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. 2023 Sep 27;15(9):e46090. doi: 10.7759/cureus.46090

Table 6. Seriousness, time of onset, outcome at two to less than four weeks following diarrhoea and other adverse drug reactions, and time to recovery or remission.

ADR, adverse drug reaction.

Category Type of ADR n (%) Seriousness Time of onset Outcome Time to recovery or remission
Serious Non-serious <1 week 1–<2 weeks 2–<4 weeks 4–<6 weeks 6–<8 weeks 8–<10 weeks 10–<12 weeks ≥12 weeks Recovered Recovering Recovered + recovering Not recovered Sequelae Death Unknown 1-3 days 4-7 days 8-14 days ≥15 days
Total Diarrhoea 107 (100) 2 (1.9) 105 (98.1) 64 (59.8) 15 ‌(14.0) 18 (16.8) 5 (4.7) 2 (1.9) 2 (1.9) 0 (0.0) 1 (0.9) 77 (72.0) 24 (22.4) 101 (94.4) 3 (2.8) 0 (0.0) 0 (0.0) 3 (2.8) 43 (40.2) 26 (24.3) 15 (14.0) 17 (15.9)
  Other 38 (100) 7 (18.4) 31 (81.6) 16 (42.1) 8 (21.1) 8 (21.1) 4 (10.5) 1 (2.6) 1 (2.6) 0 (0.0) 0 (0.0) 18 (47.4) 16 (42.1) 34 (89.5) 3 (7.9) 0 (0.0) 0 (0.0) 1 (2.6) 11 (28.9) 7 (18.4) 8 (21.1) 8 (21.1)
Age (years)
<75 Diarrhoea 74 (100) 1 (1.4) 73 (98.6) 43 (58.1) 9 (12.2) 14 (18.9) 4 (5.4) 2 (2.7) 1 (1.4) 0 (0.0) 1 (1.4) 54 (73.0) 15 (20.3) 69 (93.2) 2 (2.7) 0 (0.0) 0 (0.0) 3 (4.1) 30 (40.5) 16 (21.6) 12 (16.2) 11 (14.9)
  Other 27 (100) 4 (14.8) 23 (85.2) 10 (37.0) 6 (22.2) 7 (25.9) 3 (11.1) 1 (3.7) 0 (0.0) 0 (0.0) 0 (0.0) 13 (48.1) 12 (44.4) 25 (92.6) 2 (7.4) 0 (0.0) 0 (0.0) 0 (0.0) 7 (25.9) 7 (25.9) 4 (14.8) 7 (25.9)
≥75 Diarrhoea 33 (100) 1 (3.0) 32 (97.0) 21 (63.6) 6 (18.2) 4 (12.1) 1 (3.0) 0 (0.0) 1 (3.0) 0 (0.0) 0 (0.0) 23 (69.7) 9 (27.3) 32 (97.0) 1 (3.0) 0 (0.0) 0 (0.0) 0 (0.0) 13 (39.4) 10 (30.3) 3 (9.1) 6 (18.2)
  Other 11 (100) 3 (27.3) 8 (72.7) 6 (54.5) 2 (18.2) 1 (9.1) 1 (9.1) 0 (0.0) 1 (9.1) 0 (0.0) 0 (0.0) 5 (45.5) 4 (36.4) 9 (81.8) 1 (9.1) 0 (0.0) 0 (0.0) 1 (9.1) 4 (36.4) 0 (0.0) 4 (36.4) 1 (9.1)
Performance status (PS)
0-2 Diarrhoea 78 (100) 2 (2.6) 76 (97.4) 46 (59.0) 10 (12.8) 15 (19.2) 3 (3.8) 2 (2.6) 1 (1.3) 0 (0.0) 1 (1.3) 57 (73.1) 17 (21.8) 74 (94.9) 1 (1.3) 0 (0.0) 0 (0.0) 3 (3.8) 29 (37.2) 17 (21.8) 13 (16.7) 15 (19.2)
  Other 30 (100) 5 (16.7) 25 (83.3) 12 (40.0) 7 (23.3) 7 (23.3) 3 (10.0) 1 (3.3) 0 (0.0) 0 (0.0) 0 (0.0) 15 (50.0) 12 (40.0) 27 (90.0) 2 (6.7) 0 (0.0) 0 (0.0) 1 (3.3) 9 (30.0) 5 (16.7) 6 (20.0) 7 (23.3)
