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Nedergaard RB, Hansen TM, Mørch CD, Niesters M, Dahan A, Drewes AM. Influence of tapentadol and oxycodone on the spinal cord and brain using electrophysiology: a randomized, placebo-controlled trial. Br J Clin Pharmacol 2022; 88:5307-5316. [PMID: 35776835 PMCID: PMC9796052 DOI: 10.1111/bcp.15453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 12/30/2022] Open
Abstract
AIMS The aim of this study was to investigate the effects of tapentadol and oxycodone using the nociceptive withdrawal reflex and sensory evoked potentials. METHODS Twenty-one healthy volunteers completed a cross-over trial with oxycodone (10 mg), tapentadol (50 mg) extended-release tablets, or placebo treatment administered orally BID for 14 days. Electrical stimulations were delivered on the plantar side of the foot to evoke a nociceptive withdrawal reflex at baseline and post-interventions. Electromyography, recorded at tibialis anterior, and electroencephalography were recorded for analysis of: number of reflexes, latencies, and area under the curve of the nociceptive withdrawal reflex as well as latencies, amplitudes and dipole sources of the sensory-evoked potential. RESULTS Tapentadol decreased the odds ratio of eliciting nociceptive withdrawal reflex by -0.89 (P = .001, 95% confidence interval [CI] -1.46, -0.32), whereas oxycodone increased the latency of the N1 component of the sensory-evoked potential at the vertex by 12.5 ms (P = .003, 95% CI 3.35, 21.69). Dipole sources revealed that the anterior cingulate component moved caudally for all three interventions (all P < .02), and the insula components moved caudally in both the oxycodone and tapentadol arms (all P < .03). CONCLUSION A decrease in the number of nociceptive withdrawal reflex was observed during tapentadol treatment, possibly relating to the noradrenaline reuptake inhibition effects on the spinal cord. Both oxycodone and tapentadol affected cortical measures possible due to μ-opioid receptor agonistic effects evident in the dipole sources, with the strongest effect being mediated by oxycodone. These findings could support the dual effect analgesic mechanisms of tapentadol in humans as previously shown in preclinical studies.
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Affiliation(s)
- Rasmus Bach Nedergaard
- Mech‐Sense, Department of Gastroenterology and HepatologyAalborg University HospitalAalborgDenmark,Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Tine Maria Hansen
- Mech‐Sense, Department of Gastroenterology and HepatologyAalborg University HospitalAalborgDenmark,Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Carsten Dahl Mørch
- Department of Health Science and Technology, Center for Neuroplasticity and Pain, SMI, School of MedicineAalborg UniversityAalborgDenmark
| | - Marieke Niesters
- Department of AnesthesiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Albert Dahan
- Department of AnesthesiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Asbjørn Mohr Drewes
- Mech‐Sense, Department of Gastroenterology and HepatologyAalborg University HospitalAalborgDenmark,Department of Clinical MedicineAalborg UniversityAalborgDenmark
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Nedergaard RB, Hansen TM, Nissen TD, Mark EB, Brock C, Drewes AM. The effects of tapentadol and oxycodone on central processing of tonic pain. Clin Neurophysiol 2021; 132:2342-2350. [PMID: 34454260 DOI: 10.1016/j.clinph.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/18/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The present study investigated differences between opioids to experimental tonic pain in healthy men. METHODS Twenty-one males participated in this cross-over-trial. Interventions twice daily were oxycodone (10 mg), tapentadol (50 mg) and placebo for 14 days. Tonic pain was induced on day 1, 4 and 14 by immersing the hand in 2 °C water for 120 s. Electroencephalography was recorded during test pain at baseline and after 14 days. Spectral analysis and source localization were investigated in predefined frequency bands. RESULTS A decreased perception of pain on day 4 persisted throughout the 14 days compared to baseline (p < 0.006). Oxycodone decreased the electroencephalography spectral power in the delta and theta bands and increased power in the alpha1, alpha2 and beta1 bands (p < 0.03). Tapentadol increased spectral power in the alpha1 band (p < 0.001). Source localization revealed that oxycodone decreased activity of the temporal and limbic region in the delta band, and frontal lobe in the alpha2 and beta1 bands, whereas tapentadol decreased alpha1 band activity in the temporal lobe compared to placebo. CONCLUSION Oxycodone and tapentadol reduced pain perception and changed the central processing of tonic pain. SIGNIFICANCE Different mechanisms of action were involved, where oxycodone affected cortical structures more than tapentadol.
