Pain therapy with oxycodone/naloxone prolonged-release combination:

Błaszczyk, Feliks; Droń, Aleksandra

doi:10.5114/wo.2013.37911

Cited by 2 publications

(3 citation statements)

References 23 publications

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“…It is an exhausting symptom for the patient; moreover, it can additionally lead to fatigue due to sleep disorders and can reduce the ability to perform physical activity. The meaning of these observations is crucial because 2/3 of patients experience pain in the terminal stage of cancer [ 32 – 34 ] in moderate to severe intensity [ 35 ] and 1/3 in its intermediate stage [ 33 ]. Although painkillers often decrease the level of experienced fatigue, their side effects may intensify fatigue [ 9 ].…”

Section: Symptomsmentioning

confidence: 99%

The problem of fatigue in patients suffering from neoplastic disease

Kolak

Kamińska

Wysokińska

et al. 2017

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Modern therapeutic management of patients with cancer is associated with many adverse side effects, including fatigue defined as weariness, burnout, lassitude, malaise, apathy, impatience, and/or inability to perform daily activities. It occurs frequently before the diagnosis of cancer and may persist for a long time after the end of cancer therapy. It is a common problem that occurs regardless of the type of cancer and applied therapeutic procedure. The appearance of this symptom significantly affects the quality of life of patients and often reduces the effectiveness of implemented treatment. The symptom of fatigue occurs among approximately 80% of patients treated with chemotherapy and/or radiotherapy, as well as among more than 75% of patients with metastatic disease. Causes of fatigue include metabolic and immune system disorders as well as increased level of tumour necrosis factor α (TNF-α). Recent studies also indicate a significant contribution of other cytokines, especially pro-inflammatory ones, i.e. interleukin-1 (IL-1), interleukin-6 (IL-6), soluble tumour necrosis factor receptor type II (sTNF type II) and C-reactive protein (CRP). A patient reporting fatigue should be properly diagnosed and thoroughly interviewed by doctors. Patients are mostly treated non-pharmacologically (by means of physical exercise and psychotherapy) and pharmacologically (by applying methylphenidate and methylprednisolone). What is also extremely important is proper education of the patient and their closest family/friends on the symptoms, which significantly reduces anxiety and stress. On the other hand therapeutic management hinders the subjectivity of feeling and lack of standardised scales to rate symptoms.

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Section: Symptomsmentioning

confidence: 99%

The problem of fatigue in patients suffering from neoplastic disease

Kolak

Kamińska

Wysokińska

et al. 2017

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“…patients requiring opioids for moderate-to-severe chronic pain, the use of naloxone in combination with oxycodone in a prolonged release tablet (PR OXY/N) can prevent development of opioid-induced constipation or reduce existing opioid-induced constipation. 5 It has long been known that hepatic impairment, especially in the setting of portal hypertension, increases systemic bioavailability of naloxone, [6][7][8][9][10][11][12] potentially compromising the analgesic efficacy of PR OXY/N. For this reason, the manufacturer's recommendation is to avoid PR OXY/N in patients with known severe liver disease.…”

mentioning

confidence: 99%

“…Nevertheless, several case reports have been published describing acute opioid sedation/toxicity or inadequate analgesic efficacy in patients with hepatic impairment when switching between PR OXY/N tablets and oxycodone for cancer-related pain. [7][8][9][10][11][12] This article discusses potential treatment challenges with prolonged release oxycodone alone (PR OXY), including opioid toxicity and impaired analgesic efficacy when switching to or from oxycodone alone, in patients with advanced malignancies suffering chronic moderate-to-severe cancer pain, especially in the context of known or unrecognized impaired hepatic function.…”

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confidence: 99%

Oxycodone/naloxone prolonged‐release tablets in patients with moderate‐to‐severe, chronic cancer pain: Challenges in the context of hepatic impairment

Aggarwal

Douglas

et al. 2021

Asia-Pac J Clncl Oncology

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Opioids such as oxycodone are recommended in the management of moderate-tosevere, chronic cancer pain. All opioids can potentially cause constipation, which may be a significant barrier to their use. Multiple randomised clinical trials have shown that the use of naloxone as a peripherally acting mu-opioid receptor antagonist, in combination with oxycodone can prevent or reduce opioid-induced constipation while having equivalent analgesic efficacy to oxycodone alone. However, clinical experience has shown that unexpected events may occur in some patients when unrecognized liver impairment is present. We describe the underlying biological reasons and propose simple, but effective steps to avoid this unusual but potentially serious occurrence.In healthy individuals, naloxone undergoes extensive hepatic first pass metabolism resulting in low systemic bioavailability. However, in patients with hepatic impairment, porto-systemic shunting can increase systemic bioavailability of naloxone, potentially compromising the analgesic efficacy of oral naloxone-oxycodone combinations. This reduced first pass effect can occur in a range of settings that may not always be apparent to the treating clinician, including silent cirrhosis, non-cirrhotic portal hypertension and disruption of liver internal vasculature by metastases. Hepatic function test results correlate poorly with presence and extent of liver disease, and are not indicative of porto-systemic shunting. Presence of hepatic impairment should thus be considered when medication-related outcomes with oxycodone-naloxone combination are not as expected, even if liver function test results are normal.

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Pain therapy with oxycodone/naloxone prolonged-release combination:

Cited by 2 publications

References 23 publications

The problem of fatigue in patients suffering from neoplastic disease

The problem of fatigue in patients suffering from neoplastic disease

Oxycodone/naloxone prolonged‐release tablets in patients with moderate‐to‐severe, chronic cancer pain: Challenges in the context of hepatic impairment

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