Targinact, a modified-release combination product containing oxycodone plus naloxone, is licensed for the treatment of severe pain, which can be adequately managed only with opioid analgesics. According to the SPC, “naloxone is added to counteract opioid-induced constipation by blocking the action of oxycodone at opioid receptors locally in the gut”. This article in the Drug and Therapeutics Bulletin (DTB) considers whether Targinact offers advantages over using strong opioids plus laxatives where required. The following topics are discussed:

• Managing severe pain

• Managing constipation

• Clinical evidence

• Pain relief

• Constipation

• Long-term follow-up

• Evidence for promotional claims

• Unwanted effects and cautions

The authors conclude “we can see no reason why Targinact should be prescribed” and provide the following reasons:

• Though Targinact is licensed for severe pain, published RCTs relate to its use for moderate to severe pain, and only in the non-cancer setting.

• It has only been compared with modified-release oxycodone in these RCTs.

• The studies have provided few data to show that Targinact reduces, let alone eliminates, the need for laxatives in the long term, or whether it offers advantages for people with cancer.

• There are no published studies comparing Targinact with other oral strong opioids given with regular stool-softening and stimulant laxatives.

• Targinact is more expensive than oral morphine plus regular laxatives.