Opioid analgesics should be used with caution especially when combined with other drugs. Oxymorphone should be used with caution in elderly and debilitated patients and in patients who are known to be sensitive to central nervous system depressants such as those with cardiovascular, pulmonary, renal or hepatic disease. Oxymorphone should be used with caution in the following conditions: acute alcoholism, coma & delirium tremens. Administer Oxymorphone with extreme caution to patients with conditions accompanied by hypoxia, hypercapnia, or decreased respiratory reserve such as: asthma, chronic obstructive pulmonary disease or, severe obesity, sleep apnea syndrome, myxedema, kyphoscoliosis, CNS depression, or coma. Oxymorphone, like all opioid analgesics, should be started at 1/3 to 1/2 of the usual dose in patients who are concurrently receiving other central nervous system (CNS) depressants including sedatives or hypnotics, general anesthetics, phenothiazines, tranquilizers, and alcohol, because respiratory depression, hypotension and profound sedation, coma or death may result. Use Oxymorphone with caution in patients with mild hepatic impairment, starting with the lowest dose (e.g., 5 mg). The plasma levels of Oxymorphone administered as an extended-release tablet were about 40% higher in elderly (=65 years of age) than in younger subjects. So for geriatric patients may be started with Oxymorphone 5 mg. There are 57% and 65% increases in Oxymorphone bioavailability in patients with moderate and severe renal impairment, respectively. So for renal impaired patients may be started with Oxymorphone 5 mg. Use Oxymorphone with caution in the following conditions: adrenocortical insufficiency (e.g., Addison's disease), prostatic hypertrophy or urethral stricture, severe impairment of pulmonary or renal function, and toxic psychosis Opioid analgesics impair the mental and physical abilities needed to perform potentially hazardous activities such as driving a car or operating machinery.Dependence: Oxymorphone should not be abruptly discontinued. When the patient no longer requires therapywith Oxymorphone, doses should be tapered gradually to prevent signs and symptoms of withdrawal in thephysically dependent patient.
