What alternative can be used for Targin (oxycodone/naloxone) 5mg/10mg if it's not available?

Alternative Medication for Targin (Oxycodone/Naloxone) 5mg/10mg

When Targin (oxycodone/naloxone) 5mg/10mg is unavailable, the best alternative is to switch to oral prolonged-release oxycodone 5mg alone with appropriate laxative therapy to manage opioid-induced constipation. 1

Understanding Targin Formulation

• Targin is a fixed-dose combination product containing prolonged-release oxycodone with prolonged-release naloxone in a 2:1 ratio 2
• The 5mg/10mg formulation contains 5mg oxycodone and 10mg naloxone 2
• The naloxone component acts locally in the gut to counteract opioid-induced constipation (OIC) while the low oral bioavailability prevents it from interfering with oxycodone's analgesic effect 1, 2

Recommended Substitution Approach

Primary Recommendation

1. Replace with prolonged-release oxycodone 5mg twice daily 1

   • Oxycodone is the opioid of choice for moderate to severe pain when morphine is not suitable 1
   • Maintain the same oxycodone dosage to ensure equivalent analgesia 1

2. Add prophylactic laxative therapy 1

   • Laxatives must be routinely prescribed for both prophylaxis and management of opioid-induced constipation 1
   • Consider a combination stimulant and softener laxative 1
   • Increase dietary fiber and fluid intake as adjunctive measures 1

Alternative Options

• Consider peripherally acting mu-opioid receptor antagonists (PAMORAs) if traditional laxatives are ineffective 1

  • Naloxegol has been approved for treatment of OIC in patients with cancer-related pain in the European Union 1
  • Methylnaltrexone administered subcutaneously is available for OIC resistant to traditional laxatives 1

• Avoid concurrent use of multiple opioids as this increases risk of respiratory depression and sedation 3

  • Do not substitute with both oxycodone and morphine concurrently 3

Monitoring Recommendations

• Assess bowel function regularly using tools such as the Bowel Function Index 1
• Monitor for opioid-related adverse effects including:
  • Sedation and respiratory depression 1
  • Nausea and vomiting 1
  • Pruritus 1

Special Considerations

• For patients with renal impairment: Consider methadone as it is excreted fecally, or carefully titrate oxycodone with frequent monitoring 1
• For patients with hepatic impairment: Perform more frequent clinical observation and opioid dose adjustment 1
• For patients on concurrent medications: Exercise caution when combining opioids with other medications that have sedating effects (e.g., benzodiazepines, gabapentinoids) 1, 4

Clinical Evidence Supporting This Approach

• Studies have shown that oxycodone provides similar analgesic effects to morphine with potentially fewer side effects in some patients 1, 5
• Combined opioid/naloxone medications have been shown to reduce the risk of OIC through multiple clinical trials 1
• When switching from combined oxycodone/naloxone to oxycodone alone, maintaining the same oxycodone dose provides equivalent analgesia 2, 6