Peripherally-active mu-opioid receptor antagonists for constipation in critically ill patients receiving opioids: A case-series and a systematic review and meta-analysis of the literature.
PAMORAs
constipation
critically ill
intensive care unit
naldemedine
opioid-induced constipation
Journal
Neurogastroenterology and motility
ISSN: 1365-2982
Titre abrégé: Neurogastroenterol Motil
Pays: England
ID NLM: 9432572
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
revised:
15
09
2023
received:
12
02
2023
accepted:
09
10
2023
medline:
1
12
2023
pubmed:
23
10
2023
entrez:
23
10
2023
Statut:
ppublish
Résumé
Constipation is frequent in critically ill patients, and potentially related to adverse outcomes. Peripherally-active mu-opioid receptor antagonists (PAMORAs) are approved for opioid-induced constipation, but information on their efficacy and safety in critically ill patients is limited. We present a single-center, retrospective, case-series of the use of naldemedine for opioid-associated constipation, and we systematically reviewed the use of PAMORAs in critically ill patients. Case-series included consecutive mechanically-ventilated patients; constipation was defined as absence of bowel movements for >3 days. Naldemedine was administered after failure of the local laxation protocol. Systematic review: PubMed was searched for studies of PAMORAs to treat opioid-induced constipation in adult critically ill patients. time to laxation, and number of patients laxating at the shortest follow-up. gastric residual volumes and adverse events. A total of 13 patients were included in the case-series; the most common diagnosis was COVID-19 ARDS. Patients had their first bowel movement 1 [0;2] day after naldemedine. Daily gastric residual volume was 725 [405;1805] before vs. 250 [45;1090] mL after naldemedine, p = 0.0078. Systematic review identified nine studies (two RCTs, one prospective case-series, three retrospective case-series and three case-reports). Outcomes were similar between groups, with a trend toward a lower gastric residual volume in PAMORAs group. In a highly-selected case-series of patients with refractory, opioid-associated constipation, naldemedine was safe and associated to reduced gastric residuals and promoting laxation. In the systematic review and meta-analysis, the use of PAMORAs (mainly methylnaltrexone) was safe and associated with a reduced intolerance to enteral feeding but no difference in the time to laxation.
Sections du résumé
BACKGROUND
BACKGROUND
Constipation is frequent in critically ill patients, and potentially related to adverse outcomes. Peripherally-active mu-opioid receptor antagonists (PAMORAs) are approved for opioid-induced constipation, but information on their efficacy and safety in critically ill patients is limited. We present a single-center, retrospective, case-series of the use of naldemedine for opioid-associated constipation, and we systematically reviewed the use of PAMORAs in critically ill patients.
METHODS
METHODS
Case-series included consecutive mechanically-ventilated patients; constipation was defined as absence of bowel movements for >3 days. Naldemedine was administered after failure of the local laxation protocol. Systematic review: PubMed was searched for studies of PAMORAs to treat opioid-induced constipation in adult critically ill patients.
PRIMARY OUTCOMES
METHODS
time to laxation, and number of patients laxating at the shortest follow-up.
SECONDARY OUTCOMES
RESULTS
gastric residual volumes and adverse events.
KEY RESULTS
RESULTS
A total of 13 patients were included in the case-series; the most common diagnosis was COVID-19 ARDS. Patients had their first bowel movement 1 [0;2] day after naldemedine. Daily gastric residual volume was 725 [405;1805] before vs. 250 [45;1090] mL after naldemedine, p = 0.0078. Systematic review identified nine studies (two RCTs, one prospective case-series, three retrospective case-series and three case-reports). Outcomes were similar between groups, with a trend toward a lower gastric residual volume in PAMORAs group.
CONCLUSIONS & INFERENCES
CONCLUSIONS
In a highly-selected case-series of patients with refractory, opioid-associated constipation, naldemedine was safe and associated to reduced gastric residuals and promoting laxation. In the systematic review and meta-analysis, the use of PAMORAs (mainly methylnaltrexone) was safe and associated with a reduced intolerance to enteral feeding but no difference in the time to laxation.
Substances chimiques
Narcotic Antagonists
0
Analgesics, Opioid
0
Naltrexone
5S6W795CQM
Laxatives
0
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14694Informations de copyright
© 2023 John Wiley & Sons Ltd.
Références
Nassar AP Jr, da Silva FM, de Cleva R. Constipation in intensive care unit: incidence and risk factors. J Crit Care. 2009;24(4):630.e9-630.e612.
Mostafa SM, Bhandari S, Ritchie G, Gratton N, Wenstone R. Constipation and its implications in the critically ill patient. Br J Anaesth. 2003;91:815-819.
Vincent JL, Preiser JC. Getting critical about constipation. Practical Gastroenterol. 2015;39:14-25.
