Morphine or Oxycodone in Cancer Pain?

Heiskanen, Tarja; Ruismäki, Päivi M.; Seppαlä, Timo; Kalso, Eija

doi:10.1080/02841860050215927

Cited by 53 publications

(3 citation statements)

References 25 publications

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“…Moreover, some studies reported dose-corrected concentrations (concentrations divided by doses) for all doses combined, complicating a direct comparison with our patient sample results. [35][36][37][38][39][40] One such systematic review reported a high dose-corrected C max of morphine after multiple doses of controlled-release morphine, 36 which was transferable to higher C max levels than the upper concentration ranges for all dose groups in the present study. Therefore, we cannot exclude the possibility that blood sampling at the expected C max may result in concentrations above the proposed concentration ranges, which should be considered when interpreting these concentrations.…”

Section: Discussionsupporting

confidence: 54%

Oxycodone, Morphine, and Fentanyl in Patients With Chronic Pain: Proposal of Dose-Specific Concentration Ranges

Thaulow

Helland

Kongsgaard

et al. 2023

Therapeutic Drug Monitoring

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Background: Interpreting opioid concentrations is challenging because of the lack of reference ranges. Therefore, the authors aimed to propose dose-specific concentration ranges in serum for oxycodone, morphine, and fentanyl in patients with chronic pain, based on concentration measurements from a large number of patients and supported by theoretical pharmacokinetic calculations and previously published concentrations. Methods:The opioid concentrations in patients undergoing therapeutic drug monitoring (TDM) for various indications (TDM group) and patients with cancer (cancer group) were investigated. Patients were divided based on the daily opioid doses, and the 10th and 90th percentiles of the concentrations in each dose interval were evaluated. In addition, the expected average serum concentrations were calculated for each dose interval based on published pharmacokinetic data, and a targeted literature search for previously reported dose-specific concentrations was performed. Results:The opioid concentrations in 1054 patient samples were included: 1004 in the TDM group and 50 in the cancer group. In total, 607 oxycodone, 246 morphine, and 248 fentanyl samples were evaluated. The authors proposed dose-specific concentration ranges based mainly on 10th-90th percentiles of the concentrations mea-sured in patient samples, whereas the calculated average concentrations and previously published concentrations were used to adjust the ranges. In general, results from calculations and concentrations retrieved from previous literature were within the 10th-90th percentiles of concentrations from patient samples. However, the lowest calculated average concentrations of fentanyl and morphine were below the 10th percentiles of patient samples in all dose groups. Conclusions:The proposed dose-specific ranges may be useful for interpreting steady-state opioid serum concentrations in clinical and forensic settings.

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Section: Discussionsupporting

confidence: 54%

Oxycodone, Morphine, and Fentanyl in Patients With Chronic Pain: Proposal of Dose-Specific Concentration Ranges

Thaulow

Helland

Kongsgaard

et al. 2023

Therapeutic Drug Monitoring

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“…Six studies have a crossover design [7,8,9,10,11,12] and 4 have a parallel-group design [13,14,15,16]. The number of patients in the trials varies from 26 to 164 (total number of patients: n = 689).…”

Section: Resultsmentioning

confidence: 99%

“…The number of patients in the trials varies from 26 to 164 (total number of patients: n = 689). In these trials, controlled-release oxycodone was tested against controlled-release morphine (5 studies) [7,10,11,12, 14], immediate-release oxycodone (3 studies) [13, 15, 16], controlled-release oxymorphone (1 study) [8 ]and controlled-release hydromorphone (1 study) [9]. One study suggested the possibility of a synergistic effect between morphine and oxycodone as measured by a lower consumption of breakthrough doses [12].…”

Section: Resultsmentioning

confidence: 99%

Oxycodone and the Challenge of Neuropathic Cancer Pain: A Review

Olarte

2008

Oncology

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In order to evaluate the potential role of oxycodone in cancer pain management, neuropathic cancer pain was selected as a model for difficult pain syndromes. A nonsystematic, yet exhaustive, review of the literature provided the relevant evidence for the discussion. Ten randomized controlled trials (RCTs) and 5 open-label studies on oxycodone and cancer pain, 3 RCTs and 1 open-label study on oxycodone and neuropathic pain, and 2 RCTs on oxycodone and visceral pain were identified and reviewed. Additionally, 5 basic research studies that contributed to our knowledge of the specific mechanisms of action of oxycodone were also reviewed. Finally, recent evidence-based reviews of RCTs on neuropathic pain were selected (6 reviews), and specific RCTs on neuropathic cancer pain were also identified (2 trials). The review of the literature shows that the management of neuropathic cancer pain has changed dramatically in the last few years thanks to new approaches and novel drugs. The vast majority of these new drugs have been proven to be useful in ‘benign’ neuropathic pain syndromes. The intrinsic difficulties in performing RCTs in cancer pain have traditionally justified the acceptance of drugs already known to be effective in benign neuropathic pain, in spite of insufficient evidence in malignant neuropathic pain. Therefore, a case is made for the development of specific guidelines for the management of both simple and complex cases of neuropathic cancer pain. An example of one of such clinical guidelines is provided, in which the role of oxycodone is particularly relevant given the existing evidence.

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