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Dual Laxative OIC — SCE Medical Oncology MCQ

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HardSupportive & Palliative OncologyDual Laxative OICSCE Medical Oncology

A patient receiving modified-release morphine for metastatic pancreatic cancer remains constipated despite an adequate trial of a stimulant plus an osmotic laxative. Rectal examination excludes impaction and there is no bowel obstruction. Which funded escalation most closely matches NICE TA651?

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Correct answer: E — Add naldemedine for opioid-induced constipation after laxative treatment

TA651 recommends naldemedine for adults with opioid-induced constipation who have had laxative treatment. Cancer does not exclude eligibility. Loperamide worsens constipation, prucalopride is not a prerequisite, and reverting to docusate alone neither addresses refractory OIC nor reflects the appraisal.

Reference: NICE TA651: naldemedine for opioid-induced constipation. https://www.nice.org.uk/guidance/ta651/chapter/1-Recommendations