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. 2026 Feb 17:10966218251415472.
doi: 10.1177/10966218251415472. Online ahead of print.

Can Naldemedine Allow Higher Oxycodone Dosing in Patients with Cancer? A Single-Center Retrospective Study

Shinya Kajiura  1   2   3 , Shingo Chikaoka  2 , Yuta Yagi  2 , Nobukazu Ryu  2 , Takako Matsushita  2 , Mami Kurokawa  2 , Akihiro Yoshida  2 , Nahoko Kanai  2 , Yoko Mizuno  1   2 , Ryutatsu Yuki  2 , Kohei Nagata  3 , Iori Motoo  3 , Takayuki Ando  3 , Ichiro Yasuda  3 , Ryuji Hayashi  1   2
Affiliations

Can Naldemedine Allow Higher Oxycodone Dosing in Patients with Cancer? A Single-Center Retrospective Study

Shinya Kajiura et al. J Palliat Med. .

Abstract

Background: Opioid-induced constipation (OIC) limits opioid titration in cancer care. Before the use of peripherally acting μ-opioid receptor antagonists (PAMORAs), OIC often required switching from oxycodone to lower-risk opioids, such as transdermal fentanyl. Whether naldemedine allows oxycodone escalation without switching remains unclear. We evaluated the maximum scheduled daily oxycodone dose as a surrogate for maintaining therapy without constipation-driven switching.

Methods: We retrospectively reviewed adults with cancer pain who initiated oral oxycodone at Toyama University Hospital between June 2017 and December 2018. Patients receiving naldemedine were classified as Group A; others as Group B. The primary endpoint was the maximum scheduled controlled-release oxycodone dose during follow-up; rescue doses were excluded.

Results: Among 217 patients, the median maximum dose was higher with naldemedine (40 mg/day [range 10-480] versus 20 mg/day [10-320]; p < 0.0001).

Conclusions: Naldemedine enabled higher oxycodone dosing, suggesting OIC management reduces opioid switching.

Keywords: cancer pain; naldemedine; opioid switching; opioid titration; opioid-induced constipation; oxycodone.

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