摘要 林口長庚紀念醫院藥劑部藥師周心怡 鄭吉元 陳琦華 fentanyl (fentanyl buccal film, Painkyl) oxycodone (OxyNorm) breakthrough pain opioid analgesics fentanyl 壹 前言 buccal film oxycodone (breakthrough pain) 1-3 fentanyl (fentanyl buccal film Painkyl) 貳 突發性癌痛 一 定義 2009 4 2011 Davies 83 % 5 二 臨床特徵 32 2 藥學雜誌 127 17 藥物科學癌症突發性疼痛用藥之探討
Pharmaceutical Sciences 藥物科學繼續教育 3-10 30-90 1-10 4 2,6 3 1-2,7 三 非藥物治療 1 四 藥物治療 ( 一 )Morphine Morphine (mu) (opioid agonist) morphine (10 mg/tab) 30-40 5-1000 mg 1 Morphine Morphine morphine morphine morphine ( 二 )Hydromorphone Hydromorphone morphine morphine Hydromorphone (immediate-release) Dilaudid (8 mg/tab) 15 morphine hydromorphone (extended-release) 8 ( 三 )Fentanyl Fentanyl morphine 100 Fentanyl fentanyl fentanyl 3,7 1. Fentanyl (Oral transmucosal fentanyl citrate) Fentanyl (Actiq) 18 THE JOURNAL OF TAIWAN PHARMACY Vol.32 No.2
fentanyl 10-15 152 2. Fentanyl (Fentanyl buccal tablet) Fentanyl (Fentora ) fentanyl 2006 (US FDA) 10 10-15 3. Fentanyl (Fentanyl buccal film) Fentanyl (Painkyl) 18 ( ) morphine 60 mg/day oxycodone 30 mg/day hydromorphone 8 mg/day fentanyl 25 g/hr ( ) 9 Fentanyl 10-15 1-2 200 g 30 400 g 1200 g 2 4 Painkyl 5 9 4. Fentanyl (Sublingual fentanyl) Fentanyl 8-11 10 5. Fentanyl (Intranasal fentanyl spray; IFS) Fentanyl 2 7 IFS 2009 (European Medicine Agency, EMA) 2011 fentanyl (Fentanyl pectin intranasal spray; FPNS) ( 四 )Oxycodone Oxycodone (kappa) morphine 2 ( OxyNorm) 2014 12 31 fentanyl oxycodone (40 mg 80 mg) oxycodone 24-72 Oxycodone 32 2 藥學雜誌 127 19 藥物科學
Pharmaceutical Sciences 藥物科學繼續教育 18 10 Oxycodone 20-30 4-6 5 mg 400 mg 6,10 oxycodone 3,10 fentanyl (Painkyl) oxycodone (OxyNorm ) ( ) 表一 Fentanyl 口頰溶片 (Painkyl ) 和 oxycodone 短效劑型 (OxyNorm ) 的比較 ( ) ( ) Painkyl 100 10-15 1-2 OxyNorm 2 20-30 4-6 ( ) 參 結論 (narrow therapeutical windows) FDA fentanyl oxycodone Cancer Breakthrough Pain Therapy Hsin-Yi Chou, Chi-Yuan Cheng, Chi-Hua Chen Department of Pharmacy, Chang Gung Memorial Hospital, Linkou Abstract Cancer breakthrough pain is defined as the pain that occurs despite regularly scheduled pain medication use. The clinical features of breakthrough pain include sudden onset, severe intensity and short duration. Depending on the nature of breakthrough pain, opioid analgesics are the first choice for this kind of pain management. In Taiwan, fentanyl buccal film (Painkyl) 20 THE JOURNAL OF TAIWAN PHARMACY Vol.32 No.2
藥物科學 癌症突發性疼痛用藥之探討 is the only product marketed to treat cancer breakthrough pain. In addition, oral oxycodone short-acting tablet (OxyNorm) is also licensed and soon launched in Taiwan. Because opioid analgesics efficacy had considerable inter-patient variation, it should be cautious of dosing and dose adjustment individualized according to response and adverse reactions. 參考資料 1. 2. 國家衛生研究院 癌症疼痛處理指引 民國104年09 European study of breakthrough cancer pain: pain char- 月 acteristics and patient perceptions of current and potential Caraceni A, Davies A, Poulain P, et al: Guidelines for the management of breakthrough pain in patients with cancer. management strategies.eur J Pain. 2011;15:756-63. 6. J Natl Compr Canc Netw. 2013;11:S29-36. 3. Mercadantes: Pharmacotherapy for breakthrough cancer 7. pain. Drugs 2012;72:181-90. 4. 2013; 6: 189-200. 8. task group of the Science Committee of the Association 5. Howard S: Considerations in selecting rapid-onset opioids for the management of breakthrough pain. J Pain Res. Davies A, Dickman A, Reid C, et al: The management of cancer-related breakthrough pain: recommendations of a OxyNorm package insert, Cambridge, Bard Pharmaceuticals Limited. 黃安年 鴉片類藥物於癌症疼痛治療的最新觀念 安 寧療護雜誌 2010; 15 :196-205 for Palliative Medicine of Great Britain and Ireland. Eur J 9. 平舒疼口頰溶片仿單 民國102年04月 Pain 2009;13:331-8. 10. 奧諾美速效膠囊仿單 民國104年01月 Davies A1, Zeppetella G, Andersen S, et al: Multi-centre 第 32 卷第 2 期 藥學雜誌 第127冊 21