Cancer-related constipation.
Cancer-related constipation is common and a significant detractor from patient quality of life. It has many possible causes and is still not well understood. Information is lacking on therapies for cancer-related constipation among current medications approved by the US Food and Drug Administration (FDA). Most agents have only been formally tested in comparison with placebo in chronic idiopathic constipation if at all. Few comparative studies of laxatives have been performed to establish superiority or synergy. As we understand more about the physiology of the gastrointestinal tract, new targeted therapies have become available. These include a selective chloride channel activator, lubiprostone, and a selective 5HT4 serotonin receptor agonist, tegaserod, both of which have been FDA approved for chronic idiopathic constipation. The role of these agents in cancer-related constipation remains to be seen. On the horizon are two investigational peripherally acting opioid receptor antagonists, alvimopan and methylnaltrexone. Preliminary results in cancer-related constipation suggest that these agents may be important additions to our treatment repertoire.
Thomas
Jay
J
San Diego Hospice & Palliative Care, San Diego, San Diego, CA 92103, USA. jathomas@ucsd.edu
D000527:Alprostadil / Q000031:analogs & derivatives / Q000627:therapeutic use; D003248:Constipation / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D005227:Fatty Acids / Q000627:therapeutic use; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D000068238:Lubiprostone; D009271:Naltrexone / Q000031:analogs & derivatives / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009369:Neoplasms / Q000150:complications*; D010880:Piperidines / Q000627:therapeutic use; D000644:Quaternary Ammonium Compounds / Q000627:therapeutic use; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use
D005227:Fatty Acids; D005765:Gastrointestinal Agents; D007211:Indoles; D009292:Narcotic Antagonists; D010880:Piperidines; D000644:Quaternary Ammonium Compounds; D017366:Serotonin Receptor Agonists; C032257:methylnaltrexone; C105050:tegaserod; D009271:Naltrexone; C419502:alvimopan; D000068238:Lubiprostone; D000527:Alprostadil