Frank Peacock, MD: Avoiding Hospitalization for Opioid-Induced Constipation

Methylnaltrexone (Relistor) was found to be safe and effective in treating patients who are experiencing pain due to opioid-induced constipation.

The study, "First-Dose Efficacy of Methylnaltrexone in Patients with Severe Medical Illness and Opioid-Induced Constipation: A Pooled Analysis" was recently published in The Journal of Emergency Medicine.

In an interview with HCPLive®, Frank Peacock, MD, Professor, Research Director and Vice Chair for Research at Baylor College of Medicine, explained that administering methylnaltrexone was successful at producing rescue-free laxation (RFL) without compromising the pain management effect of the opioid.

"It doesn't cross the blood brain barrier, and so when you give it to the patient, they maintain their pain management effect," Peacock said. "They don't get pain from methylnaltrexone taking away their narcotic effect, but they have a bowel movement."

Opioid-induced constipation is a prevalent adverse event associated with long term opioid use. It's a big motivator for emergency department visits which can be costly and also leave immunocompromised patients at risk.

"They suffer the complications of the narcotic, the most common one being constipation," Peacock explained, "and so that's why about 60% of the people in this study were there as a complication from their cancer therapy."

The motivation of this study was to find a solution to keep these patients out of the hospital while maintaing their pain treatment and ultimately found that methylnaltrexone could be the answe.

"The people who got methylnaltrexone went to the bathroom, sat up, felt better, got off the bed went home," Peacock said. "The people who were in the placebo group got an enema, didn't feel better, and a lot of them are going to get hospitalized."

Methylnaltrexone allowed the pain relief from the opioid to continue, but addressed the complication of constipation that comes with it.