Narabayashi, M., Saijo, Y., Takenoshita, S., Chida, M., Shimoyama, N., Miura, T., … Advisory Committee for Oxycodone Study. (2008). Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable adverse effects: An open-label trial. Japanese Journal of Clinical Oncology, 38(4), 296–304.doi: 10.1093/jjco/hyn010
To investigate the efficacy and safety of switching from oral morphine to oral oxycodone and to evaluate this regimen in patients with renal impairment
Patients were rotated from controlled-release (CR) oral morphine to oral oxycodone CR via a 3:2 ratio. Immediate-release (IR) oxycodone was used for breakthrough pain (BTP) at 1/6 of the 24-hour oxycodone dose. If pain intensity was rated as moderate to severe or if more than 3 rescue doses of IR oxycodone were administered in 24 hours, oxycodone was titrated upward. If untoward side effects were experienced, the oxycodone dose was titrated downward. Patients were deemed successful if pain control was adequate for 10 days. Pharmacokinetic evaluation for renal impairment was conducted on patients with adequate relief.
This study was a multisite, outpatient setting study conducted at 14 sites in Japan.
This was a multicenter, open label, dose-titration study.
Rotation to oral oxycodone for patients who had inadequate pain control or significant adverse events with morphine was successful. Retention of oxycodone metabolites did not seem to exist in patients with renal compromise.
Oxycodone can be recommended as an alternative to morphine, and patients may experience fewer adverse events with oxycodone. Patients with renal compromise may benefit from oxycodone over morphine as morphine contributes to metabolite accumulation, leading to potential oversedation or adverse events.