High-dose oxycodone well tolerated and effective in palliative cancer care
MedWire News: Palliative pain relief with high-dose controlled-release oxycodone (CRO) achieves good pain control with minimal adverse effects, shows a retrospective study of cancer patients.
Study co-author Sebastiano Mercadante (La Maddalena Cancer Center, Palermo, Italy) and colleagues comment: "This study demonstrated that CRO administered in larger doses was safe and effective, showing versatility and flexibility similar to morphine."
Opioid administration is the primary therapeutic modality in the management of moderate-to-severe cancer pain.
Morphine is considered the preferred drug because of its wide availability, varied formulations, and well-characterized pharmacologic properties. Yet oxycodone has been found to be as effective as morphine and is the preferred drug for switching from morphine in the UK.
Although recent data suggest that oxycodone is efficacious and well tolerated as a first-line opioid at doses of between 20 and 40 mg/day, few reports have assessed patients receiving high doses of oxycodone.
In the current study, Mercadante et al gathered data on 212 cancer patients who were prescribed (or switched to) CRO for background analgesia during hospital admission and continued until discharge.
During hospitalization, decisions regarding the administration of opioids and adjustment of dosage were based on clinical assessment, patient's daily report, and rescue doses given during the preceding 24 hours.
Pain intensity was assessed by a numerical scale from 0 to 10 and symptoms associated with opioid therapy or commonly present in patients with advanced cancer, such as nausea and vomiting, drowsiness, confusion, constipation, and dry-mouth, were recorded using a scale from 0 to 3 (not at all, slight, a lot, awful). Distress score (DS) was calculated from the sum of symptom intensity.
Patients were discharged home when pain doses were stabilized and pain control had been achieved.
Overall, the mean dose of oxycodone was 141 mg (range 10-960 mg). In all, 129 patients were prescribed doses of oxycodone of less than 120 mg/day, 43 were prescribed 120 to 240 mg/day, and 40 patients more than 240 mg/day.
The mean hospital admission time was 4.8 days and at discharge the mean pain intensity was 2.9. Adverse effects were mild in intensity, with an average DS of 3.5, and were not related to CRO doses.
"Adverse effects were rarely dose-limiting, and safety was witnessed at time of discharge, which, as per protocol, required the achievement of an acceptable balance between analgesia and adverse effects," Mercadante et al comment in the American Journal of Hospice and Palliative Medicine.
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By Andrew Czyzewski