A Prospective Study of Methylnaltrexone for Opioid-Induced Constipation in Advanced Illness: Should We Use It or Not?

Centeno, Carlos; Carranza, Omar; Zuriarrain, Yolanda; Portela, María Angustias; Larumbe, Ana; Canal, Jaume; Palomar, C

doi:10.1016/j.jpainsymman.2013.08.009

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…Clinical studies have demonstrated the effectiveness of MNTX in the treatment of OIC not responding to traditional laxatives in patients with advanced diseases, 33 , 34 , 116 , 117 , 121 , 122 , 126 non-malignant pain, 127 – 129 and in other patient populations. 130 , 131 However, MNTX was ineffective in shortening the duration of postoperative ileus following segmental colectomy.…”

Section: Mntxmentioning

confidence: 99%

Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction

Leppert¹

2015

DDDT

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Opioid-induced bowel dysfunction (OIBD) comprises gastrointestinal (GI) symptoms, including dry mouth, nausea, vomiting, gastric stasis, bloating, abdominal pain, and opioid-induced constipation, which significantly impair patients’ quality of life and may lead to undertreatment of pain. Traditional laxatives are often prescribed for OIBD symptoms, although they display limited efficacy and exert adverse effects. Other strategies include prokinetics and change of opioids or their administration route. However, these approaches do not address underlying causes of OIBD associated with opioid effects on mostly peripheral opioid receptors located in the GI tract. Targeted management of OIBD comprises purely peripherally acting opioid receptor antagonists and a combination of opioid receptor agonist and antagonist. Methylnaltrexone induces laxation in 50%–60% of patients with advanced diseases and OIBD who do not respond to traditional oral laxatives without inducing opioid withdrawal symptoms with similar response (45%–50%) after an oral administration of naloxegol. A combination of prolonged-release oxycodone with prolonged-release naloxone (OXN) in one tablet (a ratio of 2:1) provides analgesia with limited negative effect on the bowel function, as oxycodone displays high oral bioavailability and naloxone demonstrates local antagonist effect on opioid receptors in the GI tract and is totally inactivated in the liver. OXN in daily doses of up to 80 mg/40 mg provides equally effective analgesia with improved bowel function compared to oxycodone administered alone in patients with chronic non-malignant and cancer-related pain. OIBD is a common complication of long-term opioid therapy and may lead to quality of life deterioration and undertreatment of pain. Thus, a complex assessment and management that addresses underlying causes and patomechanisms of OIBD is recommended. Newer strategies comprise methylnaltrexone or OXN administration in the management of OIBD, and OXN may be also considered as a preventive measure of OIBD development in patients who require opioid administration.

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Section: Mntxmentioning

confidence: 99%

Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction

Leppert¹

2015

DDDT

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“…51 However, all of these agents are contraindicated in MBO and should be avoided if obstruction is suspected, because severe abdominal colic and bowel perforation have been reported. 52,53 Opioid-induced mental status changes, including somnolence and confusion, contribute to anorexia and reduced performance status. For patients with relatively well-controlled pain, empiric narcotic dose reduction is a reasonable first step to address mental status changes.…”

Section: Pain Controlmentioning

confidence: 99%

Management of Malignant Bowel Obstruction Associated With GI Cancers

Franke

Iqbal

Starr

et al. 2017

JOP

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For many patients with GI malignancies, the seeding of the abdominal cavity with tumor cells, called peritoneal carcinomatosis, is a common mode of metastases and disease progression. Prognosis for patients with this aspect of their disease remains poor, with high disease-related morbidity and complications. Uniform and proven practices that provide optimal palliative care and quality of life for these patients are needed. The objective of this review is to critically assess the current literature regarding palliative strategies in the management of peritoneal carcinomatosis and associated symptoms in patients with advanced GI cancers. Despite encouraging results in the select population where cytoreductive surgery and intraperitoneal chemotherapy are indicated, the majority of patients who develop peritoneal carcinomatosis in the setting of GI cancers have poor prognosis, with malignant bowel obstruction representing a common terminal phase of their disease process. For all patients with peritoneal carcinomatosis, aggressive symptom control and early multimodality palliative care as further outlined should be sought.

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“…We read with interest the comments made by Centeno et al 1 regarding their experiences with the medication methylnaltrexone and their call for more research into this medication. This call supports the observation that as a medication becomes available, the efficacy data underpinning its registration are often ignored in subsequent use, with longer duration of use, differing dosages, broader indications, and a wider population in whom it is used.…”

Section: Methylnaltrexone In Palliative Care: Further Research Is Neededmentioning

confidence: 99%

“…To the Editor: I read with great interest the recent article by Nilsson et al 1 The prevalence of fatigue in Parkinson's disease (PD) varies from 35.4% to 59.1% and is impacted significantly by the severity of the underlying PD. 2 Quality of life is significantly impacted by PD-related fatigue.…”

Section: Parkinson's Disease-associated Fatigue: Emerging New Therapementioning

confidence: 99%

Methylnaltrexone in Palliative Care: Further Research Is Needed

Clark

Currow

2014

Journal of Pain and Symptom Management

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A Prospective Study of Methylnaltrexone for Opioid-Induced Constipation in Advanced Illness: Should We Use It or Not?

Cited by 4 publications

References 7 publications

Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction

Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction

Management of Malignant Bowel Obstruction Associated With GI Cancers

Methylnaltrexone in Palliative Care: Further Research Is Needed

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