Itopride increases the effectiveness of the management of opioid-induced constipation in palliative care patients: an observational non-interventional study

Tomasz Dzierżanowski; Michael Kozlowski

doi:10.5114/aoms.2019.85943

Itopride increases the effectiveness of the management of opioid-induced constipation in palliative care patients: an observational non-interventional study

Arch Med Sci. 2019 Jul 18;18(5):1271-1278. doi: 10.5114/aoms.2019.85943. eCollection 2022.

Authors

Tomasz Dzierżanowski^{1

2}, Michael Kozlowski³

Affiliations

¹ Laboratory of Palliative Medicine, Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland.
² Laboratory of Palliative Medicine, Chair of Oncology, Medical University of Lodz, Lodz, Poland.
³ Clinic of Pain Treatment and Palliative Care, Jagiellonian University Medical College, Krakow, Poland.

Abstract

Introduction: It is strongly recommended that laxatives be routinely prescribed for the prevention of opioid-induced constipation (OIC). The evidence supporting the effectiveness of prokinetics for this indication is sparse. This study aims to verify if itopride, added to preventive OIC therapy, increases the effectiveness of the prevention of opioid-induced constipation in adult palliative care patients.

Material and methods: In a questionnaire-based observational study, all patients received regular laxatives plus one of the following: oxycodone/naloxone (OXN); itopride (ITP); or oxycodone/naloxone + itopride (OXN + ITP). The primary measure was the decrease in the necessity of laxative use in a 0-4 scale assessed after 7 days of treatment.

Results: Ninety-two patients met the inclusion criteria in the four groups: OXN (n = 12), ITP (11), OXN + ITP (9), and the control group (laxatives only if needed) (60). The necessity of laxatives decreased in groups where itopride was used, with a statistically significant difference versus control, oxycodone/naloxone (p = 0.009), or in combination. The OXN did not decrease laxative use (p = 0.22).

Conclusions: All interventions appeared similarly effective in the prevention of OIC. However, adding itopride, but not oxycodone/naloxone, resulted in a decrease in the necessity of laxative use in OIC patients, and it seems to be valuable in this often refractory condition. Randomised, controlled trials would be valuable to obtain good quality evidence without systematic bias.

Keywords: itopride; opioid-induced constipation; palliative care; prokinetics.