Opioid analgesic drug Oxymorphone (sold under the brand names Numorphan and Opana among others) is a highly potent opioid analgesic indicated for treatment of severe pain. Pain relief after injection begins after about 5–10 minutes; after oral administration it begins after about 30 minutes and lasts about 3–4 hours for immediate-release tablets and 12 hours for extended-release tablets. The elimination half-life of oxymorphone is much faster intravenously, and as such, the drug is most commonly used orally. Like oxycodone, which metabolizes to oxymorphone, oxymorphone has a high abuse potential.
Oxymorphone was developed in Germany in 1914. It was patented in 1955 and approved for medical use in 1959. In June 2017 the FDA asked Endo Pharmaceuticals to remove its product from the US market. This was in part due to the opioid epidemic in the US, and the fact that a 2012 reformulation failed to stop illicit injection of the drug. Endo responded by voluntarily removing Opana ER from the market a month later. Generic versions of extended-release oxymorphone, such as those manufactured by Amneal Pharmaceuticals, are still available in the US.
Safety at a Glance
High Risk- It is strongly recommended that one use harm reduction practices when using this drug.
- Germany: Oxymorphone is controlled under BtMG Anlage II, making it illegal to manufacture, import, possess, sell, or ...
- Toxicity: Like most opioids, unadulterated oxymorphone does not cause many long-term complications other than dependence and co...
- Dangerous with: 3-Cl-PCP, 3-HO-PCE, 3-HO-PCP, 3-MeO-PCE (+43 more)
- Overdose risk: fatal or dangerous levels of anoxia (oxygen deprivation). This occurs because the breathing refle...
If someone is in crisis, call 911 or Poison Control: 1-800-222-1222
Dosage
oral
Duration
oral
Total: 4 hrs – 6 hrsHow It Feels
Oxymorphone occupies the upper echelons of opioid potency, and its subjective effects reflect a compound that does not merely suppress pain but rewrites the body's entire relationship with sensation. The onset is relatively swift -- fifteen to thirty minutes by oral route, near-instantaneous by injection -- and it arrives with a weight and density that immediately signals something formidable. The warmth is not gentle; it is thick, heavy, almost viscous, pouring through the body like heated honey and pooling in every joint, every muscle, every hollow space where tension used to live.
The rush, when administered by faster routes, is among the most intense in the opioid pharmacopoeia. A massive surge of warmth erupts through the chest and detonates outward, producing a full-body euphoria so powerful it borders on the overwhelming. The knees may buckle. Vision blurs. For a brief, luminous interval, the boundary between self and sensation dissolves entirely, and there is nothing but warmth -- absolute, totalizing, annihilating in its completeness. Even by oral routes, the peak carries an unmistakable gravity, a depth of comfort that goes beyond relaxation into something that feels almost geological, as though you have been pressed into the warm center of the earth.
At the plateau, consciousness operates within a cocoon of near-perfect comfort. Pain is not merely reduced but eliminated, its absence so thorough it feels almost metaphysical. The emotional state is one of profound well-being -- not the giddy, social euphoria of hydrocodone but a deep, inward-facing bliss that requires no external stimulus. The nod is pronounced: consciousness dips and surfaces in a slow, rhythmic cycle, each descent carrying you into a warm darkness that is profoundly restful without being quite sleep. Thoughts arise with dream-like fluidity, their content arbitrary and their emotional charge uniformly positive.
Physically, the body is dramatically affected. Pupils contract to their smallest possible diameter. Breathing becomes slow and shallow, each breath a minimal concession to biological necessity. The skin is warm, sometimes flushed, and the opioid itch manifests with particular intensity on the face and upper body. Nausea can be significant, a violent counterargument from the body's protective systems against the pharmacological override taking place.
