Controlled‐release oxycodone compared with controlled‐release morphine in the treatment of cancer pain: A randomized, double‐blind, parallel‐group study

Abstract

Controlled-release oral formulations of oxycodone and morphine are both suitable analgesics for moderate to severe pain. They were compared in cancer-pain patients randomized to double-blind treatment with controlled-release oxycodone (n = 48) or controlled-release morphine (n = 52) every 12 h for up to 12 days. Stable analgesia was achieved by 83% of controlled-release oxycodone and 81% of controlled-release morphine patients in 2 days (median). Following titration to stable analgesia, pain intensity (0=none to 3=severe) decreased from baseline within each group (p </= 0.005), from 1.9 (0.1) to 1.3 (0.1), mean (SE), with controlled-release oxycodone, and from 1.6 (0.1) to 1.0 (0.1) with controlled-release morphine (no significant between-group differences). Typical opioid adverse experiences were reported in both groups. Hallucinations were reported only with controlled-release morphine (n = 2). Visual analog scores (VAS) for 'itchy' and 'scratchin' were lower with controlled-release oxycodone (p </= 0.044), as was peak-to-trough fluctuation in steady-state plasma concentration (p = 0.004). The correlation between plasma concentration and dose was stronger (p = 0.026) for oxycodone (0.7) than morphine (0.3). The relationship between pain intensity (VAS) and plasma concentration was more positive for oxycodone (p = 0.046). There was a positive relationship between morphine-6-glucuronide concentrations and urea nitrogen and creatinine levels (p = 0.001). Controlled-release oxycodone was as effective as controlled-release morphine in relieving chronic cancer-related pain, and as easily titrated to the individual's need for pain control. While adverse experiences were similar, controlled-release oxycodone was associated with less itching and no hallucinations. Controlled-release oxycodone provides a rational alternative to controlled-release morphine for the management of moderate to severe cancer-related pain.

Effects of itraconazole on the pharmacokinetics and pharmacodynamics of intravenously and orally administered oxycodone

“…Oxycodone is a semi-synthetic μ-opioid receptor agonist which is widely used in the treatment of both acute and chronic pain [1] The oral bioavailability of oxycodone is over 60% and it is extensively metabolised by duodenal and hepatic cytochrome P450 (CYP) isoenzymes. Only 10% of the oxycodone dose is excreted unchanged in the urine [2][3][4][5].…”

Constipation – a difficult therapeutic problem

“…Nie wpły-wa istotnie na czas pasażu jelitowego w porównaniu z wyraźnie wydłużonym po morfinie już po kilku dniach stosowania. Częstość występowania zaparcia po oksykodonie i morfinie jest podobna, natomiast wymioty i nudności są rzadsze po oksykodonie [58][59][60][61].…”

Pre-medication with controlled-release oxycodone in the management of postoperative pain after ambulatory laparoscopic gynaecological surgery

“…It has a biphasic absorption pattern with an initial absorption of about 40% of the drug producing analgesia 1 h after consumption in most patients. The subsequent more controlled absorption accounts for its long duration of effect, which is approximately 12 h. In addition, it is associated with a lower incidence of side effects in cancer patients compared with controlled-release morphine 6 . A recent systematic review by the Cochrane Collaboration showed that singledose oxycodone at doses more than 5 mg was effective for the treatment of acute postoperative pain 7 .…”