Peripherally Acting Mu-Opioid Receptor Antagonist Use in Opioid-Induced Constipation in Patients With Cancer: A Scoping Review

BACKGROUND: Opioid-induced constipation (OIC) is a common and debilitating gastrointestinal side effect among adult patients with cancer receiving opioid therapy for pain management. Peripherally acting mu-opioid receptor antagonists (PAMORAs) have emerged as a promising treatment option. OBJECTIVES: This scoping review evaluates the current evidence regarding the efficacy and safety of three U.S. Food and Drug Administration-approved PAMORAs-naldemedine, naloxegol, and methylnaltrexone-in managing OIC in adult patients with cancer. METHODS: A literature search was conducted using PubMed®, CINAHL®, and Scopus® databases. Eight studies met the inclusion criteria and were analyzed. FINDINGS: PAMORAs effectively improved bowel movement frequency and enhanced constipation-related symptom relief and quality of life. Most adverse effects were gastrointestinal in nature but were generally mild to moderate in severity. Naloxegol and naldemedine were shown to be effective for long-term OIC management, and methylnaltrexone was effective for short-term relief.