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Naloxone SR Capsules in Patients With Opioid Induced Constipation

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00984334
Recruitment Status : Completed
First Posted : September 25, 2009
Results First Posted : December 27, 2013
Last Update Posted : December 27, 2013
Information provided by (Responsible Party):
S.L.A. Pharma AG

Brief Summary:
For many patients taking opioids for pain relief one of the most distressing side effects is constipation. Naloxone is effective in the reversal of the effects of opioids and is used following opioid overdose. If naloxone is given by mouth it would relieve the effects of constipation but as it goes into the blood stream very quickly, it would also reverse the effects of the opioid and therefore stop the pain relief. The aim of this study is to examine a slow release formulation of naloxone to see if is can reduce constipation without reducing the pain relieving effects of the opioid.

Condition or disease Intervention/treatment Phase
Chronic Pain Opioid Induced Constipation Drug: Naloxone SR 5 mg capsules Drug: Placebo Drug: Naloxone SR 10 mg capsules Drug: Naloxone SR 20mg capsules Drug: Naloxone SR 2.5 mg capsules Phase 2

Detailed Description:

Naloxone has been used for many years as an IV or IM injection for the reversal of opioid effects (following opioid overdose) and has been evaluated as an oral formulation to manage opioid-induced constipation. Immediate release oral naloxone preparations have however led to reversal of opioid effects and withdrawal. This has initiated the development of prolonged (slow release) naloxone preparations which prevent the systemic levels of naloxone reaching levels where the central opioid effects may be reversed. Naloxone has a high first pass metabolism (98%) and short half life (~1hr).

The objectives of this trial are to identify the optimum dosage regime of Naloxone SR capsules based on tolerability level, to improve spontaneous bowel movement frequency, and relieve GI symptoms, in patients suffering with opioid induced constipation.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 40 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Multicentre, Randomised, Double-Blind, Placebo-Controlled, Multiple Ascending Dose Study Evaluating the Safety, Tolerability and Efficacy of Naloxone SR Capsules in Subjects With Constipation Due to Opioids, Taken for Persistent Non-Cancer Pain
Study Start Date : October 2009
Actual Primary Completion Date : January 2012
Actual Study Completion Date : April 2012

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Constipation

Arm Intervention/treatment
Placebo Comparator: Capsules with no active drug
Placebo capsules once daily for three weeks then twice daily for three weeks.
Drug: Placebo
Active Comparator: Naloxone SR 2.5 mg capsules
Naloxone SR 2.5 mg capsules once daily for three weeks then twice daily for three weeks.
Drug: Naloxone SR 2.5 mg capsules
Experimental: Naloxone SR 10mg capsules
Naloxone SR 10 mg capsules once daily for three weeks then twice daily for three weeks.
Drug: Naloxone SR 10 mg capsules
Experimental: Naloxone SR 20 mg capsules
Two Naloxone SR 10 mg capsules once daily for three weeks then twice daily for three weeks.
Drug: Naloxone SR 20mg capsules
Experimental: Naloxone SR 5mg capsules
Naloxone SR 5 mg capsules once daily for three weeks then twice daily for three weeks.
Drug: Naloxone SR 5 mg capsules

Primary Outcome Measures :
  1. Incidence and Severity of Treatment Emergent Adverse Events on Single Dosing. [ Time Frame: 3 weeks ]
    Incidence and severity of treatment emergent adverse events on single dosing.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • All subjects must give written informed consent
  • Male or female subjects greater than 18 years of age
  • Taking opioid full agonist therapy(oral or transdermal) for persistent non-cancer pain, for at least 4 weeks prior to baseline visit
  • Subjects with at least a 3 week history of OIC prior to baseline; where bowel dysfunction is predominantly due to opioids and started following commencement of opioid therapy
  • Subjects with <3 SBMs a week and experiencing one or more bowel symptoms (incomplete evacuation, straining, hard/small pellets) for 25% or more of bowel movements during the screening period
  • Subjects must be willing to discontinue all current laxative (constipation) therapy. Bisacodyl will be provided and taken as required

