What are the effects of the mu-opioid antagonists methylnaltrexone and naldemedine for adults receiving palliative care leading to opioid-induced bowel dysfunction?

2018 ◽  
Author(s):  
Sera Tort ◽  
Marta Briarava
Keyword(s):  
Palliative Care ◽  
Bowel Dysfunction ◽  
Opioid Antagonists ◽  
Mu Opioid

Constipation and diarrhoea

2021 ◽  
pp. 545-555
Author(s):  
Philip J. Larkin
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Optimal Treatment ◽  
Opioid Antagonists ◽  
Pharmacological Interventions ◽  
Gut Motility ◽  
Mu Opioid ◽  
Clinical Interventions ◽  
New Treatments

Constipation is a common problem for palliative care patients, notably due to opioid-based pain management which physiologically impacts gut motility. Idiopathic diarrhoea is far less common in palliative care patients given opioid management. If present, it should be investigated, although it is often related to suboptimal constipation treatment. The management and treatment of both symptoms is largely a balance between pharmacological and non-pharmacological interventions. New treatments for the management of constipation using peripherally acting mu-opioid antagonists (PAMORAs) offer effective solutions as part of a range of clinical interventions to prevent and manage the problem successfully. A clear descriptive history is essential for optimal treatment of both constipation and diarrhoea.

Mu-opioid antagonists for opioid-induced bowel dysfunction

2008 ◽  
Author(s):  
Ewan D McNicol ◽  
David Boyce ◽  
Roman Schumann ◽  
Daniel B Carr
Keyword(s):  
Bowel Dysfunction ◽  
Opioid Antagonists ◽  
Mu Opioid

scholarly journals Pyrrolo- and pyridomorphinans: Non-selective opioid antagonists and delta opioid agonists/mu opioid partial agonists

2014 ◽  
Vol 22 (15) ◽  
pp. 4067-4072 ◽  
Author(s):  
V. Kumar ◽  
M.J. Clark ◽  
J.R. Traynor ◽  
J.W. Lewis ◽  
S.M. Husbands
Keyword(s):  
Opioid Antagonists ◽  
Mu Opioid ◽  
Partial Agonists ◽  
Opioid Agonists

Paradoxical modulation of the pain reducing properties of morphine

2017 ◽  
Author(s):  
Katharine Tuerke
Keyword(s):  
Opioid Receptors ◽  
Opioid Analgesic ◽  
Opioid Antagonists ◽  
Mu Opioid Receptors ◽  
Mu Opioid ◽  
Molar Ratios ◽  
Analgesic Effects ◽  
Behavioural Effects ◽  
Postural Support ◽  
Reducing Properties

Classic pharmacological theories predict that opioid antagonists should block the neurochemical and  behavioural effects of opioids. Surprisingly, this relationship does not hold true when the antagonist is administered in very low doses (i.e., nanograms instead of milligrams/kg). Co­administration of ultra­low doses of naltrexone (antagonist) and morphine (agonist) enhanced morphine’s analgesic effects, which have been attributed to the activation of mu opioid receptors. Morphine induced­catalepsy, characterized by  muscular rigidity and inhibition of postural support systems, is also mediated by mu opioid receptors and  can be blocked by standard doses of naltrexone. Our study investigated the hypothesis that ultra­low doses of naltrexone will enhance morphine­induced catalepsy. Rats (N = 56) were randomly assigned to six  different groups: saline, morphine (10 mg/kg), co­treatments of morphine (10 mg/kg) plus naltrexone (molar ratios of 1 000 000:1, 500 000:1 or 100 000:1) or naltrexone alone. For seven consecutive days, rats were administered one injection daily. Each day, catalepsy and analgesia were assessed 30 and 60 min post injection using the bar­test and tail­flick test, respectively. Ultra­low doses of naltrexone co­administered  with morphine did not potentiate catalepsy or attenuate tolerance. In contrast, ultra­low doses of naltrexone co­administered with morphine significantly and dose­dependently attenuated tolerance to morphine’s analgesic effect in comparison to morphine alone. These data suggest that the enhancement of opioid  analgesic effects and attenuated tolerance by ultra­low doses of opioid antagonists are not the result of  changes in morphine­induced catalepsy. (Funded by NSERC)

My Patient Is Twitching; Could It Be Itching?

2020 ◽  
pp. 179-188
Author(s):  
Alexis Morvant ◽  
Emma Jones
Keyword(s):  
Adverse Effect ◽  
Palliative Care ◽  
Renal Disease ◽  
Pediatric Patients ◽  
Opioid Therapy ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
Opioid Antagonists ◽  
Distressing Symptom ◽  
Primary Mechanism

Pediatric patients receiving palliative care may experience itching as a distressing symptom for a wide variety of reasons. Antihistamine medications are widely used for treatment of this symptom and have effectiveness if histamine is the primary mechanism of itch. Pruritus is a known adverse effect of opioid therapy, occurring in 2–10% of patients. Opioid-induced pruritus is not primarily histamine related and therefore better treated by partial opioid antagonists. Chronic health conditions such as renal disease, cholestasis, and malignancy are all associated with pruritus. This chapter presents a broad differential for the symptom as well as a range of pharmacologic and nonpharmacologic therapies.

Palliative Care and Pain: New Strategies for Managing Opioid Bowel Dysfunction

2008 ◽  
Vol 11 (s1) ◽  
pp. s1-s19 ◽  
Author(s):  
Jay R. Thomas ◽  
Gail Austin Cooney
Keyword(s):  
Palliative Care ◽  
Bowel Dysfunction ◽  
New Strategies
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