A randomised, placebo‐controlled trial comparing the effects of tapentadol and oxycodone on gastrointestinal and colonic transit in healthy humans

Jeong, In Du; Camilleri, Michael; Shin, Andrea; Iturrino, Johanna; Boldingh, Amy; Busciglio, Irene; Burton, Duane D.; Ryks, Michael; Rhoten, Deborah; Zinsmeister, Alan R.

doi:10.1111/j.1365-2036.2012.05040.x

Cited by 63 publications

(42 citation statements)

References 37 publications

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“…33 No difference in small intestinal transit was observed, but as previous studies have been contradictory, methodological refinements are likely needed to report consistent findings. [34][35][36] Recent in vitro studies in rodents has demonstrated tolerance to opioids in the upper, but not the lower GI tract. 37,38 Therefore differences in tolerance may partly explain our findings although direct translation to human in vivo physiology is highly questionable.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Opioid Treatment on Regional Gastrointestinal Transit

Poulsen

Nilsson

Brock

et al. 2016

J Neurogastroenterol Motil

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Background/AimsTo employ an experimental model of opioid-induced bowel dysfunction in healthy human volunteers, and evaluate the impact of opioid treatment compared to placebo on gastrointestinal (GI) symptoms and motility assessed by questionnaires and regional GI transit times using the 3-dimensional (3D)-Transit system. MethodsTwenty-five healthy males were randomly assigned to oxycodone or placebo for 5 days in a double blind, crossover design. Adverse GI effects were measured with the bowel function index, gastrointestinal symptom rating scale, patient assessment of constipation symptom questionnaire, and Bristol stool form scale. Regional GI transit times were determined using the 3D-Transit system, and segmental transit times in the colon were determined using a custom Matlab ® graphical user interface. ResultsGI symptom scores increased significantly across all applied GI questionnaires during opioid treatment. Oxycodone increased median total GI transit time from 22.2 to 43.9 hours (P < 0.001), segmental transit times in the cecum and ascending colon from 5.7 to 9.9 hours (P = 0.012), rectosigmoid colon transit from 2.7 to 9.0 hours (P = 0.044), and colorectal transit time from 18.6 to 38.6 hours (P = 0.001). No associations between questionnaire scores and segmental transit times were detected. ConclusionsSelf-assessed GI adverse effects and increased GI transit times in different segments were induced during oxycodone treatment. This detailed information about segmental changes in motility has great potential for future interventional head-to-head trials of different laxative regimes for prevention and treatment of constipation.

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Section: Discussionmentioning

confidence: 99%

The Impact of Opioid Treatment on Regional Gastrointestinal Transit

Poulsen

Nilsson

Brock

et al. 2016

J Neurogastroenterol Motil

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“…However, the acute effects of various opioids on gastrointestinal function and symptoms vary. For example, although codeine, oxycodone and tapentadol all cause constipation, only codeine delays colonic transit (Gonenne et al, 2005;Jeong et al, 2012). When compared to oxycodone, tapentadol appears to cause less constipation, nausea and vomiting (Stegmann et al, 2008).…”

Section: Physiology Of Opioid Induced Constipationmentioning

confidence: 99%

Management of opioid-induced constipation

2016

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Up to 40% of patients taking opioids develop constipation. Opioid induced constipation (OIC) may limit the adequate dosing of opioids for pain relief and reduce quality of life.Hence, healthcare providers must inquire about bowel function in patients receiving opioids.The management of OIC includes carefully reevaluating the necessity, type, and dose of opioids at each visit. Lifestyle modification and alteration of aggravating factors, the use of simple laxatives, and when essential, the addition of newer laxatives or opioid antagonists (naloxone, naloxegol or methylnaltrexone) can be used to treat OIC. This review discusses the recent literature regarding the management of OIC and provides a rational approach to assessing and managing constipation in individuals receiving opioids.Abstract word count -115

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“…[56] A recent trial in pediatric patients reported that there is no evidence to support combining these two drugs. [57] Although combining acetaminophen with a COX-2 NSAID may be relatively safe for longterm use, the efficacy of this combination has not yet been studied.…”

Section: Combination Analgesicsmentioning

confidence: 99%

Molecular Aspects of Toxicity of Centrally Acting Analgesics: A Mini Review

Samie¹

2017

WJPR

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Pain of multiple etiologies remains a significant problem for many patients presenting in the clinical setting. Improved pain relief can be maximized and adverse effects minimized, by multimodal analgesic combinations as the method to improve pain treatment. Significant suggestion supports the use of combination analgesics for the management of pain and in some cases, they have a heterogeneous pharmacologic sparing effect. Fixed-dose combination analgesics having significant efficacy and safety are extensively suitable for pain management and are usually recommended. However, further exploration is required for the best combination that which analgesics at which doses can be pooled with a co-analgesic in a patient-specific manner to attain additive, if not synergistic, multimodal pain relief with the least possible adverse values.Unsupervised intake of over-the-counter drugs offers clinical challenges to both the patient and health care providers. Couple this often unrevealed over-the-counter medication consumption event with prescription medications, which many have similar combination constituents and the potential for a therapeutic misadventure may precipitate. Patient-specific cautions are presented for opiate/opioid combinations, codeine, hydrocodone, oxycodone and propoxyphene and there is a discussion of COX I/COX II agents. This review article address the safety and efficacy of different analgesics individually and in combination with currently available prescription dosage forms with a focus on pharmacology, pharmacotherapeutics, pharmacodynamics, and pharmacokinetics, including drug interactions and toxicity profile.

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A randomised, placebo‐controlled trial comparing the effects of tapentadol and oxycodone on gastrointestinal and colonic transit in healthy humans

Cited by 63 publications

References 37 publications

The Impact of Opioid Treatment on Regional Gastrointestinal Transit

The Impact of Opioid Treatment on Regional Gastrointestinal Transit

Management of opioid-induced constipation

Molecular Aspects of Toxicity of Centrally Acting Analgesics: A Mini Review

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