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Use of Hydromorphone, with Particular Reference to the OROS® Formulation, in the Elderly

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Abstract

The prevalence of pain increases with age. However, pain is often inadequately managed in elderly people, which undermines quality of life. Pain has been associated with depression, sleep disturbances, impaired ambulation, and increased healthcare use and costs.

Effective treatment of pain improves the overall quality of life. However, pain management is complicated by the presence of multiple co-morbidities in elderly people, which increases the likelihood of polypharmacy, and therefore increases the chance of potential drug-drug interactions. Polypharmacy is also associated with poor adherence to therapy. Age-related pharmacokinetic and pharmacodynamic changes reduce the therapeutic index of drugs. Therefore, elderly people are more likely to suffer from adverse events and increased sensitivity to the analgesic properties of opioids.

OROS® hydromorphone (Jurnista®) is a once-daily, extended-release formulation that uses the OROS® push-pull technology to provide controlled release of the semi-synthetic opioid hydromorphone. Compared with conventional immediate-release hydromorphone, OROS® hydromorphone provides more consistent delivery of hydromorphone with lower peak concentrations and less variability in plasma concentrations over time. The bioavailability of hydromorphone from OROS® hydromorphone is minimally affected by food or alcohol (ethanol).

Hydromorphone is mainly metabolized in the liver and is excreted in the urine. Unlike morphine, hydromorphone does not have an active 6-glucur-onide metabolite. This metabolite of morphine can accumulate in the presence of renal failure; therefore, the lack of an active 6-glucuronide metabolite makes hydromorphone a useful alternative to morphine in elderly patients with renal failure. However, hydromorphone is similar to morphine in that it is metabolized to hydromorphone-3-glucuronide, which may be neuroexcitatory. Because of its low plasma protein binding and low probability of interfering with the metabolism of other drugs, hydromorphone may be especially suitable for patients taking multiple medications.

OROS® hydromorphone is an effective analgesic that is well tolerated and provides more stable plasma concentrations than immediate-release forms of hydromorphone. Its once-daily administration offers an advantage over immediate-release forms and longer-acting formulations that require twice-daily administration. This means OROS® hydromorphone will be more convenient for elderly patients and may improve adherence, resulting in improved pain relief and quality of life.

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References

  1. National Statistics Online. Benefits and challenges of an ageing population: population trends 134–winter 2008 [online]. Available from URL: http://www.statistics.gov.uk/pdfdir/popt1208.pdf [Accessed 2009 Feb 5]

  2. Boerlage AA, van Dijk M, Stronks DL, et al. Pain prevalence and characteristics in three Dutch residential homes. Eur J Pain 2008; 12: 910–6

    Article  PubMed  Google Scholar 

  3. Breivik H, Collett B, Ventafridda V, et al. Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. Eur J Pain 2006; 10: 287–333

    Article  PubMed  Google Scholar 

  4. Torvik K, Kaasa S, Kirkevold Ø, et al. Pain in patients living in Norwegian nursing homes. Pall Med 2009; 23: 8–16

    Article  CAS  Google Scholar 

  5. Miu DKY, Chan TY, Chan MH. Pain and disability in a group of Chinese elderly out-patients in Hong Kong. Hong Kong Med J 2004; 10: 160–5

    PubMed  CAS  Google Scholar 

  6. Davies AN, Dickman A, Reid C, et al. The management of cancer-related breakthrough pain: recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. Eur J Pain 2009; 13(4): 331–8

    Article  PubMed  Google Scholar 

  7. Blyth FM, March LM, Benabic AJM, et al. Chronic pain in Australia: a prevalence study. Pain 2001; 89(2-3): 127–34

    Article  PubMed  CAS  Google Scholar 

  8. Crook J, Rideout E, Browne G. The prevalence of pain complaints in a general population. Pain 1984; 18(3): 299–314

    Article  PubMed  CAS  Google Scholar 

  9. Henderson S, Jorm AF, Scott LR, et al. Insomnia in the elderly: its prevalence and correlates in the general population. Med J Aust 1995; 162(1): 22–4

