Opioid-induced constipation (OIC) in advanced illness patients receiving palliative care when response to laxative therapy has not been sufficient: A dialogue among nurses about the home health setting

Home health nurses (HHN) are increasingly charged with the management of OIC in patients with advanced illness receiving palliative care. Patients with advanced illnesses near the end of life are often treated with opioids for pain. Given the relationship between opioids and OIC, there is a high likelihood that they will also need a bowel management program. HHNs are charged with increasing their advocacy for advanced illness patients receiving palliative care who have OIC through improved assessment and good communication. Opioid-induced constipation has its own specific underlying mechanism of occurrence. The approval of the first peripheral mu-opioid receptor antagonist, RELISTOR® (methylnaltrexone bromide), that targets the underlying cause of OIC, was based on positive results from clinical trials. In a double-blind, randomized, placebo-controlled clinical study, advanced illness patients receiving palliative care who did not adequately respond to laxative therapy benefitted from the subcutaneou injection of RELISTOR. The response was rapid: approximately 30% of patients treated with RELISTOR had laxation within 30 minutes. This rapid onset of action may be a desirable feature for both patients and caregivers. Very importantly, centrally mediated opioid analgesia was not affected by the peripheral opioid antagonist. The most common adverse reactions were abdominal pain, flatulence, nausea, dizziness, and diarrhea. Home health nurses now have a useful tool to provide to their patients.