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Affiliation(s)
- Rasmus Bach Nedergaard
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Tine Maria Hansen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Dahl Nissen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Esben Bolvig Mark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christina Brock
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Torti M, Alessandroni J, Bravi D, Casali M, Grassini P, Fossati C, Ialongo C, Onofrj M, Radicati FG, Vacca L, Bonassi S, Stocchi F. Clinical and pharmacokinetics equivalence of multiple doses of levodopa benserazide generic formulation vs the originator (Madopar). Br J Clin Pharmacol 2019; 85:2605-2613. [PMID: 31378952 DOI: 10.1111/bcp.14086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/15/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022] Open
Abstract
AIMS While several generic preparations of levodopa/carbidopa and levodopa/benserazide (LBD) are currently available, pharmacokinetic (PK) equivalence and therapeutic equivalence studies with levodopa generics are not available in Italy. Lack of data on generic formulations is a critical factor for their limited use in this country and often lead patients to refuse the generic version of the branded drug. METHODS An experimental, 2-centre, randomized, double-blind, 2-sequence, noninferiority cross-over study was designed to evaluate both the PK equivalence and clinical equivalence of multiple doses of the generic preparation of LDB, Teva Italia, compared to the originator (Madopar). Forty-three out-patients with a diagnosis of idiopathic Parkinson's disease on LDB, were recruited and randomly assigned to 1 of 2 study sequences: generic-originator or originator-generic. Clinical evaluations were performed at the end of each study period. A PK study with an LDB fixed dose (100 + 25 mg) was performed in a subpopulation of 14 subjects. RESULTS Clinical data showed a reduction of 0.49 and 1.54 in the mean UPDRS III scores for the LDB and the originator, respectively. The 95% CIs [-2.21: 0.11] of the mean difference original vs LDB are smaller than the clinically significant difference of 3 UPDRS III points, supporting the conclusion that the treatment with LDB is not inferior to the originator. No statistically significant differences were found with respect to area under the curve to last dose, half-life, maximum concentration, time to maximum concentration and last observed concentration. CONCLUSION These findings prove the therapeutic clinical equivalence as well the PK equivalence of the generic LDB and the originator (Madopar).
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Affiliation(s)
- Margherita Torti
- Center for Parkinson's Disease, IRCCS San Raffaele Pisana, Rome, Italy.,San Raffaele Cassino, Rome, Italy
| | - Jhessica Alessandroni
- BioBIM - Multidisciplinary Interistitutional BioBank San Raffaele Pisana -Research Center, Rome, Italy
| | - Daniele Bravi
- Center for Parkinson's Disease, IRCCS San Raffaele Pisana, Rome, Italy
| | - Miriam Casali
- Center for Parkinson's Disease, IRCCS San Raffaele Pisana, Rome, Italy
| | - Paola Grassini
- Center for Parkinson's Disease, IRCCS San Raffaele Pisana, Rome, Italy
| | - Chiara Fossati
- Center for Parkinson's Disease, IRCCS San Raffaele Pisana, Rome, Italy.,Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis 15, Rome, Italy
| | - Cristiano Ialongo
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Italy.,Department of Laboratory Medicine, Tor Vergata University of Rome, Italy
| | - Marco Onofrj
- Neurology Department, Università "G. D'Annunzio" di Chieti, Italy
| | | | - Laura Vacca
- Center for Parkinson's Disease, IRCCS San Raffaele Pisana, Rome, Italy.,Casa di Cura Privata Policlinico (CCPP), Milan, Italy
| | - Stefano Bonassi
- IRCCS San Raffaele Pisana, Clinical and Molecular Epidemiology Unit, Italy (Statistical Analysis) And Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Rome, Italy
| | - Fabrizio Stocchi
- Center for Parkinson's Disease, IRCCS San Raffaele Pisana, Rome, Italy.,San Raffaele University, Rome, Italy
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