Opioid-Induced Constipation PAMORA — FRCA Final MCQ

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ModeratePain MedicineOpioid-Induced Constipation PAMORAFRCA Final

A patient on long-term opioids develops severe constipation unresponsive to standard laxatives. What is the recommended targeted treatment?

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Correct answer: A — Naloxegol (peripheral mu-opioid receptor antagonist)

Opioid-induced constipation (OIC) refractory to optimised conventional laxatives: peripheral mu-opioid receptor antagonists (PAMORAs) — naloxegol, naldemedine. These block peripheral (gut) opioid receptors without crossing BBB, so they don't reverse central analgesia. NICE recommends PAMORAs for OIC refractory to ≥2 laxatives.

Reference: NICE – 2023 – Naloxegol for OIC; FPM – 2023