Ishihara, M., Iihara, H., Okayasu, S., Yasuda, K., Matsuura, K., Suzui, M., & Itoh, Y. (2010). Pharmaceutical interventions facilitate premedication and prevent opioid-induced constipation and emesis in cancer patients. Supportive Care in Cancer, 18, 1531–1538.

• To perform a retrospective review of medical records to determine the use of prophylactic laxatives in patients receiving opioids.
• To determine the incidence of constipation in patients taking opioid medications.
• To promote use of preventative medications by educating physicians, checking orders, and educating patients.

In part 1, patients who were admitted and receiving opioids were surveyed for use of prophylactic laxatives to prevent constipation.

In part 2, prescribers were given drug information, orders were reviewed, and patients were educated about laxatives to manage constipation.

• The study reported on a sample of 83 patients with cancer in part 1 and 107 patients with cancer in part 2. 
• Mean patient age was 66.1 years (range 41-92) in part 1 and  63.7 years (range 14-83) in part 2. 
• The sample comprised 40 women and 43 men in part 1, and 40 women and 67 men in part 2.

• Single site
• Inpatient
• Japan

Patients were undergoing the active treatment phase of care.

This was a retrospective survey followed by an interventional study.

• National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), version 3.0
• Constipation medical records were reviewed.

• Of the 83 patients, 57% (47 patients) received laxatives with opioids.
• Patients who did not receive laxatives had a higher incidence of constipation than those who received laxatives (56% versus 21%, p = 0.0024).
• Patients who received laxatives had more bowel movements in seven days than patients who did not (5.6 versus 3.9, p = 0.005).
• Taking more laxatives resulted in less constipation, and the absence of prophylactic laxatives resulted in an increased risk of constipation.
• The incidence of constipation was lowest in patients who received prophylactic combination treatment with magnesium oxide and pantethine.

Laxative use prophylactically reduced the incidence of constipation in patients taking opioid therapy but did not completely prevent it.

• The study lacked an appropriate control group.
• Part 1 had fewer than 100 patients.
• The validity and reliability of medical records for determination of laxative use was questionable, and patients did not self-report use.

Laxative prophylaxis is beneficial to reduce the risk of opioid-induced constipation. Proactive interventions to increase laxative use may be beneficial to patients.