Efficacy and Safety of Dual-Opioid Therapy in Acute Pain

Abstract

Although opioids are widely accepted as standard therapy for treating acute postoperative pain, the frequent occurrence of adverse events (AEs) and the substantial burden on the patient and the costs of care are a barrier to optimal dosing and adherence to prescribed treatment. Coadministration of two opioids is not often recommended as a multimodal treatment option for moderate to severe acute pain because of lack of knowledge about the potential benefit of such combinations and due to potential concerns about side effects and doubts about the added benefits. Study results on the coadministration of two or more opioids demonstrate synergistic analgesia with a similar or lower incidence of opioid-related AEs. One such combination is morphine and oxycodone. Moxduo® (morphine/oxycodone 3/2) is a dual-opioid combination of morphine and oxycodone used to treat acute pain. Independent controlled studies of the coadministration of morphine plus oxycodone demonstrate excellent analgesia with a lower incidence or less-intense AEs, especially nausea and vomiting, compared with equianalgesic doses of individual opioids. Controlled trials with morphine/oxycodone 3/2 have enrolled approximately 1,500 subjects with moderate to severe post-surgical pain who received multiple doses of morphine/oxycodone 3/2 or single-entity opioids for a maximum of 23 days. These phase 2 and phase 3 clinical studies demonstrate analgesic efficacy that is at least comparable to the individual components and showing a 50-75% reduction in moderate to severe AEs, especially nausea and vomiting. Thus, the dual-opioid combination product, morphine/oxycodone 3/2, compared with equianalgesic monotherapy doses of oxycodone or morphine may provide effective relief of moderate or severe post-surgical pain, while reducing the impact of AEs on patients and prescribers.