Key result
Adding itopride to preventive laxative therapy significantly decreased the necessity of laxative use in palliative care patients with opioid-induced constipation compared to laxatives alone (p=0.010).
Why the study?
Laxatives are strongly recommended to prevent opioid-induced constipation, but evidence supporting the effectiveness of prokinetics is sparse.
Does itopride reduce the necessity of laxative use in adult palliative care patients with opioid-induced constipation?
Observational (n=92)
Open-label
Yes
Does itopride reduce the necessity of laxative use in adult palliative care patients with opioid-induced constipation?
p-value: p=0.010
Adding itopride to regular laxatives significantly decreases the necessity of laxative use in palliative care patients with opioid-induced constipation.
Suggests itopride may help manage opioid-induced constipation in palliative care; leaves open the need.
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 seven 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.
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Dzierżanowski et al. (2019) conducted an observational in Opioid-induced constipation (n=92). Itopride vs. Laxatives only (control) was evaluated on Mean change in the necessity of laxative use on a 0-4 scale after 7 days (95% CI -1.6-1.8, p=0.010). Adding itopride to preventive laxative therapy significantly decreased the necessity of laxative use in palliative care patients with opioid-induced constipation compared to laxatives alone (p=0.010).
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