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Symptom Control in Hospice-State of the Art
Published in Inge B. Corless, Zelda Foster, The Hospice Heritage: Celebrating Our Future, 2020
J. Cameron Muir, Lisa M. Krammer, Jacqueline R. Cameron, Charles F. von Gunten
Anecdotal evidence supports the use of gastrointestinal pro-kinetic drugs (e.g., metoclopramide, cisapride) to treat refractory constipation. Future directions include the use of poorly absorbed opiate antagonists (similar to naloxone) to treat opioid-induced constipation.
Behavioural approaches to managing substance-related problems in gastrointestinal conditions
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
Opioid-induced bowel dysfunction (OIBD) is a common condition with symptoms such as constipation, nausea, abdominal pain, gas, and gastrooesophageal reflux. Opioid-induced constipation is the most commonly reported, ranging from 15–90% of patients taking chronic opioids [28] and is associated with reduced QoL and social and work functional impairment [29]. Narcotic bowel syndrome (NBS) is a condition occurring in about 6% of patients using chronic opioids and consists of chronic or repetitive abdominal pain [14, 30]. Along with pain, patients with NBS frequently experience nausea, vomiting, abdominal distention and constipation. These symptoms can pose diagnostic challenges since NBS can co-occur with OIBD [31].
Clinical pharmacology of opioids: adverse effects of opioids
Published in Nigel Sykes, Michael I Bennett, Chun-Su Yuan, Clinical Pain Management, 2008
There is increasing interest in the therapeutic possibilities of opioid antagonists in opioid-induced constipation. Several studies have already tested naloxone, methylnaltrexone, and alvimopam and found them to be useful,156, 157, 158[II] but the potential to precipitate opioid withdrawal with the old antagonists, such as naloxone, is real.
Can NSAIDs and Acetaminophen Effectively Replace Opioid Treatment Options for Acute Pain?
Published in Expert Opinion on Pharmacotherapy, 2021
Joseph V. Pergolizzi, Peter Magnusson, Jo Ann LeQuang, Frank Breve, Robert Taylor, Charles Wollmuth, Giustino Varrassi
Opioid analgesics are associated with a wide range of adverse events that appear to be common to the entire drug class, such as nausea, vomiting, headache, dizziness, somnolence, fatigue, pruritus, and constipation[32]. Opioid-induced constipation differs from other forms of constipation and does not resolve even with opioid tolerance; it can be a distressing side effect for patients that is challenging to manage effectively[33]. However, opioid-induced constipation is likely not a treatment-limiting condition for a short course of opioids to treat acute pain of brief duration. Prolonged or even short-term exposure to opioids may put certain patients are risk for opioid use disorder, which has become a major public health crisis in the United States and other parts of the world[34]. While opioid toxicity can occur with both prescription and illicit opioids, the healthcare system is increasingly cognizant of reducing the exposure of patients to prescription opioids for multiple reasons. Opioid misuse tends to be most severe in communities where opioids are heavily prescribed[35]. In the United States, opioid prescribing varies markedly among regions with rural Appalachia having very high rates of opioid prescribing and also very high rates of overdose [36,37]. Thus, prescribing fewer opioids may reduce community misuse of opioids.
Absorption, distribution, metabolism, and excretion of radiolabeled naldemedine in healthy subjects
Published in Xenobiotica, 2019
Shuichi Ohnishi, Kazuya Fukumura, Ryuji Kubota, Toshihiro Wajima
Opioids effectively reduce pain by interacting with opioid receptors in both the central and peripheral nervous systems (Camilleri et al., 2014). A common side effect of opioid use is opioid-induced constipation (OIC), which occurs when opioids bind and activate enteric μ-opioid receptors, thereby impairing motility within the gastrointestinal tract and reducing evacuation of the bowel (Benyamin et al., 2008; Camilleri et al., 2014; Nelson & Camilleri, 2016; Swegle & Logemann, 2006). Of all the symptoms associated with opioid-induced bowel dysfunction, constipation is considered the most bothersome, and over half of the patients affected by constipation rate the impact on their quality-of-life as moderate-to-great or great (Bell et al., 2009). Further, constipation is one of the most frequent reasons patients avoid or stop using opioids, resulting in inadequate pain management (Bell et al., 2009; Thorpe, 2001).
Emerging PEGylated non-biologic drugs
Published in Expert Opinion on Emerging Drugs, 2019
Eun Ji Park, Jiyoung Choi, Kang Choon Lee, Dong Hee Na
Of the PEGylated drugs approved since 1990, 15 products are protein-based biopharmaceuticals (Table 1) and they are estimated to be part of a multi-billion dollar market [41]. Representatively, pegfilgrastim (Neulasta®, Amgen and Kyowa Hakko Kirin) is a top-selling PEGylated product with annual global sales of more than 4 billion dollars and its biosimilar versions, such as pegfilgrastim-jmdb (Fulphila®, Mylan Pharmaceuticals) and pegfilgrastim-cbqv (Udenyca®, Coherus BioSciences) were recently approved by the FDA [42]. According to the report by Global Market Insights, the market size of PEGylated drugs in North America and Europe was valued at over 7.7 billion US dollars in 2017 and is expected to exceed 10.5 billion US dollars by 2024, with more than 5% compound annual growth rate from 2018 to 2024 [43]. This report forecasted that gastrointestinal disorders related to Movantik® (Naloxegol) for the treatment of opioid-induced constipation are expected to present a possible growth of 19% over the forecast period (2018–2024) [43].