The American Gastroenterological Association (AGA) has issued new guidelines on the medical management of opioid-induced constipation (OIC). The recommendations have been published in the AGA’s official journal, Gastroenterology.
“These guidelines presume that patients have been appropriately diagnosed and that they have either a prolonged requirement or dependence on opioids,” write the authors. “Therefore, one of the first steps to managing patients with OIC is to ensure that the indication for opioid therapy is appropriate, that patients are participating in a pain management program (ideally in conjunction with a pain specialist), and that they are taking the minimum necessary opioid dose.”
The recommendations were developed using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology, with a strong recommendation indicating that most patients should receive the recommended course of action; a conditional recommendation would mean that different choices may apply depending on the patient, and a clinician may need to spend extra time to work toward a decision.
In the management of OIC, the new guidelines state the following:
- In patients with OIC, the use of laxatives as first-line agents is recommended (Strong; moderate-quality evidence)
- In patients with laxative refractory OIC, naldemedine is recommended over no treatment (Strong; high-quality evidence)
- In patients with laxative refractory OIC, naloxegol is recommended over no treatment (Strong; moderate-quality evidence)
- In patients with laxative refractory OIC, methylnaltrexone is suggested over no treatment (Conditional; low-quality evidence)
- The AGA makes no recommendation for the use of lubiprostone in OIC (No recommendation; evidence gap)
- The AGA makes no recommendation for the use of prucalopride in OIC (No recommendation; evidence gap)
Addressing their recommendations on newer agents (intestinal secretagogues, selective 5-HT agonists), the guideline panel writes that given the lack of published data on long-term use, additional studies are needed to establish the benefits of these drugs.
“Physicians have struggled with treating this condition due to previous lack of clinical guidance,” said Seth D. Crockett, MD, MPH, lead author of the guideline, University of North Carolina School of Medicine, Chapel Hill. “The new AGA guideline clarifies existing data and provides clear direction for physicians on how to best treat opioid-induced constipation.”
For more information visit gastrojournal.org.