Constipation: opioid antagonists in people prescribed opioids

Area of Science:

• Pharmacology
• Gastroenterology
• Oncology

Background:

• Opioid therapy frequently causes constipation, affecting over half of cancer patients and a higher percentage of terminally ill patients.
• Constipation is a significant adverse effect of opioid use, impacting patients with both malignant and non-malignant conditions.
• The prevalence of opioid-induced constipation necessitates effective management strategies.

Purpose of the Study:

• To systematically review the efficacy of opioid antagonists in managing constipation in individuals prescribed opioids.
• To answer the clinical question regarding the effects of opioid antagonists for opioid-induced constipation.

Main Methods:

• A systematic overview of existing literature was conducted.
• Searches were performed in major databases including Medline, Embase, and The Cochrane Library up to May 2014.
• Included studies comprised two systematic reviews and one randomized controlled trial (RCT), with a GRADE evaluation performed.

Main Results:

• The review identified and screened 84 records after initial database searches yielded 162 studies.
• Thirty-seven full publications were evaluated, leading to the inclusion of relevant systematic reviews and RCTs.
• The efficacy of three specific interventions was assessed.

Conclusions:

• The systematic overview categorized the efficacy of alvimopan, methylnaltrexone, and naloxone for treating opioid-induced constipation.
• These opioid antagonists represent potential therapeutic options for managing this common opioid side effect.
• Further evaluation of these interventions provides insight into their effectiveness in clinical practice.