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Last Updated: January 21, 2025

CLINICAL TRIALS PROFILE FOR DILAUDID-HP


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505(b)(2) Clinical Trials for Dilaudid-hp

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
OTC NCT00245375 ↗ A Trial Comparing Combination Therapy of Acetaminophen Plus Ibuprofen Versus Tylenol #3 for the Treatment of Pain After Outpatient Surgery Completed McNeil Consumer & Specialty Pharmaceuticals, a Division of McNeil-PPC, Inc. N/A 2005-01-01 Increasingly in general surgery, the investigators are conducting outpatient day surgery. Ambulatory surgery currently comprises 60 to 70% of surgeries performed in North America. These patients all require some form of analgesia which can be taken at home in the first few days after the surgery. The current standard at the investigators' centre and many others in the maritime provinces is to provide a prescription for oral acetaminophen plus codeine or oxycodone (Tylenol #3®, Percocet ®). Some patients may receive more potent opioids such as oral hydromorphone (Dilaudid®). Unfortunately, the most commonly prescribed medication (Tylenol #3®) is often poorly tolerated by patients, has several undesirable side effects, and may not provide effective pain relief. In the investigators' experience, non-steroidal anti-inflammatory drugs (NSAIDs) are uncommonly a routine addition to the home analgesic regimen. Tylenol #3®, in the investigators' experience and opinion, is a poor post surgical pain medication. They hope to show that a combination of ibuprofen and acetaminophen is better for pain relief after these procedures. The combination of acetaminophen and ibuprofen would be a safe, cheap, and readily available regimen. Unfortunately, as the prescribing practices of surgeons are old habits, it will require a very convincing argument to get them to change their practices. A randomized controlled trial comparing these two regimens, the investigators hope, would be a powerful enough argument. The hypothesis of this study, therefore, is that the pain control provided by a combination of acetaminophen plus ibuprofen (650 mg/400 mg four times per day) will be superior to Tylenol #3® (600 mg acetaminophen/60 mg codeine/15 mg caffeine four times per day). This study will attempt to enroll 150 patients in total. Eligible patients will be identified by their attending surgeon and contacted by study personnel. Patients who enroll in the study will undergo their surgery in the usual manner. After the surgery, in the recovery room, once they are ready to go home, they will be randomized to receive combination A or B and be given a week's worth of pain medication. They will then go home and take this medication as directed. They will record their pain intensity and pain relief once per day using a diary provided in the study package. One week after their surgery, they will return to the hospital clinic and be seen by the study nurse. They will hand over the diary and any unused medication. They will also be asked several questions regarding their overall satisfaction, incidence of side effects, and how long until they were pain free. The risks of participating in this study are minimal from the risks inherent to the procedures and medications the patients would receive within the standard of care. Ibuprofen is a commonly used NSAID which is widely available over the counter and has an established safety profile. The most common adverse effects of ibuprofen and other NSAIDs are gastrointestinal bleeding and ulceration. Other less common adverse effects include nephrotoxicity, hypersensitivity reactions, hepatic dysfunction (longterm use), and cognitive dysfunction. The investigators' patients will be selected to exclude those most at risk for these complications (see exclusion criteria). Acetaminophen has few side effects, with no adverse effects on platelet function and no evidence of gastric irritation.
OTC NCT00245375 ↗ A Trial Comparing Combination Therapy of Acetaminophen Plus Ibuprofen Versus Tylenol #3 for the Treatment of Pain After Outpatient Surgery Completed Nova Scotia Health Authority N/A 2005-01-01 Increasingly in general surgery, the investigators are conducting outpatient day surgery. Ambulatory surgery currently comprises 60 to 70% of surgeries performed in North America. These patients all require some form of analgesia which can be taken at home in the first few days after the surgery. The current standard at the investigators' centre and many others in the maritime provinces is to provide a prescription for oral acetaminophen plus codeine or oxycodone (Tylenol #3®, Percocet ®). Some patients may receive more potent opioids such as oral hydromorphone (Dilaudid®). Unfortunately, the most commonly prescribed medication (Tylenol #3®) is often poorly tolerated by patients, has several undesirable side effects, and may not provide effective pain relief. In the investigators' experience, non-steroidal anti-inflammatory drugs (NSAIDs) are uncommonly a routine addition to the home analgesic regimen. Tylenol #3®, in the investigators' experience and opinion, is a poor post surgical pain medication. They hope to show that a combination of ibuprofen and acetaminophen is better for pain relief after these procedures. The combination of acetaminophen and ibuprofen would be a safe, cheap, and readily available regimen. Unfortunately, as the prescribing practices of surgeons are old habits, it will require a very convincing argument to get them to change their practices. A randomized controlled trial comparing these two regimens, the investigators hope, would be a powerful enough argument. The hypothesis of this study, therefore, is that the pain control provided by a combination of acetaminophen plus ibuprofen (650 mg/400 mg four times per day) will be superior to Tylenol #3® (600 mg acetaminophen/60 mg codeine/15 mg caffeine four times per day). This study will attempt to enroll 150 patients in total. Eligible patients will be identified by their attending surgeon and contacted by study personnel. Patients who enroll in the study will undergo their surgery in the usual manner. After the surgery, in the recovery room, once they are ready to go home, they will be randomized to receive combination A or B and be given a week's worth of pain medication. They will then go home and take this medication as directed. They will record their pain intensity and pain relief once per day using a diary provided in the study package. One week after their surgery, they will return to the hospital clinic and be seen by the study nurse. They will hand over the diary and any unused medication. They will also be asked several questions regarding their overall satisfaction, incidence of side effects, and how long until they were pain free. The risks of participating in this study are minimal from the risks inherent to the procedures and medications the patients would receive within the standard of care. Ibuprofen is a commonly used NSAID which is widely available over the counter and has an established safety profile. The most common adverse effects of ibuprofen and other NSAIDs are gastrointestinal bleeding and ulceration. Other less common adverse effects include nephrotoxicity, hypersensitivity reactions, hepatic dysfunction (longterm use), and cognitive dysfunction. The investigators' patients will be selected to exclude those most at risk for these complications (see exclusion criteria). Acetaminophen has few side effects, with no adverse effects on platelet function and no evidence of gastric irritation.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for Dilaudid-hp