3-4 Diarrhoea 29 (100) 0 (0.0) 29 (100) 18 (62.1) 5 (17.2) 3 (10.3) 2 (6.9) 0 (0.0) 1 (3.4) 0 (0.0) 0 (0.0) 20 (69.0) 7 (24.1) 27 (93.1) 2 (6.9) 0 (0.0) 0 (0.0) 0 (0.0) 14 (48.3) 9 (31.0) 2 (6.9) 2 (6.9)
  Other 8 (100) 2 (25.0) 6 (75.0) 4 (50.0) 1 (12.5) 1 (12.5) 1 (12.5) 0 (0.0) 1 (12.5) 0 (0.0) 0 (0.0) 3 (37.5) 4 (50.0) 7 (87.5) 1 (12.5) 0 (0.0) 0 (0.0) 0 (0.0) 2 (25.0) 2 (25.0) 2 (25.0) 1 (12.5)
Severity of constipation before naldemedine dosing
Mild Diarrhoea 20 (100) 1 (5.0) 19 (95.0) 9 (45.0) 6 (30.0) 3 (15.0) 0 (0.0) 2 (10.0) 0 (0.0) 0 (0.0) 0 (0.0) 14 (70.0) 6 (30.0) 20 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 8 (40.0) 3 (15.0) 5 (25.0) 4 (20.0)
  Other 14 (100) 4 (28.6) 10 (71.4) 6 (42.9) 4 (28.6) 2 (14.3) 1 (7.1) 1 (7.1) 0 (0.0) 0 (0.0) 0 (0.0) 5 (35.7) 9 (64.3) 14 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 3 (21.4) 2 (14.3) 5 (35.7) 4 (28.6)
Moderate Diarrhoea 60 (100) 0 (0.0) 60 (100) 40 (66.7) 9 (15.0) 6 (10.0) 3 (5.0) 0 (0.0) 1 (1.7) 0 (0.0) 1 (1.7) 46 (76.7) 11 (18.3) 57 (95.0) 1 (1.7) 0 (0.0) 0 (0.0) 2 (3.3) 23 (38.3) 16 (26.7) 7 (11.7) 11 (18.3)
  Other 15 (100) 2 (13.3) 13 (86.7) 7 (46.7) 3 (20.0) 3 (20.0) 2 (13.3) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 7 (46.7) 5 (33.3) 12 (80.0) 2 (13.3) 0 (0.0) 0 (0.0) 1 (6.7) 4 (26.7) 2 (13.3) 2 (13.3) 4 (26.7)
Severe Diarrhoea 17 (100) 0 (0.0) 17 (100) 12 (70.6) 0 (0.0) 4 (23.5) 0 (0.0) 0 (0.0) 1 (5.9) 0 (0.0) 0 (0.0) 12 (70.6) 4 (23.5) 16 (94.1) 1 (5.9) 0 (0.0) 0 (0.0) 0 (0.0) 12 (70.6) 2 (11.8) 1 (5.9) 1 (5.9)
  Other 8 (100) 1 (12.5) 7 (87.5) 3 (37.5) 1 (12.5) 3 (37.5) 0 (0.0) 0 (0.0) 1 (12.5) 0 (0.0) 0 (0.0) 6 (75.0) 1 (12.5) 7 (87.5) 1 (12.5) 0 (0.0) 0 (0.0) 0 (0.0) 3 (37.5) 3 (37.5) 1 (12.5) 0 (0.0)
Brain metastasis
No Diarrhoea 102 (100) 2 (2.0) 100 (98.0) 60 (58.8) 15 (14.7) 18 (17.6) 4 (3.9) 2 (2.0) 2 (2.0) 0 (0.0) 1 (1.0) 74 (72.5) 23 (22.5) 97 (95.1) 3 (2.9) 0 (0.0) 0 (0.0) 2 (2.0) 40 (39.2) 25 (24.5) 15 (14.7) 17 (16.7)
  Other 32 (100) 7 (21.9) 25 (78.1) 15 (46.9) 7 (21.9) 5 (15.6) 3 (9.4) 1 (3.1) 1 (3.1) 0 (0.0) 0 (0.0) 17 (53.1) 13 (40.6) 30 (93.8) 1 (3.1) 0 (0.0) 0 (0.0) 1 (3.1) 10 (31.3) 6 (18.8) 7 (21.9) 7 (21.9)
