JOURNAL OF PALLIATIVE MEDICINE Volume 18, Number 5, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2015.0012.18.5

Oxycodone Frequently Induced Nausea and Vomiting in Oxycodone-Naı¨ve Patients with Hepatic Dysfunction Takashi Igarashi,1 Kentaro Abe,1 Tomofumi Miura, MD,2 Keita Tagami, MD,2 Shinya Motonaga,1 Yasuhiko Ichida,1 Hideaki Hasuo, MD,2 Yoshihisa Matsumoto, MD, PhD,2 Shinichiro Saito,1 and Hiroya Kinoshita, MD 2

of pain intensity. HD was defined as alanine transferase > 40 IU/L. The profiles were analyzed in patients with HD and with normal hepatic function (non-HD) using Fisher exact test. The significance was set by p < 0.05. Fifty-one patients were analyzed (female: 39.2%, mean age: 69.9 years, HD: 15 patients, non-HD: 36 patients). Results are shown in Table 1. Nausea was significantly frequent in HD (9/ 15, 60.0%) compared to non-HD (9/34, 26.5%) ( p = 0.025). Vomiting was also frequently detected in HD (5/15, 33.3%) compared with non-HD (0/34, 0%) ( p < 0.001). However, the frequency of constipation had no differences (HD: 8/14, 57.1% versus non-HD: 13/35, 37.1%, p = 0.201). Additionally, the analgesic effect had no differences in both groups (HD: 4/6, 66.7% versus non-HD: 5/13, 38.5%, p = 0.252). We first showed that HD increased nausea and vomiting of OXC in OXC-naı¨ve patients. The present report had a limitation due to small number and retrospective design. A prospective study would be desired to elucidate whether HD is the risk factor for nausea and vomiting in OXC administration.

Dear Editor: Oxycodone (OXC) is one of the commonly used opioids for cancer pain. OXC is metabolized to oxymorphone and noroxycodone through cytochrome P450 isoforms in the liver. Therefore, hepatic injury might disturb the metabolism of OXC. Although Tallgren reported OXC clearance decreased in patients before liver transplantation compared to postsurgery,1 the safety and efficacy of OXC for patients with hepatic dysfunction (HD) have never been studied. The profiles of side effect and analgesic effect in patients with HD were important for patients who might benefit from OXC. We retrospectively investigated safety and efficacy during the first three days of OXC administration in OXC-naı¨ve patients with or without HD from October 2013 to September 2014. Patients who were hospitalized and first administered OXC 10 mg/day were consecutively enrolled. Patients who took prophylactic antiemetics, received antitumor therapy within one week, or received radiation therapy within one month were excluded. Nausea was defined as the record or use of antiemetics. Vomiting was defined as the record of vomiting. Constipation was defined as the start or increase of laxatives. Analgesic effect was defined as 33% reduction

Reference

1. Tallgren M, Olkkola KT, Seppala T, et al.: Pharmacokinetics and ventilatory effects of oxycodone before and after liver transplantation. Clin Pharmacol Ther 1997;61:655–661.

Table 1. The Comparison of Safety and Efficacy in Patients with or without Hepatic Dysfunction

Nausea Vomiting Constipation Analgesic effect

1

Hepatic dysfunction N (%)

Normal liver function N (%)

p-value

9/15 5/15 8/14 4/6

9/34 0/34 13/35 5/13

0.025 < 0.001 0.201 0.252

(60.0) (33.3) (57.1) (66.7)

(26.5) (0) (37.1) (38.5)

Address correspondence to: Tomofumi Miura, MD Department of Palliative Medicine National Cancer Center Hospital East 6-5-1, Kashiwanoha, Kashiwa Chiba 277-8577, Japan E-mail: [email protected]

Department of Pharmacy, 2Department of Palliative Medicine, National Cancer Center Hospital East, Chiba, Japan.

1

Oxycodone frequently induced nausea and vomiting in oxycodone-naïve patients with hepatic dysfunction.

Oxycodone frequently induced nausea and vomiting in oxycodone-naïve patients with hepatic dysfunction. - PDF Download Free
32KB Sizes 0 Downloads 9 Views