The Medical Letter on Drugs and Therapeutics
Extended-Release Hydromorphone (Exalgo) for Pain
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The FDA has approved the opioid agonist hydromorphone in a once-daily extended-release (ER) oral tablet formulation (Exalgo – Covidien) for the management of moderate to severe pain in opioid-tolerant patients requiring continuous, long-term therapy. Another hydromorphone ER formulation (Palladone – Purdue) was available previously, but was withdrawn from the market because taking it with alcohol could interfere with the extended-release mechanism and lead to rapid release of potentially lethal amounts of the drug ("dose-dumping").1

PHARMACOLOGY — Hydromorphone has no analgesic ceiling, but dosage is usually limited by its adverse effects. This new formulation delivers hydromorphone at a controlled rate for up to 24 hours.2 Steady-state concentrations are reached after 3-4 days, and are within the same range as those ... more      

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Title: Extended-Release Hydromorphone (Exalgo) for Pain
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