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opioid-induced constipation (OIC)

Etiology: - opioid receptor agonist Clinical manifestations: - constipation - tolerance does NOT develop to constipating effects [2] Management: - stimulant laxative (senna) all patients [1] - docusate in combination with senna of no additional benefit [2] - add stimulant laxative to osmotic laxative before escalating to methylnaltrexone [2] - stool softener (dosusate) may not add benefit to senna [3] - methylnaltrexone may help relieve constipation in palliative care patients without negating analagesic effect of opioid [1] - naloxegol (Movantik) FDA-approved in 2014 - naldemedine (Symproic) FDA-approved in 2017 preferred over methylnaltrexone (GRS11) [2] - lubiprostone may be of benefit [5] - bulk laxatives (psyllium with or without docusate) of no benefit [5] - opioid rotation may be of benefit [5]

Related

narcotic bowel syndrome; opioid-induced gastrointestinal hyperalgesia

General

constipation; dyschezia drug adverse effect(s) of

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
  2. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  3. Tarumi Y, Wilson MP, Szafran O, Spooner GR. Randomized, double-blind, placebo-controlled trial of oral docusate in the management of constipation in hospice patients. J Pain Symptom Manage. 2013 Jan;45(1):2-13. PMID: 22889861
  4. Rao VL, Micic D, Davis AM. Medical Management of Opioid-Induced Constipation. JAMA. Published online November 4, 2019. PMID: 31682706 https://jamanetwork.com/journals/jama/fullarticle/2754105
  5. NEJM Knowledge+ Pain Management and Opioids: Recharge - Crockett SD, Greer KB, Heidelbaugh JJ et al American Gastroenterological Association Institute Guideline on the Medical Management of Opioid-Induced Constipation. Gastroenterology. 2019 Jan;156(1):218-226. PMID: 30340754 - Luthra P, Burr NE, Brenner DM, Ford AC. Efficacy of pharmacological therapies for the treatment of opioid-induced constipation: systematic review and network meta-analysis. Gut. 2019 Mar;68(3):434-444. PMID: 29730600 Free article.