Tips on Battling Opioid-Induced Constipation

Written by: Kyle Farina

Opioids have gotten, and continue to get, a lot of attention in the news. We hear about the opioid epidemic all the time and how scary these drugs can be. While there are downsides to using these medications, it is important to understand that, when used appropriately, these medications are helpful in treating patients with chronic pain. In fact, ~4% of the United States population uses opioids in order to manage their pain.

These opioids act by blocking mu-receptors in your body. When these receptors are blocked in the nerves, it slows down the feeling of pain and reduces pain for the patient. However, these receptors are found in other areas of your body as well, including your stomach and intestines. Similar to the sensation of pain, these medications also cause your stomach and intestines to “slow-down” and results in the medication’s most common side-effect: constipation! Unfortunately, opioid-induced constipation is something that patients will experience on opioids and do not develop a tolerance, which means constipation is possible for as long as a patient may be on opioids.

Fret not!

While this may seem disheartening, there are plenty of options available, both prescription and over-the counter, which are available to help alleviate constipation caused by these medications. Below, you find a list of some of the common medications which help manage these side effects:

 

Drug Dose Over the Counter? Generic? Side Effects?
Colace (Docusate) 100 mg twice daily YES YES Well-tolerated in most patients
Senna (Sennosides) Two, 8.6mg tablets once daily YES YES Stomach Cramps

Nausea

Diarrhea

Dulcolax (Bisacodyl) 5 – 15mg once daily YES YES Stomach Cramps

Nausea

Diarrhea

Miralax (PEG-3350) 17g (one capful) once daily YES YES Diarrhea

Gas

Stomach Cramps

Movantik (Naloxegol) 25mg once daily NO NO Stomach Cramps

Headache

Excess Sweating

*watch kidneys*

Relistor (Metylnaltrexone) Oral: 450mg once daily

Injection: 12mg once daily

NO NO Stomach Cramps

Gas

Nausea

Dizziness

Excess Sweating

Hot Flashes

These are just some of the options available to help manage constipation caused by opioids. You might be asking yourself, “which medication should I choose first?” It is recommended to start with the over-the-counter (OTC) options above, which include docusate, senna, bisacodyl, and miralax. These medications are available at all pharmacies, are relatively cheap for a large supply, and have very few side effects, which make them great choices! Just make sure to give them 2-4 days, as these medications take a bit of time to work in the intestines. However, if the OTC options are not helpful, the two prescription medications above can help manage constipation and you can discuss with your primary care provider.

If you need help managing constipation related to opioids, feel free to stop in and speak with our staff! We are always more than happy to help in selecting the right product for you!

References:

  1. Crockett SD, Greer KB, Heidelbaugh JJ, et al. American Gastroenterological Association Institute Guideline on the Medical Management of Opioid-Induced Constipation. 2019 Jan;156(1):218-226.
  2. Lexi-Comp Online [database on the internet]. Hudson (OH): Lexicomp Inc: cited 16 Mar 2019. Available from: https://online.lexi.com. Subscriptio
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