Ozawa Yuki, Haruki Yayoi, Ohata Meiko, Isono Hisayo, Takahashi Minami, Tate Aki, Ukita Seiko, Hayashi Seiichi
Department of Phamacy, Kanagawa Prefectural Keiyukai Keiyu Hospital.
Department of Palliative Care Internal Medicine, Kanagawa Prefectural Keiyukai Keiyu Hospital.
Yakugaku Zasshi. 2023;143(2):183-189. doi: 10.1248/yakushi.22-00181.
Opioid-induced constipation (OIC), an adverse event that occurs due to opioid analgesics, reportedly causes poor quality of life and adherence to opioid analgesics in patients. Therefore, this issue must be addressed appropriately. Naldemedine (NAL), a peripherally-acting μ-opioid receptor antagonist, is currently recommended for treating OIC when other laxatives are ineffective, but there have been no clinical reports of NAL being used prophylactically for OIC. Therefore, we conducted a retrospective survey of hospitalized patients who received NAL as prophylaxis for OIC with strong opioid analgesics to clarify the reality of this situation and to consider points to be taken into account in its clinical implementation. In this study, 61.7% of the subjects had an Eastern Cooperative Oncology Group performance status score of 3 or higher. The rate of addition of new laxatives and increased laxatives during seven days of NAL prophylaxis was 46.8%, and the rate of diarrhea was 6.1%. This study suggests that patients initiated with strong opioid analgesics during hospitalization often presented with poor performance status, and it is important to pay attention to constipation even under NAL prophylaxis. However, the incidence of diarrhea was low, and the safety of NAL prophylaxis was considered to be good.
阿片类药物引起的便秘（OIC）是一种由阿片类镇痛药导致的不良事件，据报道会导致患者生活质量下降以及对阿片类镇痛药的依从性降低。因此，必须妥善解决这个问题。纳洛酮（NAL）是一种外周作用的μ-阿片受体拮抗剂，目前推荐在其他泻药无效时用于治疗OIC，但尚无关于NAL预防性用于OIC的临床报告。因此，我们对接受NAL作为使用强效阿片类镇痛药时OIC预防措施的住院患者进行了一项回顾性调查，以阐明这种情况的实际情况，并考虑其临床实施中需要考虑的要点。在本研究中，61.7%的受试者东部肿瘤协作组体能状态评分为3分或更高。在NAL预防的七天内添加新泻药和增加泻药的比例为46.8%，腹泻发生率为6.1%。本研究表明，住院期间开始使用强效阿片类镇痛药的患者通常表现为体能状态较差，即使在NAL预防的情况下，关注便秘也很重要。然而，腹泻的发生率较低，NAL预防的安全性被认为良好。