The decline arrives after four to six hours and carries a weight proportional to the peak. The warmth does not fade so much as withdraw, retreating from the periphery toward the core and then dissipating entirely, leaving the body feeling emptied and unexpectedly vulnerable. The contrast between oxymorphone's peak and its absence is profound -- a gap that the nervous system registers as loss, a template for craving that makes the compound's addictive potential viscerally comprehensible.
Subjective Effects
The effects listed below are based on the Subjective Effect Index (SEI), an open research literature based on anecdotal reports and personal analyses. They should be viewed with a healthy degree of skepticism. These effects will not necessarily occur in a predictable or reliable manner, although higher doses are more liable to induce the full spectrum of effects.
Physical Effects
Physical(11)
- Constipation— A slowing or cessation of bowel movements resulting in difficulty passing stool, commonly caused by ...
- Diarrhea— Diarrhea is the occurrence of frequent, loose, or watery bowel movements as a side effect of certain...
- Headache— A painful sensation of pressure, throbbing, or aching in the head that can range from a dull backgro...
- Increased heart rate— A noticeable acceleration of heartbeat that can range from a subtle awareness of one's pulse to a fo...
- Motor control loss— A distinct decrease in the ability to control one's physical body with precision, balance, and coord...
- Nausea— An uncomfortable sensation of queasiness and stomach discomfort that may or may not lead to vomiting...
- Pain relief— A suppression of negative physical sensations such as aches and pains, ranging from dulled awareness...
- Respiratory depression— A dangerous slowing and shallowing of breathing that can progress from barely noticeable reductions ...
- Sedation— A state of deep physical and mental calming that manifests as a progressive desire to remain still, ...
- Seizure— Uncontrolled brain electrical activity causing convulsions and loss of consciousness -- a life-threa...
- Spontaneous physical movements— Spontaneous physical movements are involuntary, seemingly random yet patterned body movements — twit...
Cognitive & Perceptual Effects
Cognitive(5)
- Amnesia— A complete or partial inability to form new memories or recall existing ones during and after substa...
- Anxiety— Intense feelings of apprehension, worry, and dread that can range from a subtle background unease to...
- Anxiety suppression— A partial to complete suppression of anxiety and general unease, producing a calm, relaxed mental st...
- Depression— A persistent state of low mood, emotional numbness, hopelessness, and diminished interest or pleasur...
- Sleepiness— A progressive onset of drowsiness, heaviness, and the desire to sleep that pulls the individual towa...
Pharmacology
Oxymorphone molecules exert their effects by binding to and activating the μ-opioid receptor as an agonist. This occurs due to the way in which opioids structurally mimic endogenous endorphins. Endorphins are responsible for analgesia (reducing pain), causing sleepiness, and feelings of pleasure. They can be released in response to pain, strenuous exercise, orgasm, or excitement. This mimicking of natural endorphins results in the drug's euphoric, analgesic (pain relief), and anxiolytic (anti-anxiety) effects.
Oxymorphone is a semisynthetic narcotic analgesic related to hydromorphone. It affects the central nervous system and smooth muscles by activation of specific opiate receptors. Hydromorphone and oxymorphone are semisynthetic derivatives of morphine and potent opiate agonists which are used predominantly to treat moderate-to-severe pain.
These appear to stem from the way in which opioids mimic endogenous endorphins. Endorphins are responsible for analgesia (reducing pain), causing sleepiness, and feelings of pleasure. They can be released in response to pain, strenuous exercise, orgasm, or excitement. This mimicking of natural endorphins results in the drug's effects.
Like most opioids, unadulterated oxymorphone does not cause many long-term complications other than dependence and constipation. Outside of the extremely powerful addiction and physical dependence, the harmful or toxic aspects of oxymorphone usage are exclusively associated with not taking appropriate precautions in regards to its administration, overdosing and using impure products.
Heavy dosages of oxymorphone can result in respiratory depression, leading onto fatal or dangerous levels of anoxia (oxygen deprivation). This occurs because the breathing reflex is suppressed by agonism of µ-opioid receptors proportional to the dosage consumed.
