Numorphan (Injection)

Oxymorphone injection is used to treat moderate to severe pain, including pain from labor. It may also be given before surgery or with a general anesthetic (a medicine that puts you to sleep), and may help relieve anxiety for patients who have breathing problems due to pulmonary edema caused by heart disease.

Oxymorphone is part of a group of medicines called narcotic analgesics (pain medicines). It works on the central nervous system (CNS) to relieve pain.

Using oxymorphone for a long time may lead to habit-forming behavior, causing mental or physical dependence. However, people with ongoing pain should not let the fear of dependence stop them from using narcotics to relieve their pain. Mental dependence (addiction) is not likely to happen when narcotics are used for this reason. Physical dependence may result in withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be avoided by slowly reducing the dose over time before stopping treatment completely.

This medicine is available only with your doctor's prescription.

It is very important for your doctor to monitor your progress while you are using this medicine. This will help your doctor determine if the medicine is effective and if you should continue taking it.

Avoid using this medicine and an MAO inhibitor at the same time or within 14 days of each other.

This medicine will enhance the effects of alcohol and other CNS depressants (medicines that can make you sleepy or less alert). Some examples of CNS depressants include antihistamines or allergy/cold medications, sedatives, tranquilizers, sleeping medications, other prescription pain medicines or narcotics, seizure medications or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Consult your doctor before taking any of these medicines while using this medicine.

Signs of an overdose include severe dizziness or weakness, slow heartbeat or breathing, seizures, difficulty breathing, and cold, clammy skin. Contact your doctor immediately if you experience any of these symptoms.

This medicine may cause breathing problems during sleep (for example, sleep apnea or sleep-related hypoxemia). Your doctor may lower your dose if you experience sleep apnea while using this medicine.

This medicine may cause serious allergic reactions, including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical help. Inform your doctor right away if you develop a rash, itching, difficulty breathing, trouble swallowing, or any swelling of your hands, face, or mouth while using this medicine.

This medicine may be habit-forming. If you feel the medicine is not working as well, do not take more than your prescribed dose. Contact your doctor for guidance.

Dizziness, lightheadedness, or fainting may happen when you stand up quickly from a lying or sitting position. Getting up slowly may help reduce this issue. Also, lying down for a bit may relieve dizziness or lightheadedness.

This medicine may cause dizziness, drowsiness, confusion, or disorientation. Make sure you understand how this medicine affects you before driving, operating machinery, or doing anything else that could be dangerous if you feel dizzy or less alert.

Using narcotics for a long time can lead to severe constipation. To help prevent this, your doctor may advise you to take laxatives, drink plenty of fluids, or increase your dietary fiber. Follow these instructions carefully, as ongoing constipation can lead to more serious issues.

If you have been using this medicine regularly for several weeks or longer, do not stop taking it suddenly without consulting your doctor. Your doctor may want you to gradually decrease your dosage before stopping completely. This may help avoid worsening of your condition and lower the chance of withdrawal symptoms, such as stomach cramps, anxiety, fever, nausea, runny nose, sweating, tremors, or trouble sleeping.

Contact your doctor immediately if you experience anxiety, restlessness, a rapid heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or hallucinations. These may be signs of a serious condition called serotonin syndrome. Your risk may increase if you also take other medications that affect serotonin levels in your body.

Using this medicine during pregnancy may lead to neonatal withdrawal syndrome in your newborn. Inform your doctor immediately if your baby shows signs such as abnormal sleep patterns, diarrhea, a high-pitched cry, irritability, shakiness, weight loss, vomiting, or failure to gain weight.

Taking too much of this medicine may cause infertility (inability to have children). Discuss with your doctor before using this medicine if you plan to have children.

Do not take other medicines unless you have discussed them with your doctor. This includes prescription or over-the-counter (OTC) medicines and herbal or vitamin supplements.

In deciding to use a medication, the chances of taking the medicine must be weighed against the beneficial it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your clinician if you have ever had any unusual or allergic reaction to this drug or any other drugs. As well inform your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of oxymorphone injection in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific issues that would limit the usefulness of oxymorphone injection in the elderly. However, elderly patients are more likely to have age-related liver, kidney, heart, or lung issues, which may require caution and an adjustment in the dose for patients receiving oxymorphone injection.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks prior to using this medication while breastfeeding.

