Oral Long Acting Opioids

Drug - Oral long acting opioids

June 2016

Therapeutic area - Pain

Preferred

Morphine sulfate sustained release (generic)

Nonpreferred

• Avinza (morphine)
• Embeda
• Exalgo 
• Kadian (morphine)
• OxyContin
• Oxycodone sustained release
• MS Contin (morphine)

Opana and Opana ER (oxymorphone) are under separate PA criteria. See “Opioids_Opana,” criteria sheet.

Criteria to approve nonpreferred drug

• Patient must try at least sustained release morphine and fail by ineffectiveness at equivalent dosing OR by intolerance AND
• Presence of a patient-specific pain management plan accompanies each request and is updated at least yearly OR
• Patient has cancer-related pain and has been stabilized on requested non preferred drug

For oxycodone requests specifically, intolerance to morphine defined as

• Patient has renal insufficiency
• Patient has a true morphine allergy (as manifested by skin rash, facial swelling, or difficulty breathing)
• Patient develops morphine-related itching
• Patient cannot tolerate the nausea and vomiting of morphine 

Patients who are stabilized on OxyContin or oxycodone sustained release

Patient’s past trial with morphine at oxycodone-equivalent dosing resulted in intolerance.

Quantity limits for Oxycontin or oxycodone sustained release

Oral opioid expected equianalgesic dosing – (represents total daily dose)

Strengths and doses	Oxycodone total daily dose	Morphine daily dose range
Strengths available	10, 15, 20, 30, 40, 60, 80mg	15, 30, 60, 100 mg
Dosing frequency	Twice daily	Twice daily
Oxycodone dose and morphine dose ranges	20 mg	30 - 40 mg
	30 mg	45 - 60 mg
	40 mg	60 - 80 mg
	60 mg	90 - 120 mg
	80 mg	120 - 160 mg
	100 mg	150 - 200 mg

These recommendations are guides only. Individual patients require doses to be adjusted.

Methadone (5 and 10 mg) is long acting by its pharmacokinetic properties, not by tablet formulation. It is expected to be about equipotent to oxycodone.

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411