New Options For Opioid Induced Constipation

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?

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One Response to New Options For Opioid Induced Constipation

  1. C. Flavel says:

    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.

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