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Introduction
Oxycodone is a strong opioid analgesic that has been in clinical use for more than 80 years and is available as a prolonged release preparation. OxyContin® tablets are indicated for the treatment of moderate to severe pain in patients with cancer and post-operative pain and for the treatment of severe pain requiring the use of a strong opioid. A range of immediate release preparations (OxyNorm® capsules, liquid, and concentrate) is also available for the treatment of breakthrough and incident pain in these conditions.
The following case studies are from patients successfully treated with OxyContin® tablets. All the patients had previously received other opioid analgesics, but had remained in pain or suffered intolerable side effects. The case studies were prepared by Napp Pharmaceuticals Limited.
Patients switched from morphine
Case 1
This 75-year-old female patient presented with lung cancer and bone metastases. She was treated with diclofenac (75 mg twice-daily) and immediate release morphine (10 mg every four hours). She found that morphine gave effective pain relief, so she was switched to a prolonged release formulation (20 mg twice-daily). However, she experienced unacceptable somnolence, so her dose was reduced to 10 mg twice-daily. This did not resolve the side effect and she was switched back to immediate release morphine (10 mg every four hours). Her pain relief was good, but the somnolence persisted, so she was switched to OxyNorm® capsules,* then converted to OxyContin® tablets (10 mg twice-daily). She achieved effective pain relief with no drowsiness.
*Dose not specified in case report
Case 2
This 42-year-old male patient presented with lung cancer. He had received radiotherapy and was titrated to stable pain control with prolonged release morphine (90 mg twice-daily) and required very little escape medication. However, his compliance at this dose level was not good and he refused to take escape medication, despite the fact that he was in substantial pain. A nurse specialist discussed his pain control with him and it became clear that he was concerned about addiction to morphine and he agreed to switch to OxyContin® tablets. He was started on a product from the OxyNorm® oral range* (20 mg every four hours, as required) then converted to OxyContin® tablets (60 mg twice-daily). Stable pain control was maintained at this dose level for the duration of the follow-up (three months) and the patient required little escape medication for breakthrough pain.
*Formulation not specified in case report
Case 3
This 42-year-old female patient presented with non-Hodgkin’s lymphoma. She was treated with morphine solution, but experienced sedation and was therefore switched to OxyContin® tablets (10 mg twice-daily), supplemented with a product from the OxyNorm® oral range* for breakthrough pain. She remained on this dose for four weeks, but was changed to diamorphine via a syringe driver because she developed difficulty swallowing.
*Formulation and dose not specified in case report
Case 4
This 62-year-old male patient presented with cancer of the left mandible. He was treated with prolonged release morphine, but it caused hallucinations and nightmares. He was therefore switched to OxyContin® tablets (50 mg twice-daily), supplemented with a product from the OxyNorm® oral range* for breakthrough pain. His pain was well controlled and he no longer had hallucinations or nightmares.
*Formulation and dose not specified in case report
Patients switched from other opioids
Case 5
This 78-year-old male patient presented with carcinoma of the colon and extensive liver metastases. He was prescribed increasing doses of prolonged release dihydrocodeine (up to 60 mg every four hours), but his pain control was poor and he was drowsy and nauseous. He was switched to a product from the OxyNorm® oral range* (10 mg every four hours) then converted to OxyContin® tablets (10 mg twice-daily). Stable pain control was maintained at this dose for six weeks, but then his condition deteriorated and he was admitted to a hospice, where he was switched to parenteral analgesics.
*Formulation not specified in case report
Case 6
This 78-year-old male patient presented with carcinoma of the pancreas. He was prescribed dihydrocodeine, but did not achieve satisfactory pain control and also had nausea and constipation. A nurse specialist visited him and discussed the possibility of switching to either morphine or oxycodone. The patient expressed a preference for oxycodone and was started on OxyContin® tablets (10 mg twice-daily), supplemented with a product from the OxyNorm® oral range* for breakthrough pain. The dose of OxyContin® tablets was titrated to 20 mg twice-daily and the patient achieved stable pain control with only occasional doses of escape medication.
*Formulation and dose not specified in case report
Case 7
This 32-year-old male patient presented with a primary hepatoma. His pain had been successfully controlled with co-proxamol, but his pain increased when he developed ascites and phrenic nerve involvement. A nurse specialist suggested that he take an alternative opioid. The patient was reluctant to take morphine; he said he did not want to be heavily sedated. He was prescribed a product from the OxyNorm® oral range* (10 mg every four hours), which was converted to OxyContin® tablets (10 mg twice-daily). His dose of OxyContin® tablets was titrated up and he achieved stable pain control at a dose of 30 mg twice-daily. This was supplemented with a product from the OxyNorm® oral range* (10 mg, as required) for breakthrough pain.
*Formulation not specified in case report
Case 8
This 80-year-old female patient presented with breast cancer with secondary tumours in her spine. She had received a course of radiotherapy and was being treated with co-proxamol and diclofenac, but she was in severe pain. She was started on OxyContin® tablets (10 mg twice-daily), supplemented with a product from the OxyNorm® oral range* (5 mg, as required) for breakthrough pain. The dose of OxyContin® tablets was titrated to 20 mg twice-daily and the dose of escape medication was increased to 10 mg, as required. She achieved good pain control with no sedation.
To view more case studies on cancer-related pain, please click here
To view case studies relating to post-operative pain, please click here.