Indication(s)
The relief of moderate to severe pain in adults who require continuous opioid analgesia for several days or more. The naloxone component is indicated for the relief of opioid-induced constipation.
Formulary status
The Drug Advisory Committee (DAC) recommended that oxycodone/naloxone controlled release (CR) not be listed on any WSIB.
The WSIB has decided not to list oxycodone/naloxone CR on any of the WSIB formularies at this time.
Drug profile
Products available in Canada:
Targin® (oxycodone/naloxone CR)
Manufacturer:
Purdue Pharma
Overview
- Oxycodone/naloxone CR is a combination product containing pain reliever oxycodone and an opioid antagonist naloxone added to alleviate opioid-induced constipation (OIC). Naloxone has poor oral systemic bioavailability; its effect is limited to the gastrointestinal tract and, as such, does not induce opioid withdrawal when taken orally.
- Oxycodone/naloxone CR appears to provide similar analgesic efficacy to oxycodone CR without naloxone.
- Oxycodone/naloxone CR has been associated with improvements in constipation outcomes compared to oxycodone CR without naloxone; however, outcomes such as patient well-being or quality of life have not been investigated.
- The efficacy of oxycodone/naloxone CR has not been compared to oxycodone CR plus a preventative bowel regimen.
- Oxycodone/naloxone CR is associated with adverse effects consistent with opioids.
- Although naloxone may theoretically lower the risk of opioid abuse, studies pertaining to the abuse potential of oxycodone/naloxone CR are limited.
- Although one industry-sponsored pharmacoeconomic study found that oxycodone/naloxone is cost-effective in managing pain and OIC, the analysis was limited by the lack of an active comparator for constipation treatment, insufficient evidence to support improvements in quality of life and poor generalizability of the results.
- Ontario Drug Benefits does not list oxycodone-naloxone on its formulary and CADTH has a “do not list” recommendation for provincial drug plans.
- The DAC concluded that an independent review of the clinical efficacy, safety, and cost-effectiveness of oxycodone/naloxone CR did not indicate any therapeutic or non-therapeutic advantage in the treatment of chronic non-cancer pain over appropriate comparators available on WSIB formularies.
Original date:
Updated: January 29, 2013
Updated: May 10, 2016
The WSIB will consider all relevant facts and circumstances, and shall make its decision based upon the merits and justice of a particular case.
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