Exalgo

Exalgo is a brand name for an extended-release formulation of hydromorphone hydrochloride, an opioid analgesic used for the management of moderate to severe chronic pain in adults who are opioid-tolerant and require around-the-clock analgesia. It is intended for long-term pain control and is administered orally on a once-daily basis.

The product is designed with an abuse-deterrent formulation intended to resist crushing and injection, while preserving a convenient daily dosing schedule. Although the design aims to reduce certain routes of abuse, Exalgo remains a Schedule II controlled substance with potential for misuse and dependence.

Exalgo is available in 8 mg, 16 mg, and 32 mg extended-release tablets. The recommended starting dose for opioid-tolerant patients is 8 mg once daily, with titration in increments of 8 mg every 3 to 7 days based on analgesic response and tolerability, up to a maximum daily dose of 32 mg. It should be used only for around-the-clock pain and not as needed for intermittent pain.

Contraindications include significant respiratory depression, acute or severe bronchial asthma without adequate monitoring, known hypersensitivity to hydromorphone, and known or suspected paralytic ileus or gastrointestinal obstruction. Cautions include increased risk of respiratory depression, sedation, hypotension, and potential for misuse, particularly in the elderly or when combined with other central nervous system depressants or alcohol. Concomitant use with monoamine oxidase inhibitors is contraindicated.

Pharmacologically, hydromorphone is a mu-opioid receptor agonist. It is metabolized to hydromorphone-3-glucuronide and primarily excreted renally. Exalgo provides analgesia through central opioid pathways and may require dose adjustments in renal impairment.