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Naloxone Versus Methylnaltrexone for Opioid-Induced Constipation in Critically Ill Patients.
- Source :
-
The Annals of pharmacotherapy [Ann Pharmacother] 2023 Jul; Vol. 57 (7), pp. 762-768. Date of Electronic Publication: 2022 Oct 29. - Publication Year :
- 2023
-
Abstract
- Background: Opioid-induced constipation (OIC) may occur in up to 81% of critically ill patients and can lead to many complications. Opioid antagonists are a reasonable approach and may be used for managing OIC.<br />Objective: The purpose of this study was to assess the efficacy of enteral naloxone (NLX) versus subcutaneous methylnaltrexone (MNTX) for the management of OIC in critically ill patients.<br />Methods: A retrospective analysis was conducted on adult patients who received NLX or MNTX and a continuous opioid infusion for at least 48 hours. The primary end point was time to resolution of constipation, defined as hours to first bowel movement (BM) after the first dose of an opioid antagonist. Reversal of analgesia was assessed by comparing the total number of morphine milligram equivalents (MME) 24 hours preopioid and postopioid antagonist administration. Univariate and multivariate analyses were conducted to assess treatment response within 48 hours.<br />Results: Baseline characteristics were similar between patients receiving NTX (n = 89) and MNTX (n = 71). However, the time to the first BM with NLX was 18 hours compared with 41 hours with MNTX ( P = 0.004). There was no difference in MME requirements 24 hours pre/post NLX or MNTX administration. Naloxone administration was identified as a statistically significant predictor of BM within 48 hours (odds ratio [OR] = 2.68 [1.33-5.38]).<br />Conclusion and Relevance: The time to first BM was shorter with enteral NLX. Both NLX and MNTX appear to be effective for the management of OIC without causing reversal of analgesia. Future controlled, prospective trials comparing these agents are warranted.
- Subjects :
- Adult
Humans
Analgesics, Opioid adverse effects
Critical Illness
Retrospective Studies
Prospective Studies
Constipation chemically induced
Constipation drug therapy
Naltrexone
Narcotic Antagonists therapeutic use
Quaternary Ammonium Compounds therapeutic use
Pain drug therapy
Naloxone therapeutic use
Opioid-Induced Constipation drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1542-6270
- Volume :
- 57
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- The Annals of pharmacotherapy
- Publication Type :
- Academic Journal
- Accession number :
- 36314271
- Full Text :
- https://doi.org/10.1177/10600280221132851