Background: Opioid-induced constipation (OIC) limits opioid titration in cancer care. Before the use of peripherally acting μ-opioid receptor antagonists (PAMORAs), OIC often required switching from oxycodone to lower-risk opioids, such as transdermal fentanyl. Whether naldemedine allows oxycodone escalation without switching remains unclear. We evaluated the maximum scheduled daily oxycodone dose as a surrogate for maintaining therapy without constipation-driven switching. Methods: We retrospectively reviewed adults with cancer pain who initiated oral oxycodone at Toyama University Hospital between June 2017 and December 2018. Patients receiving naldemedine were classified as Group A; others as Group B. The primary endpoint was the maximum scheduled controlled-release oxycodone dose during follow-up; rescue doses were excluded. Results: Among 217 patients, the median maximum dose was higher with naldemedine (40 mg/day range 10–480 versus 20 mg/day 10–320; p < 0.0001). Conclusions: Naldemedine enabled higher oxycodone dosing, suggesting OIC management reduces opioid switching.
Kajiura et al. (Tue,) studied this question.