Yes Diarrhoea 5 (100) 0 (0.0) 5 (100) 4 (80.0) 0 (0.0) 0 (0.0) 1 (20.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 3 (60.0) 1 (20.0) 4 (80.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (20.0) 3 (60.0) 1 (20.0) 0 (0.0) 0 (0.0)
  Other 6 (100) 0 (0.0) 6 (100) 1 (16.7) 1 (16.7) 3 (50.0) 1 (16.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (16.7) 3 (50.0) 4 (66.7) 2 (33.3) 0 (0.0) 0 (0.0) 0 (0.0) 1 (16.7) 1 (16.7) 1 (16.7) 1 (16.7)
Anticancer drug treatment
No Diarrhoea 51 (100) 0 (0.0) 51 (100) 36 (70.6) 4 (7.8) 7 (13.7) 2 (3.9) 1 (2.0) 0 (0.0) 0 (0.0) 1 (2.0) 36 (70.6) 13 (25.5) 49 (96.1) 1 (2.0) 0 (0.0) 0 (0.0) 1 (2.0) 23 (45.1) 14 (27.5) 6 (11.8) 6 (11.8)
  Other 19 (100) 3 (15.8) 16 (84.2) 10 (52.6) 4 (21.1) 3 (15.8) 1 (5.3) 1 (5.3) 0 (0.0) 0 (0.0) 0 (0.0) 11 (57.9) 8 (42.1) 19 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 6 (31.6) 6 (31.6) 3 (15.8) 4 (21.1)
Yes Diarrhoea 56 (100) 2 (3.6) 54 (96.4) 28 (50.0) 11 (19.6) 11 (19.6) 3 (5.4) 1 (1.8) 2 (3.6) 0 (0.0) 0 (0.0) 41 (73.2) 11 (19.6) 52 (92.9) 2 (3.6) 0 (0.0) 0 (0.0) 2 (3.6) 20 (35.7) 12 (21.4) 9 (16.1) 11 (19.6)
  Other 19 (100) 4 (21.1) 15 (78.9) 6 (31.6) 4 (21.1) 5 (26.3) 3 (15.8) 0 (0.0) 1 (5.3) 0 (0.0) 0 (0.0) 7 (36.8) 8 (42.1) 15 (78.9) 3 (15.8) 0 (0.0) 0 (0.0) 1 (5.3) 5 (26.3) 1 (5.3) 5 (26.3) 4 (21.1)
Opioid analgesics used when naldemedine was started
Fentanyl only Diarrhoea 5 (100) 0 (0.0) 5 (100) 5 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 4 (80.0) 1 (20.0) 5 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (40.0) 1 (20.0) 1 (20.0) 1 (20.0)
  Other 1 (100) 0 (0.0) 1 (100) 0 (0.0) 0 (0.0) 1 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (100) 0 (0.0) 1 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (100) 0 (0.0)
Only strong opioids other than fentanyl Diarrhoea 72 (100) 2 (2.8) 70 (97.2) 43 (59.7) 10 (13.9) 10 (13.9) 5 (6.9) 1 (1.4) 2 (2.8) 0 (0.0) 1 (1.4) 50 (69.4) 18 (25.0) 68 (94.4) 2 (2.8) 0 (0.0) 0 (0.0) 2 (2.8) 30 (41.7) 16 (22.2) 10 (13.9) 12 (16.7)
  Other 29 (100) 5 (17.2) 24 (82.8) 14 (48.3) 5 (17.2) 5 (17.2) 3 (10.3) 1 (3.4) 1 (3.4) 0 (0.0) 0 (0.0) 12 (41.4) 13 (44.8) 25 (86.2) 3 (10.3) 0 (0.0) 0 (0.0) 1 (3.4) 8 (27.6) 6 (20.7) 6 (20.7) 5 (17.2)
