Methylnaltrexone or laxatives for the Management of Opioid-induced Constipation among Palliative Patients on Opioid Therapy: Evidencebased Review
- *Corresponding Author:
- Abdallah AK
Clinical instructor, Psychiatric and Mental Health
The Hashemite University, Jordan
E-mail: [email protected]
Received date: February 25, 2016; Accepted date: July 12, 2016; Published date: July 24, 2016
Citation: Nezar ASS, Abdallah AK, Nusairat A (2016) Methylnaltrexone or laxatives for the Management of Opioid-induced Constipation among Palliative Patients on Opioid Therapy: Evidence-based Review. Adv Practice Nurs 1:121. doi:10.4172/2573-0347.1000121
Copyright: © 2016 Nezar ASS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Constipation is a common symptom in advanced cancer patients. Studies have demonstrated that 40 to 80% of patients on a palliative care service have constipation, this proportion increases to ≥ 90% when patients are treated with opioids. Opioids are very effective analgesics, frequently prescribed in cancer pain, despite proven analgesic efficacy; the use of opioids is commonly associated with frequently dose-limiting constipation that seriously impacts on patients’ quality of life, almost all patients on opioids report constipation as the major side-effect. The aim of this article is to determine the effectiveness of methylnaltrexone and laxatives in the management of opioidinduced constipation among cancer patients in palliative care setting, with focus on randomized clinical trials. A comprehensive and extensive online database search of Science Direct Database, PubMed, Springer Online Database, and HINARI/WHO Database was conducted; also reference lists of related studies were searched, six studies fulfilling the inclusion criteria from 1991 to 2009 were selected and formed the basis for this paper. In three studies the laxatives lactulose, senna, co danthramer, misrakasneham, and magnesium hydroxide with liquid paraffin were evaluated, in three methylnaltrexone. In studies comparing the different laxatives evidence was inconclusive. Evidence on subcutaneous methylnaltrexone was clearer; evidence on laxatives for management of constipation remains limited due to insufficient RCTs. Ultimately it can be suggested from the data presented here that subcutaneous methylnaltrexone is effective in inducing laxation in palliative care patients with opioid-induced constipation and where conventional laxatives have failed.