Opioid-induced constipation: What to know

Opioids are prescribed by healthcare experts to alleviate pain caused by a variety of conditions, particularly in the final stages of cancer. While opioids are very efficient at relieving pain, they can cause constipation and other unpleasant side effects.

opioid-induced constipation
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Opioids are used to treat many forms of pain. Opioid-induced constipation (OIC) can add to a person’s suffering, lowering their quality of life.

Natural remedies, as well as over-the-counter and prescription drugs, are used to treat OIC.

The link between opioids and constipation, as well as OIC symptoms and therapies, are discussed in this article.

How do opioids cause constipation?

Opioids bind to opioid receptors, which are proteins in the body. These receptors can be found in the brain, spinal cord, and gastrointestinal tract.

Opioids limit the brain’s ability to sense pain by attaching to these receptors. Opioids, on the other hand, depress or slow the central nervous system.

The central nervous system is in charge of the body’s pain response. It also regulates involuntary motions, such as those of the gastrointestinal tract.

As a result, using opioids can cause constipation.

Medications that cause OIC

Medications that cause OIC contain morphine, codeine, oxycodone, and methadone, among other drugs.

OIC is caused by a variety of medicines, including:

  • methadone (Dolophine, Methadone HCl Intensol, Methadose)
  • morphine (AVINza, Kadian, Morphabond, MS Contin, Oramorph SR, Roxanol)
  • oxycodone (OxyContin, Xtampza ER, Roxicodone, OxyIR, Percocet, Endocet, Percodan, Endodan)
  • oxymorphone (Opana)
  • tapentadol (Nucynta)
  • tramadol (ConZip, FusePaq Synapryn, Rybix ODT, Ryzolt, Ultram)
  • buprenorphine (Belbuca, Probuphine, Buprenex)
  • codeine (APAP wCodeine, Capital wCodeine, Pyrigesic-C, Tylenol wCodeine, Vopac)
  • fentanyl (Actiq, Duragesic, Sublimaze)
  • hydrocodone (Anexsia, Ceta Plus, Co-Gesic, Dolorex Forte, Hycet, Lorcet, Lortab, Maxidone, Norco, Stagesic, Vicodin HP, Zydone)
  • hydromorphone (Dilaudid, Dilaudid-5, Exalgo, Palladone)
  • meperidine (Demerol, Pethidine)

Symptoms

The following are some of the most common OIC gastrointestinal symptoms:

  • nausea and vomiting
  • tiredness and lethargy
  • weight loss
  • abdominal tenderness
  • bloating, distention, or bulging in the abdomen
  • constant feeling of needing to use the bathroom
  • alternating episodes of constipation and diarrhea
  • difficulty defecating, which can result in straining, forcing, and pain
  • dry, hard stools

Treatments

Several treatments are available to aid with OIC. Lifestyle modifications, medicine, and natural therapies are among them.

Lifestyle changes

Dietary and behavioral changes are examples of lifestyle changes. The following are some lifestyle adjustments that may aid in the treatment of OIC:

  • getting some or more exercise, if possible
  • consuming more fiber
  • drinking more fluid

Medications

Both over-the-counter and prescription, may also be beneficial. When a healthcare provider prescribes an opioid to a patient, they may also prescribe a prophylactic medicine.

Among the OIC medications available over-the-counter are:

  • Lubricant laxatives: Lubricant laxatives soften and lubricate the stool by coating the gut walls and the stool. Mineral oil is one of them.
  • Stimulant cathartics: These drugs (Correctol, Dulcolax, Senna) help the intestines move around.
  • Bulk-forming laxatives: These indigestible fiber supplements flow through the body, absorbing liquid in the digestive system and forming a stool that is simpler to pass. Methylcellulose (Citrucel), polycarbophil (FiberCon), and psyllium are other examples (Metamucil).
  • Osmotic laxatives: Osmotic laxatives function by encouraging the colon to store more water, which softens the stool and increases the frequency of bowel movements. Magnesium hydroxide is one example (milk of magnesia).
  • Saline laxatives: By pulling water into the intestines, they aid in bowel movement. Supplements containing magnesium citrate are one example.
  • Stool softeners: These help feces absorb more water, making them softer and easier to pass. Docusate sodium (Colace) and docusate calcium are two examples (DulcoEase, Phillips Liqui Gels).

Traditional laxatives are recommended as a first-line treatment for OIC by the American Gastroenterological Association Institute. When over-the-counter laxatives are ineffective, the organization publishes guidelines for medical care of OIC.