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00175357 ↗ NAOMI: A Study to Compare Medically-prescribed Heroin With Oral Methadone in Chronic Opiate Addiction Completed Canadian Institutes of Health Research (CIHR) Phase 3 2005-03-01 The objective of this study is to determine whether the closely supervised provision of injectable, pharmaceutical-grade heroin (in combination with oral methadone) is more effective than methadone therapy alone in recruiting, retaining, and benefiting long-term heroin users who have not been helped by current standard treatment options.
NCT00175357 ↗ NAOMI: A Study to Compare Medically-prescribed Heroin With Oral Methadone in Chronic Opiate Addiction Completed University of British Columbia Phase 3 2005-03-01 The objective of this study is to determine whether the closely supervised provision of injectable, pharmaceutical-grade heroin (in combination with oral methadone) is more effective than methadone therapy alone in recruiting, retaining, and benefiting long-term heroin users who have not been helped by current standard treatment options.
NCT00195910 ↗ Safety and Efficacy Study of Hydromorphone and Morphine Completed Chang, Andrew, M.D. Phase 2 2004-10-01 To compare a standard weight-based dose of intravenous (IV) hydromorphone (Dilaudid) to a standard weight-based dose of IV morphine in adults presenting to the Emergency Department (ED) with acute severe pain.
NCT00195910 ↗ Safety and Efficacy Study of Hydromorphone and Morphine Completed Montefiore Medical Center Phase 2 2004-10-01 To compare a standard weight-based dose of intravenous (IV) hydromorphone (Dilaudid) to a standard weight-based dose of IV morphine in adults presenting to the Emergency Department (ED) with acute severe pain.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for Dilaudid-hp

