Opiate Induced Constipation
Started by Lumbago
does relistor work well?
I am leery of opioid-induced compensation because you could get into a lot of trouble for running a pill mill.
"Constipation"?
Oh.
Well that's completely different.
Never mind.
"Constipation"?
Oh.
Well that's completely different.
Never mind.
OK, serious answer. Avoid stimulant laxative use (e.g. Senokot) on a daily basis or they will get dependent on it.
The fiber/bulk products aren't always good because they draw water from the lumen of the bowel and can cause inspissation. Worth a try but watch for paradoxical constipation.
The preferred laxative IMHO is an osmotic one containing PEG e.g, MiraLax or GoLytely. These draw water into the lumen.
The old standby, prunes, really does work.
I have never seen anyone who was happy with just surfactants although they seem to help as an adjunct.
The fiber/bulk products aren't always good because they draw water from the lumen of the bowel and can cause inspissation. Worth a try but watch for paradoxical constipation.
The preferred laxative IMHO is an osmotic one containing PEG e.g, MiraLax or GoLytely. These draw water into the lumen.
The old standby, prunes, really does work.
I have never seen anyone who was happy with just surfactants although they seem to help as an adjunct.
Best treatment for opioid induced constipation is a taper...
In light of that, i prefer a more natural approach of prunes + fiber cereal. Magnesium doesnt work that well long term, and Miralax is pretty effective.
Finally, i have had a few patients that have required miniscule doses of naloxone for constipation; improves GI motility due to the opioids.
In light of that, i prefer a more natural approach of prunes + fiber cereal. Magnesium doesnt work that well long term, and Miralax is pretty effective.
Finally, i have had a few patients that have required miniscule doses of naloxone for constipation; improves GI motility due to the opioids.
Suggestions for Opioid induced Constipation
Avoid fiber containing products as the added bulk with a slow bowel will make things worse.
Always start with increased water intake and increased fruits and vegetables.
Constipation medications:
1. Colace 1-2 tablets daily to twice daily
2. Sennokot-S 1-2 tablets daily to twice daily
3. Miralax 1 Tbs in 8 oz water 3x per day backing off to once daily
Should the above not work please call the office and we can discuss further.
Avoid fiber containing products as the added bulk with a slow bowel will make things worse.
Always start with increased water intake and increased fruits and vegetables.
Constipation medications:
1. Colace 1-2 tablets daily to twice daily
2. Sennokot-S 1-2 tablets daily to twice daily
3. Miralax 1 Tbs in 8 oz water 3x per day backing off to once daily
Should the above not work please call the office and we can discuss further.
Colace BID, if no relief,
Miralax QD-BID, if no relief,
one bottle of MagCitrate down the hatch, if no relief,
(insert Relistor anywhere if insurance will pay)
GoLytley, 2 Liters down the hatch, if no relief
to ER for manual disimpaction 😱, and if still no relief :
the real treatment which is, (drumroll!) decrease the dose of the medicine causing the problem.
I also do colace and senna regulary. Add miralax if still a problem. Then dulcolax. Haven't used Relistor, Amitiza, or Entereg enough to have an opinion.
I also am in the taper camp, except for cancer.
I also am in the taper camp, except for cancer.
Probably not the scope you are looking for here...but for difficult inpatients/palliative we have had success with methylnaltrexone.
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very well - oral or subq
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