69 Managing opioid-induced constipation using Naloxegol: a snapshot of a hospital’s experience

Background Opioid-induced constipation has been defined as 'new or worsening symptoms of constipation when initiating, changing or increasing opioid therapy'. The symptoms must include two or more of the following in at least 25% of defecations: straining, lumpy or hard stools, sensation of incomplete evacuation, sensation of ano-rectal blockage, use of manual maneuvers to facilitate defecation, and fewer than three spontaneous bowel movements per week. Aim To showcase use of Naloxegol in patients with opioid-induced constipation in an acute hospital setting. Method Mixed-method approach, comprising retrospective extrapolation Naloxegol prescriptions from 16th October 2022 to 16th October 2023, and qualitative analysis of relevant data (convenience sampling). Results All patients who received Naloxegol prescription during the audit period: Age: 28–97 y, Females 33 (63%) Wards the patients were on: General medicine 10, Geriatrics 9, Palliative and oncology 8, Surgical wards including ENT 8, Respiratory 6, Endocrine 5, Gastroenterology 4, Orthopaedics 2 Opiates used: Morphine sulphate, Oxycodone, Buprenorphine, Fentanyl, Alfentanil, Codeine, Tramadol Diagnosis necessitating the opiate used: Cancer diagnosis - 39 (75%), Chronic pain - 5(10%), Lung disease (ILD and COPD) - 5 (10%), Trauma and orthopaedics - 3 (5%) Comparison by dose of Naloxegol prescription during the audit period: 12.5 mg (n=9) 25 mg (n=43) 2 males, 7 females Ages 55–86 y Cancer diagnosis 6/9 17 males, 26 females Ages 28–97 y Cancer diagnosis 32/52 Patient response to Naloxegol use 'Faecal load' burden was documented as relieved in all cases Conclusion The Naloxegol audit simply demonstrates that opioid-induced constipation occurs across different specialties, wards and diagnoses; although it is understandably more prevalent among patients with a cancer diagnoses. Further studies are required to understand physician and patient perception of its use.