    PubMed  CAS  Google Scholar 

  10. Severn AM, Dodds C. Cognitive dysfunction may complicate assessment of pain in elderly patients [letter]. BMJ 1997; 315(7107): 551

    Article  PubMed  CAS  Google Scholar 

  11. Mäntyselka P, Hartikainen S, Louhivuori-Laako K, et al. Effects of dementia on perceived daily pain in home-dwelling elderly people: a population-based study. Age Ageing 2004; 33: 496–9

    Article  PubMed  Google Scholar 

  12. Pergolizzi J, Böger RH, Budd K, et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract 2008; 8: 287–313

    Article  PubMed  Google Scholar 

  13. American Academy of Pain Medicine and the American Pain Society. The use of opioids for the treatment of chronic pain. A: a consensus statement from the American Academy of Pain Medicine and the American Pain Society. 1997 [online]. Available from URL: http://www.painmed.org/pdf/opioids.pdf [Accessed 2008 Oct 20]

  14. Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Pain assessment and management: an organizational approach. Oakbrook Terrace (IL): JCAHO, 2000

  15. Wittink H, Carr DB, editors. Pain management: evidence, outcomes and quality of life. A sourcebook. Amsterdam: Elsevier, 2005

    Google Scholar 

  16. Linden M, Kurtz G, Baltes MM, et al. Depression bei hochbetagten. Nervenarzt 1998; 69(1): 27–37

    Article  PubMed  CAS  Google Scholar 

  17. Von Korff M, Dworkin SF, Le Resche L, et al. An epidemiologic comparison of pain complaints. Pain 1988; 32(2): 173–83

    Article  Google Scholar 

  18. Kroenke K, Price RK. Symptoms in the community: prevalence, classification, and psychiatric comorbidity. Arch Intern Med 1993; 153(21): 2474–80

    Article  PubMed  CAS  Google Scholar 

  19. Won A, Lapane K, Gambassi G, et al. Correlates and management of nonmalignant pain in the nursing home. SAGE Study Group: Systematic Assessment of Geriatric drug use via Epidemiology. J Am Geriatr Soc 1999; 47(8): 936–42

    PubMed  CAS  Google Scholar 

  20. Mobily PR, Herr KA, Clark MK, et al. An epidemiologic analysis of pain in the elderly. J Aging Health 1994; 6(2): 139–54

    Article  Google Scholar 

  21. Ehrich EW, Bolognese JA, Watson DJ, et al. Effect of rofecoxib therapy on measures of health-related quality of life in patients with osteoarthritis. Am J Manag Care 2001; 7(6): 609–16

    PubMed  CAS  Google Scholar 

  22. Rowbotham M, Harden N, Stacey B, et al. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA 1998; 280(21): 1837–42

    Article  PubMed  CAS  Google Scholar 

  23. World Health Organization. WHO’s pain ladder [online]. Available from URL: http://www.who.int/cancer/palliative/painladder/en/ [Accessed 2008 Oct 20]

  24. Bruntsch U. Drug therapy of chronic pain: a practical approach [in German]. MMW Fortschr Med 1999; 141(42): 30–2

    PubMed  CAS  Google Scholar 

  25. Palangio M, Northfelt DW, Portenoy RK, et al. Dose conversion and titration with a novel once-daily, OROS osmotic technology, extended-release hydromorphone formulation in the treatment of chronic malignant or non-malignant pain. J Pain Symptom Manage 2002; 23(5): 355–68

    Article  PubMed  CAS  Google Scholar 

  26. Zeppetella G. Opioids for cancer breakthrough pain: a pilot study reporting patient assessment of time to meaningful pain relief. J Pain Symptom Manage 2008; 35(5): 563–7

    Article  PubMed  Google Scholar 

  27. Liukas A, Kuusniemi K, Aantaa R, et al. Plasma concentrations of oral oxycodone are greatly increased in the elderly. Clin Pharmacol Ther 2008; 84: 462–7

    Article  PubMed  CAS  Google Scholar 

  28. Bellville JW, Forrest WH, Miller E, et al. Influence of age on pain relief from analgesics: a study of postoperative patients. JAMA 1971; 217: 1835–41

