Efficacy of senna versus lactulose in terminal cancer patients treated with opioids

Abstract

The best laxative for terminal cancer patients treated with opioids still remains to be determined. This comparative study was conducted with the objective of determining treatment and cost efficiency for senna and lactulose in terminal cancer patients treated with opioids. The methodology used a randomized, open, parallel group design. The study was conducted in the Palliative Care Unit in one Madrid Health Care District. Ninety-one terminal cancer patients were randomized into two groups: A = treated with senna (starting with 0.4 mL daily), and B = treated with lactulose (starting with 15 mL daily) for a 27-day period. The main outcome measures were defecation-free intervals of 72 hr, days with defecation, general health status, and treatment cost. Laxative efficacy was analyzed through t test and analysis of variance. No difference was found between the laxatives in defecation-free intervals or in days with defecation. The final scores for general health status were similar in both groups. Given that the two treatments have similar efficacy and adverse effects, a recommendation is made for the use of senna because its cost is lower than lactulose.

Management of opioid-induced bowel dysfunction in cancer patients

“…Colonic melanosis resulting from the presence of an accumulation of apoptotic epithelial cells that have been phagocytosed by macrophages [20] has been reported when these drugs are used. No important differences have been found when comparing the effec- tiveness between osmotic and stimulant agents such as lactulose and senna [1,29]. Notwithstanding, simultaneous use of both agents produces a superior effect [48].…”

Barriers to pain management in the rehabilitation of the surgical oncology patient

“…When constipation does result, a number of medication options are available. Senna in one RCT had similar efficacy to lactulose for opioid-induced constipation among cancer patients, but the cost was significantly lower [55] (NCCN category 1). Adding poletheylene glycol (Miralax TM ) in a step-wise approach to standard management was found to be effective in 78.4% of patients [56] Opioids not only impair GI motility, but also bladder detrussor contraction.…”

Symptom Control in Palliative Care—Part I: Oncology as a Paradigmatic Example

“…The small number of randomized studies conducted in this patient group have shown conflicting results and differed in their designs and endpoints, and are therefore not helpful. [47][48][49] Most recommendations are extrapolated from other fields of medicine. Although there are various recommendations in the literature on initiating patients on a bowel regimen, the most important point to remember is that regimens should be individualized and titrated to response.…”