Pfizer Inc. (NYSE: PFE) announced today results from three Phase 4
studies of EMBEDA® (morphine sulfate and naltrexone
hydrochloride) Extended Release Capsules CII designed to assess the
effect of the drug when crushed and taken either orally or intranasally.
Studies ALO-01-10-4005 and ALO-01-10-4004 were double-blind cross-over
designed studies in non-dependent, recreational opioid users that
compared subjective measures relating to abuse potential of crushed
EMBEDA to crushed extended-release morphine sulfate and placebo
following oral (study 4005) and intranasal (study 4004) administration.
In both studies, the use of EMBEDA was associated with significantly
(p<0.01)lower scores on the primary endpoints of "drug liking” and
"high,” as well as the secondary endpoints including "good effects,”
"overall drug liking” and "take drug again” as compared with
extended-release morphine sulfate. Both medications had significantly
higher scores on all measures as compared with placebo. Common adverse
events observed following oral administration of crushed EMBEDA in study
ALO-01-10-4005 included somnolence, nausea, pruritis and dizziness, and
in study ALO-01-10-4004 following intranasal administration of crushed
EMBEDA included euphoric mood, somnolence and headache.
The third study, ALO-01-09-111, was a double-blind cross-over study in
opioid-dependent patients with moderate-to-severe non-cancer chronic
pain stabilized on EMBEDA therapy. This study used an opioid withdrawal
scale to assess the ability of a single dose of crushed EMBEDA to induce
withdrawal symptoms compared with intact EMBEDA swallowed whole, as
crushing releases the sequestered naltrexone. The trial was not fully
enrolled as the study was discontinued early due to the voluntary recall
of EMBEDA. Only six patients completed the study, compared with a target
of 12 to 16 patients. Ingestion of crushed EMBEDA induced signs and
symptoms of withdrawal of at least moderate intensity in three of the
six patients. The most common adverse events reported in the trial
following administration of crushed EMBEDA were anxiety, tremor,
yawning, nausea, restlessness, diarrhea and flushing.
EMBEDA is approved by the U.S. Food and Drug Administration for the
management of moderate-to-severe pain when a continuous,
around-the-clock opioid analgesic is needed for an extended period of
time. EMBEDA is NOT intended for use as a prn analgesic. EMBEDA contains
pellets of an extended-release oral formulation of morphine sulphate, an
opioid receptor agonist, with a sequestered core of naltrexone
hydrochloride, an opioid receptor antagonist. Proper use requires EMBEDA
to be swallowed whole or the contents of the capsules to be sprinkled on
apple sauce. The pellets in the capsules are not to be crushed,
dissolved, or chewed before swallowing. Misuse or abuse of EMBEDA by
tampering with the formulation by crushing or chewing the pellets causes
the rapid release and absorption of both morphine and naltrexone. The
resulting morphine dose may be fatal, particularly in opioid-naïve
individuals. In opioid-tolerant individuals, the absorption of
naltrexone may increase the risk of precipitating withdrawal. There is
no evidence that the naltrexone in EMBEDA reduces the abuse liability of
EMBEDA.
In March 2011, Pfizer voluntarily recalled from U.S. wholesalers and
retailers all dosage forms of EMBEDA because a pre-specified stability
requirement was not met during routine testing. Pfizer has been
continuing its efforts to address the stability requirement and
reintroduce EMBEDA to the U.S. market as quickly as possible. There are
several key decision points during 2012 that will determine the
necessary corrective action and associated timing.
Important Safety Information
WARNING: EMBEDA® (morphine sulfate and
naltrexone hydrochloride) Extended Release Capsules contain morphine, an
opioid agonist and a Schedule II controlled substance with an abuse
liability similar to other opioid agonists.
EMBEDA®
can be abused in a manner similar to other opioid agonists, legal or
illicit.
This should be considered when prescribing or dispensing
EMBEDA® in situations where the physician or
pharmacist is concerned about an increased risk of misuse, abuse, or
diversion.
