- For the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.
AND
OR
OR
AND
OR
Conversion Factors to Zohydro ER (not equianalgesic doses) | ||
Prior Oral Opioid | Oral Dose (mg) | Approximate Oral Conversion Factor |
Hydrocodone | 10 | 1 |
Oxycodone | 10 | 1 |
Methadone | 10 | 1 |
Oxymorphone | 5 | 2 |
Hydromorphone | 3.75 | 2.67 |
Morphine | 15 | 0.67 |
Codeine | 100 | 0.10 |
Conversion Factors to Hysingla ER (not equianalgesic doses) | ||
Prior Oral Opioid | Oral Dose (mg) | Approximate Oral Conversion Factor |
Codeine | 133 | 0.15 |
Hydromorphone | 5 | 4 |
Methadone | 13.3 | 1.5 |
Morphine | 40 | 0.5 |
Oxycodone | 20 | 1 |
Oxymorphone | 10 | 2 |
Tramadol | 200 | 0.1 |
Oxycodone Hydrochloride | Oxycodone base (XTAMPZA ER) |
10 mg | 9 mg |
15 mg | 13.5 mg |
20 mg | 18 mg |
30 mg | 27 mg |
40 mg | 36 mg |
Drug | Dosing Regimen | Dose Limit/ Maximum Dose |
---|---|---|
morphine sulfate controlled-release tablet (MS ContinR) | Opioid naive patients: 15 mg PO Q12 hours Conversion to MS Contin: Dosing is individualized based on previous analgesic therapy. Administer at 1/2 the total daily requirement PO Q12 hours or 1/3 the total daily requirement PO Q8 hours | The 100 mg and 200 mg tablets are reserved only for opioid-tolerant individuals |
morphine sulfate sustained-release | Opioid naive patients: 10 mg or 20 mg PO, may adjust dosage at 20 mg increment QOD Conversion to Kadian: Dosing is individualized based on previous analgesic therapy. Administer patient's total daily requirement PO Q24 hours or administer 1/2 patient's total daily requirement PO Q12 hours. | Should not be given more frequently than every 12 hours |
morphine sulfate beads sustained-release (Avinza) | Opioid naive patients: 30 mg PO Q24 hours, with dosage adjustments of not > 30 mg every 4 days Conversion to Avinza: Dosing is individualized based on previous analgesic therapy Administer patient's total daily morphine requirement PO Q24 hours | 1600 mg/day Should not be given more frequently than every 24 hours |
Drug | Dosing Regimen | Authorization Limit |
---|---|---|
Zohydro ERTM | For opioid-naive and opioid non-tolerant patients, initiate with 10 mg PO every 12 hours. Increase the dose of Zohydro ER in increments of 10 mg every 12 hours every 3 to 7 days as needed to achieve adequate analgesia. Individualize treatment; titrate to effective and tolerable dose. | Cancer pain Length of benefit End-stage medical conditions accompanied by significant pain Length of benefit All other diagnoses Initial authorization: up to 1 year Reauthorization A new pain medication contract is required every year. Up to 1 year. |
Hysingla ER | For opioid-naive and opioid non-tolerant patients, initiate with 20 mg PO every 24 hous. Increase the dose of Hysingla ER in increments of 10 mg to 20 mg every 3 to 5 days as needed to achieve adequate analgesia. Individualize treatment; titrate to effective and tolerable dose. | Cancer pain End-stage medical conditions accompanied by significant pain All other diagnoses Reauthorization |
Morphabond ER | For opioid-naive and opioid non-tolerant patients, initiate with 15 mg PO every 12 hours. | Cancer pain: |
Xtampza ER | For opioid-naive and opioid non-tolerant patients, initiate with 9 mg PO every 12 hours. Limit daily dose to a maximum of 288 mg per day. | Cancer pain: |
1. Zohydro ER [prescribing information] Pernix Ireland Pain Limited, Morristown, NJ, January 2016.
2. Hysingla [prescribing information]. Purdue Pharma L.P., Stamford, CT. November 2014.
3. Chronic Pain. American Chronic Pain Association. Accessed June 7, 2016. Available at: http://theacpa.org/conditionDetail.aspx?id=74.
4. Farrell, SE. Acetaminophen Toxicity. Medscape. Accessed June 7, 2016. Available at: http://emedicine.medscape.com/article/820200-overview .
5. Morphabond ER [prescribing information]. Inspirion Delivery Technologies LLC; Valley Cottage, NY, October 2015.
6. Xtampza ER [prescribing information]. Patheon Pharmaceuticals, Cincinnati, OH, April 2016.