Hill S, Anderson J, Baker K, Bonson B, Gager M, Lake E. Management of constipation in the critically ill patient. Nurs Crit Care. 1998;3:134-137.
Morad M, Nelson NP, Merrick J, Davidson PW, Carmeli E. Prevalence and risk factors of constipation in adults with intellectual disability in residential care centers in Israel. Res Dev Disabil. 2007;28:580-586.
Gacouin A, Camus C, Gros A, et al. Constipation in long-term ventilated patients: associated factors and impact on intensive care unit outcomes. Crit Care Med. 2010;38:1933-1938.
Zhao Q, Chen YY, Xu DQ, et al. Action mode of gut motility, fluid and electrolyte transport in chronic constipation. Front Pharmacol. 2021;12:630249.
Frantzides CT, Cowles V, Salaymeh B, Tekin E, Condon RE. Morphine effects on human colonic myoelectric activity in the postoperative period. Am J Surg. 1992;163:144-148. discussion 148-149.
Dive A, Foret F, Jamart J, Bulpa P, Installe E. Effect of dopamine on gastrointestinal motility during critical illness. Intensive Care Med. 2000;26:901-907.
Spodniewska E, Guha A. Constipation in critically ill patients and its relationship to feeding and weaning from respiratory support. Crit Care. 2013;17:P241.
van der Spoel JI, Oudemans-van Straaten HM, Kuiper MA, van Roon EN, Zandstra DF, van der Voort PH. Laxation of critically ill patients with lactulose or polyethylene glycol: a two-center randomized, double-blind, placebo-controlled trial. Crit Care Med. 2007;35:2726-2731.
Nguyen T, Frenette AJ, Johanson C, et al. Impaired gastrointestinal transit and its associated morbidity in the intensive care unit. J Crit Care. 2013;28(537):e511-e537.
Fukuda S, Miyauchi T, Fujita M, et al. Risk factors for late defecation and its association with the outcomes of critically ill patients: a retrospective observational study. J Intensive Care. 2016;4:33.
Thomas J. Opioid-induced bowel dysfunction. J Pain Symptom Manage. 2008;35:103-113.
Berde C, Nurko S. Opioid side effects-mechanism-based therapy. N Engl J Med. 2008;358:2400-2402.
Liu M, Wittbrodt E. Low-dose oral naloxone reverses opioid-induced constipation and analgesia. J Pain Symptom Manage. 2002;23:48-53.
Pergolizzi JV Jr, Christo PJ, LeQuang JA, Magnusson P. The use of peripheral mu-opioid receptor antagonists (PAMORA) in the management of opioid-induced constipation: an update on their efficacy and safety. Drug des Devel Ther. 2020;14:1009-1025.
Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC clinical practice guideline for prescribing opioids for pain-United States, 2022. MMWR Recomm Rep. 2022;71:1-95.
Patel PB, Brett SJ, O'Callaghan D, et al. Methylnaltrexone for the treatment of opioid-induced constipation and gastrointestinal stasis in intensive care patients. Results from the MOTION trial. Intensive Care Med. 2020;46:747-755.
Duprey MS, Allison H, Garpestad E, et al. Naloxegol to prevent constipation in ICU adults receiving opioids: a randomized double-blind placebo-controlled pilot trial. Crit Care Res Pract. 2022;2022:7541378.
Moss J, Dickerson D, Nunnally M, Jacobsohn E. Methylnaltrexone treats opioid-induced bowel dysfunction in three critically ill patients: 987. Am J Gastroenterol. 2011;106:S369.
Sawh SB, Selvaraj IP, Danga A, Cotton AL, Moss J, Patel PB. Use of methylnaltrexone for the treatment of opioid-induced constipation in critical care patients. Mayo Clin Proc. 2012;87:255-259.
Merchan C, Altshuler D, Papadopoulos J. Methylnaltrexone versus naloxone for opioid-induced constipation in the medical intensive care unit. Ann Pharmacother. 2017;51:203-208.
Habeeb EA, Tran LK, Goodberlet MZ, Lupi KE, DeGrado JR, Dube KM. Naloxone versus methylnaltrexone for opioid-induced constipation in critically ill patients. Ann Pharmacother. 2022;57:762-768.
Woo M, O'Connor M, Yuan CS, Moss J. Reversal of opioid-induced gastric dysfunction in a critically ill burn patient after methylnaltrexone. Anesth Analg. 2008;107:1965-1967.
Saini HS, Alvi Z, Singh B, Elsharkawy B, Yasir M. Methylnaltrexone and naloxone for opioid-induced constipation in the critical care setting. Cureus. 2020;12:e6829.
