NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Targinact®– not recommended for use

Targinact® – not recommended for use in NHS Scotland

Targinact® (oxycodone with naloxone) prolonged release tablets are not recommended for use within NHS Scotland for the treatment of severe pain which can only be managed with opioid analgesics. Despite this, use in selected clinical areas of NHSGGC has been recently highlighted.

 

• Targinact® is licensed for the treatment of severe pain which can only be managed with opioid analgesics.
• Oxycodone is an opioid analgesic established in the management of severe pain. The opioid antagonist naloxone is added to counteract opioid-induced constipation by blocking the action of oxycodone at opioid receptors locally in the gut. The Scottish Medicines Consortium (SMC) advice remains that Targinact®; is not recommended for use within NHS Scotland. It is therefore non-formulary in NHSGGC.
• The SMC commented in their advice that, when naloxone was added to oxycodone, bowel function improved when patients were not receiving regular laxative therapy. However, the clinical benefit in patients receiving regular laxative therapy is uncertain and the manufacturer did not present a sufficiently robust economic analysis to gain acceptance by SMC.
• The expectation is that there should be no routine use of any medicines which are not recommended by SMC. Access to these medicines can be requested on an individual case by case basis in accordance with local non-formulary processes e.g. Peer Approved Clinical System Tier 2 (PACS2). Details of the process and the request form can be accessed here.
• Prescribers are advised that, before considering prescribing Targinact®; in an individual patient requiring opioid analgesia, there should be a trial of an appropriate concomitant laxative (using an effective dose for a reasonable period of time). Compliance with the laxative should also be assessed. Evidence of this should be included in any PACS2 form submitted for approval.
• It should be noted that GPs are not obliged to continue prescribing medicines which are not recommended for use by SMC, but can use their discretion if access has been approved following due process.

 

Published 28/05/19. Medicines Update blogs are correct at the time of publication.