Oxymorphone can also cause nausea and vomiting; a significant number of deaths attributed to opioid overdose are caused by aspiration of vomit by an unconscious victim. This is when an unconscious or semi-conscious user who is lying on their back vomits into their mouth and unknowingly suffocates. It can be prevented by ensuring that one is lying on their side with their head tilted downwards so that the airways cannot be blocked in the event of vomiting while unconscious (also known as the recovery position).
Opioid overdoses can be treated by calling the local emergency number and administering an opioid antagonist such as naloxone.
It is strongly recommended that one use harm reduction practices when using this drug.
As with other opiate-based painkillers, the chronic use of oxymorphone can be considered extremely addictive and is capable of causing both physical and psychological dependence. When physical dependence has developed, withdrawal symptoms may occur if a person suddenly stops their usage.
Tolerance to many of the effects of oxymorphone develops with prolonged use, including therapeutic effects. This results in users having to administer increasingly large doses to achieve the same effects. The rate at which this occurs develops at different rates for different effects with tolerance to the constipation-inducing effects developing particularly slowly. Oxymorphone presents cross-tolerance with Cross-all other opioids, meaning that after the consumption of oxymorphone all opioids will have a reduced effect.
The risk of fatal opioid overdoses rise sharply after a period of cessation and relapse, largely because of reduced tolerance. To account for this lack of tolerance, it is safer to only dose a fraction of one's usual dosage if relapsing. It has also been found that the environment one is in can play a role in opioid tolerance. In one scientific study, rats with the same history of heroin administration were significantly more likely to die after receiving their dose in an environment not associated with the drug in contrast to a familiar environment.
Oxymorphone is dangerous to use in combination with other depressants as many fatalities reported as overdoses are caused by interactions with other depressant drugs like alcohol or benzodiazepines, resulting in dangerously high levels of respiratory depression.
Germany:** Oxymorphone is controlled under BtMG Anlage II, making it illegal to manufacture, import, possess, sell, or transfer it without a license.
Russia:** Oxymorphone is a Schedule I controlled substance.
Switzerland: Oxymorphone is a controlled substance specifically named under Verzeichnis A. Medicinal use is permitted.
United Kingdom:** Oxymorphone is a Class A, Schedule 2 drug in the United Kingdom.
United States:** Oxymorphone is a Schedule II Controlled Substance in the United States.
Responsible use
Opioids
Heroin
Naloxone
Oxymorphone (Wikipedia)
Oxymorphone (Erowid Vault)
Oxymorphone (Isomer Design)
Detection Methods
Standard Drug Panel Inclusion
Oxymorphone is a semi-synthetic opioid that may or may not be detected on standard 5-panel opiate immunoassays. Cross-reactivity varies significantly between immunoassay manufacturers, and many standard assays miss oxymorphone at therapeutic concentrations. Extended opioid panels with oxymorphone-specific or oxycodone-specific channels provide more reliable detection. Oxymorphone is also a metabolite of oxycodone, requiring careful interpretation.
Urine Detection
Oxymorphone is detectable in urine for approximately 2 to 4 days. It is primarily metabolized by glucuronidation to oxymorphone-3-glucuronide. A minor metabolic pathway produces noroxymorphone. Standard opiate immunoassays may not detect oxymorphone at cutoff concentrations used in workplace testing.
Blood and Saliva Detection
Blood concentrations are detectable for approximately 12 to 24 hours depending on formulation. Oral fluid testing can detect oxymorphone for 24 to 48 hours. The relationship between blood concentrations and clinical effects is well-characterized.
Hair Follicle Detection
Hair testing can detect oxymorphone for up to 90 days. Extended opioid hair panels include oxymorphone alongside oxycodone, as the metabolic relationship between the two must be accounted for in interpretation.
