Discussions that mention morphine

Pain Management board


Hey Ruko, The purdue product available in Canada is HydromorphContn, It comes in capsules ranging from 8mg to 32 mg and is designed for 12 hour dosing. I don't know how strict the canadians are when it comes to deviating from Oxycontin 12 hour prescribing instructions but I checkcked Purdue canada site and read their prescribing info and it's pretty clear it's a 12 hour med.

The new LA dilaudid aproved by the FDA in the US is called Pallodone, It is a capsule, likely simmilar to kadian or Avinza release system. It's a 24 hour med and although it's been aproved, I haven't seen any news releases about availability.It's not available in the US yet. Purdue may market it themselves or spread the joy of opiate scrutiny with another pharma distributer or sell the rights for distribution to another comapny. The big difference is Palladone is a 24 hour med like Avinza, versus a 12 hour med like Oxycontin. The fact the half life of Palladoneis 18 hours is encouraging as far as believing it's truly a 24 hour med.

This is the black box warning from the FDA which is the strongest warning the FDA issues regarding safety of a medication.
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WARNING:

Palladone™ (hydromorphone HCl extended-release) Capsules are indicated for the management of persistent, moderate to severe pain in patients requiring continuous, around-the-clock analgesia with a high potency opioid for an extended period of time (weeks to months) or longer. Palladone™ Capsules should only be used in patients who are already receiving opioid therapy, who have demonstrated opioid tolerance, and who require a minimum total daily dose of opiate medication equivalent to 12 mg of oral hydromorphone. Patients considered opioid tolerant are those who are taking at least 60 mg oral morphine/day, or at least 30 mg of oral oxycodone/day, or at least 8 mg oral hydromorphone/day, or an equianalgesic dose of another opioid, for a week or longer. Palladone™ Capsules should be administered once every 24 hours.

Appropriate patients for treatment with Palladone Capsules include patients who require high doses of potent opioids on an around-the-clock basis to improve pain control and patients who have difficulty attaining adequate analgesia with immediate-release opioid formulations.

Palladone Capsules are contraindicated for use on an as needed basis (i.e., prn).

Palladone™ Capsules are NOT intended to be used as the first opioid product prescribed for a patient, or in patients who require opioid analgesia for a short period of time.

Palladone™ Capsules are for use in OPIOID-TOLERANT patients ONLY. Use in non-opioid-tolerant patients may lead to FATAL RESPIRATORY DEPRESSION. Overestimating the Palladone dose when converting patients from another opioid medication can result in fatal overdose with the first dose. Due to the mean apparent 18-hour elimination half-life of Palladone, patients who receive an overdose will require an extended period of monitoring and treatment that may go beyond 18 hours. Even in the face of improvement, continued medical monitoring is required because of the possibility of extended effects.

Palladone™ Capsules contain the potent Schedule II opioid agonist, hydromorphone. Schedule II opioid agonists (which include hydromorphone, fentanyl, methadone, morphine, oxycodone, and oxymorphone), have the highest risk of fatal overdoses due to respiratory depression, as well as the highest potential for abuse. Palladone can be abused in a manner similar to other opioid agonists, legal or illicit. These risks should be considered when administering, prescribing, or dispensing Palladone in situations where the healthcare professional is concerned about increased risk of misuse, abuse, or diversion.

Persons at increased risk for opioid abuse include those with a personal or family history of substance abuse (including drug or alcohol abuse or addiction) or mental illness (e.g., major depression). Patients should be assessed for their clinical risks for opioid abuse or addiction prior to being prescribed opioids. All patients receiving opioids should be routinely monitored for signs of misuse, abuse and addiction. Patients at increased risk of opioid abuse may still be appropriately treated with modified-release opioid formulations; however these patients will require intensive monitoring for signs of misuse, abuse, or addiction.

Palladone Capsules are to be swallowed WHOLE and are not to be broken, chewed, opened, dissolved or crushed. Taking broken, chewed, dissolved, or crushed Palladone™ Capsules or its contents can lead to the rapid release and absorption of a potentially fatal dose of hydromorphone. Overestimating the Palladone dose when converting the patient from another opioid medication can result in fatal overdose with the first dose. With the long half-life of Palladone (18 hours), patients who receive the wrong dose will require an extended period of monitoring and treatment that may go beyond 18 hours. Even in the face of improvement, continued medical monitoring is required because of the possibility of extended effects.
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Sorry I couldn't be more help, But the problem I have always had with oral dilauadid is the half life and short duration. IV dilauadid would be my first choice for post op pain, but oral dilauadid would scare me due to it's short duration when taken orally. But that's the SA version with a half life of 2 hours.

Please let us know what you experience is although I doubt the canadian version of HydromorphContin will be available in the US with the invention and aproval of Palladone.
Take care, Dave