Opioid-induced constipation: advances and clinical guidance

Abstract

Currently opioids are the most frequently used medications for chronic noncancer pain. Opioid-induced constipation is the most common adverse effect associated with prolonged use of opioids, having a major impact on quality of life. There is an increasing need to treat opioid-induced constipation. With the recent approval of medications for the treatment of opioid-induced constipation, there are several therapeutic approaches. This review addresses the clinical presentation and diagnosis of opioid-induced constipation, barriers to its diagnosis, effects of opioids in the gastrointestinal tract, differential tolerance to opiates in different gastrointestinal organs, medications approved and in development for the treatment of opioid-induced constipation, and a proposed clinical management algorithm for treating opioid-induced constipation in patients with noncancer pain.

Colorectal Transit and Volume During Treatment With Prolonged-release Oxycodone/Naloxone Versus Oxycodone Plus Macrogol 3350

“…The exclusion criteria were: (1) known allergy towards opioids, (2) participation in any other studies within 14 days of enrolment, (3) planned medical/surgical treatment within the study duration, (4) a need to operate heavy machinery or motor vehicles during the study, (5) any previous or current drug abuse, (6) non-removable piercings or metal implants, (7) daily alcohol or nicotine consumption, (8) any known disease that may influence the results, and (9) the use of prescribed medicine and/or herbal medicine.…”

“…7 Several opioid receptor antagonists directly targeting the pathophysiology behind OIC have been introduced. Initial results have been promising, 8,9 but head-to-head comparison of these opioid antagonists versus conventional laxatives has not been conducted. Furthermore, considerable diversity in outcome measures used in previous trials makes comparison of efficacy difficult.…”

PharmaNews

“…Bei unzureichendem Ansprechen auf Laxanzien kann der kausale Wirk ansatz von peripher wirkenden μ-Opioid-Rezeptor-Antagonisten (PAMORA) wie Naloxegol (Moventig ® ) zur effektiven Behandlung der OIC beitragen [6] und eine dosisgerechte Durchführung der Schmerztherapie gewährleisten, wie PD Dr. Stefan Wirz, Bad Honnef, in einem Interview berichtet. Eine OIC kann jederzeit nach Einleitung einer Opioid-Therapie und bereits bei Verwendung schwacher Opioid-Analgetika und bei niedrigen Dosierungen auftreten [7,8]. Die Folge ist das Auftreten von zum Beispiel hartem Stuhlgang und mühevoller, oft inkompletter Stuhlentleerung sowie begleitend auftretendes Völlegefühl, Bauchdruck und -schmerzen, Blähungen, Übelkeit und Erbrechen [9][10][11].…”

Synthesis and opioid receptor binding of indium (III) and [111In]-labeled macrocyclic conjugates of diprenorphine: novel ligands designed for imaging studies of peripheral opioid receptors

“…These include mediation of cardiovascular functions, 5 visceral and inflammatory pain relief, 6 cell death and survival, 7 and smooth muscle contraction. 8 For instance, there is growing interest in peripheral opioid analgesics to evade the central side effects of respiratory depression and euphoria, 6 while peripheral antagonists are indispensable for clinical management of opioid-induced bowel dysfunction. 8b Moreover, opioid receptors are over-expressed by several types of cancer, and are emerging as molecular oncology targets for imaging and therapy.…”

“…8 For instance, there is growing interest in peripheral opioid analgesics to evade the central side effects of respiratory depression and euphoria, 6 while peripheral antagonists are indispensable for clinical management of opioid-induced bowel dysfunction. 8b Moreover, opioid receptors are over-expressed by several types of cancer, and are emerging as molecular oncology targets for imaging and therapy. 9 For illustration, PET imaging of lung cancer patients shows high levels of μ and δ opioid receptors on primary lung tumors as compared to normal lung.…”