May 15, 2018

Defining Painstipation

Note: I was compensated by Salix Pharmaceuticals for this post. However, all opinions are my own. 

As a critical care nurse, I’ve cared for many individuals living with chronic pain who suffer from opioid-induced constipation. From what I’ve heard from patients, it is very frustrating and I’ve even seen some people in tears. Recently, I learned about a new pharmaceutical drug that may help these folks named RELISTOR® (methylnaltrexone bromide) and I wanted to share some information with you.

INDICATIONS 

  • RELISTOR is a prescription medicine used to treat constipation in adults that is caused by prescription pain medicines called opioids.
  • RELISTOR tablets and RELISTOR injection are used to treat constipation caused by opioids in adults with long-lasting (chronic) pain that is not caused by active cancer.
  • RELISTOR injection is also used to treat constipation caused by opioids in adults with advanced illness or pain caused by active cancer and who need increases in their opioid dose for pain management.

IMPORTANT SAFETY INFORMATION 

  • Do not take RELISTOR if you have a bowel blockage (called an intestinal obstruction) or have a history of bowel blockage.

Please click here for full Prescribing Information for RELISTOR tablets and RELISTOR injection 

“Patients may not mention opioid induced constipation with their practitioner, so we need to have a “do ask, do tell” policy. It’s important to realize that it starts with conversation. I like to use the phrase “Painstipation.” These are chronic pain patients who are experiencing constipation due to their opioids.” - Dr. Joseph Pergolizzi, Senior Partner & Director of Research, Naples Anesthesia and Pain Associates

Defining Painstipation:

Painstipation, also known as opioid induced constipation (OIC), is the constipation caused by opioid pain medication, which is often taken for chronic pain.

On March 6, 2018, Salix brought together a group of chronic pain patient influencers, HCPs and advocacy organizations to discuss OIC. At the event, Salix shared responses from an OIC online survey that it sponsored in partnership with the U.S. Pain Foundation and asked the influencer attendees to transform the numbers into abstract artwork. These paintings were then unveiled to a group of HCPs later that evening. Attendees also got to hear from Dr. Joseph Pergolizzi about the benefits and risks of RELISTOR and the importance of patients and physicians adopting a “do ask, do tell” policy when it comes to OIC.


The responses presented below are from a national, 1-week online survey sponsored by Salix Pharmaceuticals, in partnership with the US Pain Foundation and conducted by Wakefield Research, which evaluated responses from 441 US adults, aged 18 years or older, who were living with chronic pain, on opioid therapy, and suffering from opioid induced constipation (OIC).

  • More than 37% of these patients reported changing the dosage of their opioid medication to try to alleviate the pain or discomfort from OIC
  • 77% of these patients reported suffering from OIC for at least one year
  • These patients reported waiting an average of 18 hours to have a bowel movement after taking their constipation medication
  • 43% of these patients reported suffering from OIC for more than 3 years
  • 53% of these patients said they would have preferred for their OIC medication to induce a bowel movement in less than 4 hours
  • 47% of these patients reported taking between 6 to 10 total prescription medications on a regular basis
  • 20% of these patients reported taking more than 10 prescription medications on a regular basis


INDICATIONS

  • RELISTOR® (methylnaltrexone bromide) is a prescription medicine used to treat constipation in adults that is caused by prescription pain medicines called opioids. 
  • RELISTOR tablets and RELISTOR injection are used to treat constipation caused by opioids in adults with long-lasting (chronic) pain that is not caused by active cancer. 
  • RELISTOR injection is also used to treat constipation caused by opioids in adults with advanced illness or pain caused by active cancer and who need increases in their opioid dose for pain management. 

IMPORTANT SAFETY INFORMATION

  • Do not take RELISTOR if you have a bowel blockage (called an intestinal obstruction) or have a history of bowel blockage. 
  • RELISTOR can cause serious side effects such as a tear in your stomach or intestinal wall (perforation). Stomach pain that is severe can be a sign of a serious medical condition. If you get stomach pain that is severe, does not go away, or gets worse, stop taking RELISTOR and get emergency medical help right away. 
  • Stop using RELISTOR and call your healthcare provider if you get diarrhea that is severe or that does not go away during treatment with RELISTOR. 
  • You may have symptoms of opioid withdrawal during treatment with RELISTOR including sweating, chills, diarrhea, stomach pain, anxiety, and yawning. Tell your healthcare provider if you have any of these symptoms. 
  • Tell your healthcare provider if you have kidney or liver problems. 
  • Tell your healthcare provider if you have any stomach or bowel (intestines) problems, including stomach ulcer, Crohn’s disease, diverticulitis, cancer of the stomach or bowel, or Ogilvie’s syndrome. Tell your healthcare provider if you are pregnant or plan to become pregnant. Taking RELISTOR during pregnancy may cause opioid withdrawal symptoms in your unborn baby. Tell your healthcare provider right away if you become pregnant during treatment with RELISTOR. 
  • Taking RELISTOR while you are breastfeeding may cause opioid withdrawal in your baby. You should not breastfeed during treatment with RELISTOR. You and your healthcare provider should decide if you will take RELISTOR or breastfeed. You should not do both. 
  • Also, tell your healthcare provider about all of the medicines you take, including prescription and over the-counter medicines, vitamins, and herbal supplements. 
  • In a clinical study, the most common side effects of RELISTOR tablets in people with long-lasting (chronic) pain that is not caused by cancer include: stomach-area (abdomen) pain, diarrhea, headache, swelling or a feeling of fullness or pressure in your abdomen, sweating, anxiety, muscle spasms, runny nose, and chills. 
  • In a clinical study, the most common side effects of RELISTOR injection in people with long-lasting (chronic) pain that is not caused by cancer include: stomach-area (abdomen) pain, nausea, diarrhea, sweating, hot flush, tremor, and chills. 
  • In clinical studies, the most common side effects of RELISTOR injection in people receiving treatment for their advanced illness include: stomach-area (abdomen) pain, gas, nausea, dizziness, and diarrhea. 


You are encouraged to report side effects of prescription drugs to FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

For product information, adverse event reports, and product complaint reports, please contact:
Salix Product Information Call Center
Phone: 1-800-321-4576
Fax: 1-510-595-8183
Email: salixmc@dlss.com

Please click here for full Prescribing Information for RELISTOR tablets and RELISTOR injection