From the Guidelines
Targin (oxycodone + naloxone) is preferred over codeine for pain management due to its stronger potency and reduced risk of constipation, a common opioid side effect. Codeine and Targin differ significantly in their strength and mechanism for pain management. Codeine is a mild opioid that converts to morphine in the body, providing moderate pain relief at typical doses of 15-60mg every 4-6 hours, as noted in the context of opioid treatment guidelines 1. It's suitable for mild to moderate pain but has variable effectiveness since about 10% of people lack the enzyme to convert it properly. Targin combines oxycodone, a stronger opioid (5-10 times more potent than codeine), with naloxone, which blocks opioid effects in the intestine but not in the brain. This combination provides effective pain relief while reducing constipation, a common opioid side effect. The decision of which opioid is most appropriate should be based on factors such as pharmacokinetic properties, including bioavailability, route of administration, half-life, neurotoxicity, and cost of the differing drugs, as suggested by recent guidelines 1.
Some key points to consider when choosing between codeine and Targin include:
- Pain severity: Targin is generally used for more severe pain that hasn't responded to non-opioid medications.
- Previous response to pain treatments: Patients who have not responded well to codeine or other mild opioids may benefit from Targin.
- Individual risk factors for opioid-related complications: The higher potency of oxycodone in Targin may increase the risk of dependence and other complications in some patients.
- Side effects: Both medications can cause side effects like nausea, drowsiness, and respiratory depression, with Targin having greater potential for dependence due to oxycodone's higher potency, as considered in the context of benefits and harms 1.
Given the considerations above and the recent guideline recommendations 1, the choice of Targin over codeine is supported for its efficacy and reduced side effect profile in appropriate patients.
From the Research
Comparison of Codeine and Targin for Pain Management
- Codeine is an opioid analgesic used to treat mild to moderate pain, while Targin is a combination of oxycodone and naloxone used to treat severe pain.
- Targin is designed to counteract opioid-induced constipation, a common side effect of opioid analgesics, through the local antagonist effect of naloxone in the gut wall 2.
- Studies have shown that Targin is effective in reducing opioid-induced constipation and improving bowel function in patients with chronic pain 2, 3.
- In contrast, codeine is not specifically designed to address opioid-induced constipation and may exacerbate this condition.
- The efficacy of Targin in pain management has been demonstrated in several studies, including a 12-week randomized controlled trial that showed improved pain relief and bowel function compared to oxycodone alone 2.
- Another study found that Targin reduced symptoms of constipation and improved quality of life in patients with laxative-refractory opioid-induced constipation 3.
Key Differences
- Mechanism of action: Codeine is a single opioid analgesic, while Targin is a combination of an opioid analgesic (oxycodone) and an opioid antagonist (naloxone).
- Efficacy in opioid-induced constipation: Targin is specifically designed to counteract opioid-induced constipation, while codeine may exacerbate this condition.
- Pain management: Targin has been shown to be effective in managing severe pain, while codeine is typically used for mild to moderate pain.
Clinical Considerations
- Patients with severe pain who are at risk of opioid-induced constipation may benefit from Targin over codeine 2, 3.
- The use of Targin may reduce the need for laxatives and improve quality of life in patients with chronic pain 3.
- Healthcare providers should consider the individual patient's needs and medical history when choosing between codeine and Targin for pain management 4, 5, 6.