hydromorphone extended release / Generic mfg. - LARVOL DELTA

Intrathecal Hydromorphone vs Intrathecal Morphine to Treat Post Cesarean Pain in Patients With Opioid Use Disorder Taking Buprenorphine (clinicaltrials.gov) - P4 | N=46 | Recruiting | Sponsor: University of North Carolina, Chapel Hill | Not yet recruiting ➔ Recruiting

Enrollment open • Pain • Substance Abuse

Intrathecal Hydromorphone vs Intrathecal Morphine to Treat Post Cesarean Pain in Patients With Opioid Use Disorder Taking Buprenorphine (clinicaltrials.gov) - P4 | N=46 | Not yet recruiting | Sponsor: University of North Carolina, Chapel Hill

New P4 trial • Pain • Substance Abuse

A CASE OF OPIOID WITHDRAWAL-INDUCED TAKOTSUBO CARDIOMYOPATHY (CHEST 2024) - "Review of outpatient records noted her usual hydromorphone ER 8 mg QD, hydromorphone IR 4 mg Q4H, and clonazepam were abruptly decreased to only hydromorphone 4 mg IR Q6H. Early detection and management of takotsubo prevents catastrophic complications like cardiogenic shock."

Clinical • Back Pain • Cardiomyopathy • Cardiovascular • CNS Disorders • Depression • Musculoskeletal Pain • Myocardial Infarction • Pain • Psychiatry • Respiratory Diseases • Ventricular Tachycardia

Comparison of the effects of OPRM1 A118G polymorphism using different opioids: A prospective study. (PubMed, J Pain Symptom Manage) - "Tapentadol and methadone may be more suitable than hydromorphone, oxycodone, and fentanyl for G-allele carriers due to their dual mechanism of action and low susceptibility to OPRM1 A118G polymorphism."

Journal • Oncology • Pain • OPRM1

Differences in the Analgesic Effect of Opioids on Pain in Cancer Patients With Spinal Metastases. (PubMed, Palliat Med Rep) - "A total of 274 patients were enrolled, who started a tapentadol extended-release tablet, methadone tablet, hydromorphone extended-release tablet, oxycodone extended-release tablet, or transdermal fentanyl patch for cancer pain due to spinal metastasis in Japan from January 1, 2013 to October 31, 2021. In patients without numbness, no significant differences were observed in decreases of the NRS scores on day seven among the five groups. Tapentadol and methadone may be more effective than hydromorphone, oxycodone, and fentanyl for cancer pain due to spinal metastasis with numbness."

Journal • Back Pain • Musculoskeletal Pain • Neuralgia • Oncology • Pain • Solid Tumor

NCI-2018-01124: Thoracic Epidural Analgesia or Four-Quadrant Transversus Abdominus Plane Block in Reducing Pain in Patients Undergoing Liver Surgery (clinicaltrials.gov) - P3 | N=96 | Recruiting | Sponsor: M.D. Anderson Cancer Center | Trial completion date: Aug 2024 ➔ Jul 2026 | Trial primary completion date: Aug 2023 ➔ Jul 2026

Surgery • Trial completion date • Trial primary completion date • Hepatology • Pain

Controlled-release hydromorphone and risk of infection in adults: a systematic review. (PubMed, Harm Reduct J) - "Very few studies have examined the risk of IE, HCV, and HIV infection after exposure to controlled-release hydromorphone. Very low-quality and scant evidence suggests uncertainty around the risks of blood-borne infections, such as HCV and IE to PWID using this medication."

Journal • Retrospective data • Review • Cardiovascular • Hepatitis C • Hepatology • Human Immunodeficiency Virus • Infectious Disease • Inflammation

NCI-2018-01124: Thoracic Epidural Analgesia or Four-Quadrant Transversus Abdominus Plane Block in Reducing Pain in Patients Undergoing Liver Surgery (clinicaltrials.gov) - P3 | N=96 | Recruiting | Sponsor: M.D. Anderson Cancer Center | Trial completion date: Aug 2023 ➔ Aug 2024 | Trial primary completion date: Aug 2022 ➔ Aug 2023

Surgery • Trial completion date • Trial primary completion date • Hepatology • Pain

Epidural Anesthesia Within an Enhanced Recovery Pathway in Reducing Pain in Patients Undergoing Gynecologic Surgery (clinicaltrials.gov) - P3 | N=104 | Completed | Sponsor: University of Wisconsin, Madison | Recruiting ➔ Completed

Trial completion • Anesthesia • Gynecologic Cancers • Gynecology • Oncology • Pain • CRP • IL6 • TNFA

Transversus Abdominis Plane Block in Microsurgical Breast Recon w/Abdominal Free Flap in Breast CA (clinicaltrials.gov) - P3; N=120; Completed; Sponsor: Stanford University; Recruiting ➔ Completed; Trial completion date: Mar 2020 ➔ Jun 2021

Trial completion • Trial completion date

[VIRTUAL] Patient controlled analgesia (PCA) versus non-pca intravenous hydromorphone for severe cancer pain: Update from a multi-center, phase III randomized trial, HMORCT09-1 (ESMO Asia 2020) - P3 | "Funding: Has not received any funding. Clinical trial identification: NCT03375515."

