Laxatives or methylnaltrexone for the management of constipation in palliative care patients

Candy, Bridget; Jones, Louise; Goodman, Margaret; Drake, Robyn; Tookman, Adrian

doi:10.1590/s1516-31802011000400014

Sao Paulo Med. J.

2011

DOI: 10.1590/s1516-31802011000400014

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Laxatives or methylnaltrexone for the management of constipation in palliative care patients

Bridget Candy¹,

Louise Jones²,

Margaret Goodman³

et al.

Abstract: BACKGROUND: Constipation is common in palliative care; it can generate considerable suffering due to the unpleasant physical symptoms. In the first Cochrane Review on effectiveness of laxatives for the management of constipation in palliative care patients, published in 2006, no conclusions could be drawn because of the limited number of evaluations. This article describes the first update of this review. OBJECTIVE: To determine the effectiveness of laxatives or methylnaltrexone for the management of constipat… Show more

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Opioids and GI Motility—Friend or Foe?

Lee

Hasler

2016

Curr Treat Options Gastro

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The use of opioids for the treatment of chronic non-cancer pain is growing at an alarming rate. Opioid-induced bowel dysfunction (OBD) is a common adverse effect of long-term opioid treatment manifesting as constipation, nausea, and vomiting. These effects are primarily mediated by peripheral μ-opioid receptors with resultant altered GI motility and function. As a result, patients may present with opioid-induced constipation (OIC), opioid-induced nausea and vomiting (OINV), and/or narcotic bowel syndrome (NBS). This often leads to decreased quality of life and in many cases, discontinuation of opioid therapy. There is limited evidence to support the use of traditional anti-emetics and laxatives in the treatment of OBD. Tapering the dose of opioids, switching to transdermal application, opioid rotation, or dual-action opioids, such as tapentadol, may be helpful in the treatment of OBD. Novel agents, such as peripherally acting μ-opioid receptor antagonists which target the cause of OIC, show promise in the treatment of OBD and should be considered when conventional laxatives fail. This chapter will review the pathophysiology of OBD, including OINV and OIC, and treatment options available.

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Opioids and GI Motility—Friend or Foe?

Lee

Hasler

2016

Curr Treat Options Gastro

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Evolving paradigms in the treatment of opioid-induced bowel dysfunction

Poulsen

Brock

Olesen

et al. 2015

Therap Adv Gastroenterol

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Abstract:In recent years prescription of opioids has increased significantly. Although effective in pain management, bothersome gastrointestinal adverse effects are experienced by a substantial proportion of opioid-treated patients. This can lead to difficulties with therapy and subsequently inadequate pain relief. Collectively referred to as opioid-induced bowel dysfunction, these adverse effects are the result of binding of exogenous opioids to opioid receptors in the gastrointestinal tract. This leads to disturbance of three important gastrointestinal functions: motility, coordination of sphincter function and secretion. In the clinic this manifests in a wide range of symptoms such as reflux, bloating, abdominal cramping, hard, dry stools, and incomplete evacuation, although the most known adverse effect is opioid-induced constipation. Traditional treatment with laxatives is often insufficient, but in recent years a number of novel pharmacological approaches have been introduced. In this review the pathophysiology, symptomatology and prevalence of opioid-induced bowel dysfunction is presented along with the benefits and caveats of a suggested consensus definition for opioid-induced constipation. Finally, traditional treatment is appraised and compared with the latest pharmacological developments. In conclusion, opioid antagonists restricted to the periphery show promising results, but use of different definitions and outcome measures complicate comparison. However, an international working group has recently suggested a consensus definition for opioid-induced constipation and relevant outcome measures have also been proposed. If investigators within this field adapt the suggested consensus and include symptoms related to dysfunction of the upper gut, it will ease comparison and be a step forward in future research.

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Laxatives or methylnaltrexone for the management of constipation in palliative care patients

Cited by 2 publications

References 1 publication

Opioids and GI Motility—Friend or Foe?

Opioids and GI Motility—Friend or Foe?

Evolving paradigms in the treatment of opioid-induced bowel dysfunction

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