[Efficacy and safety of compound oxycodone injection for cancer pain relief-a multicenter survey of prescriptions].

Oral oxycodone has been available since 2003 in Japan. Oxycodone consumption is increasing along with the decrease in morphine consumption. Although this drug currently has a central role in cancer pain treatment, at this time pure oxycodone injection has not yet been available in Japan. As an alternative, we can subcutaneously administer a compound oxycodone injection (Pavinal) containing a small amount of hydrocotarnine. Since few clinical reports on efficacy and safety of the compound oxycodone injection have been published in Japan, we conducted a retrospective multicenter survey with structured sheets. Monthly survey data regarding the compound prescriptions for cancer pain control have been collected from 3 cancer hospitals. Finally, sixty adult patients were analyzed with the following results. (1) The adverse effects caused by the prior opioids improved in more than half of the patients, and worsened in none. (2) Dose escalation of the drug was achieved through subcutaneous administration(the mean was 1.6 times), and resulted in pain relief with tolerable adverse effects in more than 80% of patients. (3) Adverse effects occurred in 13% of patients, but more than 80% of the episodes were mild in severity. Conversely, we found no adverse effects becoming sequelae, failure and/or fatal in severity. (4) Subcutaneous administrations with the drug were available in long-term(mean 15.4 days, maximum 53 days), including home palliative care use (1.7%). No toxicities due to accumulation were observed. (5) The conversion ratio from oral oxycodone to compound oxycodone injection was 0.82+/-0.20, and the domestic and international reports are basically consistent with our result. So we speculate that the compound can be regarded as a pure oxycodone injection using subcutaneous administration. While further studies are needed, our study indicated that compound oxycodone injection has efficacy and safety in cancer pain treatment. Especially in switching opioids and/or their routes of administration to enhance the analgesic potency along with reducing the adverse effect, we conclude that prescribing this drug can be a convenient alternative.

[Efficacy and safety of continuous subcutaneous injection of the compound oxycodone in cancer pain management: the first 4-year audit].

The compound oxycodone injection, but not pure oxycodone, has been available since the 1920's in Japan. The compound, containing oxycodone and hydrocotarnine, can be subcutaneously administered. Hydrocotarnine is a non-narcotic opium alkaloid. Nowadays, along with the increase in the prescription frequency of oral oxycodone, the compound oxycodone injection is regarded as an important alternative in palliative care. However, few clinical reports about this drug have been documented in Japan. We have intensively introduced the compound for cancer pain control since 4 years ago and we report a study on the safety and efficacy of the continuous subcutaneous administration of the compound injection. Ninety-seven patients were naively administered the compound for cancer pain control and the mean administered period was 18. 0+/-15. 5 days. 61. 9% of all cases were switched from oral oxycodone. The efficacy in cancer pain control was evaluated for the first two weeks using a numeric rating scale (NRS: 0, no pain, and 10, imaginary worst ). They had statically shown pain control improvement from 6. 8+/-2. 8 on administration to 2. 4+/-2. 5 one week later, 1. 7+/-1. 9 two weeks later, and 2. 3 +/-2. 6 on the last observation day of the study (p<0. 001). One week later on administration, no significant adverse effects were found in the serology, conscious level, and subjective symptoms of nausea and vomiting. But adverse effects difficult to manage were experienced in 7. 2%, including delirium, constipation, nausea and vomiting, vertigo, and local skin toxicity on the injected site. All episodes were experienced within 16 days of compound administration, which had been followed by switching to fentanyl or subcutaneous morphine injection. The conversion ratio from compound oxycodone injection to oral oxycodone was 1. 43 without adjustment required(n=35). We speculate that the compound can be regarded as a pure oxycodone injection using continuous subcutaneous administration. While our clinical audit is a primitive one, we may conclude that the continuous subcutaneous administration of the compound oxycodone injection should be effective and safe in clinical use for cancer pain control.

[Survey on patients' satisfaction with opioid rescue guidance by pharmacists].

To examine the influence of drug therapy guidance by pharmacists on the use of a rescue dose (RD) for opioid analgesics (opioids) and pain as well as drug therapy guidance in cancer pain treatment, we conducted a patient satisfaction survey. The subjects were 56 cancer patients undergoing opioid therapy in hospitals belonging to the Symptom Control Research Group (SCORE-G). The survey period was 2 months (from November 1 until December 31, 2006). Drug therapy guidance regarding the use of RD was performed twice in each patient to evaluate the patients' satisfaction. RD was prescribed in 87.8% of the patients in the first guidance and in 80.5% in the second guidance periods. The proportion of patients who used RD significantly increased from 63.8% to 87.5%. Five items significantly improved in the second guidance period: "marked analgesic effects," "satisfaction with current treatment," "correct understanding of RD usage," "relief through RD," and "appropriate use of RD." On comprehensive evaluation following the second round of guidance, 81% of the patients reported overall satisfaction, and 78% reported the usefulness of guidance in pain treatment. These results suggest that positive guidance by pharmacists increases patients' satisfaction. In providing guidance, it was important to confirm the characteristics and side effects of opioids as well as the necessity of RD to patients accurately and repeatedly.