    Article  PubMed  CAS  Google Scholar 

  29. Kaiko RF. Age and morphine analgesia in cancer patients with postoperative pain. Clin Pharmacol Ther 1980; 28: 823–6

    Article  PubMed  CAS  Google Scholar 

  30. AGS Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc 2009; 57: 1331–46

    Article  Google Scholar 

  31. Resine T, Pasternak G. Opioid analgesics and antagonists. In: Hardman JG, Limbird LE, Molinoff PB, et al., editors. Goodman & Gilmans the pharmacological basis of therapeutics. 9th ed. New York: McGraw-Hill, 1995: 521–55

    Google Scholar 

  32. Dilaudid® prescribing information [online]. Available from URL: http://www.rxlist.com/dilaudid-drug.htm [Accessed 2009 Nov 13]

  33. Flockhart DA. Drug interactions: cytochrome P450 drug interaction table. Indiana University School of Medicine [online]. Available from URL: http://medicine.iupui.edu/flockhart/table.htm [Accessed 2010 Jan 25]

  34. Delmonico MJ, Harris TB, Visser M, et al. Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr 2009; 90(6): 1579–85

    Article  PubMed  CAS  Google Scholar 

  35. Enzi G, Gasparo M, Biondetti PR, et al. Subcutaneous and visceral fat distribution according to sex, age, and overweight, evaluated by computed tomography. Am J Clin Nutr 1986; 44: 739–46

    PubMed  CAS  Google Scholar 

  36. Kuk JL, Lee SJ, Heymsfield SB, et al. Waist circumference and abdominal adipose tissue distribution: influence of age and sex. Am J Clin Nutr 2005; 81: 1330–4

    PubMed  CAS  Google Scholar 

  37. Atlantis E, Martin SA, Haren MT, et al. Lifestyle factors associated with age-related differences in body composition: the Florey Adelaide Male Aging Study. Am J Clin Nutr 2008; 88: 95–104

    PubMed  CAS  Google Scholar 

  38. Olbrich O, Ferguson MH, Robson JS, et al. Renal function in aged subjects. Edinb Med J 1950; 57(2): 117–27

    PubMed  CAS  Google Scholar 

  39. Durnin C, Hind ID, Ghani SP, et al. Pharmacokinetics of oral immediate-release hydromorphone (Dilaudid® IR) in young and elderly subjects. Proc West Pharmacol Soc 2001; 44: 79–80

    PubMed  CAS  Google Scholar 

  40. Chopra P, Smith H. Acute and chronic pain in the elderly. In: McCleane G, Smith H, editors. Clinical management of the elderly patient in pain. Binghamton (NY): The Haworth Medical Press, 2006: 11–22

    Google Scholar 

  41. Jurnista® prolonged-release tablets: EU summary of product characteristics. Neuss, Germany: Janssen-Cilag GmbH, 2007 Aug 23

  42. Durnin C, Hind ID, Wickens MM, et al. Pharmacokinetics of oral immediate-release hydromorphone (Dilaudid® IR) in subjects with renal impairment. Proc West Pharmacol Soc 2001; 44: 81–2

    PubMed  CAS  Google Scholar 

  43. Lee MA, Leng ME, Tiernan EJ. Retrospective study of the use of hydromorphone in palliative care patients with normal and abnormal urea and creatinine. Palliat Med 2001; 15(1): 26–34

    Article  PubMed  CAS  Google Scholar 

  44. Osborne RJ, Joel SP, Slevin ML. Morphine intoxication in renal failure: the role of morphine-6-glucuronide. BMJ 1986; 292: 1548–9

    Article  PubMed  CAS  Google Scholar 

  45. Smith MT. Neuroexcitatory effects of morphine and hydromorphone: evidence implicating the 3-glucuronide metabolites. Clin Exp Pharmacol Physiol 2000; 27: 524–8