Confirmatory Testing
LC-MS/MS can specifically identify and quantify oxymorphone, distinguishing it from oxycodone and other opioids. The ratio of oxymorphone to oxycodone is critical for determining whether oxymorphone is present from direct use or as an oxycodone metabolite.
Reagent Testing
Marquis reagent produces a dark purple color with oxymorphone. Mecke reagent yields a blue-green reaction. These color responses are consistent with the opioid class and cannot distinguish oxymorphone from other morphine-skeleton opioids without confirmatory testing.
Interactions
| Substance | Status | Note |
|---|---|---|
| 3-Cl-PCP | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| 3-HO-PCE | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| 3-HO-PCP | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| 3-MeO-PCE | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| 3-MeO-PCMo | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| 3-MeO-PCP | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| 4-MeO-PCP | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Alcohol | Dangerous | — |
| Atropa belladonna | Dangerous | Compounding CNS depression with anticholinergic effects; risk of cardiac events and respiratory failure |
| Benzodiazepines | Dangerous | — |
| Cake | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| Datura | Dangerous | Compounding CNS depression with anticholinergic effects; risk of cardiac events and respiratory failure |
| Deschloroetizolam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Deschloroketamine | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Desomorphine | Dangerous | Compounding respiratory depression and overdose risk |
| Diclazepam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Diphenhydramine | Dangerous | Compounding CNS depression with anticholinergic effects; risk of cardiac events and respiratory failure |
| Diphenidine | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Ephenidine | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Eszopiclone | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| Etizolam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Flubromazepam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Flubromazolam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Flunitrazepam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Flunitrazolam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Gaboxadol | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| GBL | Dangerous | — |
| GHB | Dangerous | — |
| Harmala alkaloid | Dangerous | Risk of serotonin syndrome and severe respiratory depression; potentially fatal |
| HXE | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Inhalants | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Ketamine | Dangerous | — |
| Lorazepam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Memantine | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Mephenaqualone | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| Metizolam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Midazolam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| MXiPr | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Naloxone | Dangerous | Compounding respiratory depression and overdose risk |
| Nicotine | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| Nifoxipam | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| O-PCE | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| PCE | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Peganum harmala | Dangerous | Risk of serotonin syndrome and severe respiratory depression; potentially fatal |
| Pentobarbital | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| Phenobarbital | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| SAMe | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| 3-FMA | Caution | Stimulants mask opioid sedation, increasing overdose risk when the stimulant wears off |
| 4-MMC | Caution | Stimulants mask opioid sedation, increasing overdose risk when the stimulant wears off |
| 8-Chlorotheophylline | Caution | Stimulants mask opioid sedation, increasing overdose risk when the stimulant wears off |
| Adrafinil | Caution | Stimulants mask opioid sedation, increasing overdose risk when the stimulant wears off |
| Benzydamine | Caution | Stimulants mask opioid sedation, increasing overdose risk when the stimulant wears off |
| Nitrous | Uncertain | — |
| PCP | Uncertain | — |
| 1,3-Butanediol | Low Risk & No Synergy | No significant pharmacological interaction; opioids may slightly dull the psychedelic experience |
| 25E-NBOH | Low Risk & No Synergy | No significant pharmacological interaction; opioids may slightly dull the psychedelic experience |
| 2C-T | Low Risk & No Synergy | No significant pharmacological interaction; opioids may slightly dull the psychedelic experience |
History
Oxymorphone belongs to the opioid class of substances, which has a history spanning thousands of years from the ancient use of opium poppy to modern synthetic and semi-synthetic analogues.
The isolation of morphine from opium in 1804 by Friedrich Sertürner marked the beginning of modern opioid pharmacology. Subsequent developments included the synthesis of heroin (diacetylmorphine) in 1874, the development of numerous semi-synthetic and fully synthetic opioids throughout the 20th century, and the identification of endogenous opioid receptors and peptides in the 1970s.
