Department of Pharmacy, Iwate Medical University Hospital, 2-1-1 Idaidouri, Yahaba-cho, Shiwa-gun, 028-3695, Iwate, Japan.
Department of Clinical Pharmaceutics, School of Pharmacy, Iwate Medical University, 1-1-1 Idaidouri, Yahaba-cho, Shiwa-gun, 028-3694, Iwate, Japan.
Support Care Cancer. 2023 Mar 13;31(4):208. doi: 10.1007/s00520-023-07676-9.
The aim of this study was to determine the frequency of opioid-induced neurotoxicity (OIN) in cancer patients receiving oral controlled-release oxycodone and to define risk factors for OIN.
This was a single-center, retrospective study of hospitalized adult cancer patients receiving oral controlled-release oxycodone between April 1, 2013, and April, 30, 2020. The onset of OIN within 30 days after oxycodone initiation in the study patients was investigated. OIN was defined as any of the following: delirium, hallucinations (visual or auditory), seizure, myoclonus, hyperesthesia, and excessive somnolence. Multivariate logistic regression analysis was performed to identify risk factors for OIN in patients receiving oxycodone.
In total, 520 patients were included in this study. The number of patients with OIN was 65 (12.5%). The median time until onset of OIN after oxycodone initiation was 7.5 days. Multivariate logistic regression analysis revealed that age ≥ 65 years (OR = 2.74, 95% CI [1.30-5.78], p = 0.008), total bilirubin ≥ 1.3 mg/dL (OR = 4.85, 95% CI [2.13-11.0], p < 0.001), and concomitant use of pregabalin or mirogabalin (OR = 3.11, 95% CI [1.47-6.61], p = 0.003) were significant independent risk factors for OIN.
Age ≥ 65 years, liver dysfunction, and concomitant use of pregabalin or mirogabalin were independent risk factors for OIN in patients receiving oxycodone. Patients with these risk factors who are receiving oxycodone should be monitored for OIN, especially early in the administration of oxycodone.
本研究旨在确定接受口服控释羟考酮的癌症患者中阿片类药物诱导的神经毒性（OIN）的发生频率，并确定 OIN 的危险因素。
这是一项单中心、回顾性研究，纳入 2013 年 4 月 1 日至 2020 年 4 月 30 日期间接受口服控释羟考酮的住院成年癌症患者。研究患者在开始使用羟考酮后 30 天内出现 OIN 的发病情况。OIN 定义为以下任何一种情况：谵妄、幻觉（视觉或听觉）、癫痫发作、肌阵挛、感觉过敏和过度嗜睡。采用多变量逻辑回归分析确定接受羟考酮治疗的患者发生 OIN 的危险因素。
本研究共纳入 520 例患者。发生 OIN 的患者有 65 例（12.5%）。从开始使用羟考酮到发生 OIN 的中位时间为 7.5 天。多变量逻辑回归分析显示，年龄≥65 岁（OR=2.74，95%CI[1.30-5.78]，p=0.008）、总胆红素≥1.3mg/dL（OR=4.85，95%CI[2.13-11.0]，p<0.001）和同时使用普瑞巴林或米那普仑（OR=3.11，95%CI[1.47-6.61]，p=0.003）是 OIN 的显著独立危险因素。
年龄≥65 岁、肝功能障碍以及同时使用普瑞巴林或米那普仑是接受羟考酮治疗的患者发生 OIN 的独立危险因素。接受羟考酮治疗且具有这些危险因素的患者应监测 OIN，尤其是在开始使用羟考酮时。
