Oxymorphone

Oxymorphone (Numorphan) or 14-Hydroxydihydromorphinone is a powerful semi-synthetic opioid analgesic that is derived from morphine, and is approximately 6-8 times more potent. Clinically, it is administered as its hydrochloride salt via injection, or suppository; typically in dosages of 1 mg (injected) to 5 mg (suppository). Endo Pharmaceuticals has received final approval from the FDA to market oxymorphone for oral administration, as Opana and Opana ER. Opana is available as 5 mg and 10 mg tablets; Opana ER, an extended-release form of oxymorphone, is available as tablets in strengths of 5 mg, 10 mg, 20 mg, and 40 mg. As with other opioids, oxymorphone can cause physical dependency, and may be abused. Addiction to opioid drugs, including oxymorphone, is possible, but is extremely rare in the context of a medical setting.

Uses

Oxymorphone is indicated for the relief of moderate to severe pain and also as a preoperative medication to alleviate apprehension, maintain anaesthesia, and as an obstetric analgesic. Additionally, it can be used for the alleviation of patients with dyspnea associated with acute left ventricular failure and pulmonary oedema.

Physical characteristics

Oxymorphone HCl occurs as odourless white crystals or white to off-white powder. It will darken in colour with prolonged exposure to light. One gram of oxymorphone is soluble in 4 ml of water and it is slightly soluble in alcohol and ether. The commercially available injection has a pH of 2.7-4.5.

Toxicity

Oxymorphone overdosage is characterised by respiratory depression, extreme somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, and sometimes bradycardia and hypotension. In a severe case of overdose, apnoea, circulatory collapse, cardiac arrest, and death may occur.

Brand Names

  • Numorphan (suppository and injectable solution)
  • Opana (tablet)
  • Opana ER (extended-release tablet)

    • Illicit Use

    Until its removal from the United States market in the early 1970s, oxymorphone in the form of Numorphan 10 mg instant-release tablets was one of the most sought-after and well-regarded opioids of the IV drug using community. Known popularly as "blues" for their light blue colour, the tablets contained very few insoluble binders — making them easy to inject — and were extremely potent when used intravenously. "Blues" were also considered to be especially euphoric; comparable to or better than heroin. Numorphan tablets, and the oxymorphone they contained, are the "blues" referred to in the film Drugstore Cowboy.

    Oxymorphone is not a component of "T's and blues", 1980s slang for a combination of pentazocine ("T's") and pyribenzamine ("blues").

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