Clinical • P3 data • Oncology • Pain

Neuraxial anesthesia provides excellent pain control for pediatric burn patients receiving excision and split-thickness skin grafts - a retrospective case series. (PubMed, Paediatr Anaesth) - "Spinal anesthesia was most commonly used for split-thickness skin grafting in the pediatric burn population and provides excellent analgesia for patients' immediate post-operative course, including their initial dressing changes, with minimal risk for complications. Pain was well controlled in all subgroups indicating that this strategy can be used flexibly in a variety of pediatric burn patients."

Journal • Retrospective data • Anesthesia • Pain • Pediatrics • Pruritus

Hydromorphone and codeine concentrations in oral fluid specimens from patients receiving substitution therapy with Substitol™ (morphine sulphate). (PubMed, Drug Test Anal) - "Concentrations were not higher in methadone- and buprenorphine-treated patients who relapsed into heroin use, or in patients on hydromorphone therapy...Clinical administration of morphine can lead to detectable concentrations of both hydromorphone and codeine in oral fluids. This should be taken into consideration when using drug testing in oral fluid samples for compliance assessment in this patient group."

Clinical • Journal • Pain

Methadone maintenance patients lack analgesic response to a cumulative intravenous dose of 32 mg of hydromorphone. (PubMed, Drug Alcohol Depend) - "The findings demonstrate that methadone-maintained individuals are highly insensitive to the analgesic effects of high-dose IV hydromorphone and may require very high doses of opioids, more efficacious opioids, or combined non-opioid analgesic strategies to achieve adequate analgesia."

Clinical • Journal • Pain • Substance Abuse

[VIRTUAL] Opioid-induced Constipation in Low Back Pain Routine Care with Tapentadol (IASP 2021) - "In depth investigations of the clinical relevance for routine clinical practice have so far not been conducted. Exploratory, retrospective longitudinal analysis of anonymized data from the German Pain eRegistry (GPeR) over 12 weeks of therapy (W12) comparing adult chronic low back pain patients (M40-M54) switched to either TAP or LAO (morphine, hydromorphone, or oxycodone ± naloxone)... Tapentadol treatment was associated with a significantly lower OIC risk and a significantly lower requirement for OTC/RX laxatives compared to the other long-acting opioids investigated during the 12-week observational study. When evaluating the findings, representativeness of the patient cohort as well as possible confounders and detection and information bias need to be considered."

Back Pain • Constipation • Gastroenterology • Gastrointestinal Disorder • Lumbar Back Pain • Musculoskeletal Pain • Pain • EREG

[VIRTUAL] Tapentadol for Low Back Pain Management in Routine Clinical Practice (IASP 2021) - "The clinical relevance for routine clinical practice has, however, so far not been thoroughly investigated. Exploratory, retrospective longitudinal analysis of anonymized data from the German Pain eRegistry (GPeR) over 12 weeks of therapy (W12) comparing adult chronic low back pain patients (M40-M54) switched to either TAP or LAO (morphine, hydromorphone, or oxycodone ± naloxone) following insufficient effectiveness and tolerability with WHO-1/2 analgesics... Under tapentadol treatment, significantly better analgesic effectiveness and tolerability as well as a significantly lower discontinuation rate due to drug-related adverse events were observed in chronic low back pain patients compared to the other oral long-acting opioids investigated. When evaluating the findings, representativeness of the patient cohort as well as possible confounders and detection and information bias need to be considered."

Clinical • Back Pain • Gastrointestinal Disorder • Lumbar Back Pain • Musculoskeletal Pain • Pain • EREG

[VIRTUAL] THE USEFULNESS OF AN ACUTE PALLIATIVE CARE UNIT IN A COMPREHENSIVE CANCER CARE CENTER (MASCC-ISOO 2021) - "Patient morphine equivalent daily dose (MEDD) was at its peak of 870mg. Later opioid rotation to oral methadone was introduced along with simultaneous decreases in the hydromorphone infusion over the next 3 days...Results Patient was eventually discharged home under the care of oncology, and PC teams. Conclusions APCUs can be effectively utilized beyond their traditional role in patients with refractory symptoms."

Back Pain • Lung Cancer • Musculoskeletal Pain • Non Small Cell Lung Cancer • Oncology • Pain • Palliative care • Solid Tumor

[VIRTUAL] AN INTERNATIONAL SURVEY OF OPIOID ROTATION AND CONVERSION RATIOS USED BY PALLIATIVE CARE PROFESSIONALS (MASCC-ISOO 2021) - "Although the median CR from intravenous to oral morphine varied significantly across regions (Europe 2.5, Canada 2, US 3), the variations with hydromorphone and fentanyl were more remarkable...Conclusions This survey provides unique insights into typical ORRs and CRs used in clinical practice internationally. It highlights the wide variation in ORR and CR among PC clinicians and the need for further research to standardize practice."

