A preliminary study of the effect of naldemedine tosylate on opioid-induced nausea and vomiting

• Published in: Supportive care in cancer 2020-03, Vol.28 (3), p.1083-1088
• Main Authors: Sato, Junya, Tanaka, Rei, Ishikawa, Hiroshi, Suzuki, Tsutomu, Shino, Michihiro
• Format: Article
• Language: English
• Subjects: Aged; Alvimopan; Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Analysis; Antiemetics; Antiemetics - therapeutic use; Cancer; Chemotherapy; Constipation; Constipation - chemically induced; Constipation - drug therapy; Constipation - prevention & control; Female; Humans; Incidence; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Morphine; Morphine - adverse effects; Morphine - therapeutic use; Naltrexone - analogs & derivatives; Naltrexone - therapeutic use; Narcotic Antagonists - therapeutic use; Narcotics; Nausea; Nausea - chemically induced; Nausea - drug therapy; Nausea - prevention & control; Nursing; Nursing Research; Oncology; Original Article; Oxycodone - adverse effects; Oxycodone - therapeutic use; Pain management; Pain Medicine; Receptors, Opioid - drug effects; Rehabilitation Medicine; Retrospective Studies; Side effects; Vomiting; Vomiting - chemically induced; Vomiting - drug therapy; Vomiting - prevention & control
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-019-04884-0

Background Opioid-induced nausea and vomiting (OINV) is induced by opioid receptor stimulation of chemoreceptor trigger zones and vestibular apparatus by opioids. Naldemedine tosylate (NALD) is a peripherally acting non-selective opioid receptor antagonist, used for opioid-induced constipation (OIC). However, the effect of NALD on OINV had not yet been investigated. In this retrospective study, we investigated the secondary effects of NALD on OINV. Method Patients who received sustained-release oral morphine or oxycodone preparation were enrolled in the study. Patients who used NALD (0.2 mg) within 2 days of opioid initiation were included in the analysis. The use of rescue antiemetics within 7 days from opioid initiation was defined as OINV expression. Patients who received antiemetics before opioid initiation or those who received chemotherapy around 4 days from opioid initiation were excluded from the analysis. The incidence of OINV was compared between patients who used and did not use NALD. Results In total, 982 patients were included in the study. Among them, 89 patients who received NALD and 614 patients who did not receive NALD were analyzed. The incidence of OINV in patients who used NALD was significantly lower than that of patients who did not use NALD (36.0% vs. 47.2%, p  = 0.046). Conclusion For patients with constipation, using NALD at an early stage of opioid initiation might have secondary benefits, such as relief from OINV, besides improvement of OIC. To confirm the effectiveness of NALD for OINV, the symptom grade and intensity during concomitant use of NALD should be observed in a future study.