Hydromorphone 24mg modified-release capsules

IntroductionPatients with opioid use disorder often have undertreated withdrawal while in hospital, leading to high rates of premature discharges. Short-acting, full agonist opioids (SAFAOs) have been proposed to alleviate withdrawal symptoms when provided as adjuncts to opioid agonist therapy (OAT). We aimed to synthesize evidence on the safety and efficacy of SAFAOs.MethodsWe searched the scientific databases MEDLINE, Embase, CINAHL, PsycInfo, Web of Science Core Collection, and the Cochrane Library for studies with adults whose opioid withdrawal symptoms were treated with SAFAOs. Results were narratively synthesized.ResultsOur search yielded 5,616 papers screened and 15 studies included. Information was gathered mostly from patient charts, followed by cohort studies, a cross-sectional study, and a clinical trial. Hydromorphone, tramadol, fentanyl, and oxycodone were described individually or as groupings to reduce withdrawal from heroin or fentanyl, initiate OAT, or as a bridge to transition between medications. Most studies observed reduced withdrawal scores and fewer occurrences of premature discharges in those who received these medications. Oversedation was observed as an adverse event in patients with ongoing opioid use.DiscussionThis systematic review provides an up-to-date synthesis on the use of SAFAOs to treat withdrawal. Our results suggest that in-hospital use of SAFAOs can reduce patient suffering and potentially the following risk for premature discharges. More clinical studies are needed to further investigate the clinical utility of SAFAO as a combination treatment with OAT.

Abstract licence: CC BY-NC-ND

Background Cancer pain significantly impacts individuals’ quality of life, with opioids being employed as the primary means for pain relief. Nevertheless, concerns persist regarding the adverse reactions and effectiveness of opioids such as morphine. Hydromorphone, recognized as a potent opioid, is a viable alternative for managing cancer-related pain. The goal of this systematic review and meta-analysis was to determine the effectiveness and safety characteristics of hydromorphone in comparison to other opioids, as well as different methods of administering this medication within the scope of cancer pain treatment. Methods The PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases were searched on December 25th, 2023. Following the PRISMA guidelines, a systematic investigation of databases was carried out, and suitable studies were chosen according to predetermined criteria (PICO framework). The meta-analyses were performed using a random-effects model. Results This review included 18 RCTs with 2271 patients who compared hydromorphone with morphine, oxycodone, or fentanyl, as well as other types of hydromorphone. Hydromorphone demonstrated efficacy similar to that of morphine and oxycodone in reducing cancer pain intensity, decreasing additional analgesic consumption, and improving quality of life. However, morphine showed slight superiority over hydromorphone in reducing breakthrough pain. Adverse events were comparable between hydromorphone and morphine or oxycodone. Patient-controlled and clinician-controlled hydromorphone administration routes yielded similar outcomes. Conclusions The outcomes of this study substantiate the efficacy of hydromorphone in the management of cancer-related pain, demonstrating similar levels of effectiveness and safety as morphine and oxycodone. These findings are consistent with prior comprehensive analyses, suggesting that hydromorphone is a feasible choice for alleviating cancer-associated pain. Additional investigations are warranted to determine its efficacy in distinct patient cohorts and for different modes of administration. Trial registration Prospero registration ID: CRD42024517513. Link: https://www.crd.york.ac.uk/PROSPERO/#recordDetails .

Abstract licence: CC BY