Observational studySupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2026
Dose-dependent association of naldemedine and magnesium oxide in the management of opioid-induced constipation.
Observational study in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study aimed to evaluate the efficacy and potential pharmacological interaction of naldemedine and magnesium oxide (MgO) in the management of opioid-induced constipation (OIC) in cancer patients, with a particular focus on the impact of different MgO doses on treatment outcomes.
methodsA total of 171 patients who received opioid therapy were included in this study. The outcome variable was defecation. Daily defecation status during the observation period was extracted from electronic medical records. To assess the effects and potential interaction between naldemedine and MgO on defecation, a generalized estimating equations (GEE) model with a logit link function was used to account for within-patient clustering. Predicted probabilities of defecation were calculated based on the fitted GEE model.
resultsThe probability of defecation increased with higher doses of MgO. Among patients receiving both MgO and naldemedine, the likelihood of defecation was significantly higher at MgO doses ≤ 1500 mg compared to those receiving MgO alone. However, at doses > 1500 mg, naldemedine did not add further benefit. Naldemedine was independently associated with improved bowel movements, regardless of MgO use. The association between MgO and defecation also strengthened with increasing doses. No significant interaction between naldemedine and MgO was observed at any dose.
conclusionThe concomitant use of MgO and naldemedine was associated with improved defecation, although no statistically significant interaction was detected. However, the added benefit of naldemedine may be limited at higher MgO doses. Naldemedine may be particularly effective in patients with constipation during opioid therapy that is insufficiently responsive to conventional laxatives, especially when an increase in MgO is difficult due to risks such as hypermagnesemia.
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