| Drug |
Dosage forms |
Dosing |
Other |
|
Sublingual tablet
Comes in packets of 12 (100, 200, 300, 400 mcg strengths only) or 32 tablets (all strengths)
|
Adult - opiate naïve
- Not recommended
- Should only be used in
opiate-tolerant cancer patients for breakthrough pain
Dosing in opioid-tolerant cancer patients
|
Other
- Providers and patients must enroll in the TIRF REMS Access program for outpatient use
- Tablet is placed under the tongue
- Special disposal instructions are provided to prevent accidental exposure
- Fentanyl is a sensitive CYP3A4 substrate. Use caution with CYP3A4 inducers and inhibitors.
Price
- No generic
- 30 tablets - $$$$
|
|
Lozenge
- 800 mcg
- 1200 mcg
- 1600 mcg
|
Adult - opiate naïve
- Not recommended
- Should only be used in
opiate-tolerant cancer patients for breakthrough pain
Dosing in opioid-tolerant cancer patients
|
Other
- Providers and patients must enroll in the TIRF REMS Access program for outpatient use
- Special lozenge disposal instructions are provided to prevent accidental exposures
- Fentanyl is a sensitive CYP3A4 substrate. Use caution with CYP3A4 inducers and inhibitors.
Price
- Generic (30 lozenges) - $$$$
|
|
Patch
Fentanyl delivered in mcg/hour
|
Adult - opiate naïve
- Not recommended
- Should only be used in
opiate-tolerant patients
Converting from other opiates
- The Duragesic PI (sec 2) contains an extensive table for
converting from other opioids to fentanyl patch
|
Other
- Old patch is removed and new patch is applied every 72 hours. Apply new patch to different skin site.
- Apply to chest, back, flank, or upper arm. Hair at application site may be clipped (not shaved).
- Flush used patches down the toilet to prevent accidental exposure
- Do not expose patch to direct heat because absorption may be increased
- Patients with fever may absorb more fentanyl from the patch
- Fentanyl is a sensitive CYP3A4 substrate. Use caution with CYP3A4 inducers and inhibitors.
Price
- Generic (30 days) - $$ - $$$$, depending on the strength
- 37.5, 62.5, and 87.5 mcg/hour doses are much more expensive
|
|
Buccal / sublingual tablet
Comes in cartons containing 7 blister cards with 4 tablets per card
|
Adult - opiate naïve
- Not recommended
- Should only be used in
opiate-tolerant cancer patients for breakthrough pain
Dosing in opioid-tolerant cancer patients
|
Other
- Providers and patients must enroll in the TIRF REMS Access program for outpatient use
- Tablet can be placed above a rear molar, between the upper cheek and gum, or under the tongue
- Special disposal instructions are provided to prevent accidental exposure
- Fentanyl is a sensitive CYP3A4 substrate. Use caution with CYP3A4 inducers and inhibitors.
Price
- No generic
- 30 tablets - $$$$
|
|
Nasal spray
- 100 mcg/100 mcL
- 400 mcg/100 mcL
- Each bottle contains 8 sprays of 100 mcL
|
Adult - opiate naïve
- Not recommended
- Should only be used in
opiate-tolerant cancer patients for breakthrough pain
Dosing in opioid-tolerant cancer patients
|
Other
- Providers and patients must enroll in the TIRF REMS Access program for outpatient use
- Special disposal instructions are provided to prevent accidental exposure
- Fentanyl is a sensitive CYP3A4 substrate. Use caution with CYP3A4 inducers and inhibitors.
Price
- No generic
- 1 bottle - $$$$
|
|
Sublingual spray
- 100 mcg
- 200 mcg
- 400 mcg
- 600 mcg
- 800 mcg
- 1200 mcg
- 1600 mcg
Comes in cartons of 10 and 30 sprays
|
Adult - opiate naïve
- Not recommended
- Should only be used in
opiate-tolerant cancer patients for breakthrough pain
Dosing in opioid-tolerant cancer patients
|
Other
- Providers and patients must enroll in the TIRF REMS Access program for outpatient use
- Each dose comes in an individual sprayer
- Special disposal instructions are provided to prevent accidental exposure
- Fentanyl is a sensitive CYP3A4 substrate. Use caution with CYP3A4 inducers and inhibitors.
Price
- No generic
- 30 sprays - $$$$
|
| Drug |
Dosage forms |
Dosing |
Other |
Hydrocodone (HC) Vicodin® Norco® Vicoprofen® |
Tablet
HC (mg) : Acetaminophen (mg)
- 2.5 : 325
- 5.0 : 325
- 7.5 : 325
- 10 : 325
- 5.0 : 300
- 7.5 : 300
- 10 : 300
HC (mg) : Ibuprofen (mg)
Solution
HC (mg) : Acetaminophen (mg)
|
Adult - opiate naïve
- 5 - 10 mg every 4 - 6 hours as needed
- Do not to exceed 50 mg a day
Children (≥ 2 years) - opiate naïve
- 0.135 mg/kg/dose every 4 - 6 hours as needed
- Do not exceed 6 doses a day
- *Based on 7.5 mg/15 ml solution
| Weight (kg) |
Dose every 4 - 6 hours |
| 12 - 15 |
1.875 mg (3.75 ml*) |
| 16 - 22 |
2.5 mg (5 ml*) |
| 23 - 31 |
3.75 mg (7.5 ml*) |
| 32 - 45 |
5 mg (10 ml*) |
|
Other
Brand names
- HC : acetaminophen - Norco®, Vicodin® Lortab®, Anexsia®
- HC : ibuprofen - Vicoprofen®, Reprexain®
Price (30 tablets)
- HC : acetaminophen - $
- HC : ibuprofen - $ - $$$, depending on strength
|
Hydrocodone (HC) Hysingla® ER |
Tablet, extended-release
|
Adult - opiate naïve
- 20 mg once daily
- Increase dose by 10 - 20 mg every 3 - 5 days as needed
Converting other HC formulations to Hysingla
- Total daily HC dose is given as once daily Hysingla dose
Converting from other opioids
|
Other
- Do not crush, cut, chew, or dissolve tablet
- Abuse-deterrent properties - when tablet is crushed and mixed with water, it forms a gel that is difficult to pull through a needle
- Hydrocodone is a sensitive CYP3A4 substrate. Use caution with CYP3A4 inducers and inhibitors.
