• Masashi Ishihara, Hiroaki Ikesue, Hisashi Matsunaga, Katsuya Suemaru, Kiyoyuki Kitaichi, Kimitaka Suetsugu, Ryozo Oishi, Toshiaki Sendo, Hiroaki Araki, Yoshinori Itoh, and Japanese Study Group for the Relief of Opioid-induced Gastrointestinal Dysfunction.
• Department of Pharmacy, Gifu University Hospital, Yanagido, Gifu, Japan.
• Clin J Pain. 2012 Jun 1; 28 (5): 373-81.

ObjectivesThe aim of this study was to evaluate the effectiveness of prophylactic treatment with laxatives and antiemetics on the incidence of gastrointestinal adverse reactions such as constipation, nausea and vomiting in cancer patients who received oral opioid analgesics for the first time.MethodsA multi-institutional retrospective study was carried out, in which 619 eligible hospitalized patients receiving oral opioid analgesics for cancer pain were enrolled from 35 medical institutions. The primary endpoint was the incidence of opioid-induced side effects in patients receiving prophylactic medication. Odds ratios of the incidence of adverse reactions in the absence or presence of premedication obtained from several institutions were subjected to a meta-analysis.ResultsAmong 619 patients, the incidence of constipation was significantly lower in patients receiving laxatives, including magnesium oxide, as premedication than in those without them (34% vs. 55%, odds ratio=0.432, 95% confidence interval=0.300-0.622, P<0.001). However, the incidence of nausea or vomiting was similar regardless of prophylactic medication with dopamine D2 blockers. The results of the meta-analysis revealed that prophylactic laxatives significantly reduced the incidence of constipation (overall odds ratio=0.469, 95% confidence interval=0.231-0.955, P=0.037), whereas dopamine D2 blockers were not effective in preventing opioid-induced nausea or vomiting.DiscussionWe showed evidence for the effectiveness of premedication with laxatives for prevention of opioid-induced constipation. However, premedication with dopamine D2 blockers was not sufficient to prevent nausea or vomiting.

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