No

Analgesic, Narcotic

Management of moderate to severe pain and preoperatively as a sedative and a supplement to anesthesia

C-II

B/D (if used for prolonged periods or in high doses at term)

Hypersensitivity to oxymorphone or any component, increased intracranial pressure; severe respiratory depression

Some preparations contain sulfites which may cause allergic reactions; infants <3 months of age are more susceptible to respiratory depression, use with caution and generally in reduced doses in this age group; use with caution in patients with impaired respiratory function or severe hepatic dysfunction and in patients with hypersensitivity reactions to other phenanthrene derivative opioid agonists (codeine, hydrocodone, hydromorphone, levorphanol, oxycodone, oxymorphone); tolerance or drug dependence may result from extended use

>10%:

Cardiovascular: Hypotension

Central nervous system: Fatigue, drowsiness, dizziness

Gastrointestinal: Nausea, vomiting, constipation

Neuromuscular & skeletal: Weakness

Miscellaneous: Histamine release

1% to 10%:

Central nervous system: Nervousness, headache, restlessness, malaise, confusion

Gastrointestinal: Anorexia, stomach cramps, xerostomia, biliary spasm

Genitourinary: Decreased urination, ureteral spasms

Local: Pain at injection site

Respiratory: Dyspnea, shortness of breath

<1%: Mental depression, hallucinations, paradoxical CNS stimulation, increased intracranial pressure, rash, urticaria, paralytic ileus, histamine release, physical and psychological dependence

Symptoms of overdose include respiratory depression, miosis, hypotension, bradycardia, apnea, pulmonary edema

Treatment of an overdose includes support of the patient's airway, establishment of an I.V. line and administration of naloxone 2 mg I.V. (0.01 mg/kg for children) with repeat administration as necessary up to a total of 10 mg.

Decreased effect with phenothiazines

Increased effect/toxicity with CNS depressants, TCAs, dextroamphetamine

Refrigerate suppository

Oxymorphone hydrochloride (Numorphan®) is a potent narcotic analgesic with uses similar to those of morphine. The drug is a semisynthetic derivative of morphine (phenanthrene derivative) and is closely related to hydromorphone chemically (Dilaudid®).

Onset of analgesia: I.V., I.M., S.C.: Within 5-10 minutes; Rectal: Within 15-30 minutes

Duration of analgesia: Parenteral, rectal: 3-4 hours

Metabolism: Conjugated with glucuronic acid

Elimination: In urine

Adults:

I.V.: 0.5 mg initially

Rectal: 5 mg every 4-6 hours

Alcohol: Additive CNS effect, avoid use

Respiratory rate, heart rate, blood pressure, CNS activity

Drowsiness and dizziness are common; may cause nervousness, restlessness or confusion; may rarely cause depression or hallucinations

Psychotropics may alter the analgesic effects of opioids; monitor for change in pain relief

No information available to require special precautions

Anticholinergic side effects can cause a reduction of saliva production or secretion contributes to discomfort and dental disease (ie, caries, oral candidiasis and periodontal disease)

If self-administered, use exactly as directed (do not increase dose or frequency); may cause physical and/or psychological dependence. While using this medication, do not use alcohol and other prescription or OTC medications (especially sedatives, tranquilizers, antihistamines, or pain medications) without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). May cause hypotension, dizziness, drowsiness, impaired coordination, or blurred vision (use caution when driving, climbing stairs, or changing position - rising from sitting or lying to standing, or when engaging in tasks requiring alertness until response to drug is known); nausea, vomiting or dry mouth (frequent mouth care, small frequent meals, chewing gum, or sucking lozenges may help); constipation (increased exercise, fluids, or dietary fruit and fiber may help - if constipation remains an unresolved problem, consult prescriber about use of stool softeners). Report persistent dizziness or headache; excessive fatigue or sedation; changes in mental status; changes in urinary elimination or pain on urination; weakness or trembling; blurred vision; or shortness of breath. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. If you are breast-feeding, take medication immediately after breast-feeding or 3-4 hours prior to next feeding.

Observe patient for excessive sedation, respiratory depression, implement safety measures, assist with ambulation

Injection, as hydrochloride: 1 mg (1 mL); 1.5 mg/mL (1 mL, 10 mL)

Suppository, rectal, as hydrochloride: 5 mg

"Drugs for Pain," Med Lett Drugs Ther, 1998, 40(1033):79-84.

Sinatra RS and Harrison DM, "Oxymorphone in Patient-Controlled Analgesia," Clin Pharm, 1989, 8(8):541, 544.