Naloxegol rescue with methylnaltrexone highly effective
Jenny Brocklebank1, Elizabeth Jane Miller2, Samuel Fingas2
1Palliative care, St Luke's Hospice, Sheffield, UK jbrocklebank@nhs.net.
BMJ Supportive & Palliative Care
|July 26, 2020
Summary
Opioid-induced constipation (OIC) is a common side effect. A patient with OIC responded to methylnaltrexone after failing naloxegol, highlighting PAMORA options.
Area of Science:
- Palliative Care
- Pharmacology
- Gastroenterology
Background:
- Opioid-induced constipation (OIC) significantly impacts patient quality of life.
- Peripherally acting µ-opioid receptor antagonists (PAMORAs) like naloxegol and methylnaltrexone are established treatments for OIC.
Observation:
- A palliative care patient with refractory OIC demonstrated an inadequate response to naloxegol.
- The same patient experienced an immediate and effective response to methylnaltrexone at a weight-based dose.
Findings:
- This case illustrates a differential response to two PAMORAs in managing OIC.
- Methylnaltrexone provided effective relief where naloxegol failed.
Implications:
- This case suggests methylnaltrexone may be a valuable alternative for OIC management when naloxegol is ineffective.
- The potential for concomitant PAMORA use warrants further investigation in OIC treatment strategies.
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