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Hospice Medication Update: Morphine/Oxycodone Combination Product (MoxDuo® IR) Expected in 2012

  
  
  
  

A few months back, we informed you of a new product that was moving closer to FDA approval: a combination product containing immediate-release morphine and immediate-release oxycodone in a 3:2 ratio called MoxDuo® IR. Now, generic manufacturer Actavis has partnered with QRxPharma and has announced their intention to launch MoxDuo® IR in the third quarter of 2012.

The New Drug Application submitted to the FDA includes results from three pivotal Phase 3 studies for the treatment of moderate to severe post-operative pain. In head-to-head comparisons with morphine, oxycodone, Percocet and placebo, more than 700 patients have been treated with MoxDuo® IR in seven clinical trials. Clinical data have consistently demonstrated that MoxDuo® IR achieves equal or better pain relief with fewer incidences of moderate to severe side effects, notably a clinically significant reduction in respiratory depression.

MoxDuo® IR is part of a larger dual opioid portfolio including intravenous (MoxDuo® IV) and controlled release (MoxDuo® CR) formulations. These formulations are designed to incorporate tamper resistance and reduced abuse liability as appropriate.

Comments

I am really curious about the pharmakinetics of this combination of opioids. Why would the risk of respiratory depression be reduced and why better results with the combination? Has anything been published to explain these findings. Curious minds want to know.
Posted @ Wednesday, January 04, 2012 10:38 AM by Marsha Farrell
This has to be the least intelligent scam that I have seen in quite some time. While diligently working to keep patients on a single opioid to ease appropriate titration of Long Acting opioid analgesic medications, this brilliant combo muddies the water even further.
Posted @ Wednesday, January 04, 2012 4:48 PM by Linda McMahan, R.Ph.
Thanks for the comments. 
 
Marsha, that's a great question, and I wasn't able to find a clear answer for you. QRxPharma has not yet published their clinical trial data. But it seems to hint at some level of synergism between opioids. We know that each opioid has distinct characteristics and binding affinities to the various classes of opioid receptors and receptor subtypes. Clinically, we see how opioids differ in subtle ways and have slightly different side effect profiles. So perhaps combining two opioids hits receptors in a broader fashion, while allowing for a lower dose of either opioid alone, hence the potential for reduced side effects. This is speculation on my part, and it will be interesting to see QRxPharma's data. 
 
Linda, I agree that this combination will make opioid titration a bit more difficult. Fortunately, the drug comes in a fixed 3:2 combination, which will help with calculations. But you're right... this sort of flies in the face of what we hospice pharmacists are usually trying to accomplish, which is to streamline each patient's opioid regimen.
Posted @ Monday, January 09, 2012 7:31 AM by Julia Harder
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