PENANGANAN NYERI

KANKER DENGAN
Oksikodon
 Cancer pain is poorly recognised and
undertreated

More than 50% of cancer Up to 80% of advanced stage cancer

patients suffer ongoing pain.1 patients suffer uncontrolled pain.2

1. van den Beuken-van Everdingen MH, et al. Prevalence of pain in patients with cancer: Asystematic review of the past 40 years. Ann Oncol 2007;18:1437–1449. 2. ACHEONWorking Group, Kim YC,et al. Current practices in cancer pain
management in Asia: Asurvey of patients and physicians across 10 countries. Cancer Med 2015;4:1196-1204.
 The
Burden of
Pain

Pasien

Fisiologis Psikologis
Keluarga

Masyarakat

Ekonomi Sosial

Pain management: a fundamental h u ma n

right.
Brennan F, Carr DB, Cousins MJ. Pain management: a fundamental human right. Anesth Anal 2007; 105: 205–21.
 Cancer
pain
journey
Immediate release opioids

Controlled release opioids Controlled release opioids

Adapted from : Smith HS et al. Painful boney metastases. Ann Palliat Med
 The WHO 3-step ladder

The WHO 3-step pain ladder aims to assist clinicians in the effective
management of cancer pain. 1

• Non-opioids for mild pain (Step 1)

• Weak opioids for mild-to-

moderate pain (Step 2)

• Strong opioids for moderate-to-

severe pain (Step 3)

• Adjuvant analgesics
(e.g. corticosteroids and
antidepressants) can be used
at any of the 3 steps

1. World Health Organization (WHO). Cancer pain relief: With a guide to opioid availab ility. 2nd ed. Geneva : WHO; 1996.
A 2-step analgesic approach

Patients receiving Step 3 opioids early Fewer patients receiving Step

had superior pain relief – i.e. fewer days 3 opioids early were
with pain intensity ≥5 out of 10 dissatisfied with therapy

Conventional treatment: treated according to WHO 3-step ladder

Innovative treatment: treated according to a 2-step approach (direct move to Step 3 after
Step 1)
Maltoni M, et al. A validation study of the WHO analgesic ladder: A two-step vs three-step strategy. Support Care Cancer 2005;13:888-894.
ID-937/PAIN/127/0129

PENGGUNAAN Oksikodon
PADA PENANGANAN NYERIKANKER
ID-937/PAIN/127/0129

MUNDIPHARMA INDONESIA OPIOID PORTFOLIO1-3

Untuk terapi nyeri berat p a d a

p asien kanker d a n p a s c a operasi

Untuk terapi nyeri berat p a d a pasien

kanker d a n p a s c a operasi serta low
back pain

Indonesia Oxynorm Injection Approved Product Information.2017

Indonesia Oxynorm Capsule Approved Product Information. 2018
Indonesia Oxyneo Tablet Approved Product Information. 2016
ID-937/PAIN/127/0129

SEDIAAN DI INDONESIA
Oxyneo Tablet Oxynorm ® C a p s u l e
Oxynorm Injection

10 mg/ml

20 mg/2ml

KALKULATORUNTUK KONVERSI DOSIS

OPIOID
“PAINFOCUS”
Oral oksikodon 10mg = Oral morphine 20mg
Oral oksikodon 15 mg = Oral morphine 30mg
Oral oksikodon 20mg = Oral morphine 40mg

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Version 1. 2018
ID-937/PAIN/127/0129

Farmakokinetik s e d i a a n Oksikodon
di Indonesia

Produk Onset Durasi T 1/2 T Max

OXYNEO® Dalam 1 12 jam2 4.5 jam2 ~4-5 jam2
jam1
OXYNORM® 5 – 8 menit3 4-6 jam4 3.5 jam7 Hingga 15
Injeksi menit6
OXYNORM 15 – 30 4-6 jam5 ~3 jam5 ~1 jam8
Kapsul menit7

1. Pan H, at al. Efficacy and tolerability of oxycodone hydrochloride controlled-release tablets in moderate to severe cancer pain. Clin Drug Invest2007;27:259-267
2. Oxyneo Indonesia Approved Product Information. 2016
3. Leow KP, Cramond T, Smith MT. Pharmacokinetics and pharmacodynamics of oxycodone when given intravenously and rectally to adult patients with cancer pain. Anesthesia &Analgesia.
1995 Feb 1;80(2):296-302.
4. Oxynorm Injeksi Indonesia Approved Product Information. 2017
5. Oxynorm Capsule Indonesia Approved Product Information. 2018
6. Napp Pharmaceuticals Limited. Data on file. Study code OXI1202
7. Pergolizzi JV, et al. Agri. 2015;27(1):1–11
8. Nieminen TH, et al. St John's wort greatly reduces the concentrations of oral oxycodone. Eur J Pain. 2010Sep;14(8):854-9.
 Pe n a t a l a k s a n a a n Nyeri Kanker d e n ga n Oksikodon d a p a t
m e m b a n tu p e n a ta la ks a n a a n nye ri ka n ke r d i s e tia p
ta h a p a n n ya

