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Oxycodone 簡介
嘉義長庚疼痛科
施明宏醫師嘉義長庚藥劑部
Cancer pain
Cancer pain
2013台灣癌症時鐘
513
51~62 60 46
61 29
23 45
Cancer pain management
1 2
3
1
Cancer pain management
2NSAID
Strong Opioid419lt755
Cancer pain management
3
Cancer pain management
Opiodmechanism
Opioid mechanism
Opioid mechanism
Opioid mechanism
Oxycodone
Oxycodne
單一成分 全面鎮痛
讓止痛單純化
Oxycodne
中重度癌症疼痛止痛藥物
全球醫療廣泛使用超過80年1917~
OxyNormreg Capsule 速效劑型Immediate Release Q6h
OxyContinreg Tablet 長效劑型Controlled Release Q12h
OxyNormreg 5mg $145capOxyContinreg 10mg $40tab
OxyContinreg 20mg $76tab
Oxycodne
bull 需要長期疼痛控制之中重度癌症疼痛病患
bull 需要長期疼痛控制之慢性中重度非癌症疼痛病患且曾經接受過類鴉片藥物而無法有效控制疼痛者
適應症
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Cancer pain
Cancer pain
2013台灣癌症時鐘
513
51~62 60 46
61 29
23 45
Cancer pain management
1 2
3
1
Cancer pain management
2NSAID
Strong Opioid419lt755
Cancer pain management
3
Cancer pain management
Opiodmechanism
Opioid mechanism
Opioid mechanism
Opioid mechanism
Oxycodone
Oxycodne
單一成分 全面鎮痛
讓止痛單純化
Oxycodne
中重度癌症疼痛止痛藥物
全球醫療廣泛使用超過80年1917~
OxyNormreg Capsule 速效劑型Immediate Release Q6h
OxyContinreg Tablet 長效劑型Controlled Release Q12h
OxyNormreg 5mg $145capOxyContinreg 10mg $40tab
OxyContinreg 20mg $76tab
Oxycodne
bull 需要長期疼痛控制之中重度癌症疼痛病患
bull 需要長期疼痛控制之慢性中重度非癌症疼痛病患且曾經接受過類鴉片藥物而無法有效控制疼痛者
適應症
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Cancer pain
2013台灣癌症時鐘
513
51~62 60 46
61 29
23 45
Cancer pain management
1 2
3
1
Cancer pain management
2NSAID
Strong Opioid419lt755
Cancer pain management
3
Cancer pain management
Opiodmechanism
Opioid mechanism
Opioid mechanism
Opioid mechanism
Oxycodone
Oxycodne
單一成分 全面鎮痛
讓止痛單純化
Oxycodne
中重度癌症疼痛止痛藥物
全球醫療廣泛使用超過80年1917~
OxyNormreg Capsule 速效劑型Immediate Release Q6h
OxyContinreg Tablet 長效劑型Controlled Release Q12h
OxyNormreg 5mg $145capOxyContinreg 10mg $40tab
OxyContinreg 20mg $76tab
Oxycodne
bull 需要長期疼痛控制之中重度癌症疼痛病患
bull 需要長期疼痛控制之慢性中重度非癌症疼痛病患且曾經接受過類鴉片藥物而無法有效控制疼痛者
適應症
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
61 29
23 45
Cancer pain management
1 2
3
1
Cancer pain management
2NSAID
Strong Opioid419lt755
Cancer pain management
3
Cancer pain management
Opiodmechanism
Opioid mechanism
Opioid mechanism
Opioid mechanism
Oxycodone
Oxycodne
單一成分 全面鎮痛
讓止痛單純化
Oxycodne
中重度癌症疼痛止痛藥物
全球醫療廣泛使用超過80年1917~
OxyNormreg Capsule 速效劑型Immediate Release Q6h
OxyContinreg Tablet 長效劑型Controlled Release Q12h
OxyNormreg 5mg $145capOxyContinreg 10mg $40tab
OxyContinreg 20mg $76tab
Oxycodne
bull 需要長期疼痛控制之中重度癌症疼痛病患
bull 需要長期疼痛控制之慢性中重度非癌症疼痛病患且曾經接受過類鴉片藥物而無法有效控制疼痛者
適應症
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Cancer pain management
1 2
3
1
Cancer pain management
2NSAID
Strong Opioid419lt755
Cancer pain management
3
Cancer pain management
Opiodmechanism
Opioid mechanism
Opioid mechanism
Opioid mechanism
Oxycodone
Oxycodne
單一成分 全面鎮痛
讓止痛單純化
Oxycodne
中重度癌症疼痛止痛藥物
全球醫療廣泛使用超過80年1917~
OxyNormreg Capsule 速效劑型Immediate Release Q6h
OxyContinreg Tablet 長效劑型Controlled Release Q12h
OxyNormreg 5mg $145capOxyContinreg 10mg $40tab
OxyContinreg 20mg $76tab
Oxycodne
bull 需要長期疼痛控制之中重度癌症疼痛病患
bull 需要長期疼痛控制之慢性中重度非癌症疼痛病患且曾經接受過類鴉片藥物而無法有效控制疼痛者
適應症
