Primary Care Considerations of the Pharmacokinetics and Clinical Use of Extended-Release Opioids in Treating Patients With Chronic Noncancer Pain

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Bruce Nicholson, MD

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Postgraduate Medicine:

Volume 125 No. 1


Clinical Features

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DOI: 10.3810/pgm.2013.01.2627
Abstract: Extended-release (ER) opioid analgesics are associated with prolonged analgesia and greater stability in pain relief compared with immediate-release formulations. Due to the pharmacokinetic (PK) characteristics of ER opioids and additional clinical advantages, the use of ER opioids for patients with moderate-to-severe chronic noncancer pain has increased. Primary care physicians are the major prescribers of opioids and require an in-depth understanding of the risks and benefits of opioid treatment in pain management. With appropriate knowledge of PK profiles and clinical outcomes of commonly prescribed ER opioids, primary care physicians can safely and effectively manage this patient population. In addition, the development of ER opioids with abuse-deterrent features marks an important milestone in potentially reducing abuse and may be factored into the clinical decision-making process. This article provides a comprehensive review of the PK and clinical effects of ER opioids and discusses novel ER opioid formulations that may limit abuse potential.

Keywords: long-acting opioid; extended-release opioid; pharmacokinetics; primary care; chronic pain