Nonpharmacologic (e.g., increased fiber uptake) and pharmacologic agents (e.g., laxatives) may be considered for the treatment and prevention of OIC
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Which medications are used in the treatment of opioid-induced constipation?
For patients with opioid-induced constipation who do not respond to laxatives, naldemidine (Symproic) and naloxegol (Movantik) have a strong recommendation for use, with methylnaltrexone (Relistor) having a conditional recommendation. All of these agents are recommended over no treatment.
What is the pathophysiology of opioid-induced constipation (OIC)?
US Pharm. 2017;42 (12)15-19. ABSTRACT: Opioid-induced constipation (OIC) is a common adverse effect experienced by many patients on opioid therapy for chronic pain. Inadequate treatment of OIC is a barrier to the management of chronic pain and leads to a poorer quality of life.
What is the best over-the-counter medicine for constipation?
Opioid-induced constipation medication. Over-the-counter (OTC) Stool softener: These include docusate (Colace) and docusate calcium (Surfak). They increase the amount of water in your colon and help stools pass easier.
What is constipation and how do you treat it?
Constipation is defined as having fewer than three bowel movements a week. Anywhere from 41 to 81 percent of people who take opioids for chronic, noncancer pain experience constipation. There are medications and natural and home remedies that can help you find relief.
How is opiate induced constipation treated?
One kind of fiber, the "soluble" type, is especially helpful for opioid constipation. You can get it in foods that get soft when you add water to them, like oatmeal, barley, and flax. You can also get fiber from fruits (especially prunes and even warm prune juice), vegetables, whole grains, seeds, and nuts.
What medications treat opioid constipation?
Drugs for Opioid ConstipationLubiprostone (Amitiza), a pill.Methylnaltrexone (Relistor), a shot.Naldemedine (Symproic), a pill.Naloxegol (Movantik), a pill.
What OTC treatment options are preferred for opioid-induced constipation?
OTC Products On the whole, stimulant laxatives, stool softeners, and enemas are equally recommended based on patient preference and efficacy. Because these products are available OTC, pharmacists should be well versed in their appropriate use and place in OIC therapy.
What is the most effective medication for constipation?
While all the new prescription products provide more treatment options, Wald says, most people don't need them. Instead, over-the-counter drugs such as polyethylene glycol (Miralax and generic), bisacodyl (Dulcolax laxative tablets and generic), or senna (Ex-Lax, Senokot, and generic) are a far better choice.
Is linzess used for opioid induced constipation?
Both linaclotide doses were well tolerated and exhibited a safety profile consistent with previous studies in IBS-C and CIC. Thus, linaclotide offers the potential for a unique treatment option in patients with OIC related to opioid therapy administered for chronic noncancer pain.
How is Relistor administered?
Inject RELISTOR subcutaneously in the upper arm, abdomen or thigh. Do not inject at the same spot each time (rotate injection sites). Once drawn into the 1 mL syringe with a 27-gauge x ½-inch needle, if immediate administration is not possible, store at ambient room temperature and administer within 24 hours.
What is the drug Relistor used for?
RELISTOR® is a prescription medicine used to treat constipation in adults that is caused by prescription pain medicines called opioids.
How long do you have to be on opioids before taking a laxative?
To be considered a candidate for these medications, a patient must be on opioid therapy for at least 4 weeks. Laxatives should be discontinued prior to PAMORA initiation; if adequate relief of constipation does not occur within 3 days, then laxatives may be reintroduced.
What are the medications that are prescribed for OIC?
Prescription medications include lubiprostrone, methylnaltrexone, naloxegol, and naldemedine. Pharmacists can take a proactive approach in helping patients prevent and manage OIC by making recommendations on therapy selection and dose adjustments and by counseling on the side effects of their medication.
What is OIC in medicine?
OIC is a common side effect of long-term opioid use. This condition may affect the patient’s activities of daily living. To achieve optimal results, healthcare providers should be familiar with the many different nonpharmacologic and pharmacologic therapies that are available for OIC management.
What is OIC in pain?
ABSTRACT: Opioid-induced constipation (OIC) is a common adverse effect experienced by many patients on opioid therapy for chronic pain. Inadequate treatment of OIC is a barrier to the management of chronic pain and leads to a poorer quality of life. Nonpharmacologic treatment includes dietary and lifestyle changes.
Why are non-OIC and OIC the same?
Non-OIC may be due to dietary choices, dehydration, or inactivity, whereas OIC is due to the previously discussed physiological changes opioids cause in the GI tract.
How to improve OIC?
Adjustments in dietary and lifestyle habits can effect notable improvements in OIC or constipation from any cause. To help improve constipation, current guidelines recommend daily ingestion of 25 to 30 g of dietary soluble fiber; adequate fluid ingestion (1.5-2 L daily); regular aerobic exercise (adjusted to individual physical fitness and preferences); balanced diet; regular meal pattern; and avoidance of heavy meals, fat, insoluble fiber, and flatulent foods. 7 Although these measures should be recommended to patients during pharmacy consultation for opioid initiation, it is unlikely that dietary and lifestyle changes alone will prevent or treat OIC. 4
What is stool softener?