- Prolonged QT interval has been seen with Hysingla doses of ≥ 160 mg
Price
- No generic
- 30 tablets - $$$$
|
Hydrocodone (HC) Zohydro® ER |
Capsule, extended-release
|
Adult - opiate naïve
- 10 mg every 12 hours
- Increase dose by 10 mg every 3 - 7 days as needed
Converting other HC formulations to Zohydro
- Total daily HC dose is divided by 2 and given once every 12 hours
Converting from other opioids
|
Other
Price
- No generic
- 30 capsules - $$$$
|
Hydrocodone (HC)
cough/cold preparations
Flowtuss® |
Solution
- HC 2.5 mg and guaifenesin 200 mg per 5 ml
|
Adults
- 10 ml every 4 - 6 hours as needed
- Do not exceed 60 ml in 24 hours
|
Other
- Guaifenesin is an expectorant
Price
|
Hydrocodone (HC)
cough/cold preparations
Hycodan® |
Syrup
- HC 5 mg and homatropine 1.5 mg per 5 ml
|
Adults
- 5 ml every 4 - 6 hours as needed
- Do not exceed 30 ml in 24 hours
Children 6 - 12 years
- 2.5 ml every 4 - 6 hours as needed
- Do not exceed 15 ml in 24 hours
NOTE: In 2018, the FDA declared that all opiate-containing cough/cold medications should not be used in patients < 18 years old
|
Other
- Homatropine is an anticholinergic medication that is included to discourage overdose
Price
|
Hydrocodone (HC)
cough/cold preparations
Hycodan® tablets |
Tablet
- HC 5 mg and homatropine 1.5 mg per tablet
|
Adults
- 1 tablet every 4 - 6 hours as needed
- Do not exceed 6 tablets in 24 hours
Children 6 - 12 years
- One-half (1/2) tablet every 4 - 6 hours as needed
- Do not exceed 3 tablets in 24 hours
NOTE: In 2018, the FDA declared that all opiate-containing cough/cold medications should not be used in patients < 18 years old
|
Other
- Homatropine is an anticholinergic medication that is included to discourage overdose
- Trade names: Hycodan®, Tussigon®
Price
|
Hydrocodone (HC)
cough/cold preparations
Hycofenix® |
Solution
- HC 2.5 mg, pseudoephedrine 30 mg, and guaifenesin 200 mg per 5 ml
|
Adults
- 10 ml every 4 - 6 hours as needed
- Do not exceed 40 ml in 24 hours
|
Other
- Guaifenesin is an expectorant
- Pseudoephedrine is a decongestant
Price
|
Hydrocodone (HC)
cough/cold preparations
Obredon® |
Solution
- HC 2.5 mg and guaifenesin 200 mg per 5 ml
|
Adults
- 10 ml every 4 - 6 hours as needed
- Do not exceed 60 ml in 24 hours
|
Other
- Guaifenesin is an expectorant
Price
- No generic
- 120 ml - $$$ - $$$$
|
Hydrocodone (HC)
cough/cold preparations
Rezira® |
Solution
- HC 5 mg and pseudoephedrine 60 mg per 5 ml
|
Adults
- 5 ml every 4 - 6 hours as needed
- Do not exceed 20 ml in 24 hours
|
Other
- Pseudoephedrine is a decongestant
Price
|
Hydrocodone (HC)
cough/cold preparations
Tussicaps® |
Capsule, extended-release
- HC 5 mg and chlorpheniramine 4 mg per capsule
- HC 10 mg and chlorpheniramine 8 mg per capsule
|
Adults and children ≥ 12 years
- 1 capsule (HC 10 mg) every 12 hours as needed
- Do not exceed 2 capsules in 24 hours
Children 6 - 11 years
- 1 capsule (HC 5 mg) every 12 hours as needed
- Do not exceed 2 capsules in 24 hours
NOTE: In 2018, the FDA declared that all opiate-containing cough/cold medications should not be used in patients < 18 years old
|
Other
- Chlorpheniramine is an antihistamine
Price
- No generic
- 30 capsules - $$$$
|
Hydrocodone (HC)
cough/cold preparations
Tussionex® Pennkinetic |
Suspension, extended-release
- HC 10 mg and chlorpheniramine 8 mg per 5 ml
|
Adults and adolescents ≥ 12 years
- 5 ml every 12 hours
- Do not exceed 10 ml in 24 hours
Children 6 - 11 years
- 2.5 ml every 12 hours
- Do not exceed 5 ml in 24 hours
NOTE: In 2018, the FDA declared that all opiate-containing cough/cold medications should not be used in patients < 18 years old
|
Other
- Chlorpheniramine is an antihistamine
Price
|
Hydrocodone (HC)
cough/cold preparations
Vituz® |
Solution
- HC 5 mg and chlorpheniramine 4 mg per 5 ml
|
Adults
- 5 ml every 4 - 6 hours as needed
- Do not exceed 20 ml in 24 hours
|
Other
- Chlorpheniramine is an antihistamine
Price
|
Hydrocodone (HC)
cough/cold preparations
Zutripro® |
Solution
- HC 5 mg, chlorpheniramine 4 mg, pseudoephedrine 60 mg per 5 ml
|
Adults
- 5 ml every 4 - 6 hours as needed
- Do not exceed 20 ml in 24 hours
|
Other
- Chlorpheniramine is an antihistamine
- Pseudoephedrine is a decongestant
Price
- Generic (120 ml) - $$ - $$$
|
| Drug |
Dosage forms |
Dosing |
Other |
Morphine sulfate immediate-release |
Tablet
Solution
- 10 mg/5 ml
- 20 mg/5 ml
- 100 mg/5 ml
|
Adult - opiate naïve
- Tablet: 15 - 30 mg every 4 hours as needed
- Solution: 10 - 20 mg every 4 hours as needed
Children (1 - 12 years) - opiate naïve
- 0.2 - 0.5 mg/kg every 4 hours as needed (max 5 mg) [2]
Alternative
- < 50 kg: 0.3 mg/kg every 3 - 4 hours as needed [5]
- ≥ 50 kg: 15 - 20 mg every 3 - 4 hours as needed [5]
Converting from parenteral to oral
- Anywhere from 3 to 6 mg of oral morphine sulfate may be required to provide pain relief equivalent to 1 mg of parenteral morphine
- In chronic dosing, 3 mg of oral morphine for every 1 mg of parenteral morphine may be sufficient [3]
|
Other
- Duration of action: 3 - 4 hours
Price
- Generic (30 tablets or 120 ml) - $
|
Morphine sulfate extended-release Arymo® ER |
Tablet, extended-release
|
Adult - opiate naïve
- 15 mg every 8 - 12 hours
- Increase dose every 1 - 2 days as needed
Converting from other oral morphine meds
- Total daily morphine dose will remain the same. Dose may given in halves every twelve hours or thirds every 8 hours.
