Laxative prescribing in relation to opioid use and the influence of pharmacy-based intervention.
BACKGROUND
Opioid-induced constipation is a common problem and can cause serious complications. It is widely advised that laxatives should be started concurrently with opiates, unless there is a clear indication not to do so.


OBJECTIVE
This study was undertaken to estimate how often laxatives were started concurrently with opiates and to describe the effect of pharmacy-based interventions to promote the use of laxatives in patients starting opioids.


METHODS
Twenty-six community pharmacies identified all patients who received a first prescription for a strong opioid during January and February of 1998, 1999 or 2000. Pharmacists collected information on patient, drug and prescriber characteristics (age, gender, use of opiates and laxatives). A separate questionnaire was used to collect data on pharmacy-based interventions to promote the simultaneous prescribing of laxatives with the opiates.


RESULTS
Overall, 37% of the patients receiving an opioid started taking laxatives within 5 days. The percentage of patients who received laxatives simultaneously with opioids increased from 31% in 1998 to 35% in 1999 and 42% in 2000. In 117 (43%) of the opioid prescriptions, pharmacy-based intervention had taken place before the prescription date. Of these, 48.7% was accompanied by a laxative. Opioid prescriptions (n=152) without a pharmacy based intervention were accompanied in 27.6%. After adjustment for covariates (including time trends), pharmacy-based intervention increased the probability of concomitant laxative use 1.9 [95% CI 1.1-3.3] times.


CONCLUSIONS
This study shows that the widely used guideline to start a laxative when prescribing an opioid is not always followed in daily practice. In addition, we showed that pharmacy-based intervention contributed to increasing laxative use in patients receiving opioids.
Bouvy
M L
ML
SIR Institute for Pharmacy Practice Research, Theda Mansholtstraat 5B, JE Leiden, The Netherlands. sir@stevenshof.nl
Buurma
H
H
Egberts
T C G
TC
D000368:Aged; D002400:Cathartics / Q000627:therapeutic use*; D003248:Constipation / Q000139:chemically induced* / Q000188:drug therapy*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000009:adverse effects*; D010353:Patient Education as Topic; D010593:Pharmaceutical Services; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
D002400:Cathartics; D009294:Narcotics