Oncology • Pain • Palliative care

[VIRTUAL] OPRM1 Significantly Related to Positive Subjective Effects of Opioids in Subjects Without Prior Opioid Abuse: A Within-Subjects Human Laboratory Study (CPDD 2021) - " 100 healthy adults (50% women) with no history of opioid misuse completed a 5-day, within-subject, inpatient study wherein they received double-blinded oral doses of placebo, and 2mg, 4mg, and 8mg of hydromorphone... Data suggest that differences in subjective experience of opioids may be partially driven by OPRM1 and OPRM1 may contribute to individual differences in risk for problematic opioid use. This is the first study of this type to be conducted among persons with no preexisting history of problematic opioid use, and these data can inform and advance efforts to prevent development of opioid use disorder, particularly among persons receiving opioid prescriptions."

Clinical • Substance Abuse

[VIRTUAL] Estimating the Cost-Utility of Injectable Opioid Agonist Therapy for Individuals with Severe Opioid Use Disorder in Ontario, Canada (CPDD 2021) - "Background : There is negligible access to injectable hydromorphone (iHDM) as a medication for opioid use disorder (MOUD) in Ontario, Canada's most populous province, despite emerging evidence of its clinical benefits and cost-effectiveness. We evaluated the cost-effectiveness of iHDM compared to methadone and sublingual buprenorphine for severe opioid use disorder (OUD) from the Ontario healthcare payer perspective... iHDM improved life years and QALYs. However, it increased healthcare costs compared to oral MOUD. This can help inform decision-making on the value of iHDM for severe OUD in Ontario and other settings."

Clinical • HEOR • Addiction (Opioid and Alcohol) • Substance Abuse

Central diabetes insipidus and pain medications - a risky combination. (PubMed, Clin Diabetes Endocrinol) - "Hyponatremia has occasionally been described as a side effect of opioids and rarely of NSAIDs in patients with CDI. Stimulation of the thirst centre may play a role with opioids while a decrease in urine output may be the mechanism with NSAIDs."

Journal • Cardiovascular • CNS Disorders • Epilepsy • Heart Failure • Metabolic Disorders • Musculoskeletal Diseases • Orthopedics • Pain

[VIRTUAL] PREVALENCE OF ANALGESICS USE AND ASSOCIATED ADVERSE OUTCOMES IN THE CHRONIC KIDNEY DISEASE POPULATION: A SYSTEMATIC REVIEW AND METAANALYSIS* (ERA-EDTA 2021) - "Analgesics investigated included opioids, Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), gabapentinoids and acetaminophen...The chronic use of oxycodone, tramadol, propoxyphene, fentanyl and hydromorphone were 3.6%, 2.0%, 1.3%, 1.1% and 0.05% respectively...Prevalence of gabapentin and pregabalin use was estimated at 10% and 3.5% respectively, on pooling of 3 studies... Only 70% of CKD patients experiencing chronic pain received an analgesic, suggesting that pain remains a significant public health burden. Despite limited evidence, opioids, NSAIDs and gabapentinoids seem to be associated with major adverse events. Their use requires cautious prescription, consideration of optimal dosage, and the development of therapeutic patient education to promote risk awareness."

Adverse events • Retrospective data • Review • Chronic Kidney Disease • Gastroenterology • Nephrology • Pain • Palliative care • Renal Disease • Transplantation

"@TGAgovau has approved the supply of an alternative product to address a shortage of DILAUDID hydromorphone hydrochloride oral. Details below: https://t.co/03eTOpy1N5" (@nbmphn)

Use of sustained release dextroamphetamine for the treatment of stimulant use disorder in the setting of injectable opioid agonist treatment in Canada: a case report. (PubMed, Harm Reduct J) - "Dextroamphetamine can be prescribed to support patients with stimulant use disorder to reduce or stop their use of cocaine. The case demonstrated that when dextroamphetamine was prescribed, a significant reduction in cocaine use was experienced among a patient that had been regularly using cocaine on a daily basis for many years. Daily contact with care for the opioid medication promoted adherence to the stimulant medication and allowed for monitoring of dose and tolerance. Settings where patients are in regular contact with care such as oral and injectable opioid agonist treatment clinics serve as a suitable location to integrate dextroamphetamine prescribing for patients that use illicit stimulants to reduce use and associated harms."

Clinical • Journal • Addiction (Opioid and Alcohol) • Pain • Substance Abuse

"The @TGAgovau has has authorised the supply of an alternative product to address a current shortage of #DILAUDID hydromorphone hydrochloride 1mg/mL oral liquid commonly used in #PalliativeCare https://t.co/AEc7RVT3gk" (@PC_CAG)

Palliative care