Weak opioids only Diarrhoea 12 (100) 0 (0.0) 12 (100) 8 (66.7) 0 (0.0) 4 (33.3) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 7 (58.3) 4 (33.3) 11 (91.7) 0 (0.0) 0 (0.0) 0 (0.0) 1 (8.3) 4 (33.3) 3 (25.0) 1 (8.3) 3 (25.0)
  Other 2 (100) 0 (0.0) 2 (100) 1 (50.0) 1 (50.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (50.0) 1 (50.0) 2 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (50.0) 0 (0.0) 0 (0.0) 1 (50.0)
Others Diarrhoea 18 (100) 0 (0.0) 18 (100) 8 (44.4) 5 (27.8) 4 (22.2) 0 (0.0) 1 (5.6) 0 (0.0) 0 (0.0) 0 (0.0) 16 (88.9) 1 (5.6) 17 (94.4) 1 (5.6) 0 (0.0) 0 (0.0) 0 (0.0) 7 (38.9) 6 (33.3) 3 (16.7) 1 (5.6)
  Other 6 (100) 2 (33.3) 4 (66.7) 1 (16.7) 2 (33.3) 2 (33.3) 1 (16.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 4 (66.7) 2 (33.3) 6 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (33.3) 1 (16.7) 1 (16.7) 2 (33.3)
Previously used laxatives
Osmotic/saline laxatives only Diarrhoea 43 (100) 1 (2.3) 42 (97.7) 23 (53.5) 11 (25.6) 6 (14.0) 1 (2.3) 1 (2.3) 0 (0.0) 0 (0.0) 1 (2.3) 31 (72.1) 11 (25.6) 42 (97.7) 1 (2.3) 0 (0.0) 0 (0.0) 0 (0.0) 15 (34.9) 9 (20.9) 9 (20.9) 9 (20.9)
  Other 15 (100) 2 (13.3) 13 (86.7) 10 (66.7) 1 (6.7) 3 (20.0) 1 (6.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 8 (53.3) 7 (46.7) 15 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 4 (26.7) 3 (20.0) 6 (40.0) 2 (13.3)
Stimulant laxatives only Diarrhoea 8 (100) 0 (0.0) 8 (100) 5 (62.5) 2 (25.0) 0 (0.0) 0 (0.0) 1 (12.5) 0 (0.0) 0 (0.0) 0 (0.0) 7 (87.5) 1 (12.5) 8 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 5 (62.5) 2 (25.0) 0 (0.0) 1 (12.5)
  Other 2 (100) 0 (0.0) 2 (100) 0 (0.0) 1 (50.0) 1 (50.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (50.0) 1 (50.0) 2 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (50.0) 1 (50.0) 0 (0.0) 0 (0.0)
Others Diarrhoea 35 (100) 0 (0.0) 35 (100) 27 (77.1) 2 (5.7) 4 (11.4) 2 (5.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 27 (77.1) 7 (20.0) 34 (97.1) 0 (0.0) 0 (0.0) 0 (0.0) 1 (2.9) 14 (40.0) 11 (31.4) 4 (11.4) 5 (14.3)
  Other 13 (100) 1 (7.7) 12 (92.3) 3 (23.1) 5 (38.5) 4 (30.8) 0 (0.0) 1 (7.7) 0 (0.0) 0 (0.0) 0 (0.0) 6 (46.2) 4 (30.8) 10 (76.9) 2 (15.4) 0 (0.0) 0 (0.0) 1 (7.7) 3 (23.1) 3 (23.1) 2 (15.4) 2 (15.4)
