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oxymorphone
generic
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about opioid use and how to mitigate associated risks; reserve opioid analgesics for patients with inadequate tx alternatives; ER form not indicated for prn analgesic use; proper dosing and titration essential to decr. respiratory depression risk
Addiction, Abuse, and Misuse
opioid agonist Schedule II controlled substance with risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all patients for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even with recommended use, especially during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately; instruct patients to swallow ER tabs whole; crushing, dissolving, or chewing ER tabs can cause rapid release and absorption of potentially fatal oxymorphone dose
Accidental Ingestion
accidental ingestion of even one dose, especially by children, can result in fatal oxymorphone overdose
Risks from Concomitant Use with Benzodiazepines, CNS Depressants
concomitant opioid use with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death; reserve concomitant use for patients with inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
advise pregnant patients with extended opioid use of risk of potentially life-threatening neonatal opioid withdrawal syndrome; ensure tx by neonatology experts available at delivery
Opioid Analgesic REMS
providers are strongly encouraged to complete risk evaluation and mitigation strategy (REMS)-compliant education program, counsel patients and/or caregivers with each Rx on serious risks, safe use, and importance of reading medication guide
Avoid Alcohol
instruct patients not to consume alcoholic beverages or use alcohol-containing prescription or non-prescription medications while taking oxymorphone; alcohol consumption during tx may result in incr. plasma levels and potentially fatal oxymorphone overdose
Adult Dosing .
Dosage forms: TAB: 5 mg, 10 mg; ER TAB: 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg, 30 mg, 40 mg
Special Note
- [prescribing info]
- Info: consider prescribing opioid overdose reversal agent (e.g., naloxone, nalmefene), especially if risk of opioid overdose or accidental ingestion
pain, severe acute
- [IR form, opioid-naive patients]
- Dose: individualize dose PO q4-6h prn; Start: 10-20 mg PO q4-6h prn, initial doses not to exceed 20 mg/dose; Info: use lowest effective dose, shortest effective tx duration; start 5 mg PO q4-6h prn, titrate slowly in patients 65 yo and older; titrate slowly in debilitated patients; give at least 1h before or 2h after meals; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
- [IR form, opioid-experienced patients]
- Dose: individualize dose PO q4-6h prn; Start: individualize based on current opioid intake, see pkg insert for conversion; Info: use lowest effective dose, shortest effective tx duration; start 5 mg PO q4-6h prn, titrate slowly in patients 65 yo and older; titrate slowly in debilitated patients; give at least 1h before or 2h after meals; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
pain, severe chronic
- [ER form, opioid-nontolerant patients]
- Dose: individualize ER dose PO q12h; Start: 5 mg ER PO q12h, may incr. by 5-10 mg ER PO q12h q3-7 days; Info: use lowest effective dose, shortest effective tx duration; titrate slowly in patients 65 yo and older and in debilitated patients; give at least 1h before or 2h after meals; do not cut/crush/chew/dissolve ER tab; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
- [ER form, opioid-experienced patients]
- Dose: individualize ER dose PO q12h; Start: individualize based on current opioid intake, see pkg insert for conversion; Info: use lowest effective dose, shortest effective tx duration; decr. start dose 50%, titrate slowly in patients 65 yo and older; titrate slowly in debilitated patients; give at least 1h before or 2h after meals; do not cut/crush/chew/dissolve ER tab; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
renal dosing
- [IR form]
- CrCl <50: start 5 mg q4-6h prn, titrate slowly
- HD/PD: not defined
- [ER form, opioid-nontolerant patients]
- renal impairment: no adjustment
- HD/PD: not defined
- [ER form, opioid-experienced patients]
- CrCl <50: decr. usual start dose by 50%, titrate slowly
- HD/PD: not defined
hepatic dosing
- [IR form]
- mild impairment: start 5 mg q4-6h prn, titrate slowly; moderate-severe impairment: contraindicated
- [ER form, opioid-nontolerant patients]
- moderate-severe impairment: contraindicated
- [ER form, opioid-experienced patients]
- mild impairment: decr. usual start dose by 50%, titrate slowly; moderate-severe impairment: contraindicated
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.