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.
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
|Dulcolax (Bisacodyl)||5 – 15mg once daily||YES||YES||Stomach Cramps
|Miralax (PEG-3350)||17g (one capful) once daily||YES||YES||Diarrhea
|Movantik (Naloxegol)||25mg once daily||NO||NO||Stomach Cramps
|Relistor (Metylnaltrexone)||Oral: 450mg once daily
Injection: 12mg once daily
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!
- 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.
- Lexi-Comp Online [database on the internet]. Hudson (OH): Lexicomp Inc: cited 16 Mar 2019. Available from: https://online.lexi.com. Subscriptio