Dr Gerald Sacks Explains Treatment Options in the Management of OIC

1. Dr Gerald Sacks Explains Treatment Options in the Management of OIC Dr Gerald Sacks, MD, Pain Institute of Santa Monica, explains how peripherally acting µ- opioid receptor antagonists work. These work by blocking the binding of the opioid to the receptor in the gastrointestinal tract while allowing the binding of the µ-opioid receptor to the opioid in the central nervous system. According to him, these antagonists affect the µ-opioid receptors in the GI tract but do not compromise the blood- brain barrier, thus maintaining opioid-induced analgesia while affecting OIC. Patients usually start with over the counter medications to treat OIC. These include stool softeners, laxatives, motility agents, and much

2. more. However, these are usually inadequate for patients who are on opioids. Thus, it is important to treat the patient with a medication that is specifically designed for that problem. In the face of this, peripherally acting µ-opioid receptor antagonists are designed to address OIC. Dr Gerald Sacks further states that medication Naloxegol can be an effective treatment for OIC. However, the issue with this medication is that it requires metabolism through the cytochrome P450 system. Although, it is an appropriate choice for some patients, it may not be an appropriate choice for patients who are taking medications that are also metabolized through the same cytochrome P450 metabolic steps in the liver. Sharing additional treatment options in the management of OIC, Dr Sacks feels that lifestyle modifications and over-the-counter products also play a very important role in preventing OIC in patients.