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Pharmacological treatment of opioid-induced constipation: moving ahead to new targets
  1. Fabio Lugoboni1,
  2. Federico Vignoni1,
  3. Stefano Tamburin2
  4. Gruppo InterSERT di Collaborazione Scientifica (GICS)
    1. 1 Department of Medicine, Addiction Medicine Unit, Integrated University Hospital of Verona, Verona, Veneto, Italy
    2. 2 Department of Neurosciences, Biomedicine & Movement Sciences, University of Verona, Verona, Italy
    1. Correspondence to Professor Stefano Tamburin, Department of Neurosciences, Biomedicine & Movement Sciences, University of Verona, Verona 37134, Italy; stefano.tamburin{at}

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    We read with great interest the systematic review and network meta-analysis on pharmacological treatments for opioid-induced constipation (OIC).1 Based on 27 randomised controlled trials (RCTs, 9149 patients), the authors concluded that peripherally acting mu-opioid receptor antagonists (PAMORAs) and the prokinetic prucalopride were all more effective than placebo for OIC and that naloxone and naldemedine were the most efficacious ones.1

    We have previously documented that OIC has high prevalence and is associated with reduced quality of life (QoL) in opioid-addicted patients treated with opioid substitution treatment (OST).2 Overweight is also common and interventions for weight loss are recommended in patients under OST.3 Orlistat, a weight-control drug that inhibits lipase, thereby decreasing fat absorption from the intestinal lumen, has been reported to improve drug-resistant constipation in small case series,4 5 and clozapine-induced constipation in a small RCT.6

    In an open-label observational study, we explored whether orlistat may improve OIC in OST patients. From a cohort of 1057 heroin-dependent patients under OST previously reported,2 we recruited patients with OIC, who were prescribed orlistat 60 mg three times a day for weight reduction. OIC was measured with …

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    • Collaborators Gruppo InterSERT di Collaborazione Scientifica (GICS): V Arcarese, C Arzillo, L Benigna, N Bersani, P Bersani, C Biasin, C Bossi, A Bottazzo, A Bove, E Caccamo, S Cancian, F Cantanchin, D Cantiero, G Canzian, D Cargnelutti, D Casalboni, R Casarini, M Cibin, P Civitelli, T Cozzi, L De Cecco, R Del Zotto, F Dersini, I Duranti, M Fadelli, E Favero, N Fontana, A Franceschini, M Gaiga, M Gardiolo, N Gentile, D Gervino, N Ghezzo, M A Giacomin, H Kashanpour, M Mazzo, D Meneghello, C Mihalcea, E Milan, M Montresor, E Moratti, A Pani, V Pavani, P Pellachin, F Peroni, M Piazza, M Pieri, D Prosa, M Residori, P Righetti, M A Ripoli, P Riscica, C Rizza, V Rizzetto, A Rossi, A Rovea, A Ruffato, C Ruzziconi, R Sabbion, E Santo, M Scarzella, N Sembianti, P Simonetto, C Smacchia, M Stellato, C Stimolo, L Suardi, A Vaiana, V Zavan, E Zerbetto, M Zerman.

    • Contributors FL: conception and design of the study, review of the literature, review and editing of the manuscript. FV: design of the study, data collection, review and editing of the manuscript. ST: conception and design of the study, review of the literature, statistical analysis, writing the manuscript. All the authors read and approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval The study protocol was approved by the Ethics Committee of the Verona University Hospital, Verona, Italy (approval ID 533CESC).

    • Provenance and peer review Not commissioned; internally peer reviewed.