Opioid-induced constipation

Abstract

Opioid-induced constipation (OIC) is a very troublesome, difficult to manage and a nearly universal complication of chronic opioid use to control pain associated with advanced illness. Some studies have reported that OIC is so intolerable in some patients that they skip their opioid medications and bear pain instead of OIC. Laxatives have commonly been used as a prophylaxis and treatment of OIC but they are frequently ineffective because the commonly available laxatives do not target the underlying mechanism of OIC, which is the blockade of peripheral mu-receptors. Recently, there have been a number of advances in the treatment of OIC, which any physician involved with opioid-prescribing discipline should be aware of. This review will update the new options and strategies available for treating OIC along with the relevant clinical trials. Finally, this review also provides a recommendation on the preferred way to approach a patient with OIC in the modern era as well as highlight on the importance of doctor–patient communication in this setting.

Key Words:

• Doctor–patient communication
• laxatives
• linaclotide
• lubiprostone
• opioid-induced-constipation
• opioid–naloxone combination
• opioids
• peripherally acting mu-opioid receptor antagonists
• tapentadol

Declaration of interest: Yuichi Ando has received grants from Sanofi, Torii Pharmaceutical, Nippon Kayaku, Mitsubishi Tanabe Pharma, and Mochida Pharmaceutical; grants and personal fees from Chugai Pharmaceutical, Takeda Pharmaceutical, Daiichi Sankyo, Kyowa Hakko Kirin, Eisai, Taiho Pharmaceutical, Yakult Honsya, and Merck Serono; and personal fees from Ono Pharmaceutical, Eli Lilly Japan, Pfizer, Novartis Pharma, Janssen Pharmaceutical, Hisamitsu Pharmaceutical, Mochida Pharmaceutical, AstraZenaca, GlaxoSmithKline, ASKA Pharmaceutical, Terumo, and Bayel Holdings. All other authors declare no competing interests.