Oxycodone在癌症疼痛的治療角色

Therapeutic Role of Oxycodone on Cancer Pain Treatment

10.3966/168395442015061501003

吳承誌(Cheng-Chih Wu)；胡沛弘(Pei-Hung Hu)；戴慶玲(Ching-Lin Tai)

鴉片類藥物轉換 ； oxycodone ； oxymorphone ； noroxycodone ； opioid rotation

腫瘤護理雜誌

15卷1期（2015 / 06 / 01）

19 - 23

繁體中文

Oxycodone為近期台灣即將上市的強效性鴉片類止痛劑。透過了解藥理機轉、藥物動力學、療效與安全性的研究結果，以利臨床醫療人員了解該藥物。Oxycodone的生體可用率高，具有速效與緩釋兩種劑型，可符合治療慢性疼痛或突發性疼痛（breakthrough pain）的目的。此藥會透過肝腎代謝，需注意潛在的藥物交互作用，進行劑量或給藥間距的調整。根據統合分析（meta-analysis）的結果顯示，Oxycodone可明顯改善癌症疼痛，且副作用會隨著使用時間越長而漸趨消弭。由於Oxycodone缺乏天花板效應（ceiling effect），考慮增加使用劑量的前提，仍需謹慎評估病人是否存在共病症或呼吸抑制等現象，以提供病人最安全有效的藥物治療計畫。

Oxycodone is an effective opioid analgesic soon to be available in Taiwan. The understanding of its pharmacological mechanism, pharmacokinetics, therapeutic efficacy, and safety can aid the healthcare practitioners in administering this pain medication. With a relatively high bioavailability, oxycodone comes in immediate-released and sustained-released dosage for relief of breakthrough pain or chronic pain based on the clinical evaluation. Oxycodone is metabolized through liver and kidney making it vulnerable to drug interactions. Therefore, dosage and dosing interval modification should be considered to avoid potential adverse effects. Results from meta-analysis have shown significant effect of oxycodone in cancer pain relief with the adverse effects diminishing or even eliminated over the long term use. Considering the lack of ceiling effect in oxycodone, special attention is warranted to potential respiratory suppression or other co-morbidities related to dose titration. Effective treatment plan and intact risk management are the essential ingredients of safe patient care.

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