clinical trials3,4
  • Widely available on managed care plans (including Medicare Part D) for 8 out of 10 covered patients*5

* As of February 2008.

OPANA

OPANA tablets

Tablets shown are not actual size

Think OPANA®- for your appropriate
patients with moderate to severe
acute pain

  • No known CYP450 PK drug-drug interactions at clinically relevant doses6
  • Rapid absorption5
  • Long 7- to 9-hour half-life7

Indications

OPANA6

  • OPANA is indicated for the relief of moderate to severe acute pain where the use of an opioid is appropriate

OPANA ER1

  • OPANA ER is indicated for the relief of moderate to severe pain in patients requiring continuous, around-the-clock opioid treatment for an extended period of time
  • OPANA ER is not intended for use as an as needed analgesic
  • OPANA ER is not indicated for pain in the immediate post-operative period (12–24 hours following surgery) for patients not previously taking opioids because of the risk of oversedation and respiratory depression requiring reversal with opioid antagonists
  • OPANA ER is not indicated for pain in the post-operative period if the pain is mild or not expected to persist for an extended period of time

Important Safety Information

OPANA® ER has a boxed warning as follows:

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

References
  1. OPANA ER Full Prescribing Information. Chadds Ford, Pa: Endo Pharmaceuticals; 2008.
  2. Adams MP, Ahdieh H. Pharmacokinetics and dose-proportionality of oxymorphone extended release and its metabolites: results of a randomized crossover study. Pharmacotherapy. 2004;24(4):468-476.
  3. Hale ME, Ahdieh H, Ma T, Rauck R. Efficacy and safety of OPANA ER (oxymorphone extended release) for relief of moderate to severe chronic low back pain in opioid-experienced patients: a 12-week, randomized, double-blind, placebo-controlled study. J Pain. 2007;8(2):175-184.
  4. Katz N, Rauck R, Ahdieh H, et al. A 12-week, randomized, placebo-controlled trial assessing the safety and efficacy of oxymorphone extended release for opioid-naive patients with chronic low back pain. Curr Med Res Opin. 2007;23(1):117-128.
  5. Data on file, Endo Pharmaceuticals, Chadds Ford, Pa.
  6. OPANA Full Prescribing Information. Chadds Ford, Pa: Endo Pharmaceuticals; 2006.
  7. Adams MP, Ahdieh H. Single- and multiple-dose pharmacokinetic and dose-proportionality study of oxymorphone immediate-release tablets. Drugs R D. 2005;6(2):91-99.