Koopmans-Klein, G., Wagemans, M.F., Wartenberg, H.C., Van Megen, Y.J., & Huygen, F.J. (2015). The efficacy of standard laxative use for the prevention and treatment of opioid induced constipation during oxycodone use: A small Dutch observational pilot study. Expert Review of Gastroenterology and Hepatology, 10, 547–553. 

DOI Link

Study Purpose

To explore the effectiveness of standard laxative treatment in the prevention of oxycodone-induced constipation

Intervention Characteristics/Basic Study Process

From July 2013 to October 2013, standard laxative treatment consisting of polyethylene glycol (PEG) with electrolytes was started at the same time as opioid intake on day 1. Bisacodyl was prescribed, and patients took this as needed. Patients prescribed oxycodone at least 20 mg slow-release tables were started on the standard laxative treatment and followed for 28 days.

Sample Characteristics

  • N = 21  
  • MEDIAN AGE = 65 years
  • RANGE = 39-92 years
  • MALES: 42%, FEMALES: 58%
  • KEY DISEASE CHARACTERISTICS: There were chronic 23 with non-malignant pain and 1 patient with malignant pain.

Setting

  • SITE: Multi-site    
  • SETTING TYPE: Not specified    
  • LOCATION: Netherlands

Phase of Care and Clinical Applications

  • PHASE OF CARE: Multiple phases of care
  • APPLICATIONS: Elder care and palliative care

Study Design

  • Prospective, observational, pilot study

Measurement Instruments/Methods

  • Bowel Function Index (BFI), measured at the start and end of study
  • Bristol stool form scale (BSF), indicates type of stool, numerical pain score, laxative, and a responder analysis using the following criteria: decrease of BFI by 12 points or patient did not develop constipation AND patient did not develop diarrhea AND patient did not discontinue laxative treatment due to adverse events

Results

The dose of PEG and electrolytes varied between 0-3 sachets, and the bisacodyl dose varied from 5 mg-20 mg. Based on responder analysis criteria, 43% of patients (9 of 21) who were prescribed a standard laxative therapy regimen did not respond.

Conclusions

A standard laxative therapy regimen may not be effective in all patients given the type of opioid they may be prescribed and what their bowel function is at the start of opioid therapy.

Limitations

  • Small sample (less than 30)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Measurement/methods not well described
  • Findings not generalizable
  • Pilot study
  • Observational study

Nursing Implications

Response to prophylactic PEG plus electrolytes is patients taking oxycodone SR is variable.