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Laxative co-medication and changes in defecation patterns during opioid use

INTRODUCTION: Opioid-induced constipation is a clinically relevant side effect and a cause of potentially avoidable drug-related hospital admissions. OBJECTIVES: To describe the presence of laxative co-medication, the reasons for not starting laxatives and to evaluate changes in stool patterns of op...

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Autores principales: de Bruin, Frans, Hek, Karin, van Lieshout, Jan, Verduijn, Monique, Langendijk, Pim, Bouvy, Marcel, Teichert, Martina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6716205/
https://www.ncbi.nlm.nih.gov/pubmed/30260269
http://dx.doi.org/10.1177/1078155218801066
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author de Bruin, Frans
Hek, Karin
van Lieshout, Jan
Verduijn, Monique
Langendijk, Pim
Bouvy, Marcel
Teichert, Martina
author_facet de Bruin, Frans
Hek, Karin
van Lieshout, Jan
Verduijn, Monique
Langendijk, Pim
Bouvy, Marcel
Teichert, Martina
author_sort de Bruin, Frans
collection PubMed
description INTRODUCTION: Opioid-induced constipation is a clinically relevant side effect and a cause of potentially avoidable drug-related hospital admissions. OBJECTIVES: To describe the presence of laxative co-medication, the reasons for not starting laxatives and to evaluate changes in stool patterns of opioid initiators. METHODS: In this observational study community pharmacists evaluated the availability of laxative co-medication in starting opioid users and registered reasons for non-use. Two opioid initiators per pharmacy were invited to complete questionnaires (‘Bristol stool form scale’ and ‘Rome III Diagnostic Questionnaire for the Adult Functional Gastrointestinal Disorders’) on their defecation prior to and during opioid use. Descriptive statistics and Chi square tests were used to analyse reasons for non-use of laxatives and changes in defecation patterns. RESULTS: Eighty-one pharmacists collected data from 460 opioid initiators. Of those, 344 (74.8%) used laxatives concomitantly. Main reason not to use laxatives was that either prescribers or patients did not consider them necessary. Sixty-seven (89.3%) of the 75 opioid starters with two questionnaires completed were not constipated at opioid start. Eleven of them (16%) developed constipation during opioid use (Chi square p=0.003). At follow-up within laxative users 10.6% were constipated compared to 20.7% in subjects without laxatives. CONCLUSION: One in four opioid starters did not dispose of laxative co-medication, mainly because they were not considered necessary by either the prescriber or the patient. The prevalence of constipation doubled during opioid use. A watchful waiting strategy for the use of laxative co-medication might include a monitoring of defecation patterns with validated questionnaires.
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spelling pubmed-67162052019-10-02 Laxative co-medication and changes in defecation patterns during opioid use de Bruin, Frans Hek, Karin van Lieshout, Jan Verduijn, Monique Langendijk, Pim Bouvy, Marcel Teichert, Martina J Oncol Pharm Pract Original Articles INTRODUCTION: Opioid-induced constipation is a clinically relevant side effect and a cause of potentially avoidable drug-related hospital admissions. OBJECTIVES: To describe the presence of laxative co-medication, the reasons for not starting laxatives and to evaluate changes in stool patterns of opioid initiators. METHODS: In this observational study community pharmacists evaluated the availability of laxative co-medication in starting opioid users and registered reasons for non-use. Two opioid initiators per pharmacy were invited to complete questionnaires (‘Bristol stool form scale’ and ‘Rome III Diagnostic Questionnaire for the Adult Functional Gastrointestinal Disorders’) on their defecation prior to and during opioid use. Descriptive statistics and Chi square tests were used to analyse reasons for non-use of laxatives and changes in defecation patterns. RESULTS: Eighty-one pharmacists collected data from 460 opioid initiators. Of those, 344 (74.8%) used laxatives concomitantly. Main reason not to use laxatives was that either prescribers or patients did not consider them necessary. Sixty-seven (89.3%) of the 75 opioid starters with two questionnaires completed were not constipated at opioid start. Eleven of them (16%) developed constipation during opioid use (Chi square p=0.003). At follow-up within laxative users 10.6% were constipated compared to 20.7% in subjects without laxatives. CONCLUSION: One in four opioid starters did not dispose of laxative co-medication, mainly because they were not considered necessary by either the prescriber or the patient. The prevalence of constipation doubled during opioid use. A watchful waiting strategy for the use of laxative co-medication might include a monitoring of defecation patterns with validated questionnaires. SAGE Publications 2018-09-27 2019-10 /pmc/articles/PMC6716205/ /pubmed/30260269 http://dx.doi.org/10.1177/1078155218801066 Text en © The Author(s) 2018 http://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Articles
de Bruin, Frans
Hek, Karin
van Lieshout, Jan
Verduijn, Monique
Langendijk, Pim
Bouvy, Marcel
Teichert, Martina
Laxative co-medication and changes in defecation patterns during opioid use
title Laxative co-medication and changes in defecation patterns during opioid use
title_full Laxative co-medication and changes in defecation patterns during opioid use
title_fullStr Laxative co-medication and changes in defecation patterns during opioid use
title_full_unstemmed Laxative co-medication and changes in defecation patterns during opioid use
title_short Laxative co-medication and changes in defecation patterns during opioid use
title_sort laxative co-medication and changes in defecation patterns during opioid use
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6716205/
https://www.ncbi.nlm.nih.gov/pubmed/30260269
http://dx.doi.org/10.1177/1078155218801066
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