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Identifying risk factors for opioid-induced neurotoxicity in cancer patients receiving oxycodone

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Abstract

Purpose

The aim of this study was to determine the frequency of opioid-induced neurotoxicity (OIN) in cancer patients receiving oral controlled-release oxycodone and to define risk factors for OIN.

Methods

This was a single-center, retrospective study of hospitalized adult cancer patients receiving oral controlled-release oxycodone between April 1, 2013, and April, 30, 2020. The onset of OIN within 30 days after oxycodone initiation in the study patients was investigated. OIN was defined as any of the following: delirium, hallucinations (visual or auditory), seizure, myoclonus, hyperesthesia, and excessive somnolence. Multivariate logistic regression analysis was performed to identify risk factors for OIN in patients receiving oxycodone.

Results

In total, 520 patients were included in this study. The number of patients with OIN was 65 (12.5%). The median time until onset of OIN after oxycodone initiation was 7.5 days. Multivariate logistic regression analysis revealed that age ≥ 65 years (OR = 2.74, 95% CI [1.30–5.78], p = 0.008), total bilirubin ≥ 1.3 mg/dL (OR = 4.85, 95% CI [2.13–11.0], p < 0.001), and concomitant use of pregabalin or mirogabalin (OR = 3.11, 95% CI [1.47–6.61], p = 0.003) were significant independent risk factors for OIN.

Conclusion

Age ≥ 65 years, liver dysfunction, and concomitant use of pregabalin or mirogabalin were independent risk factors for OIN in patients receiving oxycodone. Patients with these risk factors who are receiving oxycodone should be monitored for OIN, especially early in the administration of oxycodone.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors are grateful to Takamasa Sakai for providing professional advice concerning the planning of this research and Enago for the English language editing.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Pharmacy, Iwate Medical University Hospital, 2-1-1 Idaidouri, Yahaba-cho, Shiwa-gun, 028-3695, Iwate, Japan

    Takashi Omoto, Junichi Asaka, Satoru Nihei & Kenzo Kudo

  2. Department of Clinical Pharmaceutics, School of Pharmacy, Iwate Medical University, 1-1-1 Idaidouri, Yahaba-cho, Shiwa-gun, 028-3694, Iwate, Japan

    Junichi Asaka & Kenzo Kudo

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Contributions

TO, JA, and SN contributed to the study conception and design. Analysis was performed by TO, with the assistance of JA and SN. The first draft of the manuscript was written by TO, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Takashi Omoto.

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Ethical approval

This study was approved by the Institutional Review Board of the Iwate Medical University (IRB approval number: MH2021-009) and was performed in accordance with the Declaration of Helsinki.

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Omoto, T., Asaka, J., Nihei, S. et al. Identifying risk factors for opioid-induced neurotoxicity in cancer patients receiving oxycodone. Support Care Cancer 31, 208 (2023). https://doi.org/10.1007/s00520-023-07676-9

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