Oxycodone/Naloxone: Role in Chronic Pain Management, Opioid-Induced Constipation, and Abuse Deterrence
Identifieur interne : 000207 ( Pmc/Curation ); précédent : 000206; suivant : 000208Oxycodone/Naloxone: Role in Chronic Pain Management, Opioid-Induced Constipation, and Abuse Deterrence
Auteurs : Anne Z. Depriest [États-Unis] ; Katie Miller [États-Unis]Source :
- Pain and Therapy [ 2193-8237 ] ; 2014.
Abstract
The use of opioids in the treatment of chronic pain is widespread; the prevalence of specific opioids varies from country to country and depends on product availability, national formulary systems, and provider preferences. Patients often receive opioids for legitimate treatment of pain conditions, but on the opposite side of the spectrum, nonmedical use of opioids is a significant public health concern. Opioids are associated with several side effects, and constipation is the most commonly reported and persistent symptom. Unlike some adverse effects associated with opioid use, tolerance does not develop to constipation. Opioid-induced constipation (OIC) is the most prevalent patient complaint associated with opioid use and has been associated with declines in various quality of life measures. OIC can be extremely difficult for patients to tolerate and may prompt patients to decrease or discontinue opioid treatment. Current management strategies for OIC are often insufficient. A prolonged-release formulation of oxycodone/naloxone (OXN) has been investigated for the treatment of nonmalignant and cancer pain and mitigation of OIC, and evidence is largely favorable. Studies have demonstrated the capability of OXN to alleviate OIC while maintaining pain control comparable to oxycodone-only regimens. There is insufficient evidence for OXN efficacy for patients with mild OIC or patients maintained on high doses of opioids, and use in these populations is controversial. The reduction of costs associated with OIC may provide overall cost effectiveness with OXN. Additionally, the presence of naloxone may deter abuse/misuse by those seeking to misuse the formulation by modes of administration other than oral ingestion. Most studies to date have occurred in European countries, and phase 3 trials continue in the United States. This review will include current therapeutic options for pain and constipation, unique characteristics of OXN, evidence related to use of OXN and its place in therapy, discussion of opioid abuse/misuse, and various abuse-deterrent mechanisms, and areas of continuing research.
The online version of this article (doi:10.1007/s40122-014-0026-2) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1007/s40122-014-0026-2
PubMed: 25135384
PubMed Central: 4108020
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Depriest</name><affiliation wicri:level="2"><nlm:aff id="Aff1">Aegis Sciences Corporation, Nashville, TN USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Tennessee</region></placeName><wicri:cityArea>Aegis Sciences Corporation, Nashville</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="Aff2">University of Tennessee College of Pharmacy, Memphis, TN USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Tennessee</region></placeName><wicri:cityArea>University of Tennessee College of Pharmacy, Memphis</wicri:cityArea></affiliation></author><author><name sortKey="Miller, Katie" sort="Miller, Katie" uniqKey="Miller K" first="Katie" last="Miller">Katie Miller</name><affiliation wicri:level="2"><nlm:aff id="Aff1">Aegis Sciences Corporation, Nashville, TN USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Tennessee</region></placeName><wicri:cityArea>Aegis Sciences Corporation, Nashville</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="Aff2">University of Tennessee College of Pharmacy, Memphis, TN USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Tennessee</region></placeName><wicri:cityArea>University of Tennessee College of Pharmacy, Memphis</wicri:cityArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25135384</idno><idno type="pmc">4108020</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4108020</idno><idno type="RBID">PMC:4108020</idno><idno type="doi">10.1007/s40122-014-0026-2</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000207</idno><idno type="wicri:Area/Pmc/Curation">000207</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Oxycodone/Naloxone: Role in Chronic Pain Management, Opioid-Induced Constipation, and Abuse Deterrence</title><author><name sortKey="Depriest, Anne Z" sort="Depriest, Anne Z" uniqKey="Depriest A" first="Anne Z." last="Depriest">Anne Z. Depriest</name><affiliation wicri:level="2"><nlm:aff id="Aff1">Aegis Sciences Corporation, Nashville, TN USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Tennessee</region></placeName><wicri:cityArea>Aegis Sciences Corporation, Nashville</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="Aff2">University of Tennessee College of Pharmacy, Memphis, TN USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Tennessee</region></placeName><wicri:cityArea>University of Tennessee College of Pharmacy, Memphis</wicri:cityArea></affiliation></author><author><name sortKey="Miller, Katie" sort="Miller, Katie" uniqKey="Miller K" first="Katie" last="Miller">Katie Miller</name><affiliation wicri:level="2"><nlm:aff id="Aff1">Aegis Sciences Corporation, Nashville, TN USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Tennessee</region></placeName><wicri:cityArea>Aegis Sciences Corporation, Nashville</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="Aff2">University of Tennessee College of Pharmacy, Memphis, TN USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Tennessee</region></placeName><wicri:cityArea>University of Tennessee College of Pharmacy, Memphis</wicri:cityArea></affiliation></author></analytic><series><title level="j">Pain and Therapy</title><idno type="ISSN">2193-8237</idno><idno type="eISSN">2193-651X</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>The use of opioids in the treatment of chronic pain is widespread; the prevalence of specific opioids varies from country to country and depends on product availability, national formulary systems, and provider preferences. Patients often receive opioids for legitimate treatment of pain conditions, but on the opposite side of the spectrum, nonmedical use of opioids is a significant public health concern. Opioids are associated with several side effects, and constipation is the most commonly reported and persistent symptom. Unlike some adverse effects associated with opioid use, tolerance does not develop to constipation. Opioid-induced constipation (OIC) is the most prevalent patient complaint associated with opioid use and has been associated with declines in various quality of life measures. OIC can be extremely difficult for patients to tolerate and may prompt patients to decrease or discontinue opioid treatment. Current management strategies for OIC are often insufficient. A prolonged-release formulation of oxycodone/naloxone (OXN) has been investigated for the treatment of nonmalignant and cancer pain and mitigation of OIC, and evidence is largely favorable. Studies have demonstrated the capability of OXN to alleviate OIC while maintaining pain control comparable to oxycodone-only regimens. There is insufficient evidence for OXN efficacy for patients with mild OIC or patients maintained on high doses of opioids, and use in these populations is controversial. The reduction of costs associated with OIC may provide overall cost effectiveness with OXN. Additionally, the presence of naloxone may deter abuse/misuse by those seeking to misuse the formulation by modes of administration other than oral ingestion. Most studies to date have occurred in European countries, and phase 3 trials continue in the United States. This review will include current therapeutic options for pain and constipation, unique characteristics of OXN, evidence related to use of OXN and its place in therapy, discussion of opioid abuse/misuse, and various abuse-deterrent mechanisms, and areas of continuing research.</p><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1007/s40122-014-0026-2) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Mercadante, S" uniqKey="Mercadante S">S Mercadante</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gras, B" uniqKey="Gras B">B Gras</name></author><author><name sortKey="Magge, S" uniqKey="Magge S">S Magge</name></author><author><name sortKey="Bloom, A" uniqKey="Bloom A">A Bloom</name></author><author><name sortKey="Lembo, A" uniqKey="Lembo A">A 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article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Pain Ther</journal-id><journal-id journal-id-type="iso-abbrev">Pain Ther</journal-id><journal-title-group><journal-title>Pain and Therapy</journal-title></journal-title-group><issn pub-type="ppub">2193-8237</issn><issn pub-type="epub">2193-651X</issn><publisher><publisher-name>Springer Healthcare</publisher-name><publisher-loc>Heidelberg</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25135384</article-id><article-id pub-id-type="pmc">4108020</article-id><article-id pub-id-type="publisher-id">26</article-id><article-id pub-id-type="doi">10.1007/s40122-014-0026-2</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review</subject></subj-group></article-categories><title-group><article-title>Oxycodone/Naloxone: Role in Chronic Pain Management, Opioid-Induced Constipation, and Abuse Deterrence</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>DePriest</surname><given-names>Anne Z.</given-names></name><address><email>anne.depriest@aegislabs.com</email></address><xref ref-type="aff" rid="Aff1"></xref><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Miller</surname><given-names>Katie</given-names></name><xref ref-type="aff" rid="Aff1"></xref><xref ref-type="aff" rid="Aff2"></xref></contrib><aff id="Aff1"><label></label>Aegis Sciences Corporation, Nashville, TN USA</aff><aff id="Aff2"><label></label>University of Tennessee College of Pharmacy, Memphis, TN USA</aff></contrib-group><pub-date pub-type="epub"><day>6</day><month>5</month><year>2014</year></pub-date><pub-date pub-type="pmc-release"><day>6</day><month>5</month><year>2014</year></pub-date><pub-date pub-type="ppub"><month>6</month><year>2014</year></pub-date><volume>3</volume><issue>1</issue><fpage>1</fpage><lpage>15</lpage><history><date date-type="received"><day>5</day><month>1</month><year>2014</year></date></history><permissions><copyright-statement>© The Author(s) 2014</copyright-statement></permissions><abstract id="Abs1"><p>The use of opioids in the treatment of chronic pain is widespread; the prevalence of specific opioids varies from country to country and depends on product availability, national formulary systems, and provider preferences. Patients often receive opioids for legitimate treatment of pain conditions, but on the opposite side of the spectrum, nonmedical use of opioids is a significant public health concern. Opioids are associated with several side effects, and constipation is the most commonly reported and persistent symptom. Unlike some adverse effects associated with opioid use, tolerance does not develop to constipation. Opioid-induced constipation (OIC) is the most prevalent patient complaint associated with opioid use and has been associated with declines in various quality of life measures. OIC can be extremely difficult for patients to tolerate and may prompt patients to decrease or discontinue opioid treatment. Current management strategies for OIC are often insufficient. A prolonged-release formulation of oxycodone/naloxone (OXN) has been investigated for the treatment of nonmalignant and cancer pain and mitigation of OIC, and evidence is largely favorable. Studies have demonstrated the capability of OXN to alleviate OIC while maintaining pain control comparable to oxycodone-only regimens. There is insufficient evidence for OXN efficacy for patients with mild OIC or patients maintained on high doses of opioids, and use in these populations is controversial. The reduction of costs associated with OIC may provide overall cost effectiveness with OXN. Additionally, the presence of naloxone may deter abuse/misuse by those seeking to misuse the formulation by modes of administration other than oral ingestion. Most studies to date have occurred in European countries, and phase 3 trials continue in the United States. This review will include current therapeutic options for pain and constipation, unique characteristics of OXN, evidence related to use of OXN and its place in therapy, discussion of opioid abuse/misuse, and various abuse-deterrent mechanisms, and areas of continuing research.</p><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1007/s40122-014-0026-2) contains supplementary material, which is available to authorized users.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Abuse-deterrent formulations</kwd><kwd>Chronic pain treatment</kwd><kwd>Opioid-induced constipation</kwd><kwd>Opioids</kwd><kwd>Oxycodone/naloxone</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© Springer Healthcare 2014</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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