Prolonged-Release Oxycodone/Naloxone Improves Anal Sphincter Relaxation Compared to Oxycodone Plus Macrogol 3350

Jakob Lykke Poulsen, Christina Brock, Debbie Grønlund, Donghua Liao, Hans Gregersen, Klaus Krogh, Asbjørn Mohr Drewes

Research output: Contribution to journalJournal articleResearchpeer-review

7 Citations (Scopus)


BACKGROUND: Opioid analgesics inhibit anal sphincter function and contribute to opioid-induced bowel dysfunction (OIBD). However, it is unknown whether the inhibition can be reduced by opioid antagonism with prolonged-release (PR) naloxone and how this compares to laxative treatment.

AIMS: To compare the effects of combined PR oxycodone/naloxone or PR oxycodone plus macrogol 3350 on anal sphincter function and gastrointestinal symptoms.

METHODS: A randomized, double-blind, crossover trial was conducted in 20 healthy men. Participants were treated for 5 days with combined PR oxycodone/naloxone or PR oxycodone plus macrogol 3350. Resting anal pressure, anal canal distensibility, and relaxation of the internal sphincter to rectal distension were evaluated before treatment (baseline) and on day 5. The Patient Assessment of Constipation Symptom (PAC-SYM) questionnaire, stool frequency, and stool consistency were assessed daily.

RESULTS: Both PR oxycodone/naloxone and PR oxycodone plus macrogol treatment decreased sphincter relaxation compared to baseline (- 27.5%; P < 0.001 and - 14.7%; P = 0.01). However, sphincter relaxation was increased after PR naloxone/oxycodone treatment compared to macrogol (difference = + 17.6%; P < 0.001). Resting anal pressure and anal canal distensibility did not differ between treatments. PAC-SYM abdominal symptoms score was lower during PR naloxone compared to macrogol (0.2 vs. 3.2; P = 0.002). The number of bowel movements was lower during PR naloxone versus macrogol (4.2 vs. 5.4; P = 0.035).

CONCLUSION: Relaxation of the internal anal sphincter was significantly better after PR oxycodone/naloxone treatment compared to PR oxycodone plus macrogol 3350. These findings highlight that OIBD may require specific therapy against the complex, pan-intestinal effects of opioids.

Original languageEnglish
JournalDigestive Diseases and Sciences
Issue number11
Pages (from-to)3156-3166
Number of pages11
Publication statusPublished - 2017


  • Adolescent
  • Adult
  • Anal Canal
  • Analgesics, Opioid
  • Constipation
  • Cross-Over Studies
  • Defecation
  • Delayed-Action Preparations
  • Denmark
  • Double-Blind Method
  • Drug Combinations
  • Healthy Volunteers
  • Humans
  • Male
  • Muscle Relaxation
  • Naloxone
  • Narcotic Antagonists
  • Oxycodone
  • Polyethylene Glycols
  • Pressure
  • Surveys and Questionnaires
  • Time Factors
  • Young Adult
  • Comparative Study
  • Journal Article
  • Randomized Controlled Trial


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