
Opioid-induced constipation (OIC) is a common side effect of opioid use, affecting 40-95% of patients. It is caused by opioids binding to μ-opioid receptors in the gastrointestinal tract, reducing gastric motility and increasing fluid absorption, resulting in hard, dry stools. OIC can significantly impact a patient's quality of life, and patients may even choose to reduce or discontinue opioid medication to avoid it. While laxatives are commonly used to treat OIC, they do not address the underlying cause and are often ineffective, with around half of patients not achieving the desired improvement. This has led to the development of peripherally acting opioid antagonists, which block the constipating effects of opioids without compromising their analgesic effects.
Characteristics | Values |
---|---|
Why stimulant laxatives are given | To treat opioid-induced constipation (OIC) |
How common is OIC | 40% to 80% of patients taking opioids over the long term may suffer from this side effect |
What are the symptoms of OIC | Difficulty passing stools, hard/dry/infrequent bowel movements, pain during bowel movement, straining, incomplete evacuation of stool, bloating or distention in the stomach |
What are the complications of OIC | Stool impaction, bowel perforation, anal fissures, rectal bleeding or prolapse, stomach pain, hemorrhoids |
What causes OIC | Opioids attach to μ (mu) receptors in the central nervous system and bowel |
How to treat OIC | Prevention is preferred over treatment; dietary and lifestyle changes, laxatives, stool softeners, peripheral opioid receptor antagonists |
Laxatives side effects | Gas, bloating/fullness, sudden urge to defecate, abdominal symptoms, negative impact on quality of life |
Types of laxatives | Osmotics, stimulants, surfactants, lubricants, bulk-forming laxatives |
What You'll Learn
- Opioid-induced constipation (OIC) is a common side effect of opioid use, affecting 40-95% of patients
- OIC can cause abdominal symptoms that negatively impact a patient's quality of life
- Laxatives are commonly used to treat OIC, but they do not target the underlying mechanisms of OIC and can cause side effects
- Peripheral opioid antagonists are a type of prescription medication that can be used to treat OIC without reducing the pain-relieving effects of opioids
- Non-pharmacological approaches to managing OIC include dietary and lifestyle changes, such as increasing fibre intake, fluid intake, and physical activity
Opioid-induced constipation (OIC) is a common side effect of opioid use, affecting 40-95% of patients
OIC can cause a range of uncomfortable and distressing symptoms, including:
- Difficulty passing stools
- Hard, dry or infrequent bowel movements
- Pain during bowel movements
- Straining and incomplete evacuation of stool
- Bloating or stomach distension
If left untreated, OIC can lead to more serious complications, such as:
- Fecal impaction
- Anal fissures
- Rectal bleeding or prolapse
- Hemorrhoids
- Bowel perforation
To prevent OIC, it is recommended that patients taking opioids also take laxatives, particularly stimulant laxatives such as senna or bisacodyl. These work by irritating sensory nerve endings in the bowel, stimulating colonic motility and reducing water absorption. Laxatives should be started at the same time as opioid treatment to prevent OIC from occurring. Stool softeners are also recommended as they can help prevent constipation. However, bulk-forming laxatives, such as psyllium, should be avoided as they can worsen abdominal pain and contribute to bowel obstruction.
If OIC does occur, treatment involves both pharmacological and non-pharmacological therapies. Non-pharmacological approaches include:
- Increasing dietary fiber
- Increasing fluid intake
- Engaging in regular physical exercise
Pharmacological treatments for OIC include:
- Lubiprostone (Amitiza) - a chloride channel activator that increases fluid secretion in the GI tract, improving fecal transit.
- Methylnaltrexone (Relistor) - a peripherally acting opioid antagonist that blocks μ-opioid receptors in the gut, reversing the constipating effects of opioids.
- Naloxegol (Movantik) - another peripherally acting μ-opioid receptor antagonist.
- Naldemedine (Symproic) - a peripherally acting μ-opioid receptor antagonist that is structurally related to naltrexone.
Laxatives and Gastritis: Safe or Not?
You may want to see also
OIC can cause abdominal symptoms that negatively impact a patient's quality of life
Opioid-induced constipation (OIC) is a common side effect of opioid therapy, with prevalence estimates ranging from 40% to 95% of patients on an opioid regimen. OIC occurs when opioids bind to peripheral μ-opioid receptors in the gastrointestinal tract, leading to decreased intestinal contractility and transit, as well as diminished fluid volume in the gastrointestinal tract. This can result in difficulties in evacuating faeces, excessive straining, hard stools, abdominal discomfort, and bloating. OIC can negatively impact a patient's quality of life, causing anxiety, depression, and low self-esteem. It can also lead to increased healthcare costs, more frequent doctor visits, and higher out-of-pocket medication costs. Effective treatment of OIC is important to improve patient outcomes and reduce the burden of the disease.
Laxatives: Friend or Foe for Cats?
You may want to see also
Laxatives are commonly used to treat OIC, but they do not target the underlying mechanisms of OIC and can cause side effects
Opioid-induced constipation (OIC) is a common side effect of opioid use, affecting 40% to 80% of long-term opioid patients. OIC can occur quickly, sometimes in a matter of days, and can lead to serious complications such as fecal impaction, anal fissures, rectal bleeding, prolapse, stomach pain, hemorrhoids, or perforation. It is important to address OIC early on and not wait until it becomes a more serious issue.
