Peripherally acting μ-opioid receptor antagonists as treatment options for constipation in noncancer pain patients on chronic opioid therapy

Abstract

Joseph V Pergolizzi Jr,1 Robert B Raffa,2,3 Marco Pappagallo,4 Charles Fleischer,1 Joseph Pergolizzi III,1 Gianpietro Zampogna,5 Elizabeth Duval,1 Janan Hishmeh,1 Jo Ann LeQuang,1 Robert Taylor Jr1 1NEMA Research, Inc., Naples, FL, 2University of Arizona College of Pharmacy, University of Arizona, Tucson, AZ, 3Temple University School of Pharmacy, Temple University, Philadelphia, PA, 4Department of Medicine, Albert Einstein College of Medicine, New York, NY, 5Department of Medicine, St. Luke’s Hospital, Cleveland, OH, USA Abstract: Opioid-induced constipation (OIC), a prevalent and distressing side effect of opioid therapy, does not reliably respond to treatment with conventional laxatives. OIC can be a treatment-limiting adverse event. Recent advances in medications with peripherally acting μ-opioid receptor antagonists, such as methylnaltrexone, naloxegol, and alvimopan, hold promise for treating OIC and thus extending the benefits of opioid analgesia to more chronic pain patients. Peripherally acting μ-opioid receptor antagonists have been clinically tested to improve bowel symptoms without compromise to pain relief, although there are associated side effects, including abdominal pain. Other treatment options include fixed-dose combination products of oxycodone analgesic together with naloxone. Keywords: opioid-induced constipation, opioid bowel disorder, PAMORA, peripherally acting mu-opioid receptor antagonist, noncancer pain patients, opioid-associated side effects

Keywords

• Opioid-induced constipation
• opioid bowel disorder
• chronic opioid therapy
• noncancer pain patients
• opioid-associated side effects