Exclusion Criteria:

  • Women of childbearing potential, unless surgically sterile or using adequate contraception (either IUD, oral or depot contraceptive, or barrier plus spermicide). Women using oral contraception must have started using it at least 2 months prior to enrolment
  • Women who are pregnant or breastfeeding
  • Symptoms suggestive of non-opioid related bowel dysfunction (e.g. IBS - intermittent constipation or diarrhoea) or have diarrhoea or loose stools in the 4 weeks prior to baseline
  • History of chronic constipation prior to commencing opioid therapy
  • Gastrointestinal disorders known to affect bowel transit, or contribute to bowel dysfunction (other than OIC)
  • Chronic faecal incontinence
  • Subjects who have a colostomy, ileostomy, or colectomy with ileorectal anastomosis
  • Subjects with a history of neoplastic disease within 5 years (except for basal cell carcinoma or non-metastatic squamous cell carcinoma of the skin)
  • Subjects taking opioids for the management of drug addiction Subjects who do not meet any of the following criteria regarding baseline medications. Analgesia (including opioids and NSAIDs) should be stable throughout the trial.

    • Any baseline analgesia must have been administered at a stable dose for a minimum of 4 weeks. If non-opioid analgesia recently discontinued, must have stopped at least 4 weeks prior to baseline
    • Laxatives (outside that allowed by the protocol) are not permitted; these agents must have been discontinued at the screening visit.
    • Use of drugs known to affect gut transit time (other than opioids) are not permitted (see Section 6.9 for exceptions)
    • Use of mixed agonist/antagonist, or partial agonist opioids are not permitted (e.g. buprenorphine, pentazocine, cyclazocine, nalbuphine, nalorphine)
    • Experimental agents must have been discontinued at least 8 weeks prior to screening, or for a period equivalent to 5 half-lives (t½) of the agent (whichever is longer)
    • Subjects with a history of clinically significant and/or persistent disorder that, in the investigators opinion, may affect the clinical trial assessments
    • Subjects with any laboratory tests considered clinically significant at screening.
    • Subjects not ambulatory i.e. bedridden or require use of a commode
    • Subjects who will be unavailable for the duration of the trial, likely to be non-compliant with the protocol, or who are felt to be unsuitable by the Investigator for any other reason

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00984334

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Schmerzzentrum Berlin
Berlin, Germany, 10435
Schmerzzentrum Frankfurt
Frankfurt, Germany, 60311
Gemeinschaftspraxis Tamm-Albert-Schroter-Uhmann
Hannover, Germany, 30167
Gemeinschaftspraxis Loewenstein-Hesselbarth
Mainz, Germany, 55116
Regionales Schmerzzentrum Wuppertal
Wuppertal, Germany, 42105
United Kingdom
St Jame's Hospital Leeds
Leeds, United Kingdom, LS9 7TF
Norfolk & Norwich Hospital
Norwich, United Kingdom, NR4 7UY
Department of Pain Management, York Hospital
York, United Kingdom, LS14 6UH
Sponsors and Collaborators
S.L.A. Pharma AG
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Principal Investigator: Karen Simpson, MD St James University Hospital, Leeds, UK

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Responsible Party: S.L.A. Pharma AG Identifier: NCT00984334     History of Changes
Other Study ID Numbers: NAL-OIC-01
2009-009377-10 ( EudraCT Number )
First Posted: September 25, 2009    Key Record Dates
Results First Posted: December 27, 2013
Last Update Posted: December 27, 2013
Last Verified: November 2013

Keywords provided by S.L.A. Pharma AG:
Subjects taking opioids for chronic non-cancer pain, who
experience symptoms of opioid induced constipation

Additional relevant MeSH terms:
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Chronic Pain
Neurologic Manifestations
Signs and Symptoms
Signs and Symptoms, Digestive
Analgesics, Opioid
Central Nervous System Depressants
Physiological Effects of Drugs
Sensory System Agents
Peripheral Nervous System Agents
Narcotic Antagonists