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
1
Cancer pain management
2NSAID
Strong Opioid419lt755
Cancer pain management
3
Cancer pain management
Opiodmechanism
Opioid mechanism
Opioid mechanism
Opioid mechanism
Oxycodone
Oxycodne
單一成分 全面鎮痛
讓止痛單純化
Oxycodne
中重度癌症疼痛止痛藥物
全球醫療廣泛使用超過80年1917~
OxyNormreg Capsule 速效劑型Immediate Release Q6h
OxyContinreg Tablet 長效劑型Controlled Release Q12h
OxyNormreg 5mg $145capOxyContinreg 10mg $40tab
OxyContinreg 20mg $76tab
Oxycodne
bull 需要長期疼痛控制之中重度癌症疼痛病患
bull 需要長期疼痛控制之慢性中重度非癌症疼痛病患且曾經接受過類鴉片藥物而無法有效控制疼痛者
適應症
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
2NSAID
Strong Opioid419lt755
Cancer pain management
3
Cancer pain management
Opiodmechanism
Opioid mechanism
Opioid mechanism
Opioid mechanism
Oxycodone
Oxycodne
單一成分 全面鎮痛
讓止痛單純化
Oxycodne
中重度癌症疼痛止痛藥物
全球醫療廣泛使用超過80年1917~
OxyNormreg Capsule 速效劑型Immediate Release Q6h
OxyContinreg Tablet 長效劑型Controlled Release Q12h
OxyNormreg 5mg $145capOxyContinreg 10mg $40tab
OxyContinreg 20mg $76tab
Oxycodne
bull 需要長期疼痛控制之中重度癌症疼痛病患
bull 需要長期疼痛控制之慢性中重度非癌症疼痛病患且曾經接受過類鴉片藥物而無法有效控制疼痛者
適應症
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
3
Cancer pain management
Opiodmechanism
Opioid mechanism
Opioid mechanism
Opioid mechanism
Oxycodone
Oxycodne
單一成分 全面鎮痛
讓止痛單純化
Oxycodne
中重度癌症疼痛止痛藥物
全球醫療廣泛使用超過80年1917~
OxyNormreg Capsule 速效劑型Immediate Release Q6h
OxyContinreg Tablet 長效劑型Controlled Release Q12h
OxyNormreg 5mg $145capOxyContinreg 10mg $40tab
OxyContinreg 20mg $76tab
Oxycodne
bull 需要長期疼痛控制之中重度癌症疼痛病患
bull 需要長期疼痛控制之慢性中重度非癌症疼痛病患且曾經接受過類鴉片藥物而無法有效控制疼痛者
適應症
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Opiodmechanism
Opioid mechanism
Opioid mechanism
Opioid mechanism
Oxycodone
Oxycodne
單一成分 全面鎮痛
讓止痛單純化
Oxycodne
中重度癌症疼痛止痛藥物
全球醫療廣泛使用超過80年1917~
OxyNormreg Capsule 速效劑型Immediate Release Q6h
OxyContinreg Tablet 長效劑型Controlled Release Q12h
OxyNormreg 5mg $145capOxyContinreg 10mg $40tab
OxyContinreg 20mg $76tab
Oxycodne
bull 需要長期疼痛控制之中重度癌症疼痛病患
bull 需要長期疼痛控制之慢性中重度非癌症疼痛病患且曾經接受過類鴉片藥物而無法有效控制疼痛者
適應症
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Opioid mechanism
Opioid mechanism
Opioid mechanism
Oxycodone
Oxycodne
單一成分 全面鎮痛
讓止痛單純化
Oxycodne
中重度癌症疼痛止痛藥物
全球醫療廣泛使用超過80年1917~
OxyNormreg Capsule 速效劑型Immediate Release Q6h
OxyContinreg Tablet 長效劑型Controlled Release Q12h
OxyNormreg 5mg $145capOxyContinreg 10mg $40tab
OxyContinreg 20mg $76tab
Oxycodne
bull 需要長期疼痛控制之中重度癌症疼痛病患
bull 需要長期疼痛控制之慢性中重度非癌症疼痛病患且曾經接受過類鴉片藥物而無法有效控制疼痛者
適應症
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Opioid mechanism
Opioid mechanism
Oxycodone
Oxycodne
單一成分 全面鎮痛
讓止痛單純化
Oxycodne
中重度癌症疼痛止痛藥物
全球醫療廣泛使用超過80年1917~
OxyNormreg Capsule 速效劑型Immediate Release Q6h
OxyContinreg Tablet 長效劑型Controlled Release Q12h
OxyNormreg 5mg $145capOxyContinreg 10mg $40tab
OxyContinreg 20mg $76tab
Oxycodne
bull 需要長期疼痛控制之中重度癌症疼痛病患
bull 需要長期疼痛控制之慢性中重度非癌症疼痛病患且曾經接受過類鴉片藥物而無法有效控制疼痛者
適應症
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Opioid mechanism
Oxycodone
Oxycodne
單一成分 全面鎮痛
讓止痛單純化
Oxycodne
中重度癌症疼痛止痛藥物
全球醫療廣泛使用超過80年1917~
OxyNormreg Capsule 速效劑型Immediate Release Q6h
OxyContinreg Tablet 長效劑型Controlled Release Q12h
OxyNormreg 5mg $145capOxyContinreg 10mg $40tab
OxyContinreg 20mg $76tab
Oxycodne
