EXALGO is available in 8 mg, 12 mg, and 16 mg tablets that can be used in combination to achieve the desired dosage strength; tablets should be swallowed whole.
To convert patients to once-daily EXALGO, just remember C-A-T.
Follow these basic steps to find the appropriate starting dose for your patients and achieve successful conversion to EXALGO.
CALCULATE the equianalgesic dose
- Total all current daily opioids
- Multiply by the conversion ratio. Find approximate conversion ratios in the conversion table that is included in the Dosing and Administration Guide. Ask your sales representative or click here to order your copy
ADJUST the dose before initiating therapy
- Generally, reduce the calculated dose by 25% to 50%1-3
- Adjust this calculated dose based on the patient’s individual characteristics to enhance the likelihood that the initial dose will be effective for pain and have a low potential to cause withdrawal or other intolerable opioid-related effects
TITRATE based on patient reaction
- As EXALGO reaches steady state (3-4 days), consider supplemental analgesia as needed. It's important to manage patient expectations during this period and throughout the conversion process
- Increase the dose as needed for adequate pain relief with tolerable side effects
- Consider increases of 25% to 50% with each titration (if more than 2 doses of supplemental medication are needed for
2 consecutive days, it may be time to titrate upward) - Titrate no more often than every 3 to 4 days
Tell your patients: No more than one dose of EXALGO per day. Monitor them closely for signs of overdose. And watch for withdrawal symptoms—they may think EXALGO is not working for them when in reality the dose is too low.
- EXALGO® Prescribing Information.
- Fine PG, Portenoy RK; Ad Hoc Expert Panel on Evidence Review and Guidelines for Opioid Rotation. Establishing “best practices” for opioid rotation: conclusions of an expert panel. J Pain Symptom Manage. 2009;38:418-425.
- Hale M, Khan A, Kutch M, Li S. Once-daily OROS hydromorphone ER compared with placebo in opioid-tolerant patients with chronic low back pain. Curr Med Res Opin. 2010;26:1505-1518.
You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit http://www.fda.gov/medwatch, or call 1-800-FDA-1088.
Scroll down for Important Risk Information including boxed warning
INDICATION
EXALGO® is an extended-release oral formulation of hydromorphone hydrochloride indicated for the management of moderate to severe pain in opioid tolerant patients requiring continuous, around-the-clock opioid analgesia for an extended period of time.
IMPORTANT RISK INFORMATION
WARNING: POTENTIAL FOR ABUSE, IMPORTANCE OF PROPER PATIENT SELECTION AND LIMITATIONS OF USE
Potential for Abuse
EXALGO contains hydromorphone, an opioid agonist and a Schedule II controlled substance with an abuse liability similar to other opioid analgesics. EXALGO can be abused in a manner similar to other opioid agonists, legal or illicit. These risks should be considered when administering, prescribing, or dispensing EXALGO in situations where the healthcare professional is concerned about increased risk of misuse, abuse, or diversion. Schedule II opioid substances which include hydromorphone, morphine, oxycodone, fentanyl, oxymorphone and methadone have the highest potential for abuse and risk of fatal overdose due to respiratory depression.
Proper Patient Selection
EXALGO is an extended-release formulation of hydromorphone hydrochloride indicated for the management of moderate to severe pain in opioid tolerant patients when a continuous around-the-clock opioid analgesic is needed for an extended period of time. Patients considered opioid tolerant are those who are taking at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl/hour, 30 mg oral oxycodone/day, 8 mg oral hydromorphone/day, 25 mg oral oxymorphone/day or an equianalgesic dose of another opioid, for a week or longer.
EXALGO is for use in opioid tolerant patients only.
Fatal respiratory depression could occur in patients who are not opioid tolerant.
Accidental consumption of EXALGO, especially in children, can result in a fatal overdose of hydromorphone.
Limitations of Use
EXALGO is not indicated for the management of acute or postoperative pain.
EXALGO is not intended for use as an as-needed analgesic.
EXALGO tablets are to be swallowed whole and are not to be broken, chewed, dissolved, crushed or injected. Taking broken, chewed, dissolved or crushed EXALGO or its contents leads to rapid release and absorption of a potentially fatal dose of hydromorphone.
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EXALGO is also contraindicated in patients who:
- - need management of mild pain or pain not expected to persist
- - have significant impaired respiratory function including those with acute or severe bronchial asthma or hypercarbia.
- - have or are suspected to have paralytic ileus
- - have narrowed or obstructed gastrointestinal tract including those from previous surgery or "blind loops" in the GI tract
- - have known hypersensitivity to any components including hydromorphone hydrochloride and sulfites.
- Avoid concurrent use of alcohol and EXALGO. Concurrent use of EXALGO with CNS depressants, including alcohol, increases risk of respiratory depression, hypotension, and profound sedation, potentially resulting in coma or death. EXALGO may impair the ability to drive a car or operate machinery.
- Not intended in patients who have received MAO inhibitors within 14 days of starting EXALGO.
- Use with caution and in reduced doses in older or debilitated patients, as well as patients with renal or hepatic insufficiency, Addison's disease, delirium tremens, myxedema or hypothyroidism, prostatic hypertrophy or urethral stricture, toxic psychosis. May aggravate convulsions in patients with convulsive disorders; may induce or aggravate seizures in some clinical settings. Consider use of an alternate analgesic in patients with severe renal impairment.
- Respiratory depression, which occurs more frequently in elderly or debilitated patients, is the chief hazard with EXALGO.
- Serious adverse events could also include hypotensive effects, GI effects, cardiac arrest from overdose and precipitation of withdrawal. Most common adverse events (>10%) seen in clinical studies (N=2474) were: constipation (31%), nausea (28%), vomiting, somnolence, headache, asthenia and dizziness.
- Use EXALGO with extreme caution in patients susceptible to intracranial effects of CO2 retention.
- Do not abruptly discontinue EXALGO
Please see Full Prescribing Information, including boxed warning and Additional Important Risk Information.
