Progress on Drug Therapy for Opioid-induced Constipation

doi:10.12114/j.issn.1007-9572.2021.02.092

Abstract

Abstract:

Opioid-induced constipation (OIC) is one of the common adverse reactions of opioids, which may affect the quality of life and follow-up treatment compliance of patients. With the rise of number of cancer patients worldwide and the increase in the use of opioids in chronic non-cancerous pain, the number of OIC patients will increase accordingly. Therefore, how to achieve effective analgesia and balance the occurrence of analgesia and OIC is one of the clinical problems that need to be resolved urgently. At present, the main therapeutic drugs for OIC mainly include oral laxatives and peripheral μ-opioid receptor antagonists, secretagogues, traditional Chinese medicines, etc. This paper mainly analyzed the drug therapy of OIC, in order to provide a reference for the effective clinical prevention and treatment of OIC.

Key words: Constipation, Analgesics, opioid, Therapy, TCM therapy, Review

摘要：

阿片类药物所致便秘（OIC）是阿片类药物常见不良反应之一，会影响患者生活质量及后续治疗依从性。随着全球癌症患者数量增多及慢性非癌性疼痛患者阿片类药物使用率增加，OIC患者数量将随之增多。因此，如何实现有效镇痛并平衡镇痛与OIC的发生是临床亟须解决的问题之一。目前，OIC的治疗药物主要包括泻药、外周作用的μ-阿片受体拮抗剂、促分泌剂、中药等。本文主要分析了药物治疗OIC的研究进展，以期为临床有效防治OIC提供参考依据。

关键词: 便秘, 镇痛药，阿片类, 治疗, 中医疗法, 综述

Jiachun NI,Zengjin CAI,Qiong JIANG, et al. Progress on Drug Therapy for Opioid-induced Constipation[J]. Chinese General Practice, 2022, 25(12): 1499-1505. DOI: 10.12114/j.issn.1007-9572.2021.02.092.
倪嘉淳,蔡增进,江琼等. 药物治疗阿片类药物所致便秘的研究进展[J]. 中国全科医学, 2022, 25(12): 1499-1505. DOI: 10.12114/j.issn.1007-9572.2021.02.092.

Figures/Tables 1

References 69

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上市PAMORA	上市时间	常规用法	常见不良反应	使用注意事项
纳洛西醇	2014年9月	口服：25 mg/次，1次/d，如不耐受则剂量减半	腹痛、腹泻、恶心、胀气、呕吐、头痛等	合并肠梗阻患者禁用；禁与CYP3A4强抑制剂合用
羟考酮/纳洛酮缓释片剂	2014年7月	口服：10 mg/5 mg/次，1次/12 h	恶心、呕吐等	合并肝损伤、肠梗阻、呼吸抑制、支气管哮喘患者禁用
甲基纳曲酮	2009年11月	口服：450 mg/次，1次/早；皮下注射：12 mg/次，1次/d	腹痛、腹泻、头痛、腹胀、呕吐、多汗、焦虑等	合并肠梗阻患者禁用；中重度肝、肾功能不全者减量使用
纳德米定	2017年3月	口服：0.2 mg/次，1次/d	腹痛、腹泻、恶心	合并肠梗阻患者禁用；重度肝功能不全者不推荐使用；避免与CYP3A4抑制剂同用
阿维莫潘	2008年5月	术前30 min~5 h口服12 mg，术后口服12 mg/次，2次/d，持续7 d	贫血、消化不良、低钾血症、背痛、尿潴留	尚未被批准用于治疗OIC

上市PAMORA	上市时间	常规用法	常见不良反应	使用注意事项
纳洛西醇	2014年9月	口服：25 mg/次，1次/d，如不耐受则剂量减半	腹痛、腹泻、恶心、胀气、呕吐、头痛等	合并肠梗阻患者禁用；禁与CYP3A4强抑制剂合用
羟考酮/纳洛酮缓释片剂	2014年7月	口服：10 mg/5 mg/次，1次/12 h	恶心、呕吐等	合并肝损伤、肠梗阻、呼吸抑制、支气管哮喘患者禁用
甲基纳曲酮	2009年11月	口服：450 mg/次，1次/早；皮下注射：12 mg/次，1次/d	腹痛、腹泻、头痛、腹胀、呕吐、多汗、焦虑等	合并肠梗阻患者禁用；中重度肝、肾功能不全者减量使用
纳德米定	2017年3月	口服：0.2 mg/次，1次/d	腹痛、腹泻、恶心	合并肠梗阻患者禁用；重度肝功能不全者不推荐使用；避免与CYP3A4抑制剂同用
阿维莫潘	2008年5月	术前30 min~5 h口服12 mg，术后口服12 mg/次，2次/d，持续7 d	贫血、消化不良、低钾血症、背痛、尿潴留	尚未被批准用于治疗OIC