Converting from parenteral morphine to oral
- Between 2 to 6 mg of oral morphine may be required to provide analgesia equivalent to 1 mg of parenteral morphine. Typically, a dose of morphine that is approximately three times
the previous daily parenteral morphine requirement is sufficient.
- In chronic dosing, 3 mg of oral morphine for every 1 mg of parenteral morphine may be sufficient [3]
Discontinuation
- Taper the dose gradually, by 25% to 50% every 2 to 4 days, while monitoring carefully for signs and symptoms of withdrawal
- Do not discontinue abruptly
|
Other
- Do not crush, cut, dissolve, or chew tablets. Swallow tablets whole.
Price
- No generic
- 30 tablets - $$$$
|
Morphine sulfate extended-release Avinza® |
Capsule, extended-release
- 30 mg
- 45 mg
- 60 mg
- 75 mg
- 90 mg
- 120 mg
|
Adult - opiate naïve
- 30 mg once daily
- Increase in increments not greater than 30 mg every 4 days
Converting from other oral morphine meds
- Total daily morphine dose can be given as once daily Avinza dose
Converting from parenteral morphine to oral
- Anywhere from 3 to 6 mg of oral morphine sulfate may be required to provide pain relief equivalent to 1 mg of parenteral morphine
- In chronic dosing, 3 mg of oral morphine for every 1 mg of parenteral morphine may be sufficient [3]
|
Other
- Avinza may be opened and sprinkled on applesauce. Swallow whole. Do not chew or crush beads.
- Daily dose should not exceed 1600 mg because of fumaric acid content of drug
Price
- Generic (30 capsules) - $$-$$$$ depending on strength
|
Morphine sulfate extended-release Embeda® |
Capsule, extended-release
Morphine (mg) : Naltrexone (mg)
- 20 : 0.8
- 30 : 1.2
- 50 : 2
- 60 : 2.4
- 80 : 3.2
- 100 : 4
|
Adult - opiate naïve
- 20/0.8 mg every 24 hours
- Embeda daily dose may also be divided in half and given every 12 hours
- Increase dose at intervals of every 1 - 2 days
Converting from other oral morphine meds
- Total daily morphine dose can be given as once daily Embeda dose or divided by 2 and given every 12 hours
Converting from parenteral to oral
- Anywhere from 3 to 6 mg of oral morphine sulfate may be required to provide pain relief equivalent to 1 mg of parenteral morphine
- In chronic dosing, 3 mg of oral morphine for every 1 mg of parenteral morphine may be sufficient [3]
|
Other
- Embeda may be opened and sprinkled on applesauce. Swallow whole. Do not chew or crush pellets.
- Naltrexone is an opioid antagonist that is added as an abuse-deterrent. When pellets are crushed, naltrexone is released and the euphoric effect of the drug is reduced. If pellets are not crushed,
naltrexone remains sequestered and inactive.
Price
- No generic
- 30 capsules - $$$$
|
Morphine sulfate extended-release Kadian® |
Capsule, extended-release
- 10 mg
- 20 mg
- 30 mg
- 40 mg
- 50 mg
- 60 mg
- 70 mg
- 80 mg
- 100 mg
- 130 mg
- 150 mg
- 200 mg
|
Adult - opiate naïve
- 30 mg once daily
- Kadian daily dose may also be divided in half and given every 12 hours
- Increase dose at intervals of every 1 - 2 days
Converting from other oral morphine meds
- Total daily morphine dose can be given as once daily Kadian dose or divided by 2 and given every 12 hours
Converting from parenteral morphine to oral
- Anywhere from 3 to 6 mg of oral morphine sulfate may be required to provide pain relief equivalent to 1 mg of parenteral morphine
- In chronic dosing, 3 mg of oral morphine for every 1 mg of parenteral morphine may be sufficient [3]
|
Other
- Kadian may be opened and sprinkled on applesauce. Swallow whole. Do not chew or crush beads.
Price
- Generic (30 capsules) - $$$-$$$$ depending on strength
|
Morphine sulfate extended-release Morphabond™ ER |
Tablet, extended-release
|
Adult - opiate naïve
- 15 mg every 8 - 12 hours
- Increase dose every 1 - 2 days as needed
Converting from other oral morphine meds
- Total daily morphine dose will remain the same. Dose may given in halves every twelve hours or thirds every 8 hours.
Converting from parenteral morphine to oral
- Between 2 to 6 mg of oral morphine may be required to provide analgesia equivalent to 1 mg of parenteral morphine. Typically, a dose of morphine that is approximately three times
the previous daily parenteral morphine requirement is sufficient.
- In chronic dosing, 3 mg of oral morphine for every 1 mg of parenteral morphine may be sufficient [3]
Discontinuation
- Taper the dose gradually, by 25% to 50% every 2 to 4 days, while monitoring carefully for signs and symptoms of withdrawal
- Do not discontinue abruptly
|
Other
- Do not crush, cut, chew, or dissolve tablets. Swallow tablets whole.
- Tablet shell containing inactive ingredients may be seen in stool
Price
- No generic
- 30 tablets - $$$$
|
Morphine sulfate extended-release MS Contin® |
Tablet, extended-release
- 15 mg
- 30 mg
- 60 mg
- 100 mg
- 200 mg
|
Adult - opiate naïve
- 15 mg every 12 hours
- Increase dose at intervals of every 1 - 2 days
Children (1 - 12 years) - opiate naïve
- 0.2 - 0.8 mg/kg every 12 hours [2]
Converting from other oral morphine meds
- Total daily morphine dose can be divided in half and given every 12 hours
- Total daily morphine dose may also be divided into thirds and given every 8 hours
Converting from parenteral morphine to oral
- Anywhere from 3 to 6 mg of oral morphine sulfate may be required to provide pain relief equivalent to 1 mg of parenteral morphine
- In chronic dosing, 3 mg of oral morphine for every 1 mg of parenteral morphine may be sufficient [3]
|
Other
- Do not crush, cut, or chew tablets
Price
- Generic (60 tablets) - $-$$$ depending on strength
|
| Drug |
Dosage forms |
Dosing |
Other |
Oxycodone hydrochloride (OC) and ibuprofen |
Tablet
Oxycodone : Ibuprofen
|
Adult - opiate naïve
- 5 mg every 6 hours as needed
- Do not exceed 4 tablets in 24 hours
|
Other
Price
- Generic tablets (#30) - $
|
Oxycodone hydrochloride (OC) Percocet® Roxicet® |
Tablet
OC (mg) : Acetaminophen (mg)
- 2.5 : 325
- 5.0 : 325
- 7.5 : 325
- 10 : 325
- 2.5 : 300
- 5.0 : 300
- 7.5 : 300
- 10 : 300
Solution
Oxycodone : Acetaminophen
|
Adult - opiate naïve
- 5 mg every 6 hours as needed
- Do not exceed 60 mg of oxycodone in 24 hours
- Do not exceed 4000 mg of acetaminophen in 24 hours
|
Other
- Duration of action: 3 - 5 hours
- Oxycodone is a sensitive CYP3A4 substrate. Use caution with CYP3A4 inducers and inhibitors.
