Laxative Use Patterns for Opioid-Induced Constipation Linked to Opioid Class, Route of Administration

Patterns of laxative use for opioid-induced constipation (OIC) are consistent with the recommendations of current Japanese guidelines; however, timing and frequency of laxative use differ depending on the class of opioid at initiation and the route of administration, according to results from an observational, descriptive study published in Pain Therapy.

Researchers obtained commercially available hospital claims data of 26,939 patients with cancer who received opioid analgesic therapy from January 2018 to December 2019 for this analysis.

The patients were grouped according to opioid class: weak (13,278 patients) or strong (13,661 patients), then subsequently divided into 2 subgroups: the early medication initiation group (patients who received laxatives within 3 days of opioid therapy initiation) and the non-early medication group (patients whose laxative prescription was not initiated within 3 days after initiating opioid therapy).

Osmotic laxatives were most frequently used as first-line therapy in the early medication group, whereas stimulant laxatives were frequently used as first-line therapy in the non-early medication group (oral weak opioids: 13.7%, oral strong opioids: 7.7%, transdermal strong opioids: 15.1%).

Nearly half of the patients in the early medication group changed or added other laxatives in the first month of any first-line therapy (45.0% for osmotic; 54.7% for stimulant; 54.8% for PAMORA).

Compared with weak opioids, the number of patients receiving early medication was substantially higher in those who received strong opioids, and in those who received oral opioids. In addition, twice as many patients who received strong opioids received early laxative medication (57.3% vs 25.0%).

Moreover, the number of patients receiving laxatives early was lower in those initiating transdermal fentanyl compared with oral strong opioids.

The study findings were limited by the fact that the database did not contain data from small hospitals and clinics and it did not account for over-the counter treatments, clinical symptoms, severity of constipation, and general condition of the patients in the analysis. In addition, 40% to 50% of patients died within 3 months after initiating opioid analgesic therapy, and it is unclear whether the patients had actually taken the laxatives.

The researchers concluded, “This is the first study to demonstrate the real-world patterns of laxative use for OIC in Japanese patients with cancer using a nationwide hospital claims database . . . These results clarified the issues to be verified for the proper use of laxatives to manage OIC. Further studies will be needed to determine the optimal timing of laxative initiation and the selection of laxatives for OIC management.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.