Agents that block opioid effects on bowel but can’t enter the brain to block things there – is a new upcoming option in opoiod induced constipation – something that can be severe and hard to find acceptable alternatives
The older standbys of ground flaxseed and senokot-S work for some people but cramps seem to make certain possibilities unacceptable.
Not all that long ago osmotic laxatives came into routine use – restoralax and laxaday. They draw fluid into the bowel and are not supposed to cause cramps. – this works well for some but still cramps a few
The most recent innovations are peripheral opioid blockers-They block the effects of opioids on the bowel directly.
One agent is called Relistor (Methylnaltrexone bromide). product monogram here
- It a subcutaneous (skin level) injection done daily
- Product monogram here
- dose is by weight and varies from 0.3 mls (6mg) to 0.9 mls (18 mg)
- Comes in 0.6 ml vials – 7 tray kits in a carton
- side effects are minmal
Coming soon:
Targin – a combo of oxycodone and naloxone in a controlled release tablet – orally
- re oxycodone: naloxone they have 10:5, 20:10 and 40:20
- given that the naloxone is not really systemically absorbed, side effects are minimal
- If someone tries to shot it intravenously, they will go into acute withdrawal
- should be here by the new year
Studies on its use:
Expert Opin Pharmacother. 2009 Mar;10(4):531-43.
Combined prolonged-release oxycodone and naloxone improves bowel function in patients receiving opioids for moderate-to-severe non-malignant chronic pain: a randomised controlled trial.
Löwenstein O, Leyendecker P, Hopp M, Schutter U, Rogers PD, Uhl R, Bond S,
Kremers W, Nichols T, Krain B, Reimer K. abstract here
- Had 3 spontaneous Bowel Movements/wk versus One/wk.
Expert Opin Pharmacother. 2009 Mar;10(4):531-43.
Combined prolonged-release oxycodone and naloxone improves bowel function in patients receiving opioids for moderate-to-severe non-malignant chronic pain: a randomised controlled trial.
Löwenstein O, Leyendecker P, Hopp M, Schutter U, Rogers PD, Uhl R, Bond S,
Kremers W, Nichols T, Krain B, Reimer K. abstract here
- no detrimental effects on pain intensity
Comment – idea is great, costs are too high – unless you have coverage.
Any experiences?
I started the new drug Targin 10/5mg on January 17/2011, for chronic abdominal pain. I was previously using 10mg of Statex, every 4 hours, when needed. I find that I have a few more PAINFULL episodes than I did before. I also find that I am having larger bowel movements, than I did before.