Improving Diagnosis and Management of Opioid-Induced Constipation (OIC) in Clinical Practice: An Italian Expert Opinion

被引：0

作者：

Varrassi, Giustino ^{[1
]}

Casale, Giuseppe ^{[2
]}

De Marinis, Maria Grazia ^{[3
]}

Dentali, Francesco ^{[4
]}

Evangelista, Paolo ^{[5
]}

Gobber, Gino ^{[6
]}

Lanzetta, Gaetano ^{[7
]}

Lora Aprile, Pierangelo ^{[8
]}

Pace, Maria Caterina ^{[9
]}

Portincasa, Piero ^{[10
]}

Radaelli, Franco ^{[11
]}

Ungar, Andrea ^{[12
,13
]}

机构：

[1] Fdn Paolo Procacci, I-00193 Rome, Italy

[2] Fdn Antea, I-00135 Rome, Italy

[3] Univ Campus Biomed Roma, Fdn Policlin, Campus Biomed, I-00128 Rome, Italy

[4] Univ Insubria, Dipartimento Area Med, Asst Sette Laghi, SC Med Gen, I-21100 Varese, Italy

[5] Aquila Univ, Sch Med, I-67100 Laquila, Italy

[6] Italian Palliat Care Soc, I-38100 Trento, Italy

[7] St Camillus Int Univ Hlth & Med Sci, INI UniCamillus, I-00046 Rome, Italy

[8] Italian Coll Gen Practitioners & Primary Care, I-50100 Florence, Italy

[9] Univ Campania Luigi Vanvitelli, Dept Psychiat, I-80138 Naples, Italy

[10] Univ Bari Aldo Moro, Dept Precis & Regenerat Med Ionian Area DIMEPRE J, Clin Med A Murri, Bari, Italy

[11] Valduce Hosp Como, Dept Internal Med, Como, Italy

[12] Univ Florence, I-50100 Florence, Italy

[13] Azienda Osped Univ Careggi, I-50100 Florence, Italy

来源：

JOURNAL OF CLINICAL MEDICINE | 2024年 / 13卷 / 22期

关键词：

opioid; opioid-induced constipation; diagnosis; management; PAMORAs; clinical practice; primary care; SUBCUTANEOUS METHYLNALTREXONE; REPORTED CONSTIPATION; RECEPTOR ANTAGONISTS; ADVANCED-ILLNESS; ADVANCED CANCER; PATIENT BURDEN; DOUBLE-BLIND; PAIN; PLACEBO; EFFICACY;

D O I：

10.3390/jcm13226689

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Opioid-induced constipation (OIC) is a very common and troublesome gastrointestinal side effect following the use of opioids. Despite existing international guidelines, OIC is largely underdiagnosed and undertreated. ECHO OIC is a European project designed to improve the diagnosis and management of OIC at the primary care level. The next phase of the ECHO OIC project is to review and adapt the proposed European pathway at national level, considering the local patient journey and clinical practice. A multidisciplinary group of 12 Italian experts reviewed and discussed the European path and formulated a seven-step guide for the practical management of OIC that is also easily applicable in primary care: 1. When prescribing long-term opioids, the physician should inform the patient of the possibility of the onset of OIC; 2. At opioid prescription, doctors should also prescribe a treatment for constipation, preferably macrogol or stimulant laxatives; 3. The patient should be evaluated for OIC within the second week of initiating opioid treatment, by clinical history and Rome IV criteria; 4. In the presence of constipation despite laxatives, prescription of a PAMORA (Peripherally Acting Mu Opioid Receptor Antagonist) should be considered; 5. When prescribing a PAMORA, prescribing information should be carefully reviewed, and patients should be accurately instructed for appropriate use; 6. Efficacy and tolerability of the PAMORA should be monitored regularly by Bowel Function Index, considering a cut-off of 30 for the possible step-up of OIC treatment; 7. After 4 weeks of treatment, if the efficacy of PAMORA is deemed inadequate, discontinuation of the PAMORA, addition of an anti-constipation drugs, change of opioid type, or referral to a specialist should be considered. Spreading knowledge about the OIC problem as much as possible to the health community is crucial to obtain not only an early treatment of the condition but also to promote its prevention.

引用

页数：11

共 61 条

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