It has been alleged that "hydromorphone causes less delirium in the elderly". This does not appear to be supported by any controlled trial evidence. Is there some other evidence? What is the best reference on metabolism and overall effectiveness/toxicity of hydromorphone vs. morphine?
What about oxycodone? Some patients report that "morphine knocks me out" (cognitively or with sedation) whereas oxycodone does not? Is there any controlled trial evidence bearing on this, and/or whether oxycodone is "more addictive" (more liable to abuse and/or to causing pharmacological tolerance/dependence/dose escalation) than other opioids?
Tom Perry, M.D., FRCPC
UBC Vancouver
I haven't seen any evidence of substantial differences in the acute pain literature in the 10 or so years that I've been following analgesia-related trials that make it onto PubMed.
It's difficult to understand why different opioids exhibit different efficacy / adverse efects in different people. It may relate to pharmacogenetics (eg CYP2D6 polymorphisms and codeine and tramadol), but it is certainly not consistent nor predictable.
Oxycodone dependence has been fast-rising in some countries (such as Australia) but that may relate to availability so it has come off a low base. I read spmewhere recently that deaths from oxycodone in the US were down for the last few years.
If you find any actual evidence, rather than just opinion, I'd be delighted if you could share it!
cheers
mark
Thank you. I'm still looking, but will try to share it, if I can. Oxycodone has potentially a number of metabolites ... so it's complicated, and probably no experimental evidence.
Tom Perry
Thank you also to Dr. Noori Aldallai. I don't think there is any evidence that oxycodone is superior to other opioids from RCT, and various meta-analyses (e.g. Cochrane Systematic Reviews) find it relatively ineffectual in chronic pain (like other opioids) in most circumstances ... a surprise to many.
I was glad to see that academic life can continue in Iraq, despite present hardships.
Tom Perry
- Badges
- Science topic
- Similar topics
- Papers