The most common regimens involve the combination of a stimulant laxative, such as bisacodyl or senna, and a stool softener. There are three types of stool softeners : surfactants, lubricants, and osmotics. Surfactants such as docusate sodium are emulsifiers that facilitate the admixture of fat and water in the feces.
How to get rid of constipation from opioids?
A few home remedies may also improve OIC or help you manage discomfort. Try these along with medications or natural remedies: 1. Increase physical activity. Exercise and physical activity stimulate contractions in the intestinal tract and promote bowel activity. Aim for 30 minutes of exercise most days ...
What is the name of the medication that causes constipation?
Opioids, a type of prescription pain medication, can trigger a specific type of constipation known as opioid-induced constipation (OIC). Opioid drugs include pain medications such as: These medications are effective because they block pain signals by attaching to receptors throughout your nervous system. These receptors are also found in your ...
What percentage of people who take opioids have constipation?
Constipation is defined as having fewer than three bowel movements a week. Anywhere from 41 to 81 percent of people who take opioids for chronic, noncancer pain experience constipation. There are medications and natural and home remedies that can help you find relief.
What is the best medication for OIC?
Prescriptions approved for the treatment of OIC include: naloxegol (Movantik) methylnaltrexone (Relistor) lubiprostone (Amitiza)
What are the best stimulants for bowel movement?
They increase the amount of water in your colon and help stools pass easier. Stimulants: These include biscacodyl (Ducodyl, Dulcolax) and senna-sennosides (Senokot). These induce bowel activity by increasing intestinal contractions. Osmotics: Osmotics help fluid move through the colon.
How to get rid of bloating and abdominal pain?
Constipation can cause bloating and abdominal pain. Apply a warm or cold com press to your pelvic area to relieve discomfort. 5. Eliminate trigger foods from your diet. Fatty and processed foods are difficult to digest and may make OIC worse. Limit your intake of trigger foods, such as fast foods and junk foods.
What is the best way to move stool through the colon?
Osmotics: Osmotics help fluid move through the colon. These include oral magnesium hydroxide (Phillips Milk of Magnesia) and polyethylene glycol ( MiraLAX ). Mineral oil is a lubricant laxative that also helps stool move through the colon. It’s available as an OTC option in oral and rectal form.
How is opioid-induced constipation (OIC) managed and treated?
There are different ways to manage and treat OIC. Your healthcare provider will ask about your diet and lifestyle and recommend non-prescription medicines. If these do not work, they might prescribe a different pain medicine or a medicine to treat OIC.
Medicines for opioid-induced constipation (OIC): Non-prescription laxatives
Taking non-prescription laxative medicines may help you manage OIC. These medicines work in different ways to make it easier to have a bowel movement. They can stimulate the nerves in your digestive system, soften the waste, or make it bulkier.
Medicines for opioid-induced constipation (OIC): Prescription medicines
If laxatives do not help your OIC, you may need prescription medicines.
Drugs used to treat Opioid-Induced Constipation
The following list of medications are in some way related to, or used in the treatment of this condition.
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
What is the first approved therapeutic agent for treatment of OIC?
Subcutaneous methylnaltrexone is the first approved therapeutic agent for treatment of OIC, and studies have been conducted using the oral formulation. This editorial contains a brief overview of other selected compounds to treat OIC.
What is the effect of opioids on the body?
Opioids are potent analgesics for treating moderate to severe pain, but their use is associated with a number of adverse effects, especially opioid-induced constipation (OIC). If the centrally mediated analgesia of opioids could be separated from their peripherally mediated gastrointestinal effects, by a peripherally acting opioid receptor antagonist, opioid-induced bowel dysfunction could be prevented or reversed. There has been considerable interest in peripherally acting opioid antagonists or other compounds to treat OIC. Subcutaneous methylnaltrexone is the first approved therapeutic agent for treatment of OIC, and studies have been conducted using the oral formulation. This editorial contains a brief overview of other selected compounds to treat OIC. Other potential uses of peripherally acting opioid antagonist in clinical practice are also discussed.
What is the treatment for constipation?
Treatment of opioid-induced constipation: focus on the peripheral μ-opioid receptor antagonist methylnaltrexone. Most prescribed opioids exert their analgesic effects via activation of central μ-opioid receptors. However, μ-opioid receptors are also located in the gastrointestinal (GI) tract, and activation of these receptors by opioids can lead ...
How do opioids exert their analgesic effects?
Most prescribed opioids exert their analgesic effects via activation of central μ-opioid receptors. However, μ-opioid receptors are also located in the gastrointestinal (GI) tract, and activation of these receptors by opioids can lead to GI-related adverse effects, in particular opioid-induced const …. Treatment of opioid-induced constipation: ...
What is OIC associated with?
OIC has been associated with increased use of healthcare resources, increased healthcare costs, and decreased quality of life for patients. Nonpharmacologic (e.g., increased fiber uptake) and pharmacologic agents (e.g., laxatives) may be considered for the treatment and prevention of OIC.
Where are opioids located?
However, μ-opioid receptors are also located in the gastrointestinal (GI) tract, and activation of these receptors by opioids can lead to GI-related adverse effects, in particular opioid-induced constipation (OIC).
Can laxatives reverse OIC?
However, many interventions, such as laxatives alone, are generally insufficient to reverse OIC because they do not target the underlying cause of OIC, opioid activation of μ-opioid receptors in the GI tract.