A retrospective chart review of opioid-induced nausea and somnolence on commencement for cancer pain treatment

Yoshiaki Okamoto, BP; Satoru Tsuneto, MD, PhD; Mamiko Tsugane, PhD; Tatsuya Takagi, PhD; Etsuko Uejima, PhD

doi:10.5055/jom.2010.0041

Authors

Yoshiaki Okamoto, BP
Satoru Tsuneto, MD, PhD
Mamiko Tsugane, PhD
Tatsuya Takagi, PhD
Etsuko Uejima, PhD

DOI:

https://doi.org/10.5055/jom.2010.0041

Keywords:

opioid-induced nausea, opioid-induced somnolence, morphine, oxycodone, fentanyl, prochlorperazine, side effect, opioid

Abstract

Morphine, oxycodone, and fentanyl are major opioids available as controlledrelease morphine (CRM), controlled-release oxycodone (CRO), and transdermal fentanyl (TDF), respectively, in Japan. The authors conducted a retrospective chart review to examine (1) nausea and somnolence on commencement of CRM, CRO, and TDF for cancer pain treatment, (2) the antiemetic effectiveness of prochlorperazine to prevent opioid-induced nausea, and (3) the side effect of prochlorperazine on somnolence in patients with cancer pain. Four hundred thirteen patients with cancer were prescribed with CRM (N = 66), CRO (N = 196), and TDF (N = 151). The incidence of nausea on commencement of the TDF group (6.8 percent) was significantly lower than that of both the CRM group (22.6 percent) and the CRO group (35.4 percent; p < 0.001). There was no significant difference in the incidence of nausea on commencement of all groups combined with prochlorperazine at dosage of 15 mg/d. The incidence of somnolence on commencement of the TDF group (9.0 percent) was significantly lower than that of both the CRM group (31.3 percent) and the CRO group (41.5 percent; p < 0.001). The incidence of somnolence on commencement of the CRO group combined with prochlorperazine was significantly higher than that of the CRO combined without prochlorperazine (p < 0.05). In conclusion, the incidence of nausea and somnolence on commencement of TDF are significantly lower than that of both CRM and CRO for cancer pain treatment. Prochlorperazine at a dosage of 15 mg/d may not be effective in preventing opioid-induced nausea and may cause somnolence in patients with cancer pain.

Author Biographies

Yoshiaki Okamoto, BP

Associate Professor, Department of Hospital Pharmacy Education, Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan.

Satoru Tsuneto, MD, PhD

Professor and Chair, Department of Palliative Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.

Mamiko Tsugane, PhD

Assistant Professor, Department of Hospital Pharmacy Education, Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan.

Tatsuya Takagi, PhD

Professor, Division of Pharmacometrics and Pharmainformatics, Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan.

Etsuko Uejima, PhD

Professor, Department of Hospital Pharmacy Education, Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan.

References

Davis MP, Walsh D: Treatment of nausea and vomiting in advanced cancer. Support Care Cancer. 2000; 8(6): 444-452.

Mannix K: Palliation of nausea and vomiting in malignancy. Clin Med. 2006; 6(2): 144-147.

Teunissen SC, Wesker W, Kruitwagen C, et al.: Symptom prevalence in patients with incurable cancer: A systematic review. J Pain Symptom Manage. 2007; 34(1): 94-104.

Cherny NI: Opioid analgesics: Comparative features and prescribing guidelines. Drugs. 1996; 51(5): 713-737.

De Conno F, Ripamonti C, Fagnoni E, et al.: The MERITO Study: A multicentre trial of the analgesic effect and tolerability of normal-release oral morphine during ‘titration phase’ in patients with cancer pain. Palliat Med. 2008; 22(3): 214-221.

Suzuki T, Morishita M, Ito E, et al.: Analgesic efficacy of controlled-release oxycodone in patients with uterine or ovarian cancer. Am J Ther. 2008; 15(1): 31-35.

Yu SY: Postmarketing surveillance study of OxyContin tablets for relieving moderate to severe cancer pain. Oncology. 2008; 74 (Suppl 1): 46-51.

Bentley A, Boyd K: Use of clinical pictures in the management of nausea and vomiting: A prospective audit. Palliat Med. 2001; 15(3): 247-253.

Heiskanen T, Kalso E: Controlled-release oxycodone and morphine in cancer related pain. Pain. 1997; 73(1): 37-45.

Nugent M, Davis C, Brooks D, et al.: Long-term observations of patients receiving transdermal fentanyl after a randomized trial. J Pain Symptom Manage. 2001; 21(5): 385-391.

Tassinari D, Sartori S, Tamburini E, et al.: Adverse effects of transdermal opiates treating moderate-severe cancer pain in comparison to long-acting morphine: A meta-analysis and systematic review of the literature. J Palliat Med. 2008; 11(3): 492-501.

Twycross R (ed.): Oral Morphine, Pain Relief in Advanced Cancer. London: Churchill Livingstone, 1998.

Shord SS, Chew L, Villano J: Evaluation of opioid induced nausea and vomiting in sickle cell disease. Am J Hematol. 2008; 83(3): 196-199.

Twycross R, Wilcock A: Palliative Care Formulary. 3rd ed. UK: Palliativedrugs.com Ltd., 2007.

Carr BI, Blayney DW, Goldberg DA, et al.: High doses of prochlorperazine for cisplatin-induced emesis. A prospective, random, dose-response study. Cancer. 1987; 60(9): 2165-2169.

Tsuji Y, Miyama S, Uemura Y, et al.: Three cases of drug-induced akathisia due to antiemetics during cancer palliative care. Gan To Kagaku Ryoho. 2006; 33(2): 267-269.

Sunakawa Y, Wada M, Nishida T, et al.: A case of respiratory akathisia in a cancer patient: A case report. Palliat Support Care. 2008; 6(1): 79-81.

Ahmedzai S, Brooks D: Transdermal fentanyl versus sustained-release oral morphine in cancer pain: Preference, efficacy, and quality of life. The TTS-Fentanyl Comparative Trial Group. J Pain Symptom Manage. 1997; 13(5): 254-261.

Nigel Sykes MB, Yuan C-S (ed.): Clinical Pain Management Cancer Pain. 2nd ed. London: Mixed Sources, 2008.

Eduardo Bruera IJH, Ripamonti C, Gunten C (ed.): Textbook of Palliative Medicine. New York: Oxford University Press, 2006.