- Trade names: Percocet®, Roxicet®
Price
- Generic tablets (#30), solution (120ml) - $
|
Oxycodone hydrochloride (OC) Percodan® |
Tablet
Oxycodone : Aspirin
|
Adult - opiate naïve
- 5 mg every 6 hours as needed
- Do not exceed 60 mg of oxycodone in 24 hours
- Do not exceed 4000 mg of aspirin in 24 hours
|
Other
Price
- Generic tablets (#30) - $
|
Oxycodone hydrochloride (OC) Roxicodone® |
Tablet
- 5 mg
- 10 mg
- 15 mg
- 20 mg
- 30 mg
Capsule
Solution
|
Adult - opiate naïve
- 5 - 15 mg every 4 - 6 hours as needed
- Do not exceed 60 mg in 24 hours
Children (1 - 12 years) - opiate naïve
- 0.125 - 0.200 mg/kg every 4 hours as needed (max 5 mg/dose) [2]
|
Other
Price
- Generic solution (120 ml) - $
- Generic capsules/tablets (#30) - $
|
Oxycodone hydrochloride (OC) Oxaydo® |
Tablet
|
Adult - opiate naïve
- 5 - 15 mg every 4 - 6 hours as needed
- Do not exceed 60 mg in 24 hours
- When discontinuing, taper the dose gradually, by 25% to 50% every 2 to 4 days
|
Other
Price
- No generic
- Tablets (#30) - $$$$
|
Oxycodone hydrochloride (OC) Oxycontin® |
Tablet, extended-release
- 10 mg
- 15 mg
- 20 mg
- 30 mg
- 40 mg
- 60 mg
- 80 mg
|
Adult - opiate naïve
- 10 mg every 12 hours
- Increase dose every 1 - 2 days in increments of 25 - 50% of the current dose
Converting from other oxycodone meds
- Total daily oxycodone dose can be divided in half and given every 12 hours
Children ≥ 11 years - opiate naïve
Children ≥ 11 years - opiate-tolerant
- Patients must be receiving opioids for at least 5 consecutive days
- Patients must be receiving ≥ 20 mg/day of oxycodone or its equivalent for the 2 days prior to starting
- See Oxycontin PI sec 2.4 for dose conversion table
from other opioids
|
Other
- Abuse-deterrent properties - when tablet is crushed and mixed with water, it forms a gel that is difficult to pull through a needle
- Oxycodone is a sensitive CYP3A4 substrate. Use caution with CYP3A4 inducers and inhibitors.
Price
- No generic
- Tablets (#30) - $$$ - $$$$, depending on the strength
|
Oxycodone hydrochloride (OC) Xartemis® XR |
Tablet, extended-release
OC (mg) : Acetaminophen (mg)
|
Adult - opiate naïve
- Starting: 2 tablets every 12 hours
- The second dose of 2 tablets may be given as early as 8 hours after the initial dose in patients without adequate relief. Subsequent doses are to be administered
2 tablets every 12 hours.
- May take without regard to food
- When discontinuing, taper the dose gradually, by 25% to 50% every 2 to 4 days
- In patients with renal and/or hepatic impairment, start with 1 tablet every 12 hours and titrate as needed
|
Other
- Xartemis is not interchangeable with other oxycodone products
- Do not break, chew, crush, cut, dissolve or split the tablets
- Do not exceed 4000 mg of acetaminophen/day
- Oxycodone is a sensitive CYP3A4 substrate. Use caution with CYP3A4 inducers and inhibitors.
Price
- No generic
- Tablet (#30) - $$
|
Oxycodone hydrochloride (OC) Xtampza® ER |
Capsule, extended-release
- 9 mg (equivalent to 10 mg OC)
- 13.5 mg (equivalent to 15 mg OC)
- 18 mg (equivalent to 20 mg OC)
- 27 mg (equivalent to 30 mg OC)
- 36 mg (equivalent to 40 mg OC)
|
Adult - opiate naïve
- Starting dose is 9 mg every 12 hours with food
- Increase dose every 1 - 2 days in increments of 25 - 50% of the current dose
- Maximum daily dose is 288 mg/day
Converting from other oxycodone meds
- Total daily oxycodone dose can be divided in half and given every 12 hours
|
Other
- Each dose of Xtampza should be taken with approximately the same amount of food in order to ensure consistent plasma levels are achieved. Food increases absorption, and absorption is higher
with high-fat, high-calorie foods.
- Capsules may be opened and sprinkled on a small amount of soft food (e.g. applesauce, pudding). Swallow whole and do not chew. Rinse mouth.
- Contents of capsule may be given through feeding tube
- Abuse-deterrent properties - microspheres are difficult to manipulate for misuse and abuse
- Oxycodone is a sensitive CYP3A4 substrate. Use caution with CYP3A4 inducers and inhibitors.
Price
- No generic
- Capsules (#30) - $$$-$$$$, depending on the strength
|
| Drug |
Dosage forms |
Dosing |
Other |
|
Tablet
|
Adult - opiate naïve
- 10 - 20 mg every 4 - 6 hours as needed
- Take on an empty stomach, at least one hour prior to or two hours after eating
- Kidney disease (CrCl < 50 ml/min): Use caution. Start with 5 mg dose.
- Liver disease (Child-Pugh A): Use caution. Start with 5 mg dose.