Interactions with Medicines

Although certain medications should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially essential that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medications is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Nalmefene
• Naltrexone
• Safinamide
• Samidorphan

Using this medicine with any of the following medicines is typically not advised, but may be required in some cases. If both medications are prescribed together, your doctor may change the dose or how frequently you use one or both of the medicines.

• Acepromazine
• Alfentanil
• Almotriptan
• Alprazolam
• Alvimopan
• Amifampridine
• Amineptine
• Amitriptyline
• Amitriptylinoxide
• Amobarbital
• Amoxapine
• Amphetamine
• Anileridine
• Aripiprazole
• Asenapine
• Baclofen
• Benperidol
• Benzhydrocodone
• Benzphetamine
• Bromazepam
• Bromopride
• Brompheniramine
• Buprenorphine
• Bupropion
• Buspirone
• Butabarbital
• Butorphanol
• Calcium Oxybate
• Cannabidiol
• Cannabis
• Carbamazepine
• Carbinoxamine
• Carisoprodol
• Carphenazine
• Cetirizine
• Chloral Hydrate
• Chlordiazepoxide
• Chlorpheniramine
• Chlorpromazine
• Chlorzoxazone
• Cimetidine
• Citalopram
• Clobazam
• Clomipramine
• Clonazepam
• Clopidogrel
• Clorazepate
• Clozapine
• Cocaine
• Codeine
• Cyclobenzaprine
• Daridorexant
• Desipramine
• Desmopressin
• Desvenlafaxine
• Dexmedetomidine
• Dextroamphetamine
• Dextromethorphan
• Dezocine
• Diazepam
• Dibenzepin
• Dichloralphenazone
• Difenoxin
• Dihydrocodeine
• Diphenhydramine
• Diphenoxylate
• Dolasetron
• Donepezil
• Doxepin
• Doxylamine
• Droperidol
• Duloxetine
• Eletriptan
• Enflurane
• Escitalopram
• Esketamine
• Estazolam
• Eszopiclone
• Ethchlorvynol
• Ethopropazine
• Ethylmorphine
• Fenfluramine
• Fentanyl
• Flibanserin
• Fluoxetine
• Fluphenazine
• Flurazepam
• Fluspirilene
• Fluvoxamine
• Fospropofol
• Frovatriptan
• Furazolidone
• Gabapentin
• Gabapentin Enacarbil
• Gepirone
• Granisetron
• Halazepam
• Haloperidol
• Halothane
• Hexobarbital
• Hydrocodone
• Hydromorphone
• Hydroxyamphetamine
• Hydroxytryptophan
• Hydroxyzine
• Imipramine
• Iproniazid
• Isocarboxazid
• Isoflurane
• Ketamine
• Ketazolam
• Ketobemidone
• Lacosamide
• Lasmiditan
• Lemborexant
• Levocetirizine
• Levomilnacipran
• Levorphanol
• Linezolid
• Lisdexamfetamine
• Lithium
• Lofepramine
• Lofexidine
• Lorazepam
• Lorcaserin
• Loxapine
• Magnesium Oxybate
• Meclizine
• Melitracen
• Melperone
• Meperidine
• Mephobarbital
• Meprobamate
• Meptazinol
• Mesoridazine
• Metaxalone
• Methadone
• Methamphetamine
• Methdilazine
• Methocarbamol
• Methohexital
• Methotrimeprazine
• Methylene Blue
• Methylnaltrexone
• Metoclopramide
• Midazolam
• Milnacipran
• Mirtazapine
• Moclobemide
• Molindone
• Moricizine
• Morphine
• Morphine Sulfate Liposome
• Nalbuphine
• Nalorphine
• Naloxone
• Naratriptan
• Nefazodone
• Nialamide
• Nicomorphine
• Nitrazepam
• Nitrous Oxide
• Nortriptyline
• Olanzapine
• Ondansetron
• Opipramol
• Opium
• Opium Alkaloids
• Orphenadrine
• Oxazepam
• Oxycodone
• Ozanimod
• Paliperidone
• Palonosetron
• Papaveretum
• Paregoric
• Paroxetine
• Pentazocine
• Pentobarbital
• Perampanel
• Perazine
• Periciazine
• Perphenazine
• Phenelzine
• Phenobarbital
• Pimozide
• Piperacetazine
• Pipotiazine
• Piritramide
• Potassium Oxybate
• Prazepam
• Pregabalin
• Primidone
• Procarbazine
• Prochlorperazine
• Promazine
• Promethazine
• Propofol
• Protriptyline
• Quazepam
• Quetiapine
• Ramelteon
• Rasagiline
• Remifentanil
• Remimazolam
• Remoxipride
• Rizatriptan
• Ropeginterferon Alfa-2b-njft
• Scopolamine
• Secobarbital
• Selegiline
• Sertindole
• Sertraline
• Sibutramine
• Sodium Oxybate
• St John's Wort
• Sufentanil
• Sulpiride
• Sumatriptan
• Suvorexant
• Tapentadol
• Temazepam
• Thiethylperazine
• Thiopental
• Thiopropazate
• Thioridazine
• Tianeptine
• Tilidine
• Tizanidine
• Tolonium Chloride
• Topiramate
• Tramadol
• Tranylcypromine
• Trazodone
• Triazolam
• Trifluoperazine
• Trifluperidol
• Triflupromazine
• Trimeprazine
• Trimipramine
• Tryptophan
• Venlafaxine
• Vilazodone
• Vortioxetine
• Zaleplon
• Ziprasidone
• Zolmitriptan
• Zolpidem
• Zopiclone
• Zotepine
• Zuranolone