bull 需要長期疼痛控制之中重度癌症疼痛病患
bull 需要長期疼痛控制之慢性中重度非癌症疼痛病患且曾經接受過類鴉片藥物而無法有效控制疼痛者
適應症
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Oxycodone
Oxycodne
單一成分 全面鎮痛
讓止痛單純化
Oxycodne
中重度癌症疼痛止痛藥物
全球醫療廣泛使用超過80年1917~
OxyNormreg Capsule 速效劑型Immediate Release Q6h
OxyContinreg Tablet 長效劑型Controlled Release Q12h
OxyNormreg 5mg $145capOxyContinreg 10mg $40tab
OxyContinreg 20mg $76tab
Oxycodne
bull 需要長期疼痛控制之中重度癌症疼痛病患
bull 需要長期疼痛控制之慢性中重度非癌症疼痛病患且曾經接受過類鴉片藥物而無法有效控制疼痛者
適應症
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Oxycodne
單一成分 全面鎮痛
讓止痛單純化
Oxycodne
中重度癌症疼痛止痛藥物
全球醫療廣泛使用超過80年1917~
OxyNormreg Capsule 速效劑型Immediate Release Q6h
OxyContinreg Tablet 長效劑型Controlled Release Q12h
OxyNormreg 5mg $145capOxyContinreg 10mg $40tab
OxyContinreg 20mg $76tab
Oxycodne
bull 需要長期疼痛控制之中重度癌症疼痛病患
bull 需要長期疼痛控制之慢性中重度非癌症疼痛病患且曾經接受過類鴉片藥物而無法有效控制疼痛者
適應症
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Oxycodne
中重度癌症疼痛止痛藥物
全球醫療廣泛使用超過80年1917~
OxyNormreg Capsule 速效劑型Immediate Release Q6h
OxyContinreg Tablet 長效劑型Controlled Release Q12h
OxyNormreg 5mg $145capOxyContinreg 10mg $40tab
OxyContinreg 20mg $76tab
Oxycodne
bull 需要長期疼痛控制之中重度癌症疼痛病患
bull 需要長期疼痛控制之慢性中重度非癌症疼痛病患且曾經接受過類鴉片藥物而無法有效控制疼痛者
適應症
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Oxycodne
bull 需要長期疼痛控制之中重度癌症疼痛病患
bull 需要長期疼痛控制之慢性中重度非癌症疼痛病患且曾經接受過類鴉片藥物而無法有效控制疼痛者
適應症
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Oxycodne
PK OxyNormreg OxyContinreg
Onset 15-30 mins 1hr
Tmax 15-2 hr 4-5 hr
Steady-
State24- 36 hr 24- 36 hr
T12 32 hr 45 hr
interval Q6h or PRN Q12h
血中濃度
Ref 1 Mandema Jw et al Br J Pharmacol 199642747-56 2 Data on file 3 OxyNormreg中文仿單
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Oxycodne
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
藥物名稱 Receptor
micro ƙ
中樞與周邊鎮痛 脊髓與周邊鎮痛
Oxycodone + +Morphine + -
Fentanyl + -
hydromorphone + -
Oxycodne
1 2015 NCCN guideline version 2
2 Rang HP et al Pharmacology 5th Edition London Churchill Livingstone 2003
3 Vanderah TW et al Delta and kappa opioid receptors as suitable drug targets for pain Clin J Pain 2010 Jan26 Suppl 10S10-5
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Oxycodne
混合型癌症疼痛
Oxycodone
Other Opoids
Non-opoids
Garciacutea de Paredes ML et al First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients Results of the On studyAnn Oncol 2011 Apr22(4)924-30
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Oxycodne
OxyContinreg 10mg 1Q12h
=
OxyNormreg 5mg1Q6h
=中度疼痛
NRS 4- 6分
OxyNormreg 5mgPRN
+
NRS ≧ 4分或一日突發性疼痛≧ 3次1 長效藥物增量25- 502 突發性疼痛藥物 16 同成分長效藥物日劑量3 止痛劑量 no celling effect
1 OxyContinreg amp OxyNormreg 中文仿單
2 Auret K Pickstock S Pain management in palliative care-an update Aust Fam Physician 2006 35 (10)762-5
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Oxycodne
1 Nuacutentildeez Olarte JM et al Oxycodone and the challenge of neuropathic cancer pain a review Oncology 2008 74 (suppl 1) 83- 90
2 Cheville A et al A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee
arthroplasty J Bone Joint Surg Am 200183-A(4)572- 576
3 Markenson JA et al Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized
controlled clinical trial Clin J Pain 200521524- 535
