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Case report
Opioid toxicity after oxycodone/naloxone to oxycodone conversion: case series
  1. Mairead Doherty1,2,
  2. Hannah Joan Featherstone3,
  3. Clare McAleer1,3,
  4. Chloe Webb1,
  5. Maeve O'Reilly4,
  6. Marie Twomey4 and
  7. Regina McQuillan3,5
  1. 1 St. Francis Hospice, Raheny, Dublin, Ireland
  2. 2 Palliative Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
  3. 3 Palliative Medicine, Beaumont Hospital, Dublin, Ireland
  4. 4 Specialist Palliative Medicine Service, St Luke's Radiation Oncology Network, Dublin 6, Ireland
  5. 5 Palliative Medicine, St Francis Hospice, Dublin 5, Ireland
  1. Correspondence to Dr Hannah Joan Featherstone; featherh{at}tcd.ie

Abstract

Combination preparations of oxycodone/naloxone are marketed to aid in the management of opioid induced bowel dysfunction, with caution advised in prescribing in cases of liver dysfunction.

This case series demonstrates four cases of patients with normal liver function tests who developed significant opioid toxicity on conversion from combination oxycodone/naloxone to oxycodone at equivalent doses, necessitating significant dose reduction.

In each case, a cause for intra-hepatic shunting such as cirrhosis, porto-systemic collaterals or thrombosis were identified, highlighting these as cautionary features when prescribing combination preparations of oxycodone/naloxone and the possible need for dose reduction if converting to oxycodone.

  • Pharmacology
  • Pain

https://doi.org/10.1136/spcare-2024-004796

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    Footnotes

    • Contributors All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.