    Article  PubMed  CAS  Google Scholar 

  46. Thwaites D, McCann S, Broderick P. Hydromorphone neuroexcitation. J Palliat Med 2004; 7(4): 545–51

    Article  PubMed  Google Scholar 

  47. Davison SN, Mayo PR. Pain management in chronic kidney disease: the pharmacokinetics and pharmacodynamics of hydromorphone and hydromorphone-3-glucuronide in hemodialysis patients. J Opioid Manage 2008; 4(6): 335–44

    Google Scholar 

  48. Wynne HA, Goudevenos J, Rawlins MD, et al. Hepatic drug clearance: the effect of age using indocyanine green as a model compound. Br J Clin Pharmacol 1990; 30: 634–7

    Article  PubMed  CAS  Google Scholar 

  49. Durnin C, Hind ID, Ghani SP, et al. Pharmacokinetics of oral immediate-release hydromorphone (Dilaudid® IR) in subjects with moderate hepatic impairment. Proc West Pharmacol Soc 2001; 44: 83–4

    PubMed  CAS  Google Scholar 

  50. Paolisso G, Gambardella A, Balbi V, et al. Body composition, body fat distribution, and resting metabolic rate in healthy centenarians. Am J Clin Nutr 1995; 62: 746–50

    PubMed  CAS  Google Scholar 

  51. UK Summary of Product Characteristics. Morphine sulphate injection BP 10mg in 1 ml, 15mg in 1 ml, and 30 mg in 1ml [online]. Available from URL: http://www.emc.medicines.org.uk/medicine/7396/SPC/Morphine+Sulphate+Injection+BP+10mg+in+1ml%2c+15mg+in+1ml+%26+30mg+in+1ml/ [Accessed 2009 Nov 12]

  52. UK Summary of Product Characteristics. OxyNorm 10mg/ml solution for injection or infusion [online]. Available from URL: http://www.emc.medicines.org.uk/medicine/12151/SPC/OxyNorm+10+mg+ml+solution+for+injection+or+infusion/ [Accessed 2009 Nov 12]

  53. UK Summary of Product Characteristics. Abstral sublingual tablets [online]. Available from URL: http://www.emc.medicines.org.uk/medicine/21371/SPC/Abstral+Sublingual+Tablets/ [Accessed 2009 Nov 12]

  54. UK Summary of Product Characteristics. Methadone 10mg/ml solution for injection [online]. Available from URL: http://www.emc.medicines.org.uk [Accessed 2009 Nov 12]

  55. Sathyan G, Xu E, Thipphawong J, et al. Pharmacokinetic profile of a 24-hour controlled-release OROS® formulation of hydromorphone in the presence and absence of food. BMC Clin Pharmacol 2007; 7: 2

    Article  PubMed  Google Scholar 

  56. Sathyan G, Sivakumar K, Thipphawong J. Pharmacokinetic profile of a 24-hour controlled-release OROS formulation of hydromorphone in the presence of alcohol. Curr Med Res Opin 2008; 24(1): 297–305

    Article  PubMed  CAS  Google Scholar 

  57. Drover DR, Angst MS, Valle M, et al. Input characteristics and bioavailability after administration of immediate and a new extended-release formulation of hydromorphone in healthy volunteers. Anesthesiology 2002; 97(4): 827–36

    Article  PubMed  CAS  Google Scholar 

  58. Angst MS, Drover DR, Lotsch J, et al. Pharmacodynamics of orally administered sustained-release hydromorphone in humans. Anesthesiology 2001; 94(1): 63–73

    Article  PubMed  CAS  Google Scholar 

  59. Sathyan G, Xu E, Thipphawong J, et al. Pharmacokinetic investigation of dose proportionality with a 24-hour controlled-release formulation of hydromorphone. BMC Clin Pharmacol 2007; 7: 3

    Article  PubMed  Google Scholar 

  60. Winkler A, Teuscher AU, Mueller B, et al. Monitoring adherence to prescribed medication in type 2 diabetic patients treated with sulfonylureas. Swiss Med Wkly 2002; 132(27-28): 379–85

