Naloxone, naldemedine best for opioid induced constipation

Last Updated: 2018-05-21

By Reuters Staff

NEW YORK (Reuters Health) - Naloxone is the safest and most effective treatment for opioid-induced constipation (OIC), according to a new review and network meta-analysis published in Gut.

Using a different gauge of efficacy, naldemedine and alvimopan ranked first and second, respectively. "In network meta-analysis, naloxone and naldemedine appear to be the most efficacious treatments for OIC," Dr. Alexander C. Ford of St. James's University Hospital in Leeds, UK, and his colleagues conclude in their May 5 report.

Up to 50% of opioid users report constipation, which is linked to more physician visits, absence from work due to illness, and poorer quality of life, the authors note. Many patients with OIC use laxatives, they add, but most do not have a satisfactory response.

Several different types of drugs are available for treating OIC, including mu-opioid receptor antagonists, prokinetics and secretagogues, Dr. Ford and his team note, but their comparative effectiveness is not clear.

To investigate, the authors analyzed 27 randomized controlled trials including 9,149 patients. Naloxone, naldemedine, alvimopan, subcutaneous methylnaltrexone, and prucalopride were each more effective than placebo. When non-response was defined as failure to achieve an average of at least three bowel movements a week, with an increase of at least one BM per week over baseline, or an average of at least 3 BMs per week, naloxone was rated first in efficacy (relative risk 0.65). With non-response defined as failure to achieve an average of at least 3 BMs per week and an increase of at least 1 BM per week, naldemedine was most effective (RR 0.66), followed by alvimopan (RR 0.74).

They conclude: "Clinicians should consider the use of naloxone and naldemedine in OIC as a first choice when laxatives fail. Guidelines for the management of OIC should be updated to include this important information."

Dr. Ford was not available for an interview by press time.

SOURCE: http://bit.ly/2s2Q9xg

Gut 2018.