OR

OR

Adapted from : Smith HS et al. Painful boney metastases. Ann Palliat Med
ID-937/PAIN/127/0129

NCCN Merekomendasikan Penggunaan Opioid yang Sama

untuk Sediaan Lepas Cepat dan Lepas Lambat Dalam Penanganan
Nyeri Kanker 1
Sediaan yang lengkap dari Oksikodon dalam bentuk Kapsul lepas cepat (Oxynorm
Kapsul) dan injeksi (Oxynorm Injeksi) serta tablet lepas lambat (Oxyneo) dalam
penanganan nyeri kanker dari titrasi, background pain, dan breakthrough pain.2-4

1.National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. Adult Cancer Pain. Version 1. 2018. Available at :
https://www.nccn.org/professionals/physician_gls/pdf/pain/pdf 2.Indonesia Approved Oxynorm® product information. Mundipharma Indonesia. 2017
2.Indonesia Approved OxyNEO® product information. Mundipharma Indonesia. 2017
4.Indonesia Approved Oxynorm Capsule Product Information. Mundipharma Indonesia. 2018
5.Pergolizzi JV, et al. Aagri. 2015;27(1):1-11.2 6. Kang XH et.
al. Chin Med J (Engl). 2018 20; 131 (16);1958-1963
7. Pan H et al. Efficacy and tolerability of Oxycodone Hydrochloriide controlled release tablets in moderate to severe cancer pain. Clin Drug Investig. 2007;27(4):259-67
 1:2

* 1/6 =10%-20%
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Version 1. 2019
 Opioid with Abuse Deterrent Properties:
untuk penanganan background pain

Oxyneo merupakan opioid dengan teknologi abuse deterrent

properties yang dapat mengurangi risiko terjadinya penyalahgunaan
(misuse dan abuse) dari bahan aktif

R&DPurdue Pharma
 ID-937/PAIN/127/0129

Oksikodon memiliki bioavailabilitas oral y a n g lebih

tinggi dari morfin
Dibandingkan dengan morfin oral, oksikodon memiliki :
1. Metabolisme yang lebih dapat diprediksi, yang membuat titrasi
lebih mudah1
2. Bioavailabilitas lebih tinggi2-4 dan memberikan konsentrasi plasma
yang lebih mudah diprediksi3

Bioavalabilitas absolut setelah penggunaan oral untuk Oksikodon

vs Morin : 2
2

OXYCODONEORAL : 87%
2
MORFIN ORAL : 30%

1. Ordonez Gallego A, et al. Oxycodone: a pharmacological and clinical review. Clin Transl Oncol2007;9(5):298–307.
2. Oxynorm Capsule Approved BPOM Product Information. Mundipharma Indonesia. 2018
3. Olkkola KT, et al. Oxycodone: new ‘old’ drug. Curr Opin Anaesthesiol2009;22(4):459–462.
4. Olkkola KT, et al. Does the pharmacology of oxycodone justify its increasing use as an analgesic? Trends Pharmacol Sci
2013;34(4):206–214.
 Oksikodon ha r u s digunakan d en ga n hati-
hati p a d a pasien de n ga n ga n gg u a n ginjal
d a n hati

• Gangguan Hati akan mempengaruhi clearance Oxycodone

Immediate Release. Maka Oxynorm Injeksi dan kapsul
dikontraindikasikan untuk pasien dengan gangguan hati
sedang-berat. Oxynorm injeksi dan kapsul juga
dikontrainidikasikan pada gangguan ginjal berat
(CC<10ml/menit).

• Konsentrasi plasma pada pasien dengan gangguan ginjal dan

hati berat akan meningkat. Penggunaan Oxyneo Tablet pada
pasien dengan gangguan hati dan ginjal diperlukan
pengurangan dosis 1/3 – ½ dari dosis awal, dititrasi dengan
perlahan hingga mencapai penanganan nyeri yang adekuat.