    PubMed  Google Scholar 

  61. Hanna M, Thipphawong J, DO-118 Study Group. A randomized, double-blind comparison of OROS hydromorphone and SR morphine for patients with chronic cancer pain. BMC Palliative Care 2008; 7(1): 17

    Article  PubMed  Google Scholar 

  62. Bornhoevd K, Richarz U, Berliner M, et al. Safety, efficacy, and dosing comparison of once-daily OROS hydromorphone and immediate-release hydromorphone in patients with chronic non-cancer pain [abstract]. Ann Rheum Dis 2006; 65(11): 562

    Google Scholar 

  63. Gajria KL, Kosinski MR, Schein JR, et al. Health related quality of life outcomes in patients treated with push-pull OROS hydromorphone versus extended oxycodone for chronic hip or knee osteoarthritis pain. Patient 2008; 1(3): 223–38

    Article  PubMed  Google Scholar 

  64. Wallace M, Rauck RL, Moulin D, et al. Conversion from standard opioid therapy to once-daily oral, extended-release hydromorphone in patients with chronic cancer pain. Int J Med Res 2008; 36(2): 343–52

    CAS  Google Scholar 

  65. Wallace M, Skowronski R, Khanna S, et al. Efficacy and safety evaluation of once-daily OROS hydromorphone in patients with chronic low back pain: a pilot open-label study (DO-127). Curr Med Res Opin 2007; 23(5): 981–9

    Article  PubMed  CAS  Google Scholar 

  66. Wallace M, Rauck RL, Moulin D, et al. Once-daily OROS® hydromorphone for the management of chronic non-malignant pain: a dose-conversion and titration study. Int J Clin Pract 2007; 61(10): 1671–6

    Article  PubMed  CAS  Google Scholar 

  67. Wirz S, Wittmann M, Schenk M, et al. Gastrointestinal symptoms under opioid therapy: a prospective comparison of oral sustained-release hydromorphone, transdermal fentanyl, and transdermal buprenorphine. Eur J Pain 2009; 13: 737–43

    Article  PubMed  CAS  Google Scholar 

  68. Wirz S, Wartenberg HC, Elsen C, et al. Managing cancer pain and symptoms of outpatients by rotation to sustained-release hydromorphone. Clin J Pain 2006; 22(9): 770–5

    Article  PubMed  Google Scholar 

  69. Weinstein SM, Shi M, Buckley BJ, et al. Multicenter, open-label, prospective evaluation of the conversion from previous opioid analgesics to extended-release hydromorphone hydrochloride administered every 24 hours to patients with persistent moderate to severe pain. Clin Ther 2006; 28(1): 86–98

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

Janssen-Cilag Europe, Middle East and Africa provided funding for this review and was involved in the design of the review, reviewed the manuscript, and approved it with regard to consistency with the scientific and safety information of OROS® hydromorphone. Ute Richarz is employed by Janssen-Cilag AG. David Lussier has received honoraria from Janssen-Ortho Canada for consultation on Jurnista®. Gabriele Finco has no conflicts of interest that are directly relevant to the content of this review. The authors would like to thank Sara Hughes of Dianthus Medical Limited for assistance in preparing the manuscript on behalf of Janssen-Cilag AG in accordance with the European Medical Writers Association guidelines.

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Authors and Affiliations

  1. Institut Universitaire de Gériatrie de Montréal, University of Montreal, Montreal, Quebec, Canada

    David Lussier

  2. Division of Geriatric Medicine and Alan-Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada

    David Lussier

  3. Janssen-Cilag, Baar, Switzerland

    Ute Richarz

  4. Chief Residency Program Anesthesiology Department of Medical Sciences “M. Aresu”, University of Cagliari, Policlinico di Monserrato, S.S. 554-Bivio per Sestu-09042, Monserrato (Cagliari), Italy

    Gabriele Finco

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  1. David Lussier
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Correspondence to Gabriele Finco.

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Lussier, D., Richarz, U. & Finco, G. Use of Hydromorphone, with Particular Reference to the OROS® Formulation, in the Elderly. Drugs Aging 27, 327–335 (2010). https://doi.org/10.2165/11318320-000000000-00000

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