Interactions with Food/Tobacco/Alcohol

Certain medications should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain drugs may additionally cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medication with any of the following is typically not advised, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

• Ethanol

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you inform your physician if you have any other medical problems, especially:

• Addison's disease (adrenal gland issue) or
• Alcohol abuse, or history of or
• Brain tumor, history of or
• Breathing or lung issues (eg, COPD, cor pulmonale, hypercapnia, hypoxia, sleep apnea) or
• Depression, history of or
• Drug dependence, especially with narcotics, or history of or
• Enlarged prostate (BPH, prostatic hypertrophy) or
• Gallbladder disease or gallstones or
• Head injuries, history of or
• Heart disease or
• Hypothyroidism (an underactive thyroid) or
• Hypovolemia (low blood volume) or
• Kyphoscoliosis (curvature of the spine with breathing problems) or
• Obesity, serious or
• Problems with passing urine or
• Weakened physical condition—Use with caution. May increase risk for more severe side effects.

• Hypotension (low blood pressure) or
• Pancreatitis (inflammation of the pancreas) or
• Seizures, history of—Use with caution. May make these conditions worse.

• Kidney disease or
• Liver disease, mild—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

• Liver disease, moderate or severe or
• Lung or breathing issues (eg, asthma, respiratory depression), severe or
• Stomach or bowel blockage (eg, paralytic ileus)—Should not be used in patients with these conditions.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do, they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

Incidence not known

• Blurred vision
• chest pain or discomfort
• confusion
• constricted, pinpoint, or small pupils (black part of the eye)
• difficult or painful urination
• difficult or troubled breathing
• difficulty with sleeping
• disorientation
• double vision
• drowsiness or sleepiness
• fast, pounding, or irregular heartbeat or pulse
• frequent urge to urinate
• hallucinations
• irregular, fast or slow, or shallow breathing
• noisy breathing
• pale or blue lips, fingernails, or skin
• slow or irregular heartbeat
• seeing double
• seeing, hearing, or feeling things that are not there
• tightness in the chest
• unconsciousness
• unusual tiredness or weakness
• very slow breathing

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

• Bigger, dilated, or enlarged pupils (black part of the eye)
• cold, clammy skin
• difficult or troubled breathing
• increased sensitivity of the eyes to light
• irregular, fast or slow, or shallow breathing
• no muscle tone or movement
• pale or blue lips, fingernails, or skin
• unconsciousness
• very slow heartbeat

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known

• Abdominal or stomach cramps or pain
• bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
• bloating
• chills
• cold sweats
• cough
• decrease in frequency of urination
• decrease in urine volume
• diarrhea
• difficulty having a bowel movement (stool)
• difficulty in passing urine (dribbling)
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• dry mouth
• flushing
• headache
• lethargy
• lightheadedness
• loss of appetite
• mood or other mental changes
• nausea
• restlessness
• sleepiness or unusual drowsiness
• skin rash, hives, itching, or redness
• sweating
• swelling or puffiness of the face
• unusual tiredness
• vomiting
• weight loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

In the U.S.

• Numorphan

Chemical Class: Opioid

A nurse or other trained health professional will give you this medicine in a hospital. This medicine may be given as a shot under the skin, into a muscle or a vein.

Your doctor will give you a few doses of this medicine until your condition improves, and then switch you to an oral medicine that works the same way. If you have any concerns about this, talk to your doctor.

• Oxymorphone vs Hydromorphone - How do they compare?