ナルデメディンは,がん患者の場合,より高いオキシコドン用量を許可できますか? 単一センターの遡及研究
Shinya Kajiura1,2,3, Shingo Chikaoka2, Yuta Yagi2
1Department of Medical Oncology and Palliative Medicine, Toyama University Hospital, Toyama, Japan.
Journal of palliative medicine
|February 17, 2026
まとめ
周辺作用のμ-オピオイド受容体アンタゴニスト (PAMORA) であるナルデメディンは,オピオイド誘発性便秘 (OIC) の管理により,がん患者でより高いオキシコドンの投与を可能にします. これは,PAMORAががんの痛み管理中にオピオイドの切り替えの必要性を軽減することを示唆しています.
科学分野:
- 腫瘍学 腫瘍学
- 薬理学 薬理学とは
- 胃腸内科 胃腸内科
背景:
- オピオイド誘発性便秘 (OIC) は,がんの痛み管理における重要な課題であり,しばしばオピオイドの投与量削減またはスイッチングを必要とする.
- 歴史的に見て,OICの管理には,より効果が低いオピオイドに切り替え,痛みコントロールを制限することが含まれていました.
- 周辺作用のμ-オピオイド受容体抗体 (PAMORAs) は,中央鎮痛を危うくすることなくOICを管理するための新しいアプローチを提供します.
研究 の 目的:
- ナルデメジン (PAMORA) が,便秘に関連する治療変更なしに,がん患者でオキシコドンの投与量を増加させることができるかどうかを評価する.
- OICの成功管理とオピオイド治療の継続のための代理マーカーとして,最大スケジュールされたオキシコドン用量を評価する.
主な方法:
- 2017年6月から2018年12月までの間,経口オキシコドン投与を開始した成人がん患者の遡及レビュー.
- 患者は,グループA (ナルデメジン投与) とグループB (ナルデメジン投与を受けていない) の2つのグループに分けられました.
- 主なエンドポイントは,救命用量を除く,制御放出オキシコドンの最大予定日用量でした.
主要な成果:
- ナルデメディン (naldemedine) を投与した患者 (40 mg/日) と投与されなかった患者 (20 mg/日) の間で,オキシコドンの最大投与量の中央値は有意に高かった.
- この差は統計的に有意であった (p < 0.0001).
結論:
- ナルデメディンは,がん患者の場合,より高いオキシコドン用量を促進し,OICの効果的な管理を示しています.
- この発見は,PAMORAがOICによるオピオイドスイッチングの発生率を低減し,痛み管理戦略を改善することを示唆しています.
関連する概念動画
Drug Dosing: Obese Patients
279
In the United States, obesity is a prominent concern. It is linked to heightened mortality rates due to increased occurrences of conditions such as hypertension, atherosclerosis, coronary artery disease, and diabetes compared to nonobese individuals. A patient is classified as obese if their actual body weight surpasses the ideal or desirable body weight by 20%, based on Metropolitan Life Insurance Company data. Ideal body weights consider average weights and heights for males and females...
279
Opioid Analgesics: Synthetic and Semisynthetic Opioids
1.2K
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
1.2K
Chemotherapy-Induced Nausea and Vomiting: Cannabinoids
806
Tetrahydrocannabinol (THC) is a phytocannabinoid that primarily interacts with the CB1 receptor, a type of G protein-coupled receptor (GPCR) predominantly in and around the chemoreceptor trigger zone (CTZ) and emetic center. THC also blocks the serotonin receptor activity in the dorsal vagal complex (DVC) by inhibiting serotonin release. THC exerts its anti-emetic effects through these interactions, which are beneficial for patients undergoing chemotherapy.
Two synthetic agonists of THC,...
Two synthetic agonists of THC,...
806
Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant
241
In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
241
Drug Dosing: Geriatric Patients
289
Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
289
Drug Accumulation During Multiple Dosing: Intermittent IV Infusions
282
Intermittent intravenous (IV) infusion is a method of drug administration where medications are delivered over short infusion periods followed by intervals of no drug delivery. This approach helps to prevent sustained high drug concentrations in the bloodstream, reducing the risk of adverse effects associated with prolonged exposure. Unlike continuous infusion, steady-state concentrations may not be achieved during a single dosing cycle but can be reached through repeated...
282

