PAMORAs in opioid-induced constipation: Are we following the guidelines?

Authors

Katie Liu, Ariana Chen, Pranav Rajaram, Grayson Buning, Allen A Lee, Prashant Singh

Published in

Clinical and translational gastroenterology. Jun 13, 2025. Epub Jun 13, 2025.

Abstract

Peripherally acting u-opioid receptor antagonists (PAMORAs) are a safe and efficacious medication for treating opioid-induced constipation (OIC). This study evaluates the utilization of PAMORAs in patients with laxative refractory OIC.
Patients diagnosed with OIC from 2018-2023 were retrospectively identified at a tertiary care center. As recommended by the guidelines, patients were considered eligible for PAMORAs if they had failed at least 2 laxatives. Data on PAMORAs prescription, demographics, clinical characteristics, and specialty of managing provider were collected and analyzed with logistic regression and chi-squared analysis.
Of 281 patients diagnosed with OIC, 204 (73%) were eligible for a PAMORA of which only 58 (28%) were prescribed one. There were no differences in demographic or clinical characteristics between those offered PAMORAs vs not. There was a significant difference in prescribing patterns based on provider specialty (p<0.001). Although GI specialists saw less than half of the eligible patients, they offered PAMORAs at the highest proportion of 59% compared to non-GI specialists (13-16%) or primary care providers (18%). Multivariable logistic regression analysis showed 12.7-fold increased odds of being offered a PAMORA if the provider was from the GI department compared to all non-GI providers (p < 0.001).
PAMORAs are underutilized in patients with OIC. GI prescribers offer PAMORAs at a higher proportion than other departments and being seen in GI independently increases the likelihood of a patient receiving a PAMORA. This suggests underutilization may be due to a lack of awareness and further education about PAMORAs is warranted.

PMID:
40512185
Bibliographic data and abstract were imported from PubMed on 13 Jun 2025.

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