- Liver disease (Child-Pugh B/C): DO NOT USE
Converting from parenteral oxymorphone
- Given Opana’s absolute oral bioavailability of approximately 10%, patients receiving parenteral oxymorphone may be converted to oral Opana by administering 10 times
the patient’s total daily parenteral oxymorphone dose as Opana, in four or six equally divided doses (e.g., [IV dose x 10] divided by 4 or 6)
- For example, approximately 10 mg of Opana four times daily may be required to provide pain relief equivalent to a total daily IM dose of 4 mg oxymorphone
Discontinuation
- Taper the dose gradually, by 25% to 50% every 2 to 4 days, while monitoring carefully for signs and symptoms of withdrawal
- Do not discontinue abruptly
|
Other
Price
- Generic (30 tablets) - $$$-$$$$
|
|
Tablet, extended-release
- 5 mg
- 7.5 mg
- 10 mg
- 15 mg
- 20 mg
- 30 mg
- 40 mg
|
Adult - opiate naïve
- 5 mg every 12 hours
- Adjust dose in increments of 5 - 10 mg every 12 hours, every 3 to 7 days
- Take on an empty stomach, at least one hour prior to or two hours after eating
- Kidney disease (CrCl < 50 ml/min): Use caution. Start with 5 mg dose. For patients on prior opioid therapy, start Opana ER at 50% lower than the starting dose for
a patient with normal renal function.
- Liver disease (Child-Pugh A): Use caution. Start with 5 mg dose. For patients on prior opioid therapy, start Opana ER at 50% lower than the starting dose for
a patient with normal hepatic function.
- Liver disease (Child-Pugh B/C): DO NOT USE
Converting from Opana® to Opana® ER
- Total daily dose remains the same. Administer half the total daily Opana dose as Opana ER, every 12 hours.
Converting from parenteral oxymorphone
- The absolute oral bioavailability of Opana ER is approximately 10%. Convert patients receiving parenteral oxymorphone to Opana ER by administering 10 times the
patient's total daily parenteral oxymorphone dose as Opana ER in two equally divided doses (e.g., [IV dose x 10] divided by 2).
Converting from other opioids to Opana ER
Discontinuation
- Taper the dose gradually, by 25% to 50% every 2 to 4 days, while monitoring carefully for signs and symptoms of withdrawal
- Do not discontinue abruptly
|
Other
- Do not crush, cut, chew, or dissolve tablets
Price
- No generic
- 60 tablets - $$$$
|
| Drug |
Dosage forms |
Dosing |
Other |
Buprenorphine hydrochloride Belbuca® |
Buccal film
- 75 mcg
- 150 mcg
- 300 mcg
- 450 mcg
Comes in carton of 60 films
|
Adults - opiate-naïve - severe pain
- Approved to treat severe pain that requires long-term treatment
- 75 mcg once daily or 75 mcg every 12 hours (if tolerated) for at least 4 days
- Increase to 150 mcg every 12 hours after 4 days
- Further dose increases should be in increments of 150 mcg every 12 hours at intervals of no less than 4 days
- Doses up to 450 mcg every 12 hours were studied in opiate-naïve patients in clinical trials
Converting from other opiates
- To reduce the risk of opioid withdrawal, taper patients to no more than 30 mg of oral morphine sulfate equivalent (MSE) daily before beginning Belbuca
- Dose increases should be in increments of no more than 150 mcg every 12 hours at intervals of no less than 4 days
- Do not exceed 900 mcg every 12 hours due to potential for QT prolongation
- MSE - morphine sulfate equivalent
| Prior daily dose of MSE before taper to 30 mg MSE |
Initial Belbuca dose |
| < 30 mg |
75 mcg once daily or every 12 hours |
| 30 - 89 mg |
150 mcg every 12 hours |
| 90 - 160 mg |
300 mcg every 12 hours |
| > 160 mg |
Consider alternative |
|
Other
- Schedule III
- Buprenorphine is a partial agonist at mu opioid receptors
- FDA-approved for the treatment of severe pain requiring long-term treatment
- Belbuca is placed against the inside of the cheek
- Belbuca film dissolves within 30 minutes
- Do not eat or drink until film is dissolved
- Buprenorphine is a sensitive CYP3A4 substrate. Use caution with CYP3A4 inducers and inhibitors.
Price
- No generic
- 60 films - $$$$
|
Buprenorphine hydrochloride Buprenex® Subutex® |
Sublingual tablet
|
Adults - opiate withdrawal and maintenance
- Used to prevent withdrawal symptoms in patients who are being treated for opiate addiction
- Dosage will vary depending on the patient and their addiction characteristics
- Given as a once daily dose
- Initial dose is usually 4 - 8 mg on Day 1 given 12 - 48 hours after most recent opioid use while patient is having withdrawal symptoms
- On Day 2, dose may be increased up to 16 mg. On days 3 - 7, dose may be increased up to 30 mg.
- Maintenance dose is typically 16 - 24 mg/day
- During maintenance phase, patients should be switched to a buprenorphine-naloxone product
- Consider weaning after 1 year [9]
|
Other
- Schedule III
- Buprenorphine is an opioid partial agonist. It prevents symptoms of opiate withdrawal, but its maximal effects are less than those seen with heroin, methadone, etc.
- Buprenorphine has been associated with liver toxicity, especially in high-risk patients (alcoholism, hepatitis C, etc). Baseline and periodic LFTs are recommended.
- Buprenorphine is a sensitive CYP3A4 substrate. Use caution with CYP3A4 inducers and inhibitors.
- Providers must obtain waiver and complete special training in order to prescribe - see SAMHSA website
Price
- Generic (30 tablets) - $$
|
Buprenorphine hydrochloride Butrans® |
Transdermal patch
- 5.0 mcg/hr
- 7.5 mcg/hr
- 10 mcg/hr
- 15 mcg/hr
- 20 mcg/hr
Comes in carton of 4 patches
|
Adults - opiate-naïve - severe pain
- Approved to treat severe pain that requires long-term treatment
- One 5 mcg/hour patch every 7 days
- Increase dose at an interval of ≥ 72 hours
- Maximum dose is 20 mcg/hour because of prolonged QT interval risk
Converting from other opiates
|
Other
- Schedule III
- Buprenorphine is a partial agonist at mu opioid receptors
- FDA-approved for the treatment of severe pain requiring long-term treatment
- Buprenorphine is a sensitive CYP3A4 substrate. Use caution with CYP3A4 inducers and inhibitors.
- Apply to upper outer arm, upper chest, upper back or the side of the chest. These 4 sites (each present on both sides of the body) provide 8 possible application sites.
Rotate Butrans among the 8 described skin sites. After Butrans removal, wait a minimum of 21 days before reapplying to the same skin site.
- Apply Butrans to a hairless or nearly hairless skin site.
If none are available, the hair at the site should be clipped, not shaven.
