OROS (R) Hydromorphone in chronic pain management: when drug delivery technology matches clinical needs

The osmotic-controlled release oral delivery system (OROS (R)) is an innovative drug delivery technology that uses osmotic pressure as the driving force to deliver pharmacotherapies in many therapeutic areas. In chronic pain management requiring long-term therapy, pharmaceutical technologies that ensure the controlled release of analgesic medications are imperative. In addition, once-daily formulations ensure better patient compliance to prescribed therapies. Hydromorphone was the first opioid to be formulated as a once-daily preparation using OROS (R) technology. The purpose of this review is to discuss the application of OROS (R) technology in the field of chronic pain management and to examine clinical trial results for OROS (R) Hydromorphone. OROS (R) hydromorphone ensures the constant delivery of hydromorphone over a 24-hour period, and its pharmacokinetic profile is only minimally affected by food and alcohol. Dose-conversion studies have shown that patients with chronic pain can be easily switched from previous opioid therapies to OROS (R) hydromorphone without a loss of pain control. These studies support the clinical utility of the 5:1 ratio used for the conversion of oral morphine to oral OROS (R) hydromorphone. Furthermore, once-daily OROS (R) hydromorphone has been shown to be effective in patients with chronic cancer and non-cancer pain, and it provides similar pain relief to SR morphine and ER oxycodone. In chronic pain management, OROS (R) products can result in more stable drug concentrations, reduced dosing frequency and an improved safety profile. (Minerva Anestesiol 2010;76:1072-84)