Comparison of sustained-release morphine with sustained-release oxycodone in advanced cancer patients

Abstract

The antinociceptive effect of morphine and oxycodone is mediated preferentially at m and k receptors, respectively. The aim of this study was to evaluate the analgesic profile of the combination of morphine and oxycodone in cancer pain, compared to the standard administration of morphine alone. Controlled-release formulations of oxycodone (CRO) and morphine (CRM) were compared in 26 patients. The study started with an open-label, randomised titration phase to achieve stable pain control for 7 days, followed by a double-blind, randomised crossover phase in two periods, 14 days each. At any point, patients were allowed to use oral immediaterelease morphine (IRM) as needed, in order to keep visual analogue scale p4. Pain, satisfaction, adverse effects and number of daily rescue morphine tablets were assessed. A total of 22 patients were evaluated. The weekly upload consumption ratio in morphine/ oxycodone was 1 : 1.8 (1.80, 1.83, 1.76, 1.84). The weekly IRM consumption was higher in patients having CRM compared to patients having CRO (ratio morphine/oxycodone: 1.6, 1.6, 1.6, 1.7) (Po0.05). Patients receiving oxycodone complained of less nausea and vomiting. The rescue morphine analgesic consumption was 38% higher in patients receiving only morphine, compared to patients receiving both morphine and oxycodone. The results suggest that the combination of morphine/oxycodone (opioids with differential preferential sites of action) can be a useful alternative to morphine alone, resulting in a better analgesia profile and less emesis.

Pharmacokinetics and Variation in the Clearance of Oxycodone and Hydrocotarnine in Patients with Cancer Pain

“…6,7) It was synthesized as a half synthetic conductor of tebain, a natural alkaloid, in 1916. Compared with morphine, the analgesic effect is just as good or 2/3 as good, 8) the adverse effects are just as bad, 9) and delirium and nausea/vomiting episodes are fewer.…”

Controlled clinical trials in cancer pain. How controlled should they be? A qualitative systematic review

“…In two of these (Deschamps et al, 1992;Stambaugh et al, 2001), the description was restricted to the location of the pain. Five trials (Hays et al, 1994;Bruera et al, 1996Bruera et al, , 1998Bruera et al, , 2004Hagen and Babul, 1997) evaluated patients using the Edmonton staging system which classifies pain as visceral, Kaplan et al (1998) 180 (M) Parallel group 6 days 16 (9%) VRSpi 4 11 0/spontaneous report of nervousness, anxiety 20 Klepstad et al (2003) 40 (S) Parallel group p7 days 6 (15%) VASpi; VRSpi 5 11 'Loss of sleep'; HRQOL/HRQOL: ND; sleep data NR 21 Knudsen et al (1985) 18 (S) Crossover 14 days 2 (11%) VASpi 4 10 22 Lauretti et al (2003) 26 (S) Crossover X35 days 4 (11%) VASpi 4 10 23 Melzack et al (1979) 44 (S) Crossover 'About' 4 weeks 14 (32%) PPI 4 9 24 Mignault et al (1995) 19 (S) Crossover 10 days 8 (42%) VASpi; VASpr 4 7 25 Moriarty et al (1999) 100 ( Parris et al (1998) 111 (M) Parallel group 5 days 37 (33%) VRSpi 4 16 29 Portenoy et al (1989) 51 (S) Parallel group Max. 5 days 2 (4%) VRSpi 4 11 'Quality of sleep'/ND 30 Stambaugh et al (2001) 30 (S) Crossover Max.…”

Opioid combination for cancer pain

“…I read with interest the paper by Lauretti et al (2003) regarding the possible advantage of combining opioids in cancer pain management. They report in a crossover study that the morphine consumption given as rescue doses of immediate release morphine was lower in the oxycodone phase rather than during morphine phase.…”