Tramadol-induced oral dryness and pilocarpine treatment: Effects on total protein and IgA

Looström, Henning; Åkerman, Sigvard; Ericson, Dan; Tobin, Gunnar; Götrick, Bengt

doi:10.1016/j.archoralbio.2010.10.019

Cited by 15 publications

(8 citation statements)

References 23 publications

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“…A randomized double‐blind placebo‐controlled study using tramadol showed that xerostomia was associated with decreased whole saliva flow rates and protein content compared with healthy controls and that administration of pilocarpine increased the flow rate and protein content of saliva in the presence of tramadol (Looström et al , ). Morphine sulfate and the opioid antagonist naltrexone hydrochloride, used to manage chronic pain due to osteoarthritis in a phase 3 randomized withdrawal, double‐blind multicenter study, showed xerostomia as an adverse effect.…”

Section: Resultsmentioning

confidence: 99%

World Workshop on Oral Medicine VI: a systematic review of medication‐induced salivary gland dysfunction

et al. 2016

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The aim of this paper was to perform a systematic review of the pathogenesis of medication-induced salivary gland dysfunction (MISGD). Review of the identified papers was based on the standards regarding the methodology for systematic reviews set forth by the World Workshop on Oral Medicine IV and the PRISMA statement. Eligible papers were assessed for both the degree and strength of relevance to the pathogenesis of MISGD as well as on the appropriateness of the study design and sample size. A total of 99 papers were retained for the final analysis. MISGD in human studies was generally reported as xerostomia (the sensation of oral dryness) without measurements of salivary secretion rate. Medications may act on the central nervous system (CNS) and/or at the neuroglandular junction on muscarinic, α-and β-adrenergic receptors and certain peptidergic receptors. The types of medications that were most commonly implicated for inducing salivary gland dysfunction were those acting on the nervous, cardiovascular, genitourinary, musculoskeletal, respiratory, and alimentary systems. Although many medications may affect the salivary flow rate and composition, most of the studies considered only xerostomia. Thus, further human studies are necessary to improve our understanding of the association between MISGD and the underlying pathophysiology.

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Section: Resultsmentioning

confidence: 99%

World Workshop on Oral Medicine VI: a systematic review of medication‐induced salivary gland dysfunction

et al. 2016

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“…Pilocarpine is a low-cost muscarinic agonist that stimulates salivary flow [23,24]. Mercadante et al reported that no patients withdrew because of adverse effects and it was well tolerated [19] compared with Davies et al reporting that 9 of 38 patients withdrew because of side effects of pilocarpine [18].…”

Section: Discussionmentioning

confidence: 97%

Systematic literature review: xerostomia in advanced cancer patients

Hanchanale

Adkinson

Daniel

et al. 2014

Support Care Cancer

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Limited published data exists reporting the effectiveness of measures in the treatment of xerostomia in cancer patients. Based on primary research of low quality, firm conclusions cannot be drawn. However, pilocarpine, artificial saliva, chewing gum and acupuncture can be tried based on the available data. This highlights the explicit need to improve our evidence base. Properly constructed randomized controlled trials demonstrating effectiveness of pharmacological and non-pharmacological interventions for dry mouth are required.

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“…In concert, these synergistic effects lead to opioid-induced bowel dysfunction (OIBD) 4. Hence, OIBD is a pharmacologically induced condition manifested with different symptoms such as dry mouth, gastroesophageal reflux, vomiting, bloating, abdominal pain, anorexia, hard stools, constipation, and incomplete evacuation 5,6. Unfortunately, tolerance to OIBD does not evolve and consequently several studies have confirmed a high prevalence of OIBD in pain patients 5,7.…”

Section: Introductionmentioning

confidence: 99%

Clinical potential of naloxegol in the management of opioid-induced bowel dysfunction

Poulsen¹,

Brock²,

Olesen³

et al. 2014

CEG

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Opioid-induced bowel dysfunction (OIBD) is a burdensome condition which limits the therapeutic benefit of analgesia. It affects the entire gastrointestinal tract, predominantly by activating opioid receptors in the enteric nervous system, resulting in a wide range of symptoms, such as reflux, bloating, abdominal cramping, hard, dry stools, and incomplete evacuation. The majority of studies evaluating OIBD focus on constipation experienced in approximately 60% of patients. Nevertheless, other presentations of OIBD seem to be equally frequent. Furthermore, laxative treatment is often insufficient, which in many patients results in decreased quality of life and discontinuation of opioid treatment. Novel mechanism-based pharmacological approaches targeting the gastrointestinal opioid receptors have been marketed recently and even more are in the pipeline. One strategy is prolonged release formulation of the opioid antagonist naloxone (which has limited systemic absorption) and oxycodone in a combined tablet. Another approach is peripherally acting, μ-opioid receptor antagonists (PAMORAs) that selectively target μ-opioid receptors in the gastrointestinal tract. However, in Europe the only PAMORA approved for OIBD is the subcutaneously administered methylnaltrexone. Alvimopan is an oral PAMORA, but only approved in the US for postoperative ileus in hospitalized patients. Finally, naloxegol is a novel, oral PAMORA expected to be approved soon. In this review, the prevalence and pathophysiology of OIBD is presented. As PAMORAs seem to be a promising approach, their potential effect is reviewed with special focus on naloxegol’s pharmacological properties, data on safety, efficacy, and patient-focused perspectives. In conclusion, as naloxegol is administered orally once daily, has proven efficacious compared to placebo, has an acceptable safety profile, and can be used as add-on to existing pain treatment, it is a welcoming addition to the targeted treatment possibilities for OIBD.

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Tramadol-induced oral dryness and pilocarpine treatment: Effects on total protein and IgA

Cited by 15 publications

References 23 publications

World Workshop on Oral Medicine VI: a systematic review of medication‐induced salivary gland dysfunction

World Workshop on Oral Medicine VI: a systematic review of medication‐induced salivary gland dysfunction

Systematic literature review: xerostomia in advanced cancer patients

Clinical potential of naloxegol in the management of opioid-induced bowel dysfunction

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