Advances in pharmacotherapy for opioid-induced constipation – a systematic review

Abstract

Finding a consensus definition and inclusion criteria for OIC plus a rational balance between efficacy and AEs of drugs remain future challenges.

Treating Opioid-Induced Constipation in Older Adults: New Options

“…7 Alvimopan has similar adverse effects to those of methylnaltrexone. However, serious, but rare, adverse effects such as dehydration, bradycardia, unstable angina, and myocardial infarction are observed in alvimopan studies.…”

“…7 In a meta-analysis conducted to evaluate efficacy and safety of drugs in randomized controlled trials (RCTs) with adult OIC patients, methylnaltrexone was shown to be efficacious in all the objective outcome measures evaluated. 7 Of patients on methylnaltrexone, 53% to 70% had three or more rescue-free bowel movements (RFBMs) per week, and one RFBM increase over baseline compared with placebo (35% to 41%). Time to first bowel movement was shorter with methylnaltrexone.…”

▼Naloxegol for opioid-induced constipation

“…It can result in a significantly reduced quality of life for patients5,8,9,14 as well as decreased adherence to the opioid regime 5,12,14…”

“…increased physical activity, fluid and dietary fibre intake) where possible 8,9,12. Laxatives should be prescribed at the point of initiating strong opioids for cancer pain15; and dual therapy with a faecal softener and a peristaltic stimulant (e.g.…”

“…co-danthramer or docusate with a senna preparation) is a commonly advocated initial approach 13,16. Although there are no specific guidelines for managing opioid-induced constipation in non-cancer pain, a similar treatment strategy is advocated 8,9,12…”