1. Optimal treatment of opioid induced constipation in daily clinical practice - an observational study.
- Author
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Neefjes ECW, van der Wijngaart H, van der Vorst MJDL, Ten Oever D, van der Vliet HJ, Beeker A, Rhodius CA, van den Berg HP, Berkhof J, and Verheul HMW
- Subjects
- Aged, Analgesics, Opioid therapeutic use, Constipation etiology, Female, Fentanyl adverse effects, Fentanyl therapeutic use, Humans, Laxatives therapeutic use, Male, Middle Aged, Naltrexone analogs & derivatives, Naltrexone therapeutic use, Narcotic Antagonists therapeutic use, Neoplasms complications, Neoplasms drug therapy, Oxycodone adverse effects, Oxycodone therapeutic use, Pain Management adverse effects, Pain Management methods, Prospective Studies, Quaternary Ammonium Compounds therapeutic use, Retrospective Studies, Surveys and Questionnaires, Analgesics, Opioid adverse effects, Constipation drug therapy
- Abstract
Background: Opioids are prescribed in over 40% of patients with advanced cancer, but side effects occur frequently. In this study we evaluated the development and treatment of opioid induced constipation (OIC), and OIC resolving effect of methylnaltrexone for different opioid subtypes in daily clinical practice., Methods: Patients with cancer using opioids were included in a retrospective chart analysis. Baseline characteristics, data on opioid use, laxative use, and OIC were collected. Patients with OIC who were prescribed methylnaltrexone, were included in a prospective observational trial (NCT01955213)., Results: Thirty-nine of 327 patients (pts) with cancer who were treated with opioids suffered from OIC (overall prevalence 12%; 95%-CI: 8-15%). The prevalence of OIC was similar in patients treated with oxycodone or fentanyl (12 of 81 pts. vs. 18 of 110 pts., RR 0.9; 95%CI 0.4-2.0). The morphine equivalent daily dose did not significantly differ between opioid subtypes (fentanyl 89 mg (IQR 60-180) vs. oxycodone 40 mg (40-80), P = 0.231). Twenty-two individual patients (7%) were admitted for OIC. Most effective laxatives in admitted patients were enemas, methylnaltrexone, or 4-l polyethylene-glycol solution. In the prospective observational study, the effect of methylnaltrexone could be evaluated in 23 patients. Eleven patients achieved the primary endpoint of ≥2 laxation responses out of the first four doses methylnaltrexone, independent of opioid subtype., Conclusions: OIC is a burdensome clinical problem independent of opioid subtype. Timely intensification of prophylactic laxative treatment, especially when opioid doses increase, may help to prevent OIC. Clinically overt OIC requires a more intensive laxative regimen with for example methylnaltrexone., Trial Registration: NCT01955213 .
- Published
- 2019
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