Product: Embeda
Company: King
Pharmacologic class: Opioid + opioid antagonist
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Active ingredients: Morphine sulfate 20 mg, naltrexone HCl 0.8 mg; extended-release caps.
Indication: Moderate-to-severe pain management when continuous, around-the-clock opioid is needed for an extended time period. Not for as-needed use.
Pharmacology: Embeda contains pellets of an extended-release formulation of the opioid analgesic
morphine surrounding a sequestered core of naltrexone, a mu-opioid antagonist. The naltrexone is intended to have no effect when this product is taken as directed; however, if it is crushed or chewed, the naltrexone will be released. Naltrexone reverses the subjective and analgesic effects of morphine by competitively binding at
mu-opioid receptors.
Clinical trials: The efficacy of Embeda was evaluated in a 12-week trial in osteoarthritis patients with moderate-to-severe pain. The patients were initially titrated to pain control in an open-label phase using Embeda, then randomized to either continuation with Embeda or placebo. The mean change in the weekly pain assessment score from randomization to the end of the study was statistically significantly superior for patients using Embeda compared to those given placebo.
Adults: Swallow whole, or sprinkle pellets on applesauce; do not chew pellets. See literature. Do not give via nasogastric or gastric tubes. ³18 years: individualize; give on 24-hour or 12-hour schedule. Opioid-naïve: start at lowest dose. Adjust at intervals of at least two days. Withdraw gradually.
Children: <18 years: not recommended.
Contraindications: Concomitant alcohol (increases morphine absorption; may be fatal). Significant respiratory depression, acute or severe asthma or hypercapnia (in unmonitored settings or in absence of resuscitative equipment). Paralytic ileus. During or within 14 days of monoamine oxidase inhibitors.
Precautions: Ingestion of tampered product may precipitate withdrawal symptoms in opioid-tolerant; overdose in opioid-naïve. 100/4 strength for opioid-tolerant only. Head injury. Increased intracranial pressure. Chronic obstructive pulmonary disease. Cor pulmonale. Kyphoscoliosis. Seizure disorders. Shock. Central nervous system (CNS) depression. Toxic psychosis. Impaired pulmonary, renal, hepatic, thyroid, or adrenocortical function. GI or genitourinary obstruction. Biliary tract disease. Acute pancreatitis. Acute abdomen. Volume-depleted. Acute alcoholism. Delirium tremens. Discontinue 24 hours before cordotomy. Elderly. Debilitated. Pregnancy (Cat. C). Labor and delivery, nursing mothers: not recommended.
Interactions: See Contraindications. CNS depression with CNS depressants (e.g., antiemetics, phenothiazines, sedatives, hypnotics, muscle relaxants; reduce dose of either by half). Paralytic ileus with anticholinergics. May be potentiated by P-glycoprotein-inhibitors (e.g., quinidine). Antagonizes diuretics. Possible withdrawal symptoms with mixed agonist/antagonist opioids.
Adverse reactions: Constipation, GI upset, somnolence; respiratory depression/arrest, apnea, circulatory depression, cardiac arrest, hypotension, shock.
How supplied: Caps—100
For more information, call 800.776.3637 or visit www.Embeda.com.
