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Emerging therapies for opioid-induced constipation: what can we expect?
Ghazal Roostaei1,2, Niloofar Khoshnam Rad2,3, Maryam S Fakhri B1
1Department of Internal Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
Expert Opinion on Pharmacotherapy
|September 23, 2024
Summary
Opioid-induced constipation (OIC) management is evolving. Emerging therapies like PAMORAs show promise, but cost and further validation are needed for optimal patient care.
Area of Science:
- Gastroenterology
- Pain Management
- Pharmacology
Background:
- Opioid use for chronic and oncologic pain is increasing.
- Opioid-induced constipation (OIC) significantly impacts patient quality of life and pain management.
- Current OIC management strategies require refinement.
Purpose of the Study:
- To review and critique emerging therapies for OIC.
- To discuss the efficacy of peripherally acting mu-opioid receptor antagonists (PAMORAs) and other novel treatments.
- To highlight current guideline limitations and future research needs.
Main Methods:
- Critical review of emerging OIC therapies.
- Analysis of PAMORAs (methylnaltrexone, naloxegol, naldemedine).
- Inclusion of intestinal secretagogues, 5-HT receptor agonists, and adjunctive therapies (TENS, electroacupuncture).
Main Results:
- PAMORAs effectively target opioid-induced gut dysfunction.
- Other therapies like lubiprostone, linaclotide, and prucalopride offer alternative mechanisms.
- Adjunctive therapies show potential but need further validation.
Conclusions:
- A stepwise approach to OIC management is crucial, considering patient factors.
- PAMORAs show efficacy but face challenges with cost and comparative data.
- Future research must focus on long-term outcomes, cost-effectiveness, and comparative studies.
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