Overview and Treatment of Opioid-Induced Constipation

  title={Overview and Treatment of Opioid-Induced Constipation},
  author={Bill H. Mccarberg},
  journal={Postgraduate Medicine},
  pages={17 - 7}
  • B. Mccarberg
  • Published 19 June 2013
  • Medicine, Biology
  • Postgraduate Medicine
Abstract Opioid analgesics have a central place in the management of both chronic and acute moderate-to-severe pain. However, their potential benefits may be compromised by constipation and other related bowel adverse effects mediated by gastrointestinal μ-opioid receptors. These adverse effects occur in up to 90% of patients treated with opioids, and may be sufficiently debilitating to cause patients to discontinue or modify opioid therapy, thereby compromising effective analgesia. Thorough… 
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  • 2016
PAMORA MNTX and naloxegol and the intestinal chloride channel-2 (ClC-2) activator lubiprostone represent additional possible therapeutic options for the management of OIC in patients with chronic noncancer pain.
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The biological effects of μ-opioids on homo- or hetero-oligomerized μ-OPioid receptor are updated and potential mechanisms through which bivalent ligands exert beneficial effects are discussed, including adenylate cyclase regulation and receptor-mediated signaling pathways.
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Management of Opioid-Induced Constipation in Cancer Patients
Preliminary data suggest that methylnaltrexone could be associated with some further clinical benefits other than the treatment of opioid-related constipation, such as the improvement of gastric emptying, the relief of nausea/vomiting, and the reduction of the risk of regurgitation and pulmonary aspiration.
Novel opioid antagonists for opioid-induced bowel dysfunction
This study aims to provide a better understanding of the mechanism of action and reviews the efficacy, safety and the latest research on novel opioid antagonists for OBD.
Lubiprostone for the treatment of opioid-induced bowel dysfunction
Recent data indicate that lubiprostone, a locally acting type 2 chloride channel activator, approved for the treatment of chronic idiopathic constipation and irritable bowel syndrome with constipation, may be effective in treating OBD.
Opioid-induced bowel dysfunction: prevalence, pathophysiology and burden
Patients with OBD suffer from a wide range of symptoms including constipation, decreased gastric emptying, abdominal cramping, spasm, bloating, delayed GI transit and the formation of hard dry stools.
Opioid receptors in the gastrointestinal tract
  • P. Holzer
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    Regulatory Peptides
  • 2009
Methylnaltrexone for treatment of opioid-induced constipation in advanced illness patients.
Subcutaneous methylnaltrexone was efficacious in rapidly inducing laxation and was generally well tolerated in patients with advanced illness and OIC, and there was no change in pain scores or evidence of central opioid withdrawal.
Strategies to manage the adverse effects of oral morphine: an evidence-based report.
Evidence-based recommendations for clinical-practice formulated by an Expert Working Group of the European Association of Palliative Care are presented, highlighting the need for careful evaluation to distinguish between morphine adverse effects from comorbidity, dehydration, or drug interactions, and initial consideration of dose reduction.