Laxatives are commonly used to treat OIC. Over-the-counter (OTC) laxatives are easily accessible at drug stores or online and include osmotics, bulk formers, oral stool softeners, stimulants, and rectal suppositories. However, laxatives do not address the underlying cause of OIC, which is the effect of opioids on the μ (mu) receptors in the bowel. While laxatives can provide temporary relief by stimulating bowel movements, they do not prevent the constipating effect of opioids on the body.
Additionally, laxatives can have side effects and risks of their own. They can interact with other medications, including heart medications, antibiotics, and bone medications. Long-term or frequent use of laxatives can decrease the colon's ability to contract and lead to dependency, where the intestines lose muscle and nerve response, resulting in a reliance on laxatives for bowel movements. Laxative use can also cause diarrhea and electrolyte imbalance, especially if not taken with enough water.
While laxatives can provide temporary relief from OIC, it is important to note that they do not target the underlying mechanisms causing OIC and can have their own side effects. Preventive measures, such as increasing fluid intake, adding dietary fiber, and making lifestyle changes, are often recommended in conjunction with laxative use to manage OIC.
Cocaine: Laxatives as Cutting Agents
You may want to see also
Peripheral opioid antagonists are a type of prescription medication that can be used to treat OIC without reducing the pain-relieving effects of opioids
Opioid-Induced Constipation (OIC) is a common side effect of opioid use, affecting 40-80% of long-term opioid patients. It can cause severe discomfort and even more serious complications, such as rectal bleeding or stomach pain.
Methylnaltrexone (Relistor) is the first drug in this class to be approved by the US Food and Drug Administration (FDA). It is administered as an injection or oral tablet and is effective in treating OIC in adults with chronic non-cancer pain. Methylnaltrexone does not cross the blood-brain barrier, so it does not block the pain-relieving effects of opioids. It is also not impacted by commonly co-administered drugs or food, making it a good choice for patients with comorbidities.
Naloxegol (Movantik) is the first oral peripherally acting mu-opioid receptor antagonist approved for OIC. It has been shown to increase bowel movements per week in patients with non-cancer pain. However, it interacts with drugs that alter CYP3A4/P-glycoprotein transporter, so it should be avoided with strong CYP3A4 inhibitors.
Naldemedine (Symproic) is another peripherally acting mu-opioid receptor antagonist approved for OIC. It is effective in treating OIC in adults with chronic non-cancer pain and can be taken with or without food. Naldemedine is a sensitive P-glycoprotein substrate, and its absorption is decreased when taken with a high-fat meal.
In summary, peripheral opioid antagonists offer an effective treatment for OIC without reducing the analgesic effects of opioids. Each drug in this class has unique pharmacokinetic properties that may be impacted by co-administered drugs or food, so it is important for clinicians to have a good understanding of these nuances to make informed treatment decisions.
Laxatives and Steroids: Safe Mix?
You may want to see also
Non-pharmacological approaches to managing OIC include dietary and lifestyle changes, such as increasing fibre intake, fluid intake, and physical activity
Non-pharmacological approaches to managing opioid-induced constipation (OIC) include increasing fibre intake, fluid intake, and physical activity.
Fibre Intake
Fibre is made up of the indigestible parts or compounds of plants, which pass relatively unchanged through our stomach and intestines. Fibre is mainly a carbohydrate. The main role of fibre is to keep the digestive system healthy.
There are two categories of fibre: soluble and insoluble. Both are beneficial and should be included in our daily diets. Most plant foods contain a mixture of both.
Soluble fibre soaks up water like a sponge and helps to bulk out our faeces so it can pass through the gut more easily. It acts to slow down the rate of digestion. Good sources of soluble fibre include:
- Fruit and vegetables
- Oat bran, barley, seed husks, flaxseed, psyllium
- Legumes – dried beans, lentils, peas
- Soy milk and soy products
Insoluble fibre does not absorb water and speeds up the time that food passes through the gut. A major role of insoluble fibre is to add bulk to faeces and to prevent constipation and associated problems (such as haemorrhoids). Good sources of insoluble fibre include:
- Bran – wheat bran, corn bran, rice bran
- The skins of fruits and vegetables
Fluid Intake
A high-fibre diet may not prevent or cure constipation unless you drink enough water every day. A sudden switch from a low-fibre diet to a high-fibre diet may lead to some abdominal pain and increased flatulence (wind).
Physical Activity
Physical activity is really key to the overall health of the body but also for having a regular bowel movement.
Black Licorice: Nature's Laxative?
You may want to see also
Frequently asked questions
OIC is a common adverse effect experienced by patients on opioid therapy for chronic pain. It is caused by the activation of enteric mu-opioid receptors, which leads to reduced gastric, biliary, pancreatic, and intestinal secretions, increased absorption of water from bowel contents, and decreased gastric motility.
Frequent symptoms of OIC include difficulty passing stools, hard and dry bowel movements, pain during bowel movements, straining, and incomplete evacuation of stool.
OIC is a very common side effect of opioid use, with an estimated prevalence of 40-95% in patients treated for noncancer pain.
The treatment of OIC typically involves non-pharmacological and pharmacological approaches. Non-pharmacological management includes increasing dietary fibre and fluid intake, as well as physical activity. Pharmacological treatments include stimulant laxatives, stool softeners, enemas, and prescription medications such as lubiprostone, methylnaltrexone, naloxegol, and naldemedine.
While stimulant laxatives are commonly used to treat OIC, they do not target the underlying cause, which is the opioid binding to μ-receptors in the enteric system. Therefore, they are often ineffective, and their use is associated with abdominal symptoms that negatively impact quality of life.