Hikita E, Hashimoto M, Yasu T, Shirota M, Nakamura K. Efficacy of naldemedine in the management of constipation in a patient with severe COVID-19 receiving mechanical ventilation. J Palliat Med. 2021;24:651-652.
Mearin F, Lacy BE, Chang L, et al. Bowel disorders. Gastroenterology. 2016. doi:10.1053/j.gastro.2016.02.031
Lee AA, Hasler WL. Opioids and GI motility-friend or foe? Curr Treat Options Gastroenterol. 2016;14:478-494.
Brenner DM, Stern E, Cash BD. Opioid-related constipation in patients with non-cancer pain syndromes: a review of evidence-based therapies and justification for a change in nomenclature. Curr Gastroenterol Rep. 2017;19:12.
Leppert W. Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction. Drug Des Devel Ther. 2015;9:2215-2231.
Drewes AM, Munkholm P, Simren M, et al. Definition, diagnosis and treatment strategies for opioid-induced bowel dysfunction-recommendations of the Nordic working group. Scand J Pain. 2016;11:111-122.
Ishihara M, Ikesue H, Matsunaga H, et al. A multi-institutional study analyzing effect of prophylactic medication for prevention of opioid-induced gastrointestinal dysfunction. Clin J Pain. 2012;28:373-381.
Farmer AD, Drewes AM, Chiarioni G, et al. Pathophysiology and management of opioid-induced constipation: European expert consensus statement. United Eur Gastroenterol J. 2019;7:7-20.
Basilisco G, Marino B, Passerini L, Ogliari C. Abdominal distension after colonic lactulose fermentation recorded by a new extensometer. Neurogastroenterol Motil. 2003;15:427-433.
McPeake J, Gilmour H, MacIntosh G. The implementation of a bowel management protocol in an adult intensive care unit. Nurs Crit Care. 2011;16:235-242.
Rekatsina M, Paladini A, Drewes AM, et al. Efficacy and safety of peripherally acting mu-opioid receptor antagonist (PAMORAs) for the management of patients with opioid-induced constipation: a systematic review. Cureus. 2021;13:e16201.
Crockett SD, Greer KB, Heidelbaugh JJ, et al. American Gastroenterological Association Institute guideline on the medical management of opioid-induced constipation. Gastroenterology. 2019;156:218-226.
Luthra P, Burr NE, Brenner DM, Ford AC. Efficacy of pharmacological therapies for the treatment of opioid-induced constipation: systematic review and network meta-analysis. Gut. 2019;68:434-444.
Coluzzi F, Scerpa MS, Pergolizzi J. Naldemedine: a new option for OIBD. J Pain Res. 2020;13:1209-1222.
BouSaba J, Sannaa W, Camilleri M. Update on the role of naldemedine in opioid-induced constipation in patients with chronic noncancer pain. Therap Adv Gastroenterol. 2022;15:17562848221078638.
Hale M, Wild J, Reddy J, Yamada T, Arjona Ferreira JC. Naldemedine versus placebo for opioid-induced constipation (COMPOSE-1 and COMPOSE-2): two multicentre, phase 3, double-blind, randomised, parallel-group trials. Lancet Gastroenterol Hepatol. 2017;2:555-564.
Webster LR, Nalamachu S, Morlion B, et al. Long-term use of naldemedine in the treatment of opioid-induced constipation in patients with chronic noncancer pain: a randomized, double-blind, placebo-controlled phase 3 study. Pain. 2018;159:987-994.
Esmadi M, Ahmad D, Hewlett A. Efficacy of naldemedine for the treatment of opioid-induced constipation: a meta-analysis. J Gastrointestin Liver Dis. 2019;28:41-46.
Reintam A, Parm P, Redlich U, et al. Gastrointestinal failure in intensive care: a retrospective clinical study in three different intensive care units in Germany and Estonia. BMC Gastroenterol. 2006;6:19.
Devlin JW, Skrobik Y, Gelinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46:e825-e873.
Yan Y, Chen Y, Zhang X. The effect of opioids on gastrointestinal function in the ICU. Crit Care. 2021;25:370.
Ely EW. The ABCDEF bundle: science and philosophy of how ICU liberation serves patients and families. Crit Care Med. 2017;45:321-330.
Pun BT, Balas MC, Barnes-Daly MA, et al. Caring for critically ill patients with the ABCDEF bundle: results of the ICU liberation collaborative in over 15,000 adults. Crit Care Med. 2019;47:3-14.
Chanques G, Constantin JM, Devlin JW, et al. Analgesia and sedation in patients with ARDS. Intensive Care Med. 2020;46:2342-2356.
Devlin JW, Roberts RJ. Pharmacology of commonly used analgesics and sedatives in the ICU: benzodiazepines, propofol, and opioids. Anesthesiol Clin. 2011;29:567-585.