The prevalence of
pain increases with age. However,
pain is often inadequately managed in elderly people, which undermines quality of life.
Pain has been associated with depression, sleep disturbances, impaired ambulation, and increased healthcare use and costs. Effective treatment of
pain improves the overall quality of life. However,
pain management is complicated by the presence of multiple co-morbidities in elderly people, which increases the likelihood of
polypharmacy, and therefore increases the chance of potential
drug-drug interactions.
Polypharmacy is also associated with poor adherence to
therapy. Age-related pharmacokinetic and pharmacodynamic changes reduce the therapeutic index of drugs. Therefore, elderly people are more likely to suffer from adverse events and increased sensitivity to the
analgesic properties of
opioids. OROS
hydromorphone (Jurnista) is a once-daily,
extended-release formulation that uses the OROS push-pull technology to provide controlled release of the semi-synthetic
opioid hydromorphone. Compared with conventional immediate-release
hydromorphone, OROS
hydromorphone provides more consistent delivery of
hydromorphone with lower peak concentrations and less variability in plasma concentrations over time. The bioavailability of
hydromorphone from OROS
hydromorphone is minimally affected by food or alcohol (
ethanol).
Hydromorphone is mainly metabolized in the liver and is excreted in the urine. Unlike
morphine,
hydromorphone does not have an active 6-glucuronide metabolite. This metabolite of
morphine can accumulate in the presence of
renal failure; therefore, the lack of an active 6-glucuronide metabolite makes
hydromorphone a useful alternative to
morphine in elderly patients with
renal failure. However,
hydromorphone is similar to
morphine in that it is metabolized to
hydromorphone-3-glucuronide, which may be neuroexcitatory. Because of its low
plasma protein binding and low probability of interfering with the metabolism of other drugs,
hydromorphone may be especially suitable for patients taking multiple medications. OROS
hydromorphone is an effective
analgesic that is well tolerated and provides more stable plasma concentrations than immediate-release forms of
hydromorphone. Its once-daily administration offers an advantage over immediate-release forms and longer-acting formulations that require twice-daily administration. This means OROS
hydromorphone will be more convenient for elderly patients and may improve adherence, resulting in improved
pain relief and quality of life.