Oral prolonged‐release oxycodone/naloxone for managing pain and opioid‐induced constipation: a review of the evidence

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Published Version
Date
2017-09-25
Authors
Morlion, Bart J.
Mueller‐Lissner, Stefan A.
Vellucci, Renato
Leppert, Wojciech
Coffin, Benoît C.
Dickerson, Sara L.
O'Brien, Tony
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John Wiley & Sons, Inc.
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Research Projects
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Abstract
Background: Opioids provide effective relief from moderate‐to‐severe pain and should be prescribed as part of a multifaceted approach to pain management when other treatments have failed. Fixed‐dose oxycodone/naloxone prolonged‐release tablets (OXN PR) were designed to address the opioid class effect of opioid‐induced constipation (OIC) by combining the analgesic efficacy of oxycodone with the opioid receptor antagonist, naloxone, which has negligible systemic availability when administered orally. This formulation has abuse‐deterrent properties, since systemic exposure to naloxone by parenteral administration would antagonize the euphoric effects of oxycodone. Methods: A literature search was conducted to assess the evidence base for OXN PR to treat moderate‐to‐severe pain and its impact on bowel function, based on published clinical trials and observational studies. Results: Extensive data demonstrate that OXN PR provides effective analgesia and clinically relevant improvements in bowel function in patients with OIC and moderate‐to‐severe cancer‐related pain and noncancer pain types such as low back pain, neuropathic pain, and musculoskeletal pain. OXN PR has also been found to improve bowel function in patients with OIC refractory to multiple types of laxatives, and improve Parkinson's disease–related pain. No unanticipated safety concerns have been reported in elderly patients. Conclusions: Evidence from clinical trials and observational studies confirms that for selected patients OXN PR significantly improves moderate‐to‐severe chronic pain and provides relief from OIC. Treatment should be tailored to individual patients to establish the lowest effective dose. An absence of analgesic ceiling effect was seen across the clinically relevant dose range investigated (≤ 160/80 mg/day).
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Keywords
Narcotic antagonists , Opioid analgesics , Pain , Opioid-related disorders
Citation
Morlion, B. J., Mueller-Lissner, S. A., Vellucci, R., Leppert, W., Coffin, B. C., Dickerson, S. L. and O'Brien, T. (2017) 'Oral prolonged‐release oxycodone/naloxone for managing pain and opioid‐induced constipation: a review of the evidence', Pain Practice, 0(0). doi:10.1111/papr.12646
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© 2017, the Authors. Pain Practice published by Wiley Periodicals, Inc. on behalf of World Institute of Pain. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.