There are times the need for constipation medication is valid. Consider this example:
" I have stage four lung cancer and have begun to use morphine for the pain. My stools are very hard : no matter how much of fruits, vegetables and fiber I eat. I also have bowel hernia so I must not strain. Sodium is a big concern...
but I do take stool softeners. I have also tried herbs, over-the-counter fiber supplements etc...I need something gentle, safe with no side effects for daily use. Does anyone know of anything that could help me?"
Sadly this kind of need arises very often. One of the side effects of using narcotic painkillers is constipation. About 230 million prescriptions were written for opioids, a painkiller often given to late-stage cancer patients, in 2007 in the United States alone. It is estimated 40% - 90% of these patients suffer the side effect of chronic constipation. I live in a country of only 20 million people. So even the lowest 40% is 92 million more than 4 times my entire nation suffering from painkiller-induced constipation!!
Of course, these patients are prescribed laxatives and stool softeners but less than half find relief. Bloating, abdominal cramping, and gastroesophageal reflux are among the symptoms in which constipation is the "hallmark" syndrome. For now there are no oral drugs approved to address this problem.
Do such drugs exist? Sure they do - in the stage of development. NKTR-118( Naloxegol ) could be the drug for opioid-induced constipation. Another drug , NKTR-119 is also being developed simultaneously, with the hope of relieving pain without the constipation side effect.
Both drugs are developed by the London-based drug-maker Nektar Therapeutics, which later signed a deal with AstraZeneca, allowing the latter to continue developing, manufacture and market the aforementioned products.
Once-daily NKTR-118 increases bowel movements from once weekly to 5.5 times according to a study conducted on patients. With such impressive potential, no wonder both designer and business partner are enthusiastic about the market response:
"I don't see much in the way of competition," said Howard Robin, Nektar president and CEO.
"NKTR-118 is an important late stage programme that has the potential to address a real need for patients," according to David Brennan, CEO of AstraZeneca.
Another constipation medication in the making is OpRA III, developed by Lilly which sold the rights to the maker of constipation drug Entereg - Adolor. OpRA III is designed to restore bowel movements in users of painkillers.
The upfront for OpRA III is 2 million whereas the upfront for NKTR -118 and NKTR-119 is 125 million. If they make it to the market, Adolor will pay Lilly 75 million while the deal between AstraZeneca and Nektar may worth 1.2 - 1.5 billion! As Naloxegol is expected to complete phase 3 trial in 2012, Nektar Therapeutics shares rises.
Experimental drug that didn't make it - Development of drug codename ALKS 37 was put on a halt when it did not satisfy the manufacturer's pre- specified criteria for advancing into phase 3 clinical trials. Ireland-based Biotechnology company Alkermes Plc thus decided to end work on ALKS 37 , a medicine to treat opioid induced constipation.
Reference sources for constipation medication:
1. Reuters Sep 21, 2009 -"AstraZeneca and Nektar Sign Worldwide Agreement for Nektar Drug Development Programmes..."
2. Bioworld.com , September 22, 2009- "Nektar Coffers Brimming with Cash Thanks to $1.5B Deal"
3. Indystar.com ,September 22, 2009 "Lilly selling rights to medicine"
Your digestive tract is arguably the most important system in your body from a disease prevention standpoint. It must obtain its own nutrients from the food you consume in order to process and absorb nutrition as well as excrete waste.