Opioid toxicity after oxycodone/naloxone to oxycodone conversion: case series
Mairead Doherty1,2, Hannah Joan Featherstone3, Clare McAleer1,4
1St. Francis Hospice, Raheny, Dublin, Ireland.
BMJ Supportive & Palliative Care
|February 26, 2024
Summary
Combination oxycodone/naloxone is used for opioid-induced bowel dysfunction. Patients with intra-hepatic shunting may experience opioid toxicity when switching to oxycodone, requiring dose reduction.
Area of Science:
- Pharmacology
- Hepatology
- Gastroenterology
Background:
- Combination oxycodone/naloxone preparations are prescribed for opioid-induced bowel dysfunction.
- Caution is advised when prescribing these combinations in patients with liver dysfunction.
Purpose of the Study:
- To report cases of opioid toxicity in patients converting from oxycodone/naloxone to oxycodone.
- To identify risk factors and inform prescribing practices for these opioid formulations.
Main Methods:
- A case series of four patients who developed opioid toxicity after switching from oxycodone/naloxone to oxycodone.
- Review of patient histories to identify underlying causes of intra-hepatic shunting.
Main Results:
- Four patients with normal liver function tests experienced significant opioid toxicity upon conversion to oxycodone at equivalent doses.
- Intra-hepatic shunting (cirrhosis, porto-systemic collaterals, thrombosis) was identified in all cases.
Conclusions:
- Patients with underlying intra-hepatic shunting may require dose reduction when converting from oxycodone/naloxone to oxycodone.
- Prescribers should consider the potential for opioid toxicity and the need for dose adjustment in at-risk patients.
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