Background & Aims
Tapentadol was effective and well tolerated in the management of cancer pain with lower prevalence of nausea and vomiting (1). Opioid-induced constipation (OIC) is one of the major issues. However, actual prevalence of tapentadol-induced constipation is unknown. The present study was performed to clarify the prevalence of OIC caused by tapentadol for cancer pain treatment under the hypothesis that OIC would be reversed by naldemedine, peripheral opioid receptor antagonist.
Methods
After IRB approval, patients with cancer pain in whom tapentadol was prescribed between Aug. 2023 and Jan. 2014 were enrolled. Before the prescription of tapentadol, the presence or absence of constipation was confirmed. Patients who had been prescribed with any laxatives or those with neuropathy were excluded.
Results
Tapentadol was prescribed with initial doses of 50-200 mg/day in 34 patients. Eleven patients were excluded. Constipation has not developed in 12 patients throughout the treatment. Constipation was confirmed in 9 patients before tapentadol, although 8 patients were opioid naïve. These 8 patients were considered as chronic constipation (non-OIC), because concomitant administration of naldemedine could not reverse the constipation. In 1 patient, constipation was improved after switching from oxycodone to tapentadol. Constipation developed following tapentadol and was reversed by naldemedine in 2 patients. The overall prevalence of tapentadol-induced constipation was 8.7% (2/23).
Conclusions
Present study clearly demonstrates that the prevalence of tapentadol-induced constipation was low. More than half patients have not revealed constipation during tapentadol treatment, although the prevalence of chronic constipation since before was 34.8% (8/23). We conclude tapentadol should be prescribed for cancer pain treatment because of a high effectivity and better gastrointestinal tolerability profile.
References
(1) J Anesth 2020; 34: 834-40