The opioid crisis of the early 21st century, driven largely by overprescription of pharmaceutical opioids and the subsequent emergence of illicit fentanyl and its analogues, represents one of the most significant public health challenges in modern history. This crisis has fundamentally reshaped discussions around opioid prescribing, addiction treatment, and harm reduction policy.
Oxymorphone exists within this complex pharmacological and social context, with its history shaped by its development, clinical utility, and the broader dynamics of opioid use and regulation.
Harm Reduction
It is strongly recommended that one use harm reduction practices when using this drug.
As with other opiate-based painkillers, the chronic use of oxymorphone can be considered extremely addictive and is capable of causing both physical and psychological dependence. When physical dependence has developed, withdrawal symptoms may occur if a person suddenly stops their usage.
Tolerance to many of the effects of oxymorphone develops with prolonged use, including therapeutic effects. This results in users having to administer increasingly large doses to achieve the same effects. The rate at which this occurs develops at different rates for different effects with tolerance to the constipation-inducing effects developing particularly slowly. Oxymorphone presents cross-tolerance with Cross-all other opioids, meaning that after the consumption of oxymorphone all opioids will have a reduced effect.
The risk of fatal opioid overdoses rise sharply after a period of cessation and relapse, largely because of reduced tolerance. To account for this lack of tolerance, it is safer to only dose a fraction of one's usual dosage if relapsing. It has also been found that the environment one is in can play a role in opioid tolerance. In one scientific study, rats with the same history of heroin administration were significantly more likely to die after receiving their dose in an environment not associated with the drug in contrast to a familiar environment.
Oxymorphone is dangerous to use in combination with other depressants as many fatalities reported as overdoses are caused by interactions with other depressant drugs like alcohol or benzodiazepines, resulting in dangerously high levels of respiratory depression.
- Germany:** Oxymorphone is controlled under BtMG Anlage II, making it illegal to manufacture, import, possess, sell, or transfer it without a license.
- Russia:** Oxymorphone is a Schedule I controlled sub
Toxicity & Safety
Like most opioids, unadulterated oxymorphone does not cause many long-term complications other than dependence and constipation. Outside of the extremely powerful addiction and physical dependence, the harmful or toxic aspects of oxymorphone usage are exclusively associated with not taking appropriate precautions in regards to its administration, overdosing and using impure products.
Heavy dosages of oxymorphone can result in respiratory depression, leading onto fatal or dangerous levels of anoxia (oxygen deprivation). This occurs because the breathing reflex is suppressed by agonism of µ-opioid receptors proportional to the dosage consumed.
Oxymorphone can also cause nausea and vomiting; a significant number of deaths attributed to opioid overdose are caused by aspiration of vomit by an unconscious victim. This is when an unconscious or semi-conscious user who is lying on their back vomits into their mouth and unknowingly suffocates. It can be prevented by ensuring that one is lying on their side with their head tilted downwards so that the airways cannot be blocked in the event of vomiting while unconscious (also known as the recovery position).
Opioid overdoses can be treated by calling the local emergency number and administering an opioid antagonist such as naloxone.
It is strongly recommended that one use harm reduction practices when using this drug.
Tolerance and addiction potential
As with other opiate-based painkillers, the chronic use of oxymorphone can be considered extremely addictive and is capable of causing both physical and psychological dependence. When physical dependence has developed, withdrawal symptoms may occur if a person suddenly stops their usage.
Tolerance to many of the effects of oxymorphone develops with prolonged use, including therapeutic effects. This results in users having to administer increasingly large doses to achieve the same effects. The rate at which this occurs develops at different rates for different effects with tolerance to the constipation-inducing effects developing particularly slowly. Oxymorphone presents cross-tolerance with all other opioids, meaning that after the consumption of oxymorphone all opioids will have a reduced effect.
