Considerations on the use of oxymorphone in geriatric patients.
BACKGROUND
Pain among the elderly is pervasive, under-treated and can be properly managed by judiciously using analgesics in the armamentarium. For severe pain, opioids generally provide the most effective pain relief, but concerns about safety and tolerability have limited, often unnecessarily, their utilization in the geriatric population.


OBJECTIVE
It is common for geriatric patients to be taking more than one medicine. Oxymorphone might be particularly well suited for use in geriatric patients, in that its metabolism is mainly through non-CYPP450 pathways, thereby posing less risk of interaction with the many drugs that are metabolized by the CYPP450 system. However, oxymorphone is not as familiar to clinicians as morphine or some other opioids. We review here the clinical studies on oxymorphone to outline the key considerations for use of oxymorphone in the geriatric population.


METHODS
Nine available clinical trials of oxymorphone alone or comparing oxymorphone with placebo or other active agents were analyzed with respect to the safety and tolerability findings. These studies included geriatric patients but were not designed to evaluate oxymorphone exclusively in this population.


RESULTS
Based on the results from nine published clinical studies, oxymorphone is an effective opioid analgesic with a safety profile at least comparable to other opioid drugs. At low starting doses and individual titration, oxymorphone should be considered for appropriate geriatric patients, particularly in whom there is concern about interaction with drugs that are metabolized by CYPP450 enzymes.
Pergolizzi
Joseph V
JV
Johns Hopkins University, School of Medicine, Department of Medicine, Baltimore, MD, USA. jpjmd@jhu.edu
Raffa
Robert B
RB
Gould
Errol
E
D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000188:drug therapy; D001711:Biotransformation; D002986:Clinical Trials as Topic; D003248:Constipation / Q000139:chemically induced; D004347:Drug Interactions; D014453:Glucuronosyltransferase / Q000378:metabolism; D006801:Humans; D008099:Liver / Q000378:metabolism; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009325:Nausea / Q000139:chemically induced; D009369:Neoplasms / Q000503:physiopathology; D009293:Opioid-Related Disorders / Q000517:prevention & control; D010111:Oxymorphone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010149:Postoperative Pain / Q000188:drug therapy; D019338:Polypharmacy; D017450:Receptors, Opioid, mu / Q000187:drug effects; D012894:Sleep Stages / Q000187:drug effects; D014839:Vomiting / Q000139:chemically induced
D009294:Narcotics; D017450:Receptors, Opioid, mu; D010111:Oxymorphone; C491474:UGT2B7 protein, human; D014453:Glucuronosyltransferase