Tanaka Masayuki, Maeba Hirofumi, Senoo Takeshi, Yoshimiya Nana, Ozaki Haruna, Uchitani Kazuki, Tanigawa Noboru, Okazaki Kazuichi
Faculty of Pharmaceutical Sciences, Setsunan University, 45-1 Nagaotoge-Cho, Hirakata, Osaka, 573-0101, Japan.
Department of Pharmacy, Kansai Medical University Hospital, Hirakata, Japan.
J Pharm Health Care Sci. 2024 Oct 7;10(1):63. doi: 10.1186/s40780-024-00384-4.
Morphine is effective in palliative care for patients with end-stage heart failure; however, its use is avoided in patients with impaired renal function because it tends to induce adverse effects. Although oxycodone has been reported to be a useful alternative, the evidence is insufficient. Therefore, we investigated the safety and efficacy of oxycodone in eight patients with end-stage heart failure complicated by chronic kidney disease. METHODS: This single-center retrospective study reviewed patients with end-stage heart failure who were referred to the heart failure multidisciplinary team at our institution and administered oxycodone for refractory dyspnea during hospitalization between January 2011 and December 2018. We examined the details of oxycodone usage, vital signs, and the Modified Borg Scale (MBS), which quantifies the symptoms of dyspnea and adverse events.
Oxycodone was administered for refractory dyspnea in eight patients with end-stage heart failure [mean age: 81 years, men: 4, New York Heart Association functional class IV: 8, median left ventricular ejection fraction: < 40% (n = 6) and ≥ 50% (n = 2)]. Renal function was reduced in all patients; the estimated glomerular filtration rate (eGFR) in seven patients was < 30 mL/min/1.73 m. The median initial intravenous dose of oxycodone was 7.05 mg/day (range: 5-10 mg/day), and the average duration of administration was 15.8 days. Significant decreases in MBS (before: median 9, range 7-10 vs. after: median 2.5, range 1-8; p < 0.01) were observed at a median of 2.0 days (range: 2 h to 7 days) after beginning oxycodone administration. Systolic blood pressure, heart rate, and respiratory rate were not significantly altered after treatment. Adverse events, including constipation, nausea, and tremors, were observed in three patients. However, no lethal adverse events related to oxycodone treatment occurred during treatment.
This study revealed the clinical practice of oxycodone treatment and suggested that it is an alternative therapy as a viable palliative for refractory dyspnea in patients with end-stage heart failure who should avoid the use of morphine.
吗啡对终末期心力衰竭患者的姑息治疗有效；然而，由于其易引发不良反应，肾功能受损患者应避免使用。尽管据报道羟考酮是一种有用的替代药物，但证据不足。因此，我们调查了羟考酮在8例终末期心力衰竭合并慢性肾脏病患者中的安全性和有效性。
这项单中心回顾性研究对转诊至我院心力衰竭多学科团队的终末期心力衰竭患者进行了回顾，这些患者在2011年1月至2018年12月住院期间因难治性呼吸困难接受了羟考酮治疗。我们检查了羟考酮的使用细节、生命体征以及改良的博格量表（MBS），该量表用于量化呼吸困难症状和不良事件。
8例终末期心力衰竭患者（平均年龄：81岁，男性4例，纽约心脏协会心功能IV级：8例，左心室射血分数中位数：<40%（n = 6）且≥50%（n = 2））因难治性呼吸困难接受了羟考酮治疗。所有患者肾功能均减退；7例患者的估计肾小球滤过率（eGFR）<30 mL/min/1.73 m²。羟考酮的初始静脉剂量中位数为7.05 mg/天（范围：5 - 10 mg/天），平均给药持续时间为15.8天。在开始使用羟考酮后中位数2.0天（范围：2小时至7天）观察到MBS显著降低（之前：中位数9，范围7 - 10；之后：中位数2.5，范围1 - 8；p < 0.01）。治疗后收缩压、心率和呼吸频率无显著变化。3例患者出现了包括便秘、恶心和震颤在内的不良事件。然而，治疗期间未发生与羟考酮治疗相关的致命不良事件。
本研究揭示了羟考酮治疗的临床实践，并表明它是一种替代疗法，可作为应避免使用吗啡的终末期心力衰竭患者难治性呼吸困难的可行姑息治疗方法。
