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The following serious adverse reactions are discussed elsewhere in the labeling:

  • Addiction, Abuse, and Misuse [see WARNINGS AND PRECAUTIONS]
  • Life Threatening Respiratory Depression [see WARNINGS AND PRECAUTIONS]
  • Neonatal Opioid Withdrawal Syndrome [see WARNINGS AND PRECAUTIONS]
  • Interactions with Other CNS Depressants [see WARNINGS AND PRECAUTIONS]
  • Hypotensive Effect [see WARNINGS AND PRECAUTIONS]
  • Gastrointestinal Effects [see WARNINGS AND PRECAUTIONS]
  • Seizures [see WARNINGS AND PRECAUTIONS]

In the randomized study, the most common adverse reactions with KADIAN therapy were drowsiness, constipation, nausea, dizziness, and anxiety. The most common adverse reactions leading to study discontinuation were nausea, constipation (may be severe), vomiting, fatigue, dizziness, pruritus, and somnolence.

Clinical Trial Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Clinical trial patients with chronic cancer pain (n=227) (AE by Body System as seen in 2% or more of patients) Percentage %
CENTRAL NERVOUS SYSTEM 28
  Drowsiness 9
  Dizziness 6
  Anxiety 5
  Confusion 4
  Dry mouth 3
  Tremor 2
GASTROINTESTINAL 26
  Constipation 9
  Nausea 7
  Diarrhea 3
  Anorexia 3
  Abdominal pain 3
  Vomiting 2
BODY AS A WHOLE 16
  Pain 3
  Disease progression 3
  Chest pain 2
  Diaphoresis 2
  Fever 2
  Asthenia 2
  Accidental injury 2
RESPIRATORY 3
  Dyspnea 3
SKIN & APPENDAGES 3
  Rash 3
METABOLIC & NUTRITIONAL 3
  Peripheral edema 3
HEMIC & LYMPHATIC 4
  Anemia 2
  Leukopenia 2

In clinical trials in patients with chronic cancer pain, the most common adverse events reported by patients at least once during therapy were drowsiness (9%), constipation (9%), nausea (7%), dizziness (6%), and anxiety (6%). Other less common side effects expected from KADIAN or seen in less than 2% of patients in the clinical trials were:

  • Body as a Whole: Headache, chills, flu syndrome, back pain, malaise, withdrawal syndrome
  • Cardiovascular: Tachycardia, atrial fibrillation, hypotension, hypertension, pallor, facial flushing, palpitations, bradycardia, syncope
  • Central Nervous System: Confusion, anxiety, abnormal thinking, abnormal dreams, lethargy, depression, loss of concentration, insomnia, amnesia, paresthesia, agitation, vertigo, foot drop, ataxia, hypesthesia, slurred speech, hallucinations, vasodilation, euphoria, apathy, seizures, myoclonus
  • Endocrine: Hyponatremia due to inappropriate ADH secretion, gynecomastia
  • Gastrointestinal: Dysphagia, dyspepsia, stomach atony disorder, gastro-esophageal reflux, delayed gastric emptying, biliary colic
  • Hemic and Lymphatic: Thrombocytopenia
  • Metabolic and Nutritional: Hyponatremia, edema
  • Musculoskeletal: Back pain, bone pain, arthralgia
  • Respiratory: Hiccup, rhinitis, atelectasis, asthma, hypoxia, respiratory insufficiency, voice alteration, depressed cough reflex, non-cardiogenic pulmonary edema
  • Skin and Appendages: Decubitus ulcer, pruritus, skin flush
  • Special Senses: Amblyopia, conjunctivitis, miosis, blurred vision, nystagmus, diplopia
  • Urogenital: Urinary abnormality, amenorrhea, urinary retention, urinary hesitancy, reduced libido, reduced potency, prolonged labor
Four-Week Open-Label Safety Study

In the open-label, 4-week safety study, 1418 patients ages 18 to 85 with chronic, non-malignant pain (e.g., back pain, osteoarthritis, neuropathic pain) were enrolled. The most common adverse events reported at least once during therapy were constipation (12%), nausea (9%), and somnolence (3%). Other less common side effects occurring in less than 3% of patients were vomiting, pruritus, dizziness, sedation, dry mouth, headache, fatigue, and rash.

Post-Marketing Experience

Anaphylaxis has been reported with ingredients contained in KADIAN. Advise patients how to recognize such a reaction and when to seek medical attention.