Leppert, W. (2014). Oxycodone/naloxone in the management of patients with pain and opioid-induced bowel dysfunction. Current Drug Targets, 15, 124-135. 

DOI Link

Purpose

STUDY PURPOSE: To review the literature evaluating approaches to the management of opioid-induced bowel dysfunction (OIBD) and the combination of an opioid agonist with an opioid receptor antagonist versus the administration of purely peripherally-acting opioid receptor antagonists
 
TYPE OF STUDY: General review, semisystematic

Search Strategy

DATABASES USED: PubMed and MEDLINE databases till July 31, 2013
 
KEYWORDS: Opioid-induced bowel dysfunction, opioid-induced constipation, opioid receptor antagonists, oxycodone/naloxone, pain
 
INCLUSION CRITERIA: All studies of were of oxycodone and naloxone and were randomized, controlled trials or open, uncontrolled studies. Studies on pharmacokinetics and pharmacodynamics of oxycodone/naloxone also were included.
 

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 65
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Not explained

Sample Characteristics

FINAL NUMBER STUDIES INCLUDED = 18
 
KEY SAMPLE CHARACTERISTICS: Patients with chronic, nonmalignant pain; patients with cancer-related pain; and patients with postoperative pain

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care
 
APPLICATIONS: Palliative care

Results

Oxycodone plus naloxone (OXN) appeared to provide similar analgesic effects as oxycodone, but it also improved bowel function, defined as more frequent and complete spontaneous bowel movements and less consumption of laxatives. In addition, OXN improved the passing of urine in patients with postoperative pain while reducing OIBD, improving compliance, and enhancing quality of life. OXN may be administered to opioid-naïve patients with moderate to severe pain and to patients not responding to weak opioids. The evidence from studies of chronic nonmalignant and cancer-related pain demonstrated the role of OXN in the prevention and treatment of OIBD in patients who required opioid therapy for moderate to severe pain. An evaluation of the value of the literature and studies was not evident in this article.

Conclusions

OIBD is a common complication in patients receiving long-term opioid treatment. The use of OXN was demonstrated by a number of studies to be effective for the management of pain and to have a role in the prevention of OIBD in patients with moderate to severe chronic nonmalignant and cancer-related pain.

Limitations

Demographic characteristics were generally well-balanced between OXN groups and placebo or oxycodone groups. However, there was a larger sample size of patients with cancer-related pain in one specific study that could have altered the results. There was a high rate of variability in the type of studies that were included, and there was no critical analysis of the literature.

Nursing Implications

OXN appears to provide similar analgesic effects as oxycodone, but it improves bowel function, defined as more frequent and complete spontaneous bowel movements and a less frequent consumption of laxatives. In addition, patients receiving OXN had improved quality of life scores with decreased OIBD complications.

Legacy ID

4952