Oxycodone to Targin Conversion
Convert the patient's current oxycodone 5 mg four times daily (total 20 mg/day) to Targin 10 mg/5 mg twice daily, which provides equivalent oxycodone dosing while adding naloxone to counteract opioid-induced constipation.
Conversion Rationale
The conversion is straightforward because Targin contains oxycodone as its active analgesic component in a fixed 2:1 ratio with naloxone:
- Current regimen: Oxycodone 5 mg × 4 = 20 mg total daily dose
- Targin conversion: 10 mg/5 mg (oxycodone/naloxone) twice daily = 20 mg oxycodone total daily dose
This represents a 1:1 oxycodone equivalence with no dose adjustment needed 1.
Targin Formulation Details
Targin combines prolonged-release oxycodone with prolonged-release naloxone in a fixed 2:1 ratio. The naloxone component:
- Acts locally on opioid receptors in the gastrointestinal tract
- Has minimal systemic bioavailability due to extensive first-pass hepatic metabolism
- Maintains analgesic efficacy while reducing opioid-induced constipation 2, 3
Practical Implementation
Switching protocol:
- Discontinue immediate-release oxycodone 5 mg four times daily
- Start Targin 10 mg/5 mg every 12 hours (twice daily dosing)
- Provide immediate-release oxycodone 2-3 mg for breakthrough pain (approximately 10% of total daily dose) 4
- Monitor closely during the first 24-72 hours for adequate analgesia and adverse effects 1
Important Clinical Considerations
Advantages of Targin over standard oxycodone:
- Improved bowel function with reduced constipation rates 2, 5
- Decreased need for laxatives 5
- Equivalent analgesic efficacy at standard doses 2, 3
Critical caveat: Evidence suggests that at higher doses (>80-120 mg/day oxycodone equivalent), Targin may provide inferior analgesia compared to oxycodone alone 6. At your patient's dose of 20 mg/day, this is not a concern, but be aware if future dose escalation is needed.
Monitoring parameters:
- Pain intensity scores at rest and with movement
- Bowel function (frequency, consistency, straining)
- Adverse effects (nausea, somnolence, dizziness occur in 1-2% of patients) 5
- Breakthrough medication requirements
When Targin may be less optimal: Some retrospective data suggest Targin may produce slightly higher pain scores in the immediate postoperative period compared to oxycodone alone 7, though this is less relevant for chronic pain management.
The conversion maintains the same total daily oxycodone dose while potentially improving gastrointestinal tolerability through the addition of naloxone.