Supportive Care in Cancer

, Volume 12, Issue 9, pp 613–618 | Cite as

Management of opioid-induced bowel dysfunction in cancer patients

  • Antonio Cesar Tamayo
  • Paola Andrea Diaz-Zuluaga
Review Article

Abstract

The gastrointestinal (GI) effects of morphine and other opioids may result in opioid-induced bowel dysfunction (OBD) and the need for treatment. Although OBD is very common in morphine-treated patients, it is usually under-diagnosed. Opioids deliver their GI effect through central and peripheral mechanisms. Laxatives are the pharmaceuticals prescribed most in this area. Prokinetics as well as cholinergic agonists have been used satisfactorily. One-third of patients with OBD have to be treated rectally. The use of opioid antagonists has been favored, but the bioavailability of oral forms is poor. Opioid antagonists with a quaternary structure have a high affinity for peripheral opioid receptors and therefore do not interfere with the analgesia, nor do they generate alkaloid withdrawal syndrome. Opioid rotation is another strategy for maintaining or improving analgesic quality directed toward decreasing the effects of previous opiates on the GI tract.

Keywords

Opioid-induced bowel dysfunction Morphine Constipation Laxatives 

Notes

Acknowledgement

We would like to thank Liliana de Lima for her valuable observations.

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Antonio Cesar Tamayo
    • 1
  • Paola Andrea Diaz-Zuluaga
    • 2
  1. 1.Pain and Palliative Medicine UnitInstituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”México, D.F.Mexico
  2. 2.Acute Leukemia ClinicInstituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”México, D.F.México

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