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首页> 外文期刊>Clinical drug investigation >Management of opioid-induced constipation in cancer patients: Focus on methylnaltrexone
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Management of opioid-induced constipation in cancer patients: Focus on methylnaltrexone

机译：阿片类药物引起的便秘的癌症患者治疗：专注于甲基纳曲酮

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摘要

Opioids are one of the most widely used therapies for the palliative treatment of cancer pain; however, despite their proven analgesic efficacy, they are associated with several adverse effects. Associated with psychological distress and multiple concomitant clinical concerns, constipation is the most commonly occurring adverse effect of chronic opioid therapy in cancer patients. Whilst prophylaxis remains the first-line management option, methylnaltrexone is a recommended treatment option for opioid-related constipation if administration of laxatives is ineffective.Due to its inability to cross the blood-brain barrier, methylnaltrexone exerts a peripheral inhibition of opioid-related effects without influencing the opioid-induced central effects; as a result, the analgesic effect of opioids is unaffected. Moreover, multiple clinical trials, albeit not always conducted specifically in cancer patients, have demonstrated that up to 4 months treatment with either intravenous or subcutaneous methylnaltrexone provides effective relief from opioid-related constipation and is well tolerated. Preliminary evidence indicates that the addition of methylnaltrexone to standard care for opioid-related constipation may also be advantageous from a pharmacoeconomic perspective. In addition, preliminary data suggest that methylnaltrexone could be associated with some further clinical benefits other than the treatment of opioid-related constipation, such as the improvement of gastric emptying, the relief of nauseavomiting, and the reduction of the risk of regurgitation and pulmonary aspiration. This narrative review examines the most recent evidence and evaluates the current role of methylnaltrexone in the management of opioid-related constipation, and its potential efficacy in cancer patients. The pharmacokinetics, pharmacodynamics, efficacy and tolerability of methylnaltrexone are discussed.
机译：阿片类药物是姑息治疗癌症疼痛的最广泛使用的疗法之一。然而，尽管已证明它们具有镇痛作用，但它们仍具有多种不良反应。与心理困扰和多种伴随的临床问题相关，便秘是慢性阿片类药物治疗在癌症患者中最常见的不良反应。预防仍然是一线治疗方案，但如果泻药给药无效，则推荐使用甲基纳曲酮治疗与阿片类药物有关的便秘由于甲基纳曲酮不能穿过血脑屏障，因此对阿片类药物相关作用具有外周抑制作用不影响阿片类药物引起的中枢效应;结果，阿片类药物的镇痛作用不受影响。此外，尽管并非总是专门针对癌症患者进行的多项临床试验表明，静脉或皮下注射甲基纳曲酮长达4个月的治疗可有效缓解阿片类药物相关的便秘，并且耐受性良好。初步证据表明，从阿片类药物相关便秘的标准护理中添加甲基纳曲酮可能从药物经济学角度来看也是有利的。此外，初步数据表明，除了治疗阿片类药物相关的便秘外，甲基纳曲酮还可能具有其他一些临床益处，例如改善胃排空，缓解恶心，减少返流和肺误吸的风险。 。这篇叙述性综述检查了最新证据，并评估了甲基纳曲酮在阿片相关性便秘管理中的当前作用及其对癌症患者的潜在疗效。讨论了甲基纳曲酮的药代动力学，药效学，功效和耐受性。

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