Nothing Diarrhoea 21 (100) 1 (4.8) 20 (95.2) 9 (42.9) 0 (0.0) 8 (38.1) 2 (9.5) 0 (0.0) 2 (9.5) 0 (0.0) 0 (0.0) 12 (57.1) 5 (23.8) 17 (81.0) 2 (9.5) 0 (0.0) 0 (0.0) 2 (9.5) 9 (42.9) 4 (19.0) 2 (9.5) 2 (9.5)
  Other 8 (100) 4 (50.0) 4 (50.0) 3 (37.5) 1 (12.5) 0 (0.0) 3 (37.5) 0 (0.0) 1 (12.5) 0 (0.0) 0 (0.0) 3 (37.5) 4 (50.0) 7 (87.5) 1 (12.5) 0 (0.0) 0 (0.0) 0 (0.0) 3 (37.5) 0 (0.0) 0 (0.0) 4 (50.0)
Concomitant laxatives
Osmotic/saline laxatives only Diarrhoea 40 (100) 1 (2.5) 39 (97.5) 22 (55.0) 8 (20.0) 7 (17.5) 2 (5.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (2.5) 28 (70.0) 11 (27.5) 39 (97.5) 0 (0.0) 0 (0.0) 0 (0.0) 1 (2.5) 12 (30.0) 8 (20.0) 9 (22.5) 10 (25.0)
  Other 16 (100) 2 (12.5) 14 (87.5) 10 (62.5) 1 (6.3) 3 (18.8) 2 (12.5) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 9 (56.3) 7 (43.8) 16 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 4 (25.0) 3 (18.8) 6 (37.5) 3 (18.8)
Stimulant laxatives only Diarrhoea 7 (100) 0 (0.0) 7 (100) 4 (57.1) 1 (14.3) 0 (0.0) 0 (0.0) 2 (28.6) 0 (0.0) 0 (0.0) 0 (0.0) 6 (85.7) 1 (14.3) 7 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 5 (71.4) 1 (14.3) 0 (0.0) 1 (14.3)
  Other 2 (100) 0 (0.0) 2 (100) 0 (0.0) 1 (50.0) 1 (50.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (50.0) 1 (50.0) 2 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (50.0) 1 (50.0) 0 (0.0) 0 (0.0)
Others Diarrhoea 44 (100) 0 (0.0) 44 (100) 28 (63.6) 6 (13.6) 5 (11.4) 3 (6.8) 0 (0.0) 2 (4.5) 0 (0.0) 0 (0.0) 34 (77.3) 7 (15.9) 41 (93.2) 2 (4.5) 0 (0.0) 0 (0.0) 1 (2.3) 17 (38.6) 14 (31.8) 5 (11.4) 5 (11.4)
  Other 18 (100) 4 (22.2) 14 (77.8) 4 (22.2) 6 (33.3) 4 (22.2) 2 (11.1) 1 (5.6) 1 (5.6) 0 (0.0) 0 (0.0) 7 (38.9) 7 (38.9) 14 (77.8) 3 (16.7) 0 (0.0) 0 (0.0) 1 (5.6) 5 (27.8) 3 (16.7) 2 (11.1) 4 (22.2)
Nothing Diarrhoea 16 (100) 1 (6.3) 15 (93.8) 10 (62.5) 0 (0.0) 6 (37.5) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 9 (56.3) 5 (31.3) 14 (87.5) 1 (6.3) 0 (0.0) 0 (0.0) 1 (6.3) 9 (56.3) 3 (18.8) 1 (6.3) 1 (6.3)
  Other 2 (100.0) 1 (50.0) 1 (50.0) 2 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (50.0) 1 (50.0) 2 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (50.0) 0 (0.0) 0 (0.0) 1 (50.0)