Mu-opioid antagonists for opioid-induced bowel dysfunction in people with cancer and people receiving palliative care

Abstract

Mu-opioid antagonists for opioid-induced bowel dysfunction in people with cancer and people receiving palliative care.

A Rapid Review on the Management of Constipation for Hospice and Palliative Care Patients

“…The reviewers found moderate-quality evidence that naldemedine increased Bowel Movement for up to 2 weeks and methylnaltrexone increased BMs within 24 hours and up to 2 weeks. 8 Increased risk of serious adverse effects with moderate-quality evidence was found with naldemedine, whereas naloxone taken with oxycodone and methylnaltrexone did not increase overall risks.…”

“…19 Eight of the 11 studies focused on cancer, or advanced cancer, and constipation. 2,8,[12][13][14][15]18,21 Three studies, a case report, 12 a systematic review of international randomized controlled trials, 8 and a systematic review and meta-analysis 16 examined peripherally acting μ-opioid receptor antagonists (PAMORAs). Dias et al 15 (2021) considered the impact of advanced lung cancer versus drug-induced gastrointestinal dysmotility using a case report.…”

“…2,[6][7][8] Rome III criteria, published in 2006, outlined patient-reported symptoms for diagnosing chronic or functional constipation. 8 Rome IV criteria expanded the definition to include 4 subtypes of constipation: (1) functional constipation, (2) irritable bowel syndrome with constipation, (3) opioid-induced constipation (OIC), and (4) functional defecation disorders, including inadequate defecatory propulsion and dyssynergia defecation (insufficiently coordinated contractions of the anorectal muscles). [9][10][11] Treating constipation in palliative care patients poses challenges.…”

“…Current research and various guidelines offer a wide range of definitions, with some contradicting each other 6 . Some palliative care teams use the Rome Foundation Clinical Diagnostic Criteria for Disorders of Gut-Brain Interaction to define and categorize constipation 2,6-8 . Rome III criteria, published in 2006, outlined patient-reported symptoms for diagnosing chronic or functional constipation 8 .…”

“…Some palliative care teams use the Rome Foundation Clinical Diagnostic Criteria for Disorders of Gut-Brain Interaction to define and categorize constipation 2,6-8 . Rome III criteria, published in 2006, outlined patient-reported symptoms for diagnosing chronic or functional constipation 8 . Rome IV criteria expanded the definition to include 4 subtypes of constipation: (1) functional constipation, (2) irritable bowel syndrome with constipation, (3) opioid-induced constipation (OIC), and (4) functional defecation disorders, including inadequate defecatory propulsion and dyssynergia defecation (insufficiently coordinated contractions of the anorectal muscles) 9-11 …”