(443) Evaluation of the clinical abuse potential of Opana ER versus oxymorphone HCl powder

Shusterman, Neil H.; Diana, Frank J.; Ciliberto, C F; Xiang, Qinfang; Jobes, Janet; Kelsh, Debra; Vince, Bradley

doi:10.1016/j.jpain.2016.01.420

Cited by 2 publications

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“…In 2012, even though crush-resistant formulation was introduced by pharmaceutical companies, IV drug users continue to inject the drug in melted form. 2 , 3 …”

Section: Introductionmentioning

confidence: 99%

Opana ER (Oxymorphone)–Induced Thrombotic Microangiopathy: An Atypical Presentation in a Patient With Hepatitis C

Mehmood

Khan

Marwat

et al. 2018

Journal of Investigative Medicine High Impact Case Reports

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Oxymorphone is a semisynthetic extended release opiate used to treat moderate to severe chronic pain. The Food and Drug Administration approved the oral form of oxymorphone available as Opana and Opana ER (extended release) since 2006. The Food and Drug Administration and the Centers for Disease Control and Prevention issued warning against intravenous use of Opana ER. We are presenting a case report of a 37-year-old female with a history of active intravenous drug abuse who presented to our hospital with acute kidney injury. Urinalysis showed red blood cell sediments, many dysmorphic red blood cell casts along with nephrotic range proteinuria of 12 g/deal per day. Kidney biopsy showed microscopic thrombotic microangiopathy (TMA) involving glomeruli and vessels. Further workup was undertaken for TMA, and apart from mildly elevated lactate dehydrogenase of 380 (normal <243), active hepatitis C, and slightly low ADAMTS-13 (55%), there was no other laboratory evidence of TMA. On literature search, we found that intravenous injection of chronic Opana ER has been reported to cause TMA resulting in chronic kidney disease. Our patient also admitted to use of intravenous Opana ER abuse for the past 5 years. She had a normal platelet count and an absence of schistocytes, which makes it an atypical presentation of TMA resulting in chronic kidney disease in an opiate user. We strongly urge physicians to avoid prescribing opiates for chronic pain, especially Opana ER, which if injected intravenously for recreational purposes can lead to serious side effects like TMA. Treatment is mainly supportive and avoidance of drug in future.

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“…In 2012, even though crush-resistant formulation was introduced by pharmaceutical companies, IV drug users continue to inject the drug in melted form. 2 , 3 …”

Section: Introductionmentioning

confidence: 99%

Opana ER (Oxymorphone)–Induced Thrombotic Microangiopathy: An Atypical Presentation in a Patient With Hepatitis C

Mehmood

Khan

Marwat

et al. 2018

Journal of Investigative Medicine High Impact Case Reports

View full text Add to dashboard Cite

show abstract

“…In 2012, a crush resistant formulation was developed by Endo Pharmaceuticals to help curtail abuse of the drug. With this formulation, the drug could no longer be crushed and snorted, but this did not prevent it from being used intravenously [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Thrombotic Microangiopathy Secondary to Intravenous Abuse of Opana® ER

Thakur

Agrawal

Kass

et al. 2017

Case Reports in Hematology

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Opana ER (oxymorphone) is an opioid drug available throughout the United States, and intravenous abuse of the crushed oral formulation has been associated with drug-induced thrombotic microangiopathy. In this abstract, we describe two young patients who lived together and used Opana ER intravenously. Both presented with microangiopathic hemolytic anemia that mimicked thrombotic thrombocytopenic purpura (TTP). Treating this condition poses a clinical challenge, as it is difficult to distinguish it from TTP. The role for plasma exchange is not clear but can be used while awaiting the results of the ADAMTS-13 activity, but ultimately supportive care with drug discontinuation is the recommended therapy of choice. Patients should be counseled against Opana ER's intravenous use, and users should be offered drug rehabilitation therapy.

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(443) Evaluation of the clinical abuse potential of Opana ER versus oxymorphone HCl powder

Cited by 2 publications

References 0 publications

Opana ER (Oxymorphone)–Induced Thrombotic Microangiopathy: An Atypical Presentation in a Patient With Hepatitis C

Opana ER (Oxymorphone)–Induced Thrombotic Microangiopathy: An Atypical Presentation in a Patient With Hepatitis C

Thrombotic Microangiopathy Secondary to Intravenous Abuse of Opana® ER

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