Which of the following agents has an FDA-approved indication for use to treat patients with opioid-induced constipation in the setting of advanced cancer?
d. Methylnaltrexone bromide
The correct answer: D.
Methylnaltrexone is indicated for treatment of opioid-induced constipation (OIC) in adult patients with chronic, non-malignant pain, as well as in those patients with refractory OIC in the setting of advanced illness and who “are receiving palliative care.” Of the choices, it is the only that has an approved indication for treating OIC in cancer patients. Alvimopan is an oral peripheral acting µ-opioid receptor antagonist indicated on labeling “to accelerate the time to gastrointestinal recovery following surgeries” (post-op ileus). Naloxegol is another oral antagonist with FDA label indication to treat OIC in adult patients with chronic non-cancer pain. Linaclotide is a small bowel secretagogue, and is approved for irritable bowel syndrome.
FAST FACTS AND CONCEPTS #295. Opioid induced constipation Part II: newer therapies