Opioid Antagonists: A Review of Their Role in Palliative Care, Focusing on Use in Opioid-Related Constipation

Opioid antagonists have well-established indications in the reversal of life-threatening opioid toxicity, but also hold considerable promise for other applications in palliative care practice, particularly management of opioid-related constipation. We briefly review current understanding of opioid r...

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Bibliographic Details
Published in:Journal of Pain and Symptom Management 2002-07, Vol.24 (1), p.71-90
Main Authors: Choi, Youn Seon, Billings, J.Andrew
Format: Article
Language:English
Subjects:
Biological and medical sciences
constipation
Constipation - drug therapy
Constipation - etiology
Digestive system
gastrointestinal motility
Humans
Medical sciences
nalmephene
naloxone
naltrexone
Narcotic antagonists
Narcotic Antagonists - therapeutic use
Narcotics - adverse effects
nausea/vomiting
opioid-related disorders
Palliative Care - methods
Pharmacology. Drug treatments
pruritus
respiratory depression
substace-related disorders
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Summary:Opioid antagonists have well-established indications in the reversal of life-threatening opioid toxicity, but also hold considerable promise for other applications in palliative care practice, particularly management of opioid-related constipation. We briefly review current understanding of opioid receptors, focusing on their complex role in gastrointestinal physiology. We summarize the pharmacology, conventional indications, and clinical usage of three major groups of opioid antagonists, including a promising new peripherally acting agent, methylnaltrexone, which is not commercially available. We suggest an approach to administering opioid antagonists for reduction of life-threatening opioid toxicity in patients with pain. The literature on opioid-induced constipation and its treatment with opioid-antagonists is reviewed in detail. Finally, other potential uses of opioid antagonists in palliative care are described, especially strategies for reducing such opioid side effects as nausea and pruritus and for improving analgesia or reducing tolerance by concomitantly administrating both an opioid agonist and low dosages of an antagonist.
ISSN:0885-3924
1873-6513
DOI:10.1016/S0885-3924(02)00424-4