EMBEDA® contains pellets of an
extended-release oral formulation of morphine sulfate, an opioid
receptor agonist, surrounding an inner core of naltrexone hydrochloride,
an opioid receptor antagonist indicated for the management of moderate
to severe pain when a continuous, around-the-clock opioid analgesic is
needed for an extended period of time.
EMBEDA® is NOT intended for use as a prn
analgesic.
EMBEDA® 100 mg/4 mg IS FOR USE IN
OPIOID-TOLERANT PATIENTS ONLY. Ingestion of these capsules or the
pellets within the capsules may cause fatal respiratory depression when
administered to patients not already tolerant to high doses of opioids.
Patients should not consume alcoholic beverages while on EMBEDA®
therapy. Additionally, patients must not use prescription or
non-prescription medications containing alcohol while on EMBEDA®
therapy.
The co-ingestion of alcohol with EMBEDA®
may result in an increase of plasma levels and potentially fatal
overdose of morphine.
EMBEDA® is to be
swallowed whole or the contents of the capsules sprinkled on apple sauce.
The pellets in the capsules are not to be crushed, dissolved, or
chewed due to the risk of rapid release and absorption of a potentially
fatal dose of morphine.
Crushing, chewing, or dissolving EMBEDA®
will also result in the release of naltrexone which may precipitate
withdrawal in opioid-tolerant individuals.
The common adverse events seen on initiation of therapy with EMBEDA® are
dose dependent, and their frequency depends on the clinical setting, the
patient’s level of opioid tolerance, and host factors specific to the
individual. They should be expected and managed as part of opioid
analgesia. The most frequent of these include drowsiness, dizziness,
constipation, and nausea.
Additional common adverse events reported during clinical studies
include constipation, nausea, and somnolence.
Indications and Usage
EMBEDA® is an extended-release oral formulation of morphine
sulfate and naltrexone hydrochloride indicated for the management of
moderate to severe pain when a continuous, around-the-clock opioid
analgesic is needed for an extended period of time.
EMBEDA® is NOT intended for use as a prn analgesic.
EMBEDA® is not indicated for acute/postoperative pain or if
the pain is mild or not expected to persist for an extended period of
time. EMBEDA® is only indicated for postoperative use if the
patient is already receiving chronic opioid therapy prior to surgery or
if the postoperative pain is expected to be moderate to severe and
persist for an extended period of time.
For EMBEDA Full Prescribing Information please visit www.embeda.com
Pfizer Inc.: Working together for a healthier world®
At Pfizer, we apply science and our global resources to improve health
and well-being at every stage of life. We strive to set the standard for
quality, safety and value in the discovery, development and
manufacturing of medicines for people and animals. Our diversified
global health care portfolio includes human and animal biologic and
small molecule medicines and vaccines, as well as nutritional products
and many of the world’s best-known consumer products. Every day, Pfizer
colleagues work across developed and emerging markets to advance
wellness, prevention, treatments and cures that challenge the most
feared diseases of our time. Consistent with our responsibility as the
world’s leading biopharmaceutical company, we also collaborate with
health care providers, governments and local communities to support and
expand access to reliable, affordable health care around the world. For
more than 150 years, Pfizer has worked to make a difference for all who
rely on us. To learn more about our commitments, please visit us at www.pfizer.com.
DISCLOSURE NOTICE: The information contained in this release is as of
December 22, 2011. Pfizer assumes no obligation to update
forward-looking statements contained in this release as the result of
new information or future events or developments.
This release contains forward-looking information that involves
substantial risks and uncertainties regarding the reintroduction of
EMBEDA in the U.S. market as quickly as possible. Such risks and
uncertainties include, among other things, the Company’s ability to
address the stability requirement and the timing of the necessary
corrective action. A further list and description of risks and
uncertainties can be found in Pfizer’s Annual Report on Form 10-K for
the fiscal year ended December 31, 2010 and in its reports on Form 10-Q
and Form 8-K.
