암환자의 마약성 진통제 유발성 변비에 대한 예방적 완하제 사용 및 복약순응도 평가
Prophylactic laxative use and the compliance in relation to opioid-induced constipation
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Constipation is the most common adverse effect occurring with chronic opioid use. Constipation resulting from opioids is dose-related, and patients do not develop tolerance to this symptom. Prophylaxis is crucial because opioid-induced constipation is much easier to prevent than to treat. This study was undertaken to estimate how often laxatives were started concurrently with opiates and to describe the compliance of laxatives and patient’s awareness about the side effect. We identified all outpatients who received a first prescription for oral opioid analgesics for a year from the the January 2007 in Cancer Center, Seoul National University Hospital. And we surveyed by telephone patients who received opioid analgesics more than 4 weeks through a questionnaire about medication compliance and patient’s awareness of the side effect for two months from the 16 August 2008. Overall, 45% of the patients received laxatives simultaneously with opioids. The 50 patients participated in the survey. 55% of patients for whom laxatives are prescribed took a laxative regularly. Of these patients 35% experienced opoioid-induced constipation. 45% of patients took a laxative irregularly, and of these patients 74% experienced constipation. The risk of developing constipation was significantly higher in irregularly taking laxative group [odds ratio 5.3(95% CI 1.4-19.9)]. The laxative compliance was higher with recognition of the reason for taking laxatives [odds ratio 3.9(95% CI 1.1-14.2)]. This study shows that prophylactic treatments are essential to minimize opioid-induced constipation. In addition, it is important to educate patients to raise their compliance and understanding of the reason for taking medication and necessity.
Abstract
Constipation is the most common adverse effect occurring with chronic opioid use. Constipation resulting from opioids is dose-related, and patients do not develop tolerance to this symptom. Prophylaxis is crucial because opioid-induced constipation is much easier to prevent than to treat. This study was undertaken to estimate how often laxatives were started concurrently with opiates and to describe the compliance of laxatives and patient’s awareness about the side effect. We identified all outpatients who received a first prescription for oral opioid analgesics for a year from the the January 2007 in Cancer Center, Seoul National University Hospital. And we surveyed by telephone patients who received opioid analgesics more than 4 weeks through a questionnaire about medication compliance and patient’s awareness of the side effect for two months from the 16 August 2008. Overall, 45% of the patients received laxatives simultaneously with opioids. The 50 patients participated in the survey. 55% of patients for whom laxatives are prescribed took a laxative regularly. Of these patients 35% experienced opoioid-induced constipation. 45% of patients took a laxative irregularly, and of these patients 74% experienced constipation. The risk of developing constipation was significantly higher in irregularly taking laxative group [odds ratio 5.3(95% CI 1.4-19.9)]. The laxative compliance was higher with recognition of the reason for taking laxatives [odds ratio 3.9(95% CI 1.1-14.2)]. This study shows that prophylactic treatments are essential to minimize opioid-induced constipation. In addition, it is important to educate patients to raise their compliance and understanding of the reason for taking medication and necessity.
참고문헌 (10)
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