Condition Name

Condition Name for Dilaudid-hp
Intervention Trials
Pain 28
Acute Pain 12
Pain, Postoperative 9
Analgesics, Opioid 4
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Condition MeSH

Condition MeSH for Dilaudid-hp
Intervention Trials
Acute Pain 21
Pain, Postoperative 14
Opioid-Related Disorders 7
Emergencies 6
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Clinical Trial Locations for Dilaudid-hp

Trials by Country

Trials by Country for Dilaudid-hp
Location Trials
United States 98
Canada 13
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Trials by US State

Trials by US State for Dilaudid-hp
Location Trials
New York 25
Ohio 9
Texas 7
California 7
Maryland 6
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Clinical Trial Progress for Dilaudid-hp

Clinical Trial Phase

Clinical Trial Phase for Dilaudid-hp
Clinical Trial Phase Trials
Phase 4 30
Phase 3 24
Phase 2/Phase 3 2
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Clinical Trial Status

Clinical Trial Status for Dilaudid-hp
Clinical Trial Phase Trials
Completed 63
Terminated 13
Recruiting 9
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Clinical Trial Sponsors for Dilaudid-hp

Sponsor Name

Sponsor Name for Dilaudid-hp
Sponsor Trials
Montefiore Medical Center 13
Alza Corporation, DE, USA 11
M.D. Anderson Cancer Center 4
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Sponsor Type

Sponsor Type for Dilaudid-hp
Sponsor Trials
Other 115
Industry 25
NIH 12
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DILAUDID-HP: Clinical Trials, Market Analysis, and Projections

Introduction

DILAUDID-HP, a high-potency formulation of hydromorphone hydrochloride, is an opioid analgesic indicated for the management of moderate-to-severe pain in opioid-tolerant patients. This article will delve into the clinical trials, market analysis, and projections for DILAUDID-HP, providing a comprehensive overview of its role in pain management.

Clinical Trials and Efficacy

Analgesic Effects

Clinical trials have demonstrated the efficacy of DILAUDID-HP in providing significant analgesia. In double-blind controlled trials, DILAUDID ORAL LIQUID, which contains hydromorphone, showed that doses of 5 mg and 10 mg provided more analgesia than placebo in patients with post-surgical pain[1].

Patient Population

DILAUDID-HP is specifically designed for opioid-tolerant patients who require higher doses of opioids to manage their pain. These patients are defined as those taking at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone per day, or an equianalgesic dose of another opioid for one week or longer[3][4].

Safety and Tolerability

While DILAUDID-HP is effective, it comes with significant safety concerns. The drug is contraindicated in patients with known hypersensitivity to hydromorphone, respiratory depression without resuscitative equipment, status asthmaticus, and gastrointestinal obstruction. It is also contraindicated in patients who are not opioid-tolerant due to the high risk of overdose and death[2][3].

Market Analysis

Market Demand

The demand for potent opioid analgesics like DILAUDID-HP is driven by the need for effective pain management in patients with severe pain who have developed tolerance to lower doses of opioids. The opioid market, while facing regulatory scrutiny due to abuse and misuse concerns, continues to see demand for products that can manage chronic and acute pain effectively.

Competitive Landscape

The opioid market is highly competitive, with several other potent opioids available, such as fentanyl and oxymorphone. However, DILAUDID-HP stands out due to its high concentration (10 mg/mL) and the convenience of a lower total volume of administration, which can reduce discomfort associated with larger injection volumes[1][2].

Regulatory Environment

The regulatory environment for opioids is stringent due to concerns about abuse, misuse, and overdose. DILAUDID-HP, as a Schedule II controlled substance, is subject to strict prescribing and dispensing guidelines. Healthcare providers must carefully assess patients for opioid tolerance and monitor them closely for signs of respiratory depression and other adverse effects[3][4].

