Effectiveness and Tolerability of Amidotrizoate for the Treatment of Constipation Resistant to Laxatives in Advanced Cancer Patients

Abstract

Context. Constipation is a common problem for advanced cancer patients, and is generally inadequately treated.Objectives. The aim of this study was to prospectively evaluate the effectiveness and tolerability of amidotrizoate (AM) in patients unresponsive to current laxatives.Methods. A consecutive sample of advanced cancer patients was surveyed. Inclusion criteria were no bowel movements for three days despite receiving regular doses of senna or lactulose. AM 50 mL was administered orally; the dose could be repeated the day after, based on clinical judgment and/or patients' preference. Age, sex, primary tumor, previous abdominal surgery, chemotherapy and radiotherapy performed in the previous month, and the use of opioids were recorded. Nausea, the presence of early satiety, and fluid and food intake also were measured. Time to first bowel movement was recorded, and adverse effects attributable to AM.Results. Ninety-nine patients were surveyed (36 women/63 men). The mean age was 65.7 years (SD AE 12.2) and the mean Karnofsky score was 46.8 (SD AE 9.4). Patients had no bowel movement for a mean of four days (SD AE 1.8, range 3e15 days). A total of 80.8% of patients were receiving opioids in doses of mean daily oral morphine equivalents of 164 mg (SD AE 235). After AM administration (mean 9.9 AE 6.5 hours), 44.4% of patients had a bowel movement within 24 hours. This effect was associated with significant improvement of other symptoms and was independent of age (P ¼ 0.513), gender (P ¼ 0.090), Karnofsky status (P ¼ 0.979), days of constipation (P ¼ 0.198), concomitant chemotherapy (P ¼ 0.098) or radiotherapy (P ¼ 0.414), the use of opioids (P ¼ 0.361), opioid doses (P ¼ 0.420), and primary tumor (P ¼ 0.231). The treatment was more effective in patients who had previous abdominal surgery (HR ¼ 3.33).

Public Knowledge, Attitude, and Practice on Herbal Remedies Used During Pregnancy and Lactation in West Bank Palestine

“…Studies have affirmed that cinnamon (C. verum) has many benefits, including management of blood glucose levels (Hlebowicz et al, 2007), weight loss (Whitfield et al, 2016), detoxification (Xing et al, 2014), and increasing the amount of milk (Guler and Seker, 2009;Dog, 2009), but it should not be combined with fenugreek (T. arabica) because it can lower blood pressure (Talpur et al, 2005). Anise (P. anisum) can be used to increase the amount of milk (Kent et al, 2012), for constipation and irritable bowel syndrome (Mercadante et al, 2011;Mosaffa-Jahromi et al, 2016), and to induce sleep (Marinov and Valcheva-Kuzmanova, 2015). Peppermint (M. piperita) is mainly used to induce calming and relaxing effects (Cook and Lynch, 2008).…”

Oral Morphine Effectiveness in Nigerian Patients With Advanced Cancer

“…This distressing complication had been a focus of study for some researchers (12) in the field of palliative care and many new relieving medications such as amidotrizoate were now being offered to patients with this symptom (13). Excessive somnolence due to the sedative action of oral morphine was reported by 32 patients, necessitating discontinuation of the medication in 5 patients and reduced dosage in the remaining.…”

MASCC recommendations on the management of constipation in patients with advanced cancer

“…traditional remedies, complementary therapies, and other pharmacological interventions. Interventions that have been reported as being effective in patients with advanced cancer include acupuncture (and associated techniques) [60], aroma massage [61], petroleum jelly [62], amidotrizoate / diatrizoate [63], and neostigmine [64]. However, the evidence base (and indeed experience) with these interventions is more limited than with previously discussed interventions.…”