Indonesia Oxynorm Injection Approved Product Information. 2017

Indonesia Oxynorm Capsule Approved Product Information. 2018
Indonesia Oxyneo Tablet Approved Product Information.2016
Oxyneo Product Monograph.2014.
ID-937/PAIN/127/0129

PENANGANAN BREAKTHROUGH PAIN

DENGAN OXYNORM KAPSUL
 Kebutuhan Opioid untuk Pe n a n g a n a n
Breakthrough Pain disesuaikan d e n g a n
tipe nya

• Kebutuhan opioid disesuaikan dengan tipe breakthrough

pain yang dialami pasien.1

Breakthrough Breakthrough
Pain yang Pain yang
dapat tidak Nyeri Idiopatik
diprediksi terprediksi

• Opioid Oral kerja cepat • Opioid lipofilik transmukosal

• Diberikan 30-40 menit yang memiliki onset cepat
sebelum aktivitas yang • Diberikan sesaat setelah
diketahui memicu BTP2 onset. Opioid yang lipofilik
akan terdistribusi dengan
cepat kedalam jaringan2

1. McCarberg BH. Treatment of breakthrough pain. Pain Medicine 2007;8:S8–S13. 2. Archer M, et al. Drug class review: Short-acting and rapid-acting opioid agents. Final report. February 2014.
Available at http://www.health.utah.gov/pharmacy/ptcommittee/files/Criteria%20Review%20Documents/ 02.14/Short-Acting%20Opioid%20Drug%20Class%20Review.pdf. Accessed ID-937/PAIN/127/0129
February2018.
ID-937/PAIN/127/0129

Onset dan T-Max morfin immediate

release

Adapted from : McCarberg BH. Treatment of breakthrough pain. Pain Medicine2007;8:S8–S13.

Onset morfin 1jam

IR T- Max 4 jam

McCarberg BH. Treatment of breakthrough pain. Pain Medicine2007;8:S8–S13.

ID-937/PAIN/127/0129

Oxynor m Kapsul member ikan onset

yang cepat untuk p e n a n g a n a n
breakthrough pain 1

Penanganan breakthrough pain3

Onset1 Durasi2 Gambar di atas menunjukkan kesesuaian antara profil nyeri

pasien dengan obat yang ideal untuk penanganan BTP. Obat yang
memiliki onset cepat dan durasi pendek adalah profil yang ideal
untuk penanganan BTP. Pada saat mulai terjadi BTP, obat yang
*BTP : breakthrough pain ideal akan mencover dengan cepat puncak nyeri BTP tersebut

1. Pergolizzi JV,et al. Maximizing value in opioid utilization: Is oxycodone immediate release a good option for pain management?Agri 2015;27(1):1–11.
2. Indonesia Oxynorm Capsule BPOM Approved Product Information. 2018.
3. McCarberg BH. Treatment of breakthrough pain. Pain Medicine 2007;8:S8–S13.
ID-937/PAIN/127/0129

DOSIS OXYNORM KAPSUL

UNTUK PENANGANAN
BREAKTHROUGH PAIN

yang perlu dievaluasi kembali dosisnya.

*1/6=10-20%
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Version 1. 2018
ID-937/PAIN/127/0129

TOLERABILITAS Oksikodon
DIBANDINGKAN DENGAN
OPIOID LAINNYA
ID-937/PAIN/127/0129

Oksikodon dapat ditoleransi dengan baik

olehpasien

Efek samping yang biasa terjadi pada oksikodon

1

Efek samping mual, halusinasi, dan gatal lebih rendah dari morfin2
1.
2.

Cheung CW, et al. Pain Physician: Opioid Special Issue 2017: 20:SE33-
SE52 Colluzi F, et at. Minerva Anestesiol 2005;71(7-8):451-460
ID-937/PAIN/127/0129

OKSIKODON MEMILIKI KEJADIAN

HALUSINASI DAN MUAL YANG RELATIF
LEBIH MINIMAL DARI MORFIN

Kalso E et al. Clin Pharmacol Ther. (1990) 47(5): 639-46

 KESIMPULAN

1. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. Adult Cancer Pain. Version 1. 2018. Available at : https://www.nccn.org/professionals/physician_gls/pdf/pain/pdf 2.Indonesia Approved OxyNEO®product
information. Mundipharma Indonesia. 2017
3. Indonesia Approved Oxynorm®product information. Mundipharma Indonesia. 2017
4. Indonesia Approved Oxynorm Capsule Product Information. Mundipharma Indonesia. 2018
5. Cheung CW,et al. Pain Physician: Opioid Special Issue 2017: 20:SE33-SE52 ID-937/PAIN/127/0129
TERIMAKASIH
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