- Do not expose patch to direct heat because absorption may be increased
- Patients with fever may absorb more buprenorphine from the patch
- Special disposal instructions are provided to prevent accidental exposure. Used patches may be flushed down toilet.
Price
- No generic
- 4 patches - $$$$
|
Buprenorphine hydrochloride Probuphine® |
Subdermal implant
- Each implant contains 80 mg of buprenorphine HCL
- Comes in kit with 4 implants and disposable applicator
|
Adults - maintenance of opioid dependence
- Approved for the maintenance treatment of opioid dependence
- Four implants inserted subdermally in the inner side of the upper arm every 6 months
- Patients should be on stable (≥ 3 months) maintenance doses of ≤ 8 mg/day of Subutex or Suboxone. For Bunavail, stable maintenance doses should be
≤ 4.2 mg/0.7 mg.
For Zubsolv, stable maintenance doses should be ≤ 5.7 mg/1.4 mg.
- If another insertion is desired after 6 months, the opposite arm should be used
- After one insertion in each arm, patients should be transitioned back to transmucosal buprenorphine. Reinserting Probuphine in a previously-treated arm has not been studied.
|
Other
Price
Studies
- Probuphine vs Sublingual Buprenorphine, JAMA (2016) - randomized, placebo-controlled trial in outpatient opioid-dependent patients (n=177)
PRIMARY OUTCOME: ≥ 4 out of 6 months without opioid-positive urine test
RESULTS: Primary outcome occurred in 86% of probuphine-treated patients and 72% of sublingual-treated patients (p=0.03).
[PMID 27434441]
|
Buprenorphine hydrochloride Sublocade® |
Prefilled syringe, single-dose
- 100 mg/0.5 ml
- 300 mg/1.5 ml
|
Adults - maintenance of opioid dependence
- Indicated for patients who have initiated treatment with a transmucosal buprenorphine-containing product, followed by dose adjustment for a minimum of 7 days. Patients should be
receiving the equivalent of 8 to 24 mg of buprenorphine daily.
- For abdominal subcutaneous administration only
- Should only be administered by healthcare provider
- Dosing: 300 mg monthly for the first two months followed by a maintenance dose of 100 mg monthly
- Maintenance dose may be increased to 300 mg monthly for patients who tolerate the 100 mg dose, but do not demonstrate a satisfactory clinical response
- There should be a minimum of 26 days between doses
- Occasional delays in dosing up to 2 weeks are not expected to have a clinically significant impact on treatment effect
|
Other
- Schedule III
- Subclocade is injected as a liquid, and the subsequent precipitation of the poly polymer creates a solid depot which contains buprenorphine. The depot disintegrates over time, but may
be removed surgically before total disintegration.
- After steady-state has been achieved (4-6 months), patients discontinuing Sublocade may have detectable plasma levels of buprenorphine for twelve months or longer
- Providers must be certified in the Sublocade REMS program in order to prescribe Sublocade
Price
- No generic
- 1 syringe - $$$$
|
Buprenorphine and Naloxone Suboxone®
Zubsolv® Bunavail® |
Suboxone® - sublingual tablet
Buprenorphine (mg) : Naloxone (mg)
Suboxone® - sublingual film
Buprenorphine (mg) : Naloxone (mg)
Zubsolv® - sublingual tablet
Buprenorphine (mg) : Naloxone (mg)
Bunavail® - buccal film
Buprenorphine (mg) : Naloxone (mg)
- 2.1 : 0.3
- 4.2 : 0.7
- 6.3 : 1.0
|
Adults - opiate withdrawal and maintenance
- Used to prevent withdrawal symptoms in patients who are being treated for opiate addiction
- Buprenorphine/naloxone is preferred after induction with buprenorphine alone
- Naloxone is included to deter injection of buprenorphine. Naloxone has no effect when taken orally, but acts as an opioid antagonist when injected.
- Dosage will vary depending on the patient and their addiction characteristics
- Given as once daily dose
- Maintenance dose is typically 4 - 24 mg/day of buprenorphine, except for Zubsolv and Bunavail which have slightly different conversion ratios. See
Zubsolv PI (sec 2) and
Bunavail PI (sec 2).
|
Other
- Schedule III
- Buprenorphine is an opioid partial agonist. It prevents symptoms of opiate withdrawal, but its maximal effects are less than those seen with heroin, methadone, etc.
- Naloxone is an opioid antagonist. It has no effect when taken orally, but acts as an opioid antagonist when injected.
- Buprenorphine has been associated with liver toxicity, especially in high-risk patients (alcoholism, hepatitis C, etc). Baseline and periodic LFTs are recommended.
- Buprenorphine is a sensitive CYP3A4 substrate. Use caution with CYP3A4 inducers and inhibitors.
- Providers must obtain waiver and complete special training in order to prescribe - see SAMHSA website
Price
- Suboxone generic (30 tablets) - $$-$$$
- Suboxone (30 films) - $$$$
- Zubsolv (30 tablets) - $$$$
- Bunavail (30 films) - $$$$
|
| Drug |
Dosage forms |
Dosing |
Other |
Codeine phosphate (CP) Tylenol #3 Tylenol #4 |
Tablet
CP (mg) : Acetaminophen (mg)
- 15 : 300
- 30 : 300
- 60 : 300
|
Adults
- 15 - 60 mg every 4 hours as needed
- Do not exceed 360 mg in 24 hours
Children
- 0.5 mg/kg/dose every 4 hours as needed
Alternative
- < 50 kg: 0.5 - 1 mg/kg every 3 - 4 hours [5]
- ≥ 50 kg: 30 - 60 mg every 3 - 4 hours [5]
NOTE: In 2017, the FDA declared that all codeine products are contraindicated in children < 12 years old
|
Other
- Schedule III
- Codeine has no analgesic activity unless it is metabolized into morphine by CYP2D6. Poor metabolizers may not receive
any pain relief from codeine while rapid metabolizers may experience toxicity. Because of the risk for toxicity, codeine is contraindicated for postoperative pain in children.
Trade names
- Tylenol® No 3 - 30 mg/300 mg
- Tylenol® No 4 - 60 mg/300 mg
Price
|
Codeine phosphate (CP) solution |
Solution
- Codeine 12 mg and acetaminophen 120 mg per 5 ml
|
Adults
- 15 ml every 4 hours as needed
Children
- 3 - 6 years: 5 ml three to four times daily
- 7 - 12 years: 10 ml three to four times daily
NOTE: In 2017, the FDA declared that all codeine products are contraindicated in children < 12 years old
|
Other
- Schedule V
- Codeine has no analgesic activity unless it is metabolized into morphine by CYP2D6. Poor metabolizers may not receive
any pain relief from codeine while rapid metabolizers may experience toxicity. Because of the risk for toxicity, codeine is contraindicated for postoperative pain in children.
