Efficacy and side-effect profiles of lactulose, docusate sodium, and sennosides compared to PEG in opioid-induced constipation: a systematic review.

摘要

Opioid-induced constipation (OIC) is an unpleasant and ubiquitous side effect of opioid treatment. Ineffective treatment of OIC can result in decreased adherence to opioid therapy, decreased quality of life, and increased morbidity and mortality. The constipating effects of opioids result from their inhibitory effects on micro, kappa, and delta receptors in the gastrointestinal tract causing hard and dry stools, prolonged transit time, decreased gastric secretions, and ineffective colonic emptying. Current treatment of OIC occurs by trial and error; little evidence exists to guide practice. Docusate sodium, sennosides, and lactulose are common drugs used in constipation prevention and management in OIC. This systematic review investigates whether PEG is superior to doscusate sodium, sennosides, and/or lactulose in the treatment of OIC. Despite extensive search strategies, no studies met our inclusion criteria. Consequently, insufficient evidence exists to address this clinical question. Further research is required and high-powered, well-designed clinical trials are economically feasible.