December 7, 2018

New Guidelines for Opioid-Induced Constipation

If you missed it in October, the American Gastroenterology Association (AGA) issued new guidelines on opioid-induced constipation (OIC), providing guidance on managing pharmacotherapy.

OIC is a common side effect of opioid therapy, and according to the AGA, it can occur in 40-60% of patients taking chronic opioid therapy.

First and foremost, the AGA encourages providers to ensure that the indication for opioid therapy that leads to OIC is correct, and that patients are in a pain management program, taking the lowest opioid dose possible, to potentially avoid the issue of OIC altogether.

The guidelines then go over various medications used to treat OIC, examining the evidence-base that supports a drug type’s appropriate use, giving recommendations on the use of such therapies.

The guidelines state that laxatives are a first-line treatment, and if a trial of laxatives produces unsatisfactory results, then peripherally-acting mu-opioid receptor antagonist (PAMORA) drugs may be recommended. This includes naldemedine, naloxegol, and methylnaltrexone.

Naldemedine is associated with a high-quality level of supportive evidence for effective use, while naloxegol produced moderate-quality evidence, and methylnaltrexone is associated with conditional, low-quality evidence for effective use.

The AGA made no recommendations for the use of lubiprostone or prucalopride, citing an evidence gap. This evidence gap was cited once more as the AGA did not provide recommendations on newer medications.

For more information, read the guidelines in full online at the Journal of Gastroenterology.

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