The risk of fatal opioid overdoses rise sharply after a period of cessation and relapse, largely because of reduced tolerance. To account for this lack of tolerance, it is safer to only dose a fraction of one's usual dosage if relapsing. It has also been found that the environment one is in can play a role in opioid tolerance. In one scientific study, rats with the same history of heroin administration were significantly more likely to die after receiving their dose in an environment not associated with the drug in contrast to a familiar environment.
Dangerous interactions
Oxymorphone is dangerous to use in combination with other depressants as many fatalities reported as overdoses are caused by interactions with other depressant drugs like alcohol or benzodiazepines, resulting in dangerously high levels of respiratory depression.
Warning: Many psychoactive substances that are reasonably safe to use on their own can suddenly become dangerous and even life-threatening when combined with certain other substances. The following list provides some known dangerous interactions (although it is not guaranteed to include all of them).
Always conduct independent research (e.g. Google, DuckDuckGo, PubMed) to ensure that a combination of two or more substances is safe to consume. Some of the listed interactions have been sourced from TripSit.
Alcohol - Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely
Stimulants - Stimulants increase respiration rate which allows for a higher dose of opiates than would otherwise be used. If the stimulant wears off first then the opiate may overcome the user and cause respiratory arrest.
Benzodiazepines - Central nervous system and/or respiratory-depressant effects may be additively or synergistically present. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position blackouts/memory loss likely.
DXM - Generally considered to be toxic. CNS depression, difficulty breathing, heart issues, and liver toxicity have been observed. Additionally if one takes DXM, their tolerance of opiates goes down slightly, thus causing additional synergistic effects.
GHB/GBL - The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position
Ketamine - Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.
MAOIs - Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.
MXE - MXE can potentiate the effects of opioids but also increases the risk of respiratory depression and organ toxicity.
Nitrous - Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are common.
PCP - PCP may reduce opioid tolerance, increasing the risk of overdose.
Tramadol - Increased risk of seizures. Tramadol itself is known to induce seizures and it may have additive effects on seizure threshold with other opioids. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present.
Grapefruit - While grapefruit is not psychoactive, it may affect the metabolism of certain opioids. Tramadol, oxycodone, and fentanyl are all primarily metabolized by the enzyme CYP3A4, which is potently inhibited by grapefruit juice. This may cause the drug to take longer to clear from the body. it may increase toxicity with repeated doses. Methadone may also be affected. Codeine and hydrocodone are metabolized by CYP2D6. People who are on medicines that inhibit CYP2D6, or that lack the enzyme due to a genetic mutation will not respond to codeine as it can not be metabolized into its active product: morphine.
Overdose Information
fatal or dangerous levels of anoxia (oxygen deprivation). This occurs because the breathing reflex is suppressed by agonism of µ-opioid receptors proportional to the dosage consumed.
Oxymorphone can also cause nausea and vomiting; a significant number of deaths attributed to opioid overdose are caused by aspiration of vomit by an unconscious victim. This is when an unconscious or semi-conscious user who is lying on their back vomits into their mouth and unknowingly suffocates. It can be prevented by ensuring that one is lying on their side with their head tilted downwards so that the airways cannot be blocked in the event of vomiting while unconscious (also known as the recovery position).
Opioid overdoses can be treated by calling the local emergency number and administering an opioid antagonist such as naloxone.
It is strongly recommended that one use harm reduction practices when using this drug.
As with other opiate-based painkillers, the chronic use of oxymorphone can be considered extremely addictive and is capable of causing both physical and psychological dependence. When physical dependence has developed, withdrawal symptoms may occur if a person suddenly stops their usage.
Tolerance to many of the effects of oxymorphone develops with prolonged use, including therapeutic effects. This results in users having to administer increasingly large doses to achieve the same effects. The rate at which this occurs develops at different rates for different effects with tolerance to the constipation-inducing effects developing particularly slowly. Oxymorphone presents cross-tolerance with Cross-all other opioids, meaning that after the consumption of oxymorphone all opioids will have a reduced effect.
