Lubiprostone for the treatment of opioid-induced bowel dysfunction

INTRODUCTION: Opioid-induced bowel dysfunction (OBD) is a prevalent condition that leads to reduced opioid use, human suffering and a high burden and cost on the healthcare system. Opioid-induced constipation (OIC) is the most troublesome aspect of OBD, for which standard laxatives are often ineffective. A major unmet need is effective and safe OIC treatment without inhibiting opioid analgesia or inducing opioid withdrawal symptoms. Recent data indicate that lubiprostone, a locally acting type 2 chloride channel activator, approved for the treatment of chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation, may be effective in treating OBD. AREAS COVERED: The areas covered are: i) an overview of clinical trials of lubiprostone in the treatment of OBD based on peer-reviewed literature and congress materials from 2005 to 2010; and ii) an evaluation of the efficacy and potential mechanisms of action of lubiprostone in the treatment of OBD. EXPERT OPINION: Lubiprostone has potential in treating OBD and deserves additional study. Lubiprostone's ability to promote fluid secretion locally at the apical membrane of intestinal epithelial cells ensures it does not provoke opioid withdrawal or compromise analgesia. Lubiprostone seems safe for long-term use in CIC patients, and a similar safety profile is anticipated in OBD.