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Oxycodne
生物利用度60-87
CYP3A4
CYP2D6
Noroxycodone
Oxymorphone
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Oxycodne
長效性藥物
Receptors口服生體
可用率藥效作用起始時間
穩定血中濃度
適用病人 CostdayBreakthrough
Pain (同成分藥物)μ κ
MST + - 20-40 1小時 1-2天嚴重及頑固性
疼痛
25元 day= Morphine
60mg
嗎啡針劑 嗎啡速效錠 嗎啡口服液
OxyContinreg + + 60-87 1 小時 1-15天
中重度癌痛中重度非癌痛
80元 day= Morphine
40mg
OxyNormreg 5mg145元 顆
15-30 mins onset
FentanylPatch
+ - - 12 小時 4- 6天慢性疼痛與頑固性疼痛
63元 day= Morphine
30mg
Fentanyl Buccal200μg 單片 275元
Hydromor-phone
+ - 22-26 6-8小時 第4天僅用於癌症
末期病患之嚴重疼痛
135元 day= Morphine
40mg無
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Oxycodne
Day 0 Pain
score 784 Day 7 Pain
score 335
- 57- 723
Tessaro et al European Review Med Pharma Science 2010 14113-121
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Oxycodne
Narabayashi M et al Advisory Committee for Oxycodone Study Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable
adverse effects an open-label trial Jpn J Clin Oncol 200838296-304
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Oxycodne
副作用 OR P值
眩暈 104 090
噁心 052 0009
嘔吐 061 012
困倦 119 062
瘙癢 113 082
便秘 055 001
厭食 070 067
排尿困難 145 055
Wang YM et al Exp Ther Med 2012 4(2) 249-254
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
=
OxyContinreg 10mg 1Q12h
OxyNormreg 5mg1Q6h
=
PotencyMorphine Oxycodone
1 15~2
NRS 4- 6分
Oxycodne
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Opioid rotation
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Opioid rotation
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Opioid rotation
Le
ve
l o
f A
ctiva
tio
n
MOR-1
Variant 1
Drug 1
Drug 2
Receptor
MOR-1
Variant 2
MOR-1
Variant 3
MOR-1
Variant 4
MOR-1
Variant 5
MOR = mu opioid receptor
Adapted from Pasternak GW Trends Pharmacol Sci 20012267
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Essential Opioids (WHO)
bull Codeine
bull Morphine
bull Oxycodone
bull Hydromorphone
bull Methodone
bull Buprenorphine
Ref WHO Model List of Essential Medicines 18th list (April 2013
httpwwwwhointmedicinespublicationsessentialmedicines18th_EML_Final_web_8Jul13pdf
2013 WHO Essential Medicines in Palliative Care
Essential Opioids (IAHPC)
Oxycodone and hydromorphone mentioned as the two alternatives to morphine
bull Codeine
bull Fentanyl
bull Methadone
bull Morphine
bull Oxycodone
bull Tramadol
Opioid rotation
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Opioid rotation
90
80
70
60
50
40
30
20
10
0
o
f pa
tie
nts
Prescription
1 (N=86)
Prescription
5 (N=7)
Prescription
2 (N=52)
Prescription
3 (N=30)
Prescription
4 (N=18)
Side effect
Ineffectiveness
Effective
Total effective
Quang-Cantagrel ND et al Anesth Analg 200090(4)933
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Opioid rotation
Opioid-induced Hyperalgesia
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Opioid rotation
Opioids Dosage Conversion
ios
Opioid Calculator
android
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Opioid rotation
Opioids of choice in frail elderly and renal failure
Hydromorphone
Oxycodone
Fentanyl
Methadone
Poppy
Poppy
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