Price
|
Codeine phosphate (CP) Fioricet® with codeine |
Capsule
- Fioricet® with codeine
- Codeine 30 mg, acetaminophen 325 mg, butalbital 50 mg, caffeine 40 mg per capsule
- Other
- Codeine 30 mg, acetaminophen 300 mg, butalbital 50 mg, caffeine 40 mg per capsule
|
Adults
- 1 - 2 capsules every 4 hours as needed
- Do not exceed 6 capsules in 24 hours
|
Other
- Schedule III
- FDA-approved for tension headaches
- Butalbital is a barbiturate
- Codeine has no analgesic activity unless it is metabolized into morphine by CYP2D6. Poor metabolizers may not receive
any pain relief from codeine while rapid metabolizers may experience toxicity.
Price
- Generic (30 capsules) - $
- NOTE: product with 300 mg of acetaminophen is $$$$
|
Codeine phosphate (CP) Fiorinal® with codeine |
Capsule
- Codeine 30 mg, aspirin 325 mg, butalbital 50 mg, caffeine 40 mg per capsule
|
Adults
- 1 - 2 capsules every 4 hours as needed
- Do not exceed 6 capsules in 24 hours
|
Other
- Schedule III
- FDA-approved for tension headaches
- Butalbital is a barbiturate
- Codeine has no analgesic activity unless it is metabolized into morphine by CYP2D6. Poor metabolizers may not receive
any pain relief from codeine while rapid metabolizers may experience toxicity.
Price
- Generic (30 capsules) - $ - $$
|
Codeine phosphate (CP) Soma® compound with codeine |
Tablet
- Codeine 16 mg, aspirin 325 mg, carisoprodol 200 mg per tablet
|
Adults
- 1 - 2 tablets four times daily as needed
|
Other
- Schedule III
- Carisoprodol is a centrally-acting muscle relaxant. See carisoprodol for more.
- Codeine has no analgesic activity unless it is metabolized into morphine by CYP2D6. Poor metabolizers may not receive
any pain relief from codeine while rapid metabolizers may experience toxicity.
Price
- Generic (30 capsules) - $ - $$
|
Codeine cough/cold preparationsCheratussin DAC® |
Liquid
- Codeine 10 mg, guaifenesin 100 mg, pseudoephedrine 30 mg per 5 ml
- Contains 2.1% alcohol
|
Adults and children ≥ 12 years
- 10 ml every 4 hours as needed
- Do not take more than 4 doses in 24 hours
Children 6 - 11 years old
- 5 ml every 4 hours as needed
- Do not take more than 4 doses in 24 hours
NOTE: In 2018, the FDA declared that all opiate-containing cough/cold medications should not be used in patients < 18 years old
|
Other
- Schedule V
- Guaifenesin is an expectorant
- Pseudoephedrine is a decongestant
Price
|
Codeine cough/cold preparationsPhenergan® with codeine |
Syrup
Codeine (mg) : Promethazine (mg)
- 10 : 6.25 per 5 ml
- Contains 7% alcohol
|
Adults and children ≥ 12 years
- 5 ml every 4 - 6 hours as needed
- Do not take more than 30 ml in 24 hours
Children 6 - 11 years old
- 2.5 - 5 ml every 4 - 6 hours as needed
- Do not take more than 30 ml in 24 hours
NOTE: In 2018, the FDA declared that all opiate-containing cough/cold medications should not be used in patients < 18 years old
|
Other
- Schedule V
- Promethazine is an antihistamine/anticholinergic medication
Price
|
Codeine cough/cold preparationsPhenergan® VC with codeine |
Syrup
- Codeine 10 mg, phenylephrine 5 mg, promethazine 6.25 mg per 5 ml
- Contains 7% alcohol
|
Adults and children ≥ 12 years
- 5 ml every 4 - 6 hours as needed
- Do not take more than 30 ml in 24 hours
Children 6 - 11 years old
- 2.5 - 5 ml every 4 - 6 hours as needed
- Do not take more than 30 ml in 24 hours
NOTE: In 2018, the FDA declared that all opiate-containing cough/cold medications should not be used in patients < 18 years old
|
Other
- Schedule V
- Phenylephrine is a decongestant
- Promethazine is an antihistamine/anticholinergic medication
Price
|
Codeine cough/cold preparations
Robitussin® AC |
Liquid/solution
Codeine (mg) : Guaifenesin (mg)
- 10 : 100 per 5 ml
- Solution is alcohol free
- Liquid contains 3 - 4% alcohol
|
Adults and children ≥ 12 years
- 10 ml every 4 hours as needed
- Do not take more than 6 doses in 24 hours
Children 6 - 11 years old
- 5 ml every 4 hours as needed
- Do not take more than 6 doses in 24 hours
NOTE: In 2018, the FDA declared that all opiate-containing cough/cold medications should not be used in patients < 18 years old
|
Other
- Schedule V
- Guaifenesin is an expectorant
- Other brand names: Cheratussin AC®, Guaiatussin AC®, Virtussin AC®
Price
|
Codeine cough/cold preparationsTuzistra™ XR |
Suspension, extended-release
- Codeine 14.7 mg and chlorpheniramine 2.8 mg per 5 ml
|
Adults 18 years and older
- 10 ml every 12 hours as needed
- Do not exceed 20 ml in 24 hours
|
Other
- Schedule III
- Chlorpheniramine is an antihistamine
Price
- No generic
- Brand (120 ml) - $$$
|
| Drug |
Dosage forms |
Dosing |
Other |
|
Tablet
|
Adults
- 50 - 100 mg every 4 - 6 hours as needed
- Do not exceed 400 mg in 24 hours
|
Other
- Tablets are scored so they can be halved
- Tramadol is a synthetic opioid that acts at opiate receptors in the central nervous system
- Tramadol has been shown to inhibit reuptake of norepinephrine and serotonin. Tramadol should be used with caution when taken with other serotonergic drugs
(see serotonin syndrome for more).
- Patients who are allergic to opiates should not receive tramadol
- Tramadol lowers the seizure threshold and increases the risk of seizures. Seizure risk may also be increased when taken with SSRIs, TCAs, other opioids, MAO inhibitors, and neuroleptics.
