Oxymorphone is Not Recommended for Pediatric Patients
Oxymorphone should not be used in a 10kg pediatric patient, as there is no established pediatric dosing for this medication and it lacks safety data in children. 1, 2
Critical Evidence Gap
- Oxymorphone (both immediate-release and extended-release formulations) was approved in 2006 for adult use only, with no pediatric studies conducted or pediatric dosing established 1, 2
- The available literature on oxymorphone focuses exclusively on adult populations, including elderly patients, but contains no data on pediatric safety, efficacy, or appropriate dosing 1, 2
- Unlike morphine, which is the gold standard opioid in pediatric palliative care with well-established weight-based dosing, oxymorphone has not been studied in children 3
Recommended Alternative: Morphine
For a 10kg opioid-naïve child requiring moderate to severe pain management, morphine is the appropriate first-line opioid with established pediatric dosing. 4, 3
Morphine Dosing for a 10kg Child
- IV/IM route: 0.1 mg/kg = 1 mg IV/IM slowly, repeated as necessary for clinical effect 4
- Oral route: 0.2-0.5 mg/kg = 2-5 mg orally every 3-4 hours 4
- Pediatric dosing should not exceed the corresponding adult dose when adjusted for body weight 4
Important Safety Considerations
- Morphine can cause histamine release with flushing, itching, and hypotension, particularly in unstable cardiac or trauma patients 4
- There is increased risk of apnea when combined with other sedative agents, particularly benzodiazepines 4
- Monitor vital signs and oxygen saturation continuously 4
- Have naloxone available for reversal of respiratory depression (dose: 0.1 mg/kg IV/IM for children <5 years or <20kg) 4
- Burn pain often requires larger or more frequent doses 4
Alternative Opioid Options if Morphine is Contraindicated
Hydromorphone
- IV route: 0.015-0.03 mg/kg = 0.15-0.3 mg IV every 3-4 hours 4
- Oral route: 0.03-0.08 mg/kg = 0.3-0.8 mg orally every 3-4 hours 4
- Pediatric dose should not exceed adult dose when weight-adjusted 4
Fentanyl
- IV route: 1-2 mcg/kg = 10-20 mcg IV 4
- Duration of effect: 0.5-1 hour 4
- Preferred in hemodynamically unstable patients due to less histamine release compared to morphine 4
Common Pitfall to Avoid
- Never attempt to extrapolate adult oxymorphone dosing to pediatric patients - the pharmacokinetics and pharmacodynamics of opioids differ significantly in children, particularly in those under 1 year of age, and oxymorphone lacks any pediatric safety data 5, 1
- Do not use oxymorphone simply because it is a newer agent - morphine remains the gold standard in pediatric pain management with decades of safety data 3