Management of moderate to severe cancer pain in opioid tolerant patients requiring continuous, around-the-clock opioid analgesia for an extended period of time.
Patient currently not routinely receiving opioids Initially ≤8 mg 24 hrly, may be titrated upward or downward in 4-8 mg increments 24 hrly. Patient currently receiving opioid analgesics Starting dose should be based on the prior daily opioid dose using standard equianalgesic ratios.
View Jurnista overdosage for action to be taken in the event of an overdose.
Administration
May be taken with or without food: Take at approx the same time each day. Do not take more than once in every 24 hr. If a dose is missed, take the next dose immediately & start a new 24-hr regimen. Swallow whole, do not chew/divide/crush.
Contraindications
Hypersensitivity. Surgical procedures &/or underlying disease that would result in narrowing of the GI tract, have blind loops or GI obstruction. Management of acute or post-op pain. Status asthmaticus; resp insufficiency; acute abdominal pain of unknown origin. Concomitant treatment w/ MAOIs or w/in 14 days of stopping such treatment; buprenorphine, nalbuphine or pentazocine. Patient in a coma state. Severely decreased liver function. Pregnancy, labor, delivery. Childn.
Not for use as an as needed analgesic, management of acute or post-op pain. Hypotension. Discontinue if paralytic ileus is suspected. Patients w/ substantially decreased resp reserve or pre-existing resp depression, COPD; head injuries; chronic constipation; inflammatory or obstructive bowel disorders; acute pancreatitis secondary to biliary disease; about to undergo biliary surgery; CNS depression, kyphoscoliosis, toxic psychosis, acute alcoholism, delirium tremens, convulsive disorders. Patients scheduled for regional anesth procedures or other interruptions of pain transmission pathways. Concomitant use w/ CNS depressants; follow patients closely for signs of resp depression & sedation. Should not be abruptly discontinued. Patients w/ rare hereditary problems of galactose intolerance, the Lapp deficiency or glucose-galactose malabsorption. Contains Na metabisulfite which may cause allergic-type reactions. Monitor patients for signs of abuse, misuse or addiction. May impair ability to drive & operate machinery. Renal insufficiency or mild to moderate hepatic insufficiency. Not to be used during breastfeeding. Elderly.
MAOIs may cause CNS excitation or depression, hypotension or HTN. Reduction of analgesic effect w/ morphine agonists/antagonists. Concomitant use w/ CNS depressants eg, benzodiazepines & other hypnotics/sedatives, general anesth, antipsychotics & alcohol may increase CNS depressant effects.
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