Price
|
|
Tablet
- Tramadol 37.5 mg and acetaminophen 325 mg per tablet
|
Adults
- 2 tablets every 4 - 6 hours as needed
- Do not exceed 8 tablets in 24 hours
|
Other
- Tramadol is a synthetic opioid that acts at opiate receptors in the central nervous system
- Tramadol has been shown to inhibit reuptake of norepinephrine and serotonin. Tramadol should be used with caution when taken with other serotonergic drugs
(see serotonin syndrome for more).
- Patients who are allergic to opiates should not receive tramadol
- Tramadol lowers the seizure threshold and increases the risk of seizures. Seizure risk may also be increased when taken with SSRIs, TCAs, other opioids, MAO inhibitors, and neuroleptics.
Price
|
|
Tablet, extended-release
|
Adults
- 100 mg once daily
- Increase dose in 100 mg increments every 5 days as needed
- Do not exceed 300 mg once daily
|
Other
- Do not crush, cut, or chew tablet
- Tramadol is a synthetic opioid that acts at opiate receptors in the central nervous system
- Tramadol has been shown to inhibit reuptake of norepinephrine and serotonin. Tramadol should be used with caution when taken with other serotonergic drugs
(see serotonin syndrome for more).
- Patients who are allergic to opiates should not receive tramadol
- Tramadol lowers the seizure threshold and increases the risk of seizures. Seizure risk may also be increased when taken with SSRIs, TCAs, other opioids, MAO inhibitors, and neuroleptics.
Price
- Generic (30 tablets) - $$-$$$
|
|
Capsule, extended-release
|
Adults
- 100 mg once daily
- Increase dose in 100 mg increments every 5 days as needed
- Do not exceed 300 mg once daily
|
Other
- Do not crush, cut, chew, or open capsule
- Tramadol is a synthetic opioid that acts at opiate receptors in the central nervous system
- Tramadol has been shown to inhibit reuptake of norepinephrine and serotonin. Tramadol should be used with caution when taken with other serotonergic drugs
(see serotonin syndrome for more).
- Patients who are allergic to opiates should not receive tramadol
- Tramadol lowers the seizure threshold and increases the risk of seizures. Seizure risk may also be increased when taken with SSRIs, TCAs, other opioids, MAO inhibitors, and neuroleptics.
Price
- No Generic
- Price (30 capsules) - $$$$
|
| Drug |
Dosage forms |
Dosing |
Other |
|
Injection
- Prefilled, single-use autoinjector pen containing 0.4 mg of naloxone per injection
- Comes in carton that contains 2 pens
|
Acute opiate overdose
- May be given intramuscularly or subcutaneously
- Injection device comes with speaker that gives audio instructions when activated
- Inject into anterolateral thigh. May be given through clothes.
- Dose may be repeated after 2 - 3 minutes
- If given to infant < 1 year old, pinch middle of outer thigh before giving
|
Other
- Seek immediate medical help. Naloxone may wear off and opiate-induced respiratory depression may return.
- Reversal of buprenorphine and pentazocine may require higher doses
- Time to max blood concentration is about 15 minutes
- Average naloxone half-life is about 1.3 hours
- See opioid antagonists for a review of how these drugs work
Price
- No generic
- Carton of 2 syringes - $$$$
|
|
Nasal spray
- 4 mg single-use spray
- Comes in a carton with 2 single-use sprays
|
Acute opiate overdose
- Initial: administer one spray in one nostril
- May give an additional spray every 2 - 3 minutes depending on response. Alternate nostrils.
- Use each nasal spray only one time
- Lay patient on their back and provide support to the back of the neck to allow the head to tilt back before giving
- Lay patient on side after giving
|
Other
- Seek immediate medical help. Naloxone may wear off and opiate-induced respiratory depression may return.
- Reversal of buprenorphine and pentazocine may require higher doses
- Median time to max blood concentration:
- One spray (4 mg): 30 minutes
- Two sprays (8 mg): 20 minutes
- Average naloxone half-life is about 2 hours
- See opioid antagonists for a review of how these drugs work
Price
- No generic
- Carton of 2 sprays - $$$$
|
| Drug |
Dosage forms |
Dosing |
Other |
|
Tablet
|
Alcohol dependence
- 50 mg once daily
- Has been used for up to 12 weeks in trials
Opiate dependence
- Start with 25 mg once daily
- If no withdrawal signs occur, the dose may be increased to 50 mg once daily
- Naltrexone should not be used during acute opiate withdrawal
|
Other
- Naltrexone 50 mg a day should block the action of most parenterally administered opiates
- After stopping naltrexone, patients may be more sensitive to opioids and at greater risk for adverse events
- See opioid antagonists for a review of how these drugs work
- Brand name: Revia®
Price
|
|
Injectable suspension
- 380 mg vial
- Carton comes with vial, diluent, special needle and syringe
|
Alcohol dependence
- 380 mg intramuscularly every 4 weeks
Opiate dependence
- 380 mg intramuscularly every 4 weeks
- Naltrexone should not be used during acute opiate withdrawal
|
Other
- Dose should be administered by a healthcare provider
- Dose is given in the gluteus. Alternate buttocks with each injection.
- Vivitrol should only be administered with the needle and diluent that comes with it
- Allow Vivitrol to reach room temperature before injecting
- Vivitrol should be refrigerated. Vivitrol is good for 7 days when kept at room temperature.
- After stopping naltrexone, patients may be more sensitive to opioids and at greater risk for adverse events
- See opioid antagonists for a review of how these drugs work
Price
- No generic
- One injection - $$$$
Studies
- Vivitrol vs Buprenorphine to Prevent Opiate Relapse, Lancet (2018) - Randomized, open-label trial (N=570) in opiate-addicted patients.
Results: 24-week relapse events were greater for Buprenorphine (65%) than for Vivitrol (57%).
[PMID 29150198]
- Vivitrol vs Buprenorphine to Prevent Opiate Relapse, JAMA Psych (2017) - Randomized, open-label trial (N=159) in opiate-dependent patients.
Results: Vivitrol was as effective as buprenorphine-naloxone in maintaining short-term abstinence from heroin and other illicit substances.
[PMID 29049469]
- Vivitrol vs Usual Care to Prevent Opiate Relapse, NEJM (2016) - Randomized, open-label trial (N=308) in convicts who abused opioids.
Results: The vivitrol group had a longer median time to relapse than did those assigned to usual treatment (10.5 vs. 5.0 weeks, p<0.001).
[PMID 27028913]
|
