Update on prescription extended-release opioids and appropriate patient selection

Abstract

Chronic pain is largely underdiagnosed, often undertreated, and expected to increase as the American population ages. Many patients with chronic pain require long-term treatment with analgesic medications, and pain management may involve use of prescription opioids for patients whose pain is inadequately controlled through other therapies. Yet because of the potential for abuse and addiction, many clinicians hesitate to treat their patients with pain with potentially beneficial agents. Finding the right opioid for the right patient is the first – often complicated – step. Ensuring that patients continue to properly use the medication while achieving therapeutic analgesic effects is the long-term goal. Combined with careful patient selection and ongoing monitoring, new formulations using extended-release technologies incorporating tamper-resistant features may help combat the growing risk of abuse or misuse, which will hopefully reduce individual suffering and the societal burden of chronic pain. The objective of this manuscript is to provide an update on extended-release opioids and to provide clinicians with a greater understanding of which patients might benefit from these new opioid formulations and how to integrate the recommended monitoring for abuse potential into clinical practice.

Pooled Post Hoc Analysis of Population Pharmacokinetics of Oxycodone and Acetaminophen Following Multiple Oral Doses of Biphasic Immediate‐Release/Extended‐Release Oxycodone/Acetaminophen Tablets

“…As the first IR/ER opioid formulation indicated specifically for acute pain, IR/ER OC/APAP 7.5/325‐mg tablets expand the options available to prescribers. Compared with IR formulations, ER formulations provide more consistent plasma concentrations and require less‐frequent dosing to achieve durable analgesia . Although IR/ER OC/APAP 7.5/325‐mg tablets have a novel FDC formulation combining IR and ER characteristics, no unexpected clinically relevant effects of population characteristics on the PK of OC or APAP were found in this study.…”

Opioid‐induced hypogonadism: Pathophysiology, clinical and therapeutics review

“…In the event of non‐opioids or other analgesics failure, opioids alone or in combination have a role . On the other hand, in moderate to severe cancer pain, strong opioids are the treatment of choice, particularly extended‐release preparations . Both the public and physicians have long feared morphine, mainly because of the erroneous belief that its therapeutic use is intrinsically linked to abuse and addiction or severe adverse reactions .…”

Use of immediate-release opioids as supplemental analgesia during management of moderate-to-severe chronic pain with buprenorphine transdermal system

“…Opioid medications can be classified as immediate-release (IR) or extended-release (ER)/long-acting (LA) opioid formulations on the basis of their duration of action. Usually, IR opioids are short-acting, intended for use every 3–6 hours, and are more appropriate for transient pain types, such as acute, breakthrough, or intermittent pain 3,4. Common IR opioids (eg, morphine, hydromorphone, oxymorphone, codeine, fentanyl, tramadol, tapentadol, oxycodone, and hydrocodone) may be available as single entity or in combination with acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs).…”

“…Due to associated risks of hepatic and gastrointestinal toxicity with acetaminophen or NSAIDs, the maximum daily amount of these combination therapies may be limited 4. On the other hand, ER/LA opioids have a prolonged half-life and deliver a dose over a longer period of time (greater than 8 hours), which makes them appropriate for patients with persistent chronic pain that requires stable, around-the-clock dosing 3,4. Generally, ER/LA opioids are intended to result in less frequent administration than IR-opioid formulations 5…”