Background Opioid induced constipation (OIC) affects approximately 40% of people taking opioids and is a cause of significant morbidity. Naloxegol is a peripherally acting mu-opioid receptor antagonist used in people who have had an inadequate response to laxative treatment. Most evidence for its use is in patients with non-malignant chronic pain with opioid induced constipation and there is little data for its use in palliative care. The aim of this project is to evaluate the use of naloxegol in people receiving inpatient specialist palliative care.
Methods Retrospective data analysis over a 12-month period for in-patients receiving care in a hospital palliative care unit. The primary outcome of this project was to determine the change in frequency of spontaneous bowel movements in the week following the use of naloxegol.
Results Naloxegol was used in 13 people. Nine males (69%) and 4 females (31%), mean age 58 (range 47–56). Twelve (93%) had cancer, 1 (7%) patient had a diagnosis of COPD. The majority (n=11, 84%) received two or more laxatives prior to commence naloxegol. Naloxegol was effective in 8 (62%) of people, which was demonstrated by an increase in spontaneous bowel movements. There were no side effects documented for 12 (92%) individuals. One person (8%) developed diarrhoea, which resolved with a dose reduction.
Conclusion Naloxegol was well tolerated and effective in the management of OIC in the majority of this palliative care cohort. This will inform further development of regional guidelines for the management of OIC. Future work is needed to evaluate efficacy and to better understand how naloxegol affects quality of life for people with serious illness.
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