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Indications and Usage for Opana ER

Limitations of Use

• Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with extended-release opioid formulations [see Warnings and Precautions, reserve Opana ER for use in patients for whom alternative treatment options (e.g., non-opioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain.

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Dosage and Administration

2.1  Important Dosage and Administration Instructions

Opana ER should be prescribed only by healthcare professionals who are knowledgeable in the use of potent opioids for the management of chronic pain.

• Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals [see Warnings and Precautions.
• Initiate the dosing regimen for each patient individually, taking into account the patient’s severity of pain, patient response, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse [see Warnings and Precautions.
• Monitor patients closely for respiratory depression, especially within the first 24-72 hours of initiating therapy and following dosage increases with Opana ER and adjust the dosage accordingly [see Warnings and Precautions.

Instruct patients to swallow Opana ER tablets whole, one tablet at a time, with enough water to ensure complete swallowing immediately after placing in the mouth [see Patient Counseling Information.  Crushing, chewing, or dissolving Opana ER tablets will result in uncontrolled delivery of oxymorphone and can lead to overdose or death [see Warnings and Precautions. Where to Buy Opana ER 40mg (Oxymorphone) Online For Sale

Administer on an empty stomach, at least 1 hour prior to or 2 hours after eating.

Opana ER is administered orally every 12 hours.

2.2  Initial Dosing

Use of Opana ER as the First Opioid Analgesic

Initiate treatment with Opana ER with the 5 mg tablet orally every 12-hours.

Use of Opana ER in Patients who are not Opioid Tolerant

The starting dose for patients who are not opioid tolerant is Opana ER 5 mg orally every 12 hours.

Patients considered opioid tolerant are those taking, for one week or longer, at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone per day, 8 mg oral hydromorphone per day, 25 mg oral oxymorphone per day, 60 mg oral hydrocodone per day, or an equianalgesic dose of another opioid.

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Use of higher starting doses in patients who are not opioid tolerant may cause fatal respiratory depression.

Conversion from OPANA to Opana ER

Conversion from Parenteral Oxymorphone to Opana ER

In conclusion, the absolute oral bioavailability of Opana ER is approximately 10%. So, convert patients receiving parenteral oxymorphone to Opana ER by administering 10 times the patient’s total daily parental oxymorphone dose as Opana ER in two equally divided doses (e.g., [IV dose x 10] divided by 2).  Due to patient variability with regards to opioid analgesic response, upon conversion monitor patients closely to evaluate for adequate analgesia and side effects.