The effects of food on opioid-induced nausea and vomiting and pharmacological parameters: a systematic review

ABSTRACT

Opioids remain the standard of care for treating moderate to severe pain resulting from surgery or injury in cases of acute pain, and are recommended for patients who have not responded to nonopioid analgesics. Effective management of pain has an impact on clinical course and often depends on achieving an acceptable balance between opioid efficacy, safety, and tolerability. Common opioid-related adverse events such as nausea and vomiting are associated with an overall lower achievement of effective pain management and patient satisfaction. However, in practice, clinicians employ various strategies to maximize efficacy, minimize these adverse effects, and ensure the careful, judicious, and evidence-based use of opioids for patients who require them. Typical strategies for management and minimization of these types of adverse events include dose reduction, dose titration, opioid rotation, prescription for an antiemetic, and recommending the patient take opioids with food. Overall, the most straightforward approach that clinicians tend to employ that does not require additional visits or adjustment of prescriptions, is to recommend patients take opioids with food. However, given the current climate with opioids, it is critical and imperative that decisions for use of opioids be grounded in a solid and thorough evidence-base. In fact, several opioids are recommended to be taken explicitly with or without food because of interactions with abuse-deterrent technologies that can cause increased adverse events or inadequate analgesia. Therefore, we sought to review, synthesize, and summarize the literature for randomized, controlled trials and other studies to support the hypothesis that taking opioids with food reduces opioid-related events such as nausea and vomiting. Based on the current evidence we surveyed, the recommendation to take opioids with food does not appear to consistently and unequivocally reduce nausea and vomiting and, in many cases, increases the frequency of these adverse events in the studies we examined.

KEYWORDS:

• Opioid
• food-effect
• opioid-induced nausea
• opioid pharmacokinetics

Declaration of interest

R Raffa is periodically a consultant, invited to advisory board meetings, and/or has spoken at symposia for the following pharmaceutical companies within the last 5 years: AstraZeneca, Collegium, Daiichi-Sankyo, Depomed, Egalet, Endo, Grünenthal, Inspirion Delivery Technologies, Iroko, Johnson & Johnson, Kaléo, KemPharm, Kirax, Mallinckrodt/Covidien, Mundipharma, Pfizer, Purdue, Shionogi, Teva, Trevena, and others. R Raffa is also a co-founder of CaRafe Drug Innovation, a non-opioid drug discovery/development company. J Pergolizzi has acted as a consultant/speaker and researcher for: Inspirion, Mallinckrodt, Baxter, Purdue Pharma LLP, Grunenthal GmhB, BDSI, ENDO Pharmaceuticals Iroko, DepoMed, Collegium, and Mundi Pharma. Editorial and writing assistance was provided by David Marks, Phd, of ETHOS Health Communications, Yardley, PA and was funded by Daiichi Sankyo and Charleston Laboratories. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This article was sponsored by Daiichi Sankyo Co., Ltd, Tokyo, Japan and Charleston Laboratories.