Zaparcia indukowane opioidowymi lekami przeciwbólowymi stosowanymi w opiece paliatywnej. Jak zapobiegać? Jak leczyć?
Opioid-induced constipation in palliative care. How to prevent? How to treat?

Summary/Abstract: Opioid analgetics (the most potent painkillers) are widely used in palliative care of patients with terminal malignant neoplasms. They often cause such gastrointestinal adverse effects as nausea, vomiting, flatulence, abdominal pain and constipation, referred to as opioid-induced bowel dysfunction (OIBD ). While some of them, like nausea and vomiting, disappear or at least tend to diminish with continued use, patients do not develop tolerance to opioid-induced constipation. Constipation is an adverse effect of all opioid analgetics and its severity increases with the dose of an opioid, as well as with the progression of the neoplastic disease, markedly decreasing the patient’s quality of life.The incidence of opioid-induced constipation is significantly reduced by the administration of controlled-release tablets containing an opioid receptor agonist and antagonist (oxycodone + naloxone) which acts as a painkiller and reduces the frequency and/or severity of OIBD symptoms. Nowadays, apart from laxatives (initially usually osmotic and/or stimulant agents), new medications such as methylnaltrexone (a peripheral opioid receptor antagonist), administered in subcutaneous injections, are successfully used in the treatment of opioid-induced constipation.The aim of this review is to present the incidence, etiology, prophylaxis and treatment of opioid-induced constipation in the population of patients with malignant neoplasms in palliative care.

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