Market Projections

Growth Potential

Despite the regulatory challenges, the market for opioid analgesics is expected to grow, driven by the increasing prevalence of chronic pain conditions and the need for effective pain management solutions. DILAUDID-HP, with its high potency and targeted use in opioid-tolerant patients, is positioned to capture a significant share of this market.

Revenue Forecast

The revenue forecast for DILAUDID-HP is positive, with projected growth in the coming years. This growth will be driven by the increasing acceptance of the drug among healthcare providers and the expanding patient population requiring high-dose opioid therapy.

Challenges and Opportunities

While the market for DILAUDID-HP is promising, it faces challenges such as the risk of misuse and abuse, which could impact sales and regulatory approval. However, the drug's unique formulation and the need for effective pain management solutions present opportunities for growth and market expansion.

Key Considerations for Healthcare Providers

Patient Selection

Healthcare providers must carefully select patients for DILAUDID-HP, ensuring they are opioid-tolerant and require the high doses provided by this formulation. This involves a comprehensive assessment of the patient's pain severity, opioid use history, and risk factors for abuse and addiction[3][4].

Dosing and Administration

The dosing and administration of DILAUDID-HP must be precise to avoid dosing errors, which could lead to overdose and death. The usual starting dose is 1 mg to 2 mg subcutaneously or intramuscularly every 2 to 3 hours, with intravenous administration given slowly over at least 2 to 3 minutes[2][3].

Monitoring and Follow-Up

Patients on DILAUDID-HP require close monitoring for signs of respiratory depression, sedation, and other opioid-related adverse reactions. Frequent communication between the prescriber, healthcare team, patient, and caregiver is crucial for managing pain effectively and minimizing risks[3].

Key Takeaways

  • Efficacy: DILAUDID-HP is effective in providing analgesia for opioid-tolerant patients with moderate-to-severe pain.
  • Safety: The drug is contraindicated in non-opioid tolerant patients and those with certain medical conditions due to the risk of respiratory depression and other adverse effects.
  • Market Demand: The demand for potent opioid analgesics is driven by the need for effective pain management in chronic and acute pain conditions.
  • Regulatory Environment: Strict prescribing and dispensing guidelines are in place due to the risk of abuse and misuse.
  • Growth Potential: The market for DILAUDID-HP is expected to grow, driven by the increasing prevalence of chronic pain conditions.

FAQs

Q: What is DILAUDID-HP indicated for?

A: DILAUDID-HP is indicated for the management of moderate-to-severe pain in opioid-tolerant patients who require higher doses of opioids.

Q: Who is considered opioid-tolerant for DILAUDID-HP?

A: Patients are considered opioid-tolerant if they are taking at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl per hour, or an equianalgesic dose of another opioid for one week or longer.

Q: What are the contraindications for DILAUDID-HP?

A: DILAUDID-HP is contraindicated in patients with known hypersensitivity to hydromorphone, respiratory depression without resuscitative equipment, status asthmaticus, and gastrointestinal obstruction, as well as in non-opioid tolerant patients.

Q: How should DILAUDID-HP be administered?

A: DILAUDID-HP should be administered subcutaneously, intramuscularly, or intravenously with careful attention to dosing to avoid errors. Intravenous administration should be given slowly over at least 2 to 3 minutes.

Q: What are the key safety concerns with DILAUDID-HP?

A: The key safety concerns include respiratory depression, misuse, abuse, and the risk of overdose and death, especially in non-opioid tolerant patients.

Sources

  1. FDA Label: DILAUDID® and DILAUDID-HP® INJECTION 1 mg/mL, 2 mg/mL.
  2. Drugs.com: Dilaudid-HP: Package Insert / Prescribing Information.
  3. FDA Label: DILAUDID® INJECTION and DILAUDID-HP® INJECTION Label.
  4. FDA Label: DILAUDID-HP® INJECTION (hydromorphone hydrochloride), CII.

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