| One-Minute Clinician

New Medications for Pain and Palliative Care

There’s a new oral formulation for opioid induced constipation and it falls under the class of the PAMORAs which are the peripherally acting mu-opioid receptor antagonists. 

So far on the market we have methylnaltrexone which is subcutaneous, we have alvimopan which is oral but it causes heart attacks so we’re really restricted on its use to using that oral formulation. The new kid on the block is naloxegol, it’s an oral formulation once a day for opioid induced constipation.  So far the clinical trials have been in non-cancer pain that the patients had constipation but I’m excited to see what the trials and our clinical experience with the oncology patient population is. But, nothing in its pharmacology contraindicates it for oncology so you can use it in those patients pretty safely. 

There is a new oral single dose medication combination for chemotherapy induced nausea vomiting and this is huge, because you need the patients to complete the cycle of therapy. The number one factor for stopping chemotherapy that might save your life is the nausea and vomiting. This single agent has shown what I think is most impressive results in the clinical trials so far in that the majority of the patients have completed the chemo they needed to get. So, we’ll see how that plays out versus what is now the standard of care.

And there is a new medication for insomnia which involves a completely different mechanism of action in that it’s not dependent on the GABA receptor.  It’s the orexin receptor that we’re looking at, the neurotransmitter and we’re inhibiting that because that’s been known to cause wakefulness, arousal and even appetite stimulant. This may be particularly helpful in addressing the comorbidity of pain and sleep because it may not carry the risk for breathing problems that you might have with GABA receptors and opioid receptors. This medication was studied in a small subset of patients who had sleep apnea, which are the patients we worry about with opioids and sleep medications. It was deemed to be safe in this small patient population and I’m hopeful that it will be useful for those patients who may have breathing issues with today’s sedative medications.