Combined oral prolonged-release oxycodone and naloxone in opioid-induced bowel dysfunction: review of efficacy and safety data in the treatment of patients experiencing chronic pain.
BACKGROUND
Despite proven analgesic efficacy, opioid use is associated with frequently dose-limiting bowel dysfunction that seriously impacts patients' quality of life (QoL). Agents used at present to manage opioid-induced constipation do not address the underlying opioid receptor-mediated cause of bowel dysfunction and are often ineffective. There is, therefore, a significant need for more effective treatment options. The combination of the strong opioid oxycodone and the opioid antagonist naloxone has the potential to prevent opioid-induced bowel dysfunction (OIBD) while maintaining analgesic efficacy.


OBJECTIVE
To review the safety and efficacy of oral prolonged-release (PR) oxycodone/naloxone in the treatment of patients experiencing chronic pain.


METHODS
A MEDLINE search was done (January 2002 - July 2009) for available literature for prolonged release oxycodone and naloxone in different patient groups. Results were limited to English-language and clinical trials. Data were also obtained from congress materials. WHAT KNOWLEDGE THE READER WILL GAIN: Unmet needs of opioid pain treatment in terms of OIBD, reduced QoL and low treatment compliance, leading to reduced efficacy. A data overview demonstrates the efficacy and tolerability of PR oxycodone/naloxone in the management of severe chronic pain without the burden of severe gastrointestinal adverse events. The combined formulation of a highly effective opioid and an antagonist that acts locally to reduce gastrointestinal side effects is expected to simplify pain management.


CONCLUSIONS
The combination of PR oxycodone/naloxone offers the potential of maintaining normal bowel function in patients requiring opioid therapy--it is a strong analgesic that is well tolerated.
Clemens
Katri Elina
KE
University of Bonn, Malteser Hospital Bonn/Rhein-Sieg, Centre for Palliative Medicine, Department of Science and Research, von-Hompesch-Str. 1, D-53123 Bonn, Germany. katri-elina.clemens@malteser.de
Mikus
Gerd
G
D000284:Administration, Oral; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D003248:Constipation / Q000139:chemically induced / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000009:adverse effects; D006801:Humans; D009270:Naloxone / Q000009:adverse effects / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000009:adverse effects*; D010098:Oxycodone / Q000009:adverse effects / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement / Q000187:drug effects; D011788:Quality of Life; D011957:Receptors, Opioid / Q000378:metabolism; D012449:Safety
D009292:Narcotic Antagonists; D011957:Receptors, Opioid; D009270:Naloxone; D010098:Oxycodone