Evidence Based Review of Pharmacotherapy for Opioid-Induced Constipation in Noncancer Pain

The Annals of Pharmacotherapy
Julie A Murphy, Erica A Sheridan

Abstract

To summarize and evaluate the existing literature regarding medications to treat opioid-induced constipation (OIC) in patients with chronic noncancer pain (CNCP). PubMed, EMBASE, and Web of Science were searched using the following terms: constipation, opioid, chronic, pain, noncancer, nonmalignant, methylnaltrexone, alvimopan, lubiprostone, naloxegol, and naldemedine. The search was limited to randomized controlled trials reporting human outcomes. Data extracted included the following: study design, population, intervention, control, outcomes related to OIC and safety, and potential biases assessed using Cochrane Collaboration's Risk of Bias Assessment Tool. After assessment, 16 of the 190 studies were included: methylnaltrexone (n = 4), naloxegol (n = 3), naldemedine (n = 2), lubiprostone (n = 3), and alvimopan (n = 4). Lubiprostone was the only nonperipherally acting µ-opioid receptor antagonist included. Only 1 study (naloxegol) used "usual care" (nonstudy laxative) rather than placebo as a comparator. Placebo-controlled trials demonstrated benefit for methylnaltrexone, naloxegol, naldemedine, and lubiprostone, with conflicting evidence for alvimopan. No data suggest that one agent is better than another. Overall risk of bi...Continue Reading

References

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Citations

Jul 7, 2018·Expert Opinion on Pharmacotherapy·Shilan MozaffariMohammad Abdollahi
Jan 18, 2019·Expert Review of Clinical Pharmacology·Xuesong SongShiyong Teng
Apr 6, 2018·Current Pain and Headache Reports·Peter S OstlingAlan D Kaye
May 16, 2019·The Korean Journal of Pain·Kordula Lang-Illievich, Helmar Bornemann-Cimenti
Dec 20, 2019·Current Treatment Options in Oncology·Ricard MesíaEduardo Pujol
Aug 3, 2021·Journal of Pain Research·Flaminia ColuzziFabio Lugoboni

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