Oxycodone/naloxone preparation can cause acute withdrawal symptoms when misused parenterally or taken orally

Wong, Anselm; Macleod, Dawson; Robinson, Jeffrey S.; Koutsogiannis, Zeff; Graudins, Andis; Greene, Shaun L

doi:10.3109/15563650.2015.1060486

Cited by 14 publications

(10 citation statements)

References 8 publications

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“…The area under the curve of naloxone was increased by 11 000% in patients with decompensated cirrhosis (Child Pugh Scores 10-15) compared with healthy subjects; however, there was no observed increase in adverse events in patients with hepatic impairment. 4 Acute opioid withdrawal has previously been reported by Greene et al 6 following both oral ingestion and intravenous injection of crushed tablets in patients with opioid dependence. More recently, Hauser et al 7 described multiple cases where administration of oxycodone-naloxone led to severe uncontrolled pain in patients with liver metastases, proposed to be secondary systemic opioid antagonism.…”

Section: Discussionmentioning

confidence: 90%

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Acute opioid withdrawal following administration of oral oxycodone–naloxone due to portosystemic shunts

Peterson

Aminian

Hey

et al. 2019

Pharmacy Practice and Res

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Background The management of pain in patients with advanced liver disease is a clinical challenge. Initial pharmacokinetic safety data advised against the use of oxycodone–naloxone in this population, but in clinical practice it is commonly used. Our case aims to illustrate a potential mechanism by which administration of oxycodone–naloxone can cause systemic opioid antagonism and harm to patients. Clinical details A 45‐year‐old man received two separate doses of oxycodone–naloxone in the immediate postoperative setting, resulting in symptoms and signs consistent with acute opioid withdrawal. A review of his imaging revealed significant portosystemic shunts. Outcomes Portosystemic shunts in patients with advanced liver disease may lead to a decrease in the Phase II hepatic metabolism of naloxone and increased systemic levels. In the case of someone with pre‐existing opioid dependence, this may precipitate acute opioid withdrawal. Conclusion The use of oxycodone–naloxone preparations should be avoided in patients with liver disease and portosystemic shunts.

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Section: Discussionmentioning

confidence: 90%

“…Acute opioid withdrawal has previously been reported by Greene et al . following both oral ingestion and intravenous injection of crushed tablets in patients with opioid dependence.…”

Section: Discussionmentioning

confidence: 98%

Acute opioid withdrawal following administration of oral oxycodone–naloxone due to portosystemic shunts

Peterson

Aminian

Hey

et al. 2019

Pharmacy Practice and Res

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“…Switching to oxycodone/naloxone also increased after the reformulation; as oxycodone/naloxone has abuse-deterrent properties and causes withdrawal symptoms if injected, 44 switching to this formulation is unlikely to be related to misuse, but could be a result of its increasing popularity as a substitute for oxycodone CR since its subsidization in 2011. 4 Patients and prescribers may have seen the reformulation as an opportunity to switch.…”

Section: Discussionmentioning

confidence: 99%

Person-level changes in oxycodone use after the introduction of a tamper-resistant formulation in Australia

Schaffer

Buckley

Degenhardt

et al. 2018

CMAJ

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“…An ineffective medical treatment can be the result of a development of medicine tolerance, in which the same dose of the medication is applied for so many times, and resulting the response gradually diminishes and the dose must be increased to produce the same response [21][22] . If your analgesic effect is not good for you, please communicate with your doctor in time and change the medication under the guidance of your doctor, but do not change or stop the medicine by yourself.…”

Section: The Medication Did Not Work Appropriatelymentioning

confidence: 99%

The effectiveness of application of the standardized terminology for telephone follow-up model in discharge follow-up of patients with cancer pain.

PENG

Xing

XIONG

2020

Preprint

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Purpose This article aims to explore a standardized telephone follow-up model for patients with cancer pain, thus to promote standardized management of discharge follow-up of the patients with cancer pain.Method We have developed a flow chart of standard terminology for discharge follow-up of the patients with cancer pain. The 80 patients with cancer pain who have discharged from our hospital were divided into the control group (40 cases) and the observation group (40 cases), both groups were followed up by telephone within one week of discharge. The pain nurses have done the discharge follow up by telephone using the communication method of routine follow-up and the communication method of standardized terminology, self-monitoring, treatment compliance, adverse reaction management, self-management ability and satisfaction with telephone follow-up were compared between the two groups. Results The total scores of self-pain monitoring, treatment compliance, adverse reaction management and self-management ability in the observation group were higher than those in the control group (P<0.05). The satisfaction of the observation group was significantly higher than that of the control group (P<0.05).Conclusion The application of the standardized terminology telephone follow-up mode can promote effective communication between nurses and patients, standardize the process and content of telephone follow-up. It can effectively improve the effectiveness of telephone follow-up and the satisfaction of patients with nursing services, which is suitable for clinical reference.

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Oxycodone/naloxone preparation can cause acute withdrawal symptoms when misused parenterally or taken orally

Cited by 14 publications

References 8 publications

Acute opioid withdrawal following administration of oral oxycodone–naloxone due to portosystemic shunts

Acute opioid withdrawal following administration of oral oxycodone–naloxone due to portosystemic shunts

Person-level changes in oxycodone use after the introduction of a tamper-resistant formulation in Australia

The effectiveness of application of the standardized terminology for telephone follow-up model in discharge follow-up of patients with cancer pain.

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