Treatment with subcutaneous and transdermal fentanyl: results from a population pharmacokinetic study in cancer patients

Oosten, Astrid W.; Abrantes, João A.; Jönsson, Siv; Bruijn, Peter de; Kuip, Evelien; Falcão, Amı́lcar; Rijt, Carin C.D. van der; Mathijssen, Ron H.J.

doi:10.1007/s00228-015-2005-x

Cited by 24 publications

(11 citation statements)

References 35 publications

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“…For the primary endpoint, the following analysis approach was taken. A natural log transformation was applied to the AUC 0–4 h and AUC 0–6 h values in order to normalize the distributions [ 4 , 7 , 32 ]. Estimates for the mean differences in (log) AUCs were obtained using a linear mixed effect model with treatment, sequence and period as fixed effects and subject within sequence as a random effect [ 33 ].…”

Section: Methodsmentioning

confidence: 99%

“…A steady state is usually reached after application of a second transdermal fentanyl patch [ 6 ], although plasma concentration vary over the 72 hour period wherein a single patch is used [ 7 ]. Unfortunately, there is a wide intra- and interpatient pharmacokinetic variation in patients using fentanyl patches [ 7 – 11 ]. In clinical practice patients may already describe less painkilling effects of the cutaneous patch after 48 hours, and they may use extra opioids in the last 24 hours.…”

Section: Introductionmentioning

confidence: 99%

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Influence of aprepitant and localization of the patch on fentanyl exposure in patients with cancer using transdermal fentanyl

et al. 2018

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Background and ObjectivesThe cutaneous fentanyl patch is widely used to treat continuous pain in patients with cancer. Its use is hampered by a high inter- and intrapatient pharmacokinetic variability. Factors that influence this pharmacokinetic variability are largely unclear. The aim of these studies was to test if common patient variables, i) the use of the moderate CYP3A4 inhibitor aprepitant and ii) the localization of the fentanyl patch (upper arm versus thorax) influence systemic exposure to fentanyl in patients with cancer using a transdermal fentanyl patch.ResultsThe AUC0–6 h of fentanyl was 7.1% (95% CI: −28% to +19%) lower if patients concurrently used aprepitant, compared to the period when patients used fentanyl only. The AUC0–4 h of fentanyl was 7.4% (95% CI: −22% to +49%) higher when the cutaneous fentanyl patch was applied to the upper arm compared to application at the thorax.ConclusionsNeither the concurrent use of aprepitant, nor the localization of the fentanyl patch showed a statistically significant influence on fentanyl pharmacokinetics.MethodsWe performed two prospective cross-over pharmacokinetic intervention studies. Both studies had two eight-day study periods. At day 8 of each study period blood samples were collected for pharmacokinetic analysis. In each study 14 evaluable patients were included.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of aprepitant and localization of the patch on fentanyl exposure in patients with cancer using transdermal fentanyl

et al. 2018

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“…The action time of each patch is 72 hours, remaining for 12 to 18 hours after its removal. The transmucosal formulation has short action duration, non-invasive administration route, and tolerable safety profile 14,17,25,26,34,35 .…”

Section: Fentanylmentioning

confidence: 99%

The use of opioids in the treatment of oncologic pain in the elderly

Silva

Mendanha

Gomes

2020

Brazilian Journal of Pain

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BACKGROUND AND OBJECTIVES: The use of opioids in cancer is already widespread and proven by several well-controlled clinical trials. However, the elderly with cancer pain are undertreated due to the lack of knowledge in the management of these patients, the underestimation of pain, as well as the fear of complications arising in this age group. Therefore, the scientific community contributes to giving inputs to create possible clinical and health guidelines. The present study aimed to perform a systematic literature review of opioid treatments proposed for cancer-related pain in elderly patients. CONTENTS: The search on the literature included papers addressing cancer pain treatment with opioids among the elderly, published from 2008 to 2018, and available in Portuguese or English. Searches were conducted on Medical Literature, Analysis, and Retrieval System Online (MEDLINE) and Latin American and Caribbean Health Sciences Literature (LILACS) electronic databases using the keywords "cancer pain", "opioids", and "elderly" in both languages, combined with the Boolean operator "AND". To analyze the quality of the method, the adapted Critical Appraisal Skills Programme was used. Of a total of 411 studies found, 32 were included. About 75% of the selected articles were published in the last five years. CONCLUSION: The results showed that opioids remain the pillar to treat cancer-related pain in the elderly. They can be used for better management of pain, but with caution due to the possible adverse effects. In addition, pain management in the elderly requires a multifactorial analysis, including comorbidities, polypharmacy, and patient functionality. Therefore, an individualized approach in the elderly patient is required in order to enhance results, reduce side effects, and improve quality of life.

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“…The inactive metabolites, and approximately 10% of the intact molecule, are mainly excreted by the kidneys. [ 34 ]…”

Section: Ethodsmentioning

confidence: 99%

Indian society for study of pain, cancer pain special interest group guidelines on pharmacological management of cancer pain (Part I)

Thota¹,

Ramanjulu²,

Ahmed³

et al. 2020

Indian J Palliat Care

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The Indian Society for Study of Pain (ISSP), Cancer Pain Special Interest Group guidelines on pharmacological management of cancer pain in adults provides a structured, step-wise approach which will help to improve the management of cancer pain and to provide the patients with a minimally acceptable quality of life. The guidelines have been developed based on the available literature and evidence, to suit the needs, patient population, and situations in India. A questionnaire based on the key elements of each sub drafts addressing certain inconclusive areas where evidence was lacking, was made available on the ISSP website, and circulated by E-mail to all the ISSP and Indian Association of Palliative Care (IAPC) members. We recommend that analgesics for cancer pain management should follow the World Health Organization three-step analgesic ladder appropriate for the severity of pain. The use of paracetamol and nonsteroidal anti-inflammatory drugs alone or in combination with opioids for mild-to-moderate pain should be used. For mild-to-moderate pain, weak opioids such as tramadol, tapentadol, and codeine can be given in combination with nonopioid analgesics. We recommend morphine as the opioid of first choice for moderate-to-severe cancer pain.

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Treatment with subcutaneous and transdermal fentanyl: results from a population pharmacokinetic study in cancer patients

Cited by 24 publications

References 35 publications

Influence of aprepitant and localization of the patch on fentanyl exposure in patients with cancer using transdermal fentanyl

Influence of aprepitant and localization of the patch on fentanyl exposure in patients with cancer using transdermal fentanyl

The use of opioids in the treatment of oncologic pain in the elderly

Indian society for study of pain, cancer pain special interest group guidelines on pharmacological management of cancer pain (Part I)

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