Constipation caused by opioids can be relieved with the use of these prescription medications:

  • Peripheral μ-opioid receptor antagonists (PAMORA): These drugs work to counteract the effects of OIC and can provide pain relief similar to opioids. Methylnaltrexone (Relistor), naldemedine (Symproic), and naloxegol  (Movantik) are PAMORA medications.
  • Intestinal secretagogues: These drugs, which include lubiprostone (Amitiza), stimulate chloride and water discharges in the intestines.
  • Selective 5-HT agonists: These drugs may aid in the improvement of gastrointestinal motions. Prucalopride (Resolor, Motegrity), cisapride (Prepulsid, Propulsid), and tegaserod (Zelnorm, Zelmac) are some of these drugs.
  • Prostaglandins or prokinetic medications: By altering the way the intestines absorb water and electrolytes, these drugs enhance the bulk and movement of stools.

Natural or herbal remedies

Natural ingredients, in addition to drinking more water, eating more fiber, and exercising whenever feasible, may help ease OIC. These are some of them:

  • aloe vera
  • products containing sennosides (such as Senna)
  • fiber supplements

Before using herbal remedies, talk to your doctor or pharmacist because they may interact with or reduce the effectiveness of some prescriptions.

Over-the-counter fiber supplements, such as Citrucel, Metamucil, or FiberCon, may be recommended by a healthcare expert. These may aid in the production of a bowel movement.

Before taking a herbal cure, a person should consult with their healthcare provider because it may interact with certain prescriptions.

Laxative side effects

Laxatives are typically regarded as safe and effective when used as advised and for short periods of time by healthcare professionals. However, as with any medication, utilizing laxatives to treat OIC might cause negative effects. The following are some of the most common negative effects:

  • bloating
  • vomiting
  • flatulence
  • abdominal cramping
  • diarrhea
  • fluid loss
  • nausea

If symptoms do not improve or if they experience troubling symptoms associated to laxative use, a person taking a laxative for OIC should speak with their healthcare provider.

Who takes opioids?

Opioids are prescribed by doctors to relieve chronic pain caused by a variety of diseases. Opioids are also prescribed to manage pain during cancer treatment and in the later stages of the disease.

Chronic pain-causing conditions

Opioids can be prescribed by doctors to manage chronic pain in a variety of ways, including:

According to data collected between 1999 and 2012, over 22% of adults in the United States suffer from chronic pain, with roughly 7% reporting moderate to severe pain. Furthermore, according to the findings of numerous research, opioid-induced constipation affects 41–81 percent of persons with chronic pain that is not caused by cancer.

Palliative cancer care

Opioid drugs are frequently prescribed by healthcare experts to cancer patients, especially when the disease progresses to later stages.

Researchers published the findings of a 6-year investigation examining opioid prescription rates for cancer patients in 2017. Changes in the type and dose of opioids prescribed were studied in detail.

From 2010 to 2015, the researchers looked at 750 pertinent U.S. health records. According to their research, pain has an impact on:

  • around 55% of people who are currently receiving treatment for cancer
  • about 66% of people with cancer that is in an advanced, metastatic, or terminal stage
  • about 39% of people who have survived cancer

Adverse side effects of opioids

In addition to OIC, opioids can have other serious adverse effects. These include:

  • physical dependence
  • overdose
  • misuse or potential to develop opioid use disorder
  • drowsiness
  • nausea
  • slower breathing and general depression of the respiratory system

Both the Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC) have raised concern about these medications being overprescribed.

Conclusion

Opioid pain medication can cause constipation and other digestive difficulties, as they diminish nervous system activity. People who take opioids for pain treatment frequently get OIC.

Drinking plenty of water, eating high-fiber foods, and staying active can all help to mitigate the effects.

If these natural remedies don’t work, a healthcare expert can suggest other treatment options, such as laxatives, vitamins, or prescription medications.

Sources:

  • https://www.niehs.nih.gov/health/topics/agents/aloe/index.cfm
  • https://www.cdc.gov/media/releases/2018/p0919-cdc-opiod-battle-funding.html
  • https://www.gastrojournal.org/article/S0016-5085(18)34782-6/fulltext#secsectitle0015
  • https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5946725/
  • https://www.osmosis.org/learn/Laxatives:_Nursing_Pharmacology
  • https://www.frontiersin.org/articles/10.3389/fpain.2021.721357/full
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772344/
  • https://www.medicalnewstoday.com/articles/323430
  • https://www.hhs.gov/opioids/about-the-epidemic/opioid-crisis-statistics/index.html
  • https://www.drugabuse.gov/drug-topics/opioids
  • https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC7075239/
  • https://www.drugabuse.gov/publications/drugfacts/prescription-opioids
  • https://www.ncbi.nlm.nih.gov/books/NBK493184/
  • https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/treatment
  • https://pubmed.ncbi.nlm.nih.gov/29429768/

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