opioid-induced constipation (OIC)
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Etiology
Clinical manifestations
- constipation
- tolerance does NOT develop to constipating effects[2]
Management
- stimulant laxative (senna) all patients[1]
- methylnaltrexone may help relieve constipation in palliative care patients without negating analagesic effect of opioid[1][2][6]
- 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]
- unlikely that switching to another opioid will improve constipation[2]
More general terms
Additional terms
References
- ↑ Jump up to: 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- ↑ Jump up to: 2.0 2.1 2.2 2.3 2.4 2.5 2.6 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
Geriatric Review Syllabus, 12th edition (GRS12) Colburn JL, Wescott AM, Potter JF (eds) American Geriatrics Society, 2025 - ↑ Jump up to: 3.0 3.1 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: https://www.ncbi.nlm.nih.gov/pubmed/22889861
- ↑ Rao VL, Micic D, Davis AM. Medical Management of Opioid-Induced Constipation. JAMA. Published online November 4, 2019. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31682706 https://jamanetwork.com/journals/jama/fullarticle/2754105
- ↑ Jump up to: 5.0 5.1 5.2 5.3 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/29730600 Free article. - ↑ Jump up to: 6.0 6.1 Zhang YY, Zhou R, Gu WJ. Efficacy and Safety of Methylnaltrexone for the Treatment of Opioid-Induced Constipation: A Meta-analysis of Randomized Controlled Trials. Pain Ther. 2021 Jun;10(1):165-179. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33575953 PMCID: PMC8119523 Free PMC article. Review. https://pmc.ncbi.nlm.nih.gov/articles/PMC8119523/