title: Management of opioid-induced constipation in pregnancy: a concise review with emphasis on the PAMORAs.
abstract: OBJECTIVE
  Opioid-induced constipation (OIC) is one of the most common opioid-induced adverse effects. Pregnancy also predisposes to bowel dysfunctions due to the associated endocrine changes. Pregnant women are thus at greater risk of OIC. We review the non-pharmacologic and pharmacologic treatment options as a guide for achieving a clinically optimal strategy for the management of OIC during pregnancy.
  
  
  METHODS
  The published literature was searched for current therapeutic options, including non-pharmacologic dietary modifications, laxatives, and the peripherally acting mu-opioid receptor antagonists (PAMORAs). Each was assessed for efficacy and safety, particularly as they relate to pregnancy.
  
  
  CONCLUSIONS
  Non-pharmacologic approaches such as dietary change are generally safe, but generally insufficient when used alone to control OIC in pregnancy. Laxatives (bulking, osmotic, stimulant) can be effective, but have potential adverse effects that might be particularly troublesome during pregnancy (e.g. electrolyte disturbances, dehydration, abdominal pain, and pulmonary oedema or hypermagnesaemia in the extreme). PAMORAs, which attenuate OIC without affecting opioid-induced analgesia, have been associated with only minimal side effects during the clinical studies to date.
  
  
  CONCLUSIONS
  Conventional non-pharmacologic and pharmacologic options for the management of OIC in pregnancy are often suboptimal due to insufficient efficacy or adverse effects particularly troublesome during pregnancy. The PAMORA strategy appears to provide a safe and effective new option superior to conventional therapies for the management of OIC during pregnancy.
authors.affiliation: Temple University School of Pharmacy, Philadelphia, PA, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Pharmacology, Temple University School of Medicine, Philadelphia, PA, USA.|Association of Chronic Pain Patients, Houston, TX, USA.
authors.forename: J V
authors.initials: JV
authors.lastname: Pergolizzi
authors.affiliation: Women's Health Center of Hunterdon County, Flemington, NJ, USA.
authors.forename: R P
authors.initials: RP
authors.lastname: Huttner
authors.affiliation: NEMA Research, Bonita Springs, FL, USA.
authors.forename: G
authors.initials: G
authors.lastname: Zampogna
authors.affiliation: Temple University School of Pharmacy, Philadelphia, PA, USA.
authors.forename: F
authors.initials: F
authors.lastname: Breve
authors.affiliation: Temple University School of Pharmacy, Philadelphia, PA, USA.
authors.forename: R B
authors.initials: RB
authors.lastname: Raffa
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D000818:Animals; D003248:Constipation / Q000139:chemically induced* / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006801:Humans; D054368:Laxatives / Q000494:pharmacology* / Q000627:therapeutic use*; D011247:Pregnancy; D017450:Receptors, Opioid, mu / Q000037:antagonists & inhibitors*
chemical_list: D000701:Analgesics, Opioid; D054368:Laxatives; D017450:Receptors, Opioid, mu
keywords: constipation management; opioid-induced constipation during pregnancy; peripheral mu-opioid receptor antagonists (PAMORAs)