Oxycodone/acetaminophen at low dosage: An alternative pain treatment for patients with rheumatoid arthritis

Abstract

Objectives: To assess efficacy and safety of the association oxycodone/acetaminophen (oxycodone/ acetaminophen) for pain treatment and disability improvement in patients with rheumatoid arthritis (RA).Methods: Patients with RA (n = 29), suffering from moderate to severe pain for more than 3 months, were included in the study, except those under RA therapy with biological drugs. The treatment started with oxycodone/acetaminophen at the dosage of 5 mg/325 mg, and then the dosage was titrated until the attainment of good pain relief. Antiemetic and laxative therapy was used for the prophylaxis of known opioid-related adverse events.Results: Patients continued their RA therapy without changing the dosages, reported reduced pain intensity and disease activity, and improvement of disability. Forty-two percent of patients had a good clinical response to oxycodone/acetaminophen treatment, according to European League against Rheumatism (EULAR) assessment criteria, and 50 percent of patients reached the American College of Rheumatology 20 percent improvement criteria (ACR20). At the end of the study, the mean (±SD) daily effective oxycodone/acetaminophen dose was 13.8 (±6.8) mg/720.4 (±291.0) mg. No serious adverse event was observed. Nausea, vomiting, and stipsis of mild-moderate intensity were the most common adverse events.Conclusion: Oxycodone/acetaminophen at low dosages for the treatment of chronic pain in RA patients can be a good alternative to non-steroidal anti-inflammatory drugs (NSAIDs), allowing the reduction of their consumption, while keeping RA therapy stable.

Pharmacokinetics and bioavailability of oxycodone and acetaminophen following single-dose administration of MNK-795, a dual-layer biphasic IR/ER combination formulation, under fed and fasted conditions

“…It is well documented that analgesics containing a combination of opioid and nonopioid agents can provide effective pain relief. Combination opioid/nonopioid therapy with oxycodone (OC) and acetaminophen (APAP), for example, has been shown to provide effective analgesia in the treatment of low back pain,2–4 arthritis,2,5–8 cancer,2,9 and postoperative pain 2,10–13. In addition, combining analgesic agents with different mechanisms of action is intended to be additive or synergistic, such that lower doses of each agent may theoretically be used 2,14–17…”

Oxycodone/Paracetamol

“…The majority of adverse events involved the central nervous system and gastrointestinal system, with somnolence, dizziness, nausea, headache, constipation, sweating, vomiting and pruritus occurring in ‡5% of either treatment group. [34] Furthermore, 14 weeks' treatment with oxycodone/paracetamol IR 5 mg/325 mg was well tolerated by patients with chronic cancer-related pain, with side effects typical of opioids and not substantially different from those reported with comparator drugs (codeine, buprenorphine, pentazocine, dextropropoxyphene, all taken in combination with paracetamol). [28] Treatment with oxycodone/paracetamol IR was also well tolerated in fragile elderly female patients (n = 154; mean age 78 years) with pain associated with osteoarthritis.…”

“…[34] Oxycodone/paracetamol IR 5 mg/325 mg once daily was titrated to determine the optimal dosage for pain relief (maximum dosage 20 mg/325 mg four times daily). [34] Oxycodone/paracetamol IR 5 mg/325 mg once daily was titrated to determine the optimal dosage for pain relief (maximum dosage 20 mg/325 mg four times daily).…”

Adherence and long-term effect of oxycodone/paracetamol in chronic noncancer pain: a retrospective study

“…2 For a wide range of patients who do not achieve control of CNCP with standard therapies, the combination of oxycodone/paracetamol at low doses has been efficacious and well tolerated in the short-to medium-term. [7][8][9][10][11][12][13][14][15][16][17] The current study investigates whether this efficacy and tolerability also extends to medium-tolong-term use by analyzing clinical charts from consecutive outpatients remaining in treatment with oxycodone/paracetamol. All patients were still in treatment at the last available follow-upappointment.…”