Can Naldemedine Allow Higher Oxycodone Dosing in Patients with Cancer? A Single-Center Retrospective Study.

BACKGROUND

Opioid-induced constipation (OIC) limits opioid titration in cancer care. Before the use of peripherally acting μ-opioid receptor antagonists (PAMORAs), OIC often required switching from oxycodone to lower-risk opioids, such as transdermal fentanyl. Whether naldemedine allows oxycodone escalation without switching remains unclear. We evaluated the maximum scheduled daily oxycodone dose as a surrogate for maintaining therapy without constipation-driven switching.

METHODS

We retrospectively reviewed adults with cancer pain who initiated oral oxycodone at Toyama University Hospital between June 2017 and December 2018. Patients receiving naldemedine were classified as Group A; others as Group B. The primary endpoint was the maximum scheduled controlled-release oxycodone dose during follow-up; rescue doses were excluded.

RESULTS

Among 217 patients, the median maximum dose was higher with naldemedine (40 mg/day [range 10-480] versus 20 mg/day [10-320]; p < 0.0001).

CONCLUSIONS

Naldemedine enabled higher oxycodone dosing, suggesting OIC management reduces opioid switching.