The risk of fatal opioid overdoses rise sharply after a period of cessation and relapse, largely because of reduced tolerance. To account for this lack of tolerance, it is safer to only dose a fraction of one's usual dos
Dangerous Interactions
The combinations listed below may be life-threatening. Independent research should always be conducted to ensure safety when combining substances.
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Compounding CNS depression with anticholinergic effects; risk of cardiac events and respiratory failure
Severe respiratory depression risk; leading cause of polydrug overdose
Compounding CNS depression with anticholinergic effects; risk of cardiac events and respiratory failure
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Compounding respiratory depression and overdose risk
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Compounding CNS depression with anticholinergic effects; risk of cardiac events and respiratory failure
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Severe respiratory depression risk; leading cause of polydrug overdose
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Severe respiratory depression risk; leading cause of polydrug overdose
Risk of serotonin syndrome and severe respiratory depression; potentially fatal
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Severe respiratory depression risk; leading cause of polydrug overdose
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Compounding respiratory depression and overdose risk
Severe respiratory depression risk; leading cause of polydrug overdose
Severe respiratory depression risk; leading cause of polydrug overdose
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Risk of serotonin syndrome and severe respiratory depression; potentially fatal
Severe respiratory depression risk; leading cause of polydrug overdose
Severe respiratory depression risk; leading cause of polydrug overdose
Severe respiratory depression risk; leading cause of polydrug overdose
Tolerance
| Full | Develops rapidly with repeated use |
| Half | 3 - 7 days |
| Zero | 1 - 2 weeks |
Cross-tolerances
Legal Status
Germany:** Oxymorphone is controlled under BtMG Anlage II, making it illegal to manufacture, import, possess, sell, or transfer it without a license.
Russia:** Oxymorphone is a Schedule I controlled substance.
Switzerland: Oxymorphone is a controlled substance specifically named under Verzeichnis A. Medicinal use is permitted.
United Kingdom:** Oxymorphone is a Class A, Schedule 2 drug in the United Kingdom.
United States:** Oxymorphone is a Schedule II Controlled Substance in the United States.
Responsible use
Oxymorphone (Wikipedia)
Oxymorphone (Erowid Vault)
Oxymorphone (Isomer Design)
Experience Reports (1)
Tips (6)
Always have naloxone on hand when using oxymorphone and never use alone. Due to its high potency, respiratory depression can onset rapidly. Multiple naloxone doses may be needed as oxymorphone's duration can outlast a single naloxone administration.
Oxymorphone is significantly more potent than oxycodone or morphine. Even experienced opioid users should start with the lowest available dose and titrate up. The jump from a therapeutic dose to a dangerous dose is very narrow with this compound.
Opioid tolerance and cross-tolerance are complex with Oxymorphone. Switching between different opioids requires careful dose conversion. Do not assume equivalent effects at standard conversion ratios; start lower than calculated.
Be extremely cautious with novel opioid analogues related to oxymorphone such as MR-2096. These compounds have very limited human safety data and the potency can vary dramatically between enantiomers. One form may be an agonist while another is an antagonist.
ALWAYS have naloxone (Narcan) on hand when using Oxymorphone. It reverses opioid overdose and is available over the counter in many places. Make sure someone nearby knows how to administer it. This is non-negotiable.
In most US states, Good Samaritan laws protect you from drug charges if you call 911 for an overdose. Never hesitate to call emergency services. A legal charge is infinitely preferable to a death.
Community Discussions (1)
See Also
References (4)
- Opioid receptors — Pasternak & Pan Annual Review of Pharmacology (2013)paper
- PubChem: Oxymorphone
PubChem compound page for Oxymorphone (CID: 5284604)
pubchem - Oxymorphone - TripSit Factsheet
TripSit factsheet for Oxymorphone
tripsit - Oxymorphone - Wikipedia
Wikipedia article on Oxymorphone
wikipedia