What happens if patients forego treatment of opioid-induced constipation (OIC) for fear of blunting the analgesic effects of their pain medication? What if these patients present in an emergency department setting or are receiving palliative care at home for advanced cancer?
Special considerations for these OIC treatment scenarios are explored below.
Oncology and
emergency medicine
What happens if patients forego treatment of opioid-induced constipation (OIC) for fear of blunting the analgesic effects of their pain medication? What if these patients present in an emergency department setting or are receiving palliative care at home for advanced cancer?
Special considerations for these OIC treatment scenarios are explored below.
When facing active cancer pain1
of patients treated with morphine for cancer-related pain experienced OIC, per a 2006 study2
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RELISTOR subcutaneous injection is the first and only PAMORA available for adult patients with OIC and active cancer pain who require opioid dosage escalation for palliative care1,3-6
PAMORA, peripherally acting mu-opioid receptor antagonist.
RELISTOR injection: When speed is clinically useful1,7,8
Advanced illness*: In focus
RELISTOR injection: When speed is clinically useful1,7,8
Advanced illness*: In focus
of patients (n=47) in Study 4 receiving 0.15 mg/kg dose of RELISTOR experienced a spontaneous bowel movement (SBM)† within 4 hours of first dose vs 14% receiving placebo (n=52; P<.0001)1,7
of patients (n=62) in Study 5 receiving 0.15 mg/kg dose of RELISTOR experienced a SBMǂ within 4 hours of first dose vs 16% receiving placebo (n=71; P<.0001)1,8
In Study 5, significantly more patients in the RELISTOR injection cohort (52%; n=62) experienced laxation within the first 4 hours after at least 2 of the first 4 doses vs 9% for placebo (n=71; P<.0001)1
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*In patients who require opioid dosage escalation for palliative care.1
†SBM is defined as laxation without the use of a rescue laxative during the previous 24 hours.1
of patients with advanced illness in Study 4 who responded to RELISTOR injection (0.15 or 0.3 mg/kg) experienced a SBM‡ within 30 minutes of first dose7
Limitations of data: The proportion of patients who experienced a SBM within 30 minutes is an exploratory endpoint. No conclusions about efficacy can be drawn from these descriptive data because they are results from exploratory endpoints7
‡SBM is defined as laxation without the use of a rescue laxative during the previous 24 hours.1
Once-daily dosing options for patients with chronic non-cancer pain1
RELISTOR has a well-established safety profile1
Adverse reactions from all doses in double-blind placebo-controlled clinical studies of RELISTOR injection in adult patients with OIC and advanced illness (Studies 4 and 5)1
ADVERSE REACTIONS§ | RELISTOR INJECTION (n=165) |
PLACEBO (n=123) |
---|---|---|
ABDOMINAL PAIN|| | 29% | 10% |
FLATULENCE | 13% | 6% |
NAUSEA | 12% | 5% |
DIZZINESS | 7% | 2% |
DIARRHEA | 6% | 2% |
ADVERSE REACTIONS§ | |
---|---|
ABDOMINAL PAIN|| | |
RELISTOR INJECTION (n=165) | 29% |
Placebo (n=123) | 10% |
FLATULENCE | |
RELISTOR INJECTION (n=165) | 13% |
Placebo (n=123) | 6% |
NAUSEA | |
RELISTOR INJECTION (n=165) | 12% |
Placebo (n=123) | 5% |
DIZZINESS | |
RELISTOR INJECTION (n=165) | 7% |
Placebo (n=123) | 2% |
DIARRHEA | |
RELISTOR INJECTION (n=165) | 6% |
Placebo (n=123) | 2% |
§Adverse reactions occurring in at least 5% of patients receiving all doses of RELISTOR injection (0.075, 0.15, and 0.3 mg/kg) and at an incidence greater than placebo.1
||Includes abdominal pain, upper abdominal pain, lower abdominal pain, abdominal discomfort, and abdominal tenderness.1
.For additional Important Safety Information, please see the sidebar to the right
.For additional Important Safety Information, please see bottom of the page
Emergency Medicine
When working in the emergency department (ED)
The ED often sees patients with OIC. OIC occurs in 40% to 80% of all patients receiving an opioid medication for chronic pain.9-11
Not actual size.
RELISTOR injection is available in vials and pre-filled syringes1
REFERENCES: 1. RELISTOR [prescribing information]. Bridgewater, NJ: Salix Pharmaceuticals. 2. Glare P, Walsh D, Sheehan D. The adverse effects of morphine: a prospective survey of common symptoms during repeated dosing for chronic cancer pain. Am J Hosp Palliat Care. 2006;23(3):229-235. 3. Amitiza. Prescribing information. Sucampo Pharma Americas, LLC; 2020. 4. Movantik. Prescribing information. RedHill Biopharma Inc; 2023. 5. Symproic. Prescribing information. Collegium Pharmaceutical, Inc; 2020. 6. Pergolizzi JV Jr, Christo PJ, LeQuang JA, Magnusson P. The use of peripheral μ-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. 7. Slatkin N, Thomas J, Lipman AG, et al. Methylnaltrexone for treatment of opioid-induced constipation in advanced illness patients. J Support Oncol. 2009;7(1):39-46. 8. Thomas J, Karver S, Cooney GA, et al. Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med. 2008;358(22):2332-2343. 9. Bell TJ, Panchal SJ, Miaskowski C, Bolge SC, Milanova T, Williamson R. The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European patient survey (PROBE 1). Pain Med. 2009;10(1):35-42. 10. Kalso E, Edwards JE, Moore AR, McQuay HJ. Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain. 2004;112(3):372-380. 11. Hjalte F, Berggren AC, Bergendahl H, Hjortsberg C. The direct and indirect costs of opioid-induced constipation. J Pain Symptom Manage. 2010;40(5):696-703.