To the Editor

DepoDur™ will certainly find its niche in the acute pain management arena; however, this formulation should be used with extreme caution. Not only did 75% of the patients need additional analgesia via an IV-PCA pump with all its associated problems as described by Dr. Viscusi,1 the drug also had a higher side-effect profile. Whether it was 5% of the patients or 12.5%2 needing an opioid antagonist, these figures compare with 0% in the IV-PCA group. The higher side-effect profile was in the elderly patients with comorbid conditions, the subgroup who could potentially benefit most from this formulation. As the package insert highlights,3 extreme vigilance and close monitoring is needed when DepoDur™ is used, a condition that is not achievable in the surgical wards of most hospitals.

Babak Roboubi, MD
Director, Acute Pain Service
Washington Hospital Center
Washington, DC

References

1. Viscusi ER. DepoDur™: A new drug formulation with unique safety considerations. APSF Newsletter 2005;20:50-1.
2. Viscusi ER, Martin G, Hartrick CT, et al. Forty-eight hours of postoperative pain relief after total hip arthroplasty with a novel, extended-release epidural morphine formulation. Anesthesiology 2005;102:1014-22.
3. DepoDur™ Package Insert: Full Prescribing Information, Endo Pharmaceuticals, Chadds Ford, PA, 2005