Best Laxatives To Combat Oic: Finding Relief

Opioid-induced constipation (OIC) is a common side effect of opioid pain medication. It can cause discomfort and negatively impact a person's quality of life. OIC occurs when opioids attach to receptors in the gut, slowing down the time it takes for stool to pass through the gastrointestinal system. Treatment options for OIC include over-the-counter (OTC) and prescription medications, as well as natural remedies and lifestyle changes. OTC options include stool softeners, stimulants, osmotics, and lubricant laxatives. Prescription medications for OIC include lubiprostone, methylnaltrexone, naloxegol, and naldemedine. Natural remedies such as fiber supplements, aloe vera, and senna may also help relieve OIC. Lifestyle changes such as increasing physical activity, consuming more fluids, and eating more fiber-rich foods can also help manage OIC.

Natural remedies: Aloe vera, fibre, and senna

Aloe Vera

Aloe vera juice has been used to treat digestive ailments, including constipation, due to its soothing qualities. It can be added to foods like smoothies, cocktails, and juice blends, or cooked with for health benefits and flavouring. The aloe leaf innards are rich in compounds and plant mucilage, which can help with skin inflammation and burns, and may also alleviate inflammation of the digestive tract.

However, it is important to note that drinking too much aloe vera juice may lead to unwanted side effects. The green outer parts and latex of the aloe plant contain anthraquinones, which are powerful plant laxatives. Taking too many laxatives may be dangerous and could worsen symptoms. Check labels carefully before purchasing, and discontinue use if you experience abdominal cramps, diarrhoea, or worsened IBS.

Fibre

Fibre is a natural laxative that increases the bulk in your stool, helping to cause movement of the intestines. It also increases the amount of water in the stool, making it softer and easier to pass. It is recommended to eat fibre-rich foods such as bran, fresh fruits, and vegetables.

Senna

Senna is a natural laxative that contains sennosides, which help to stimulate the nerves and muscles of the intestines, promoting bowel movements. It is often taken in the form of tea or capsules.

Over-the-counter medications: Stool softeners, stimulants, osmotics, and mineral oil

Opioid-induced constipation (OIC) is a common side effect of opioid pain medication. It can cause discomfort and negatively impact a person's quality of life. To treat OIC, over-the-counter (OTC) medications such as stool softeners, stimulants, osmotics, and mineral oil are available.

Stool softeners increase the amount of water in the colon, making it easier for stools to pass. Examples include docusate (Colace) and docusate calcium (Surfak). Lubricant laxatives like mineral oil are also available as OTC options in oral and rectal forms. They work by coating the intestine walls and the stool, softening and lubricating it.

Stimulant laxatives induce bowel activity by increasing intestinal contractions. Examples include biscacodyl (Ducodyl, Dulcolax) and senna-sennosides (Senokot). Osmotic laxatives, such as oral magnesium hydroxide (Phillips Milk of Magnesia) and polyethylene glycol (MiraLAX), help fluid move through the colon, softening stools and increasing the frequency of bowel movements.

OTC medications are typically recommended alongside dietary and lifestyle changes, such as increasing fluid intake, consuming more fiber, and exercising. These changes can help improve OIC and constipation. However, if OTC medications and lifestyle changes do not provide relief, it is recommended to consult a healthcare provider, who may suggest prescription medications or alternative pain relief.

Prescription medications: Lubiprostone, methylnaltrexone, naloxegol, and naldemedine

Opioid-induced constipation (OIC) is a common side effect of chronic opioid therapy. Here are four prescription medications that can be used to treat OIC:

Lubiprostone

Lubiprostone is an oral bicyclic fatty acid that activates type 2 chloride channels on intestinal epithelial cells, leading to the secretion of chloride and water into the gut lumen. It is approved for the treatment of OIC in the United States.

Three large randomized controlled studies have been conducted to assess the efficacy and safety of lubiprostone in OIC in non-cancer patients. The results showed that lubiprostone was more effective than a placebo in increasing the frequency of spontaneous bowel movements (SBM) and improving constipation symptoms and severity. However, lubiprostone had limited effectiveness in treating methadone-induced constipation. The most common adverse events reported were nausea, diarrhea, and abdominal distension.

Methylnaltrexone

Methylnaltrexone is a μ-opioid receptor antagonist that has been developed as a quaternary amine. This restricts its ability to cross the blood-brain barrier, allowing it to reduce the symptoms of OIC without affecting the analgesic effects of opioid medications.

A Phase 3 clinical trial evaluated the efficacy and safety of oral methylnaltrexone in patients with chronic noncancer pain and OIC. The results showed that methylnaltrexone, particularly at a dose of 450 mg, was effective and safe for treating OIC. The incidence of adverse events was slightly higher in patients treated with oral methylnaltrexone compared to placebo, with hyperhidrosis being the most common potential symptom of opioid withdrawal.

Naloxegol

Naloxegol is a specific μ-opioid receptor antagonist. When administered at the recommended dosage, it antagonizes the μ-receptor in the gastrointestinal tract, thereby decreasing the constipating effects of opioids.

Naldemedine

Naldemedine is a peripherally acting μ-opioid receptor antagonist that has demonstrated efficacy in the treatment of OIC. It has been shown to increase the proportion of patients experiencing a spontaneous bowel movement (SBM) and improve the weekly SBM frequency compared to a placebo. The most common treatment-emergent adverse events were gastrointestinal-related, including abdominal pain, diarrhea, and nausea.

Lifestyle changes: Exercise, hydration, diet, and trigger food elimination

Lifestyle changes are a cornerstone of the management of lipid and lipoprotein disorders. These changes include:

• Adopting a diet low in saturated and trans fatty acids, and incorporating functional foods rich in bioactive substances such as fibre, antioxidants, plant sterols and stanols.
• Regular exercise.
• Maintaining a healthy weight.
• Avoiding trans-fat.
• Increasing physical activity.

Non-prescription laxatives: Stool softeners, stimulants, and polyethylene glycol

Opioid-induced constipation (OIC) is a common side effect of opioid pain medication. Opioids are effective pain relievers because they block pain signals by attaching to receptors throughout the nervous system, including the gut. This slows down the central nervous system and the movement of stool through the gastrointestinal system.

Non-prescription laxatives are often recommended by healthcare providers to help manage OIC. These laxatives work in different ways to stimulate bowel movements. They can be taken in combination with each other, depending on the patient's needs and preferences. Here are some types of non-prescription laxatives that can be used to treat OIC:

Stool softeners

Stool softeners increase the amount of water in the colon, making it easier for stools to pass. Examples include docusate (Colace) and docusate calcium (Surfak, DulcoEase, Phillips Liqui Gels). Stool softeners are generally safer to use in high doses than laxatives or combination products.

Stimulants

Stimulant laxatives, also known as stimulant cathartics, increase intestinal contractions and promote movement in the intestines. They make the nerves in the digestive system more active and sensitive, getting the digestive system moving again. Examples include biscacodyl (Ducodyl, Dulcolax), senna-sennosides (Senokot), and Correctol.

Polyethylene glycol

Polyethylene glycol (PEG), also known as Miralax, is a type of osmotic laxative. It increases the amount of water in the intestinal tract, which stimulates bowel movements. PEG helps to hydrate the stools, making them softer and easier to pass.

While non-prescription laxatives can be effective in managing OIC, it is important to use them with caution. The body can become dependent on some of these supplements, and overuse may result in the inability to produce bowel movements without them. In rare cases, these products may also cause electrolyte imbalances. It is recommended to consult a healthcare provider to determine the best course of treatment for OIC and to ensure the safe and effective use of laxatives.

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