Update on prescription extended-release opioids and appropriate patient selection

Figures & data

Figure 1 Putative pharmacokinetic advantages of extended-release versus immediate-release opioids.^26,33

Table 1 Extended-release opioids^53–66

Opioid	Generic name	Brand name	Available doses	Dosing interval
Morphine	Morphine sulfate ER capsules	Avinza	30, 45b, 60b, 75b, 90b, 120b mg	Once daily
	Morphine sulfate and naltrexone	Embedaa	–a	Once or twice daily
	HCl ER capsules
	Morphine sulfate ER capsules	Kadian	10, 20, 30, 40, 50, 60, 70, 80, 100b, 130, 150, 200b mg	Once or twice daily
	Morphine sulfate CR tablets	MS Contin	15, 30, 60, 100b, 200b mg	Every 8–12 hours
	Morphine sulfate SR tablets	Oramorph SR	15, 30, 60, 100 mg	Every 8–12 hours
Oxymorphone	Oxymorphone HCl ER tablets	Opana ER	5, 10, 20, 30, 40 mg	Every 12 hours
Hydromorphone	Hydromorphone HCl ER tablets	Exalgo	8b, 12b, 16b, 32b mg	Once daily
Tapentadol	Tapentadol ER oral tablets	Nucynta ER	50, 100, 150, 200, 250 mg	Every 12 hours
Oxycodone	Oxycodone HCl CR tablets	OxyContin	10, 15, 20, 30, 40, 60b, 80b mg	Every 12 hours
Methadonec	Methadone HCl tablets	Dolophine	5, 10 mg	Every 8–12 hours
		Methadose	10 mg
Fentanyl	Fentanyl transdermal system	Duragesic	12b, 25b, 50b, 75b, 100b mcg/hour	1 patch every 72 hours
Buprenorphined	Buprenorphine transdermal system	Butrans	5, 10, 20 mcg/hour	1 patch weekly

Notes:

a Embeda is not currently being marketed in the United States

b doses available only for opioid-tolerant patients

c methadone is the only medication considered a long-acting opioid formulation

d Schedule III agent.

Abbreviations: CR, controlled release; ER, extended release; HCl, hydrochloride; SR, sustained release.

Figure 2 Factors to consider before initiating treatment with an opioid analgesic.^12–14

Figure 3 Ten steps of universal precautions in pain medicine.

Note: data from Gourlay et al.¹⁴³

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