Key Points
- Opioid bowel dysfunction (OBD) is the term used to define the constellation of gastrointestinal (GI) adverse events related to opioid therapy.
- OBD and opioid-induced constipation (OIC) are interchangeable terms.
- Opioid medications more than double the need for laxative therapy.
- OIC can occur with the first opioid dose given.
- Severity of OIC is not related linearly to the dosage.
- Tolerance to the constipating effects of opioids does not develop.
- Nearly half of patients with OIC find laxatives ineffective.
- Reversal of opioid effects in the GI system is possible without loss of analgesia.
Selecting a Treatment Regimen
Table 1. Some Commonly Used Laxative Preparations
Product (Brand) | Starting Dosage* | Onset Time | Side Effects | Comments |
---|---|---|---|---|
Bulk-Forming Laxatives | ||||
Metamucil®, FiberChoice®, Phillips’ FiberCaps® |
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Lubricant Laxatives | ||||
Fleet Mineral Oil® |
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Osmotic Laxatives | ||||
Saline — Magnesium hydroxide |
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Sodium phosphate Fleet Enema® |
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| ||
Sugars, alcohols — Lactulose, sorbitol |
|
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Macrogols — Polyethylene glycol MiraLAX® |
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Stimulant Laxatives | ||||
Senna Senokot–S® |
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Bisacodyl Dulcolax® Fleet® |
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| |
Stool Softeners | ||||
| According to package directions | 1-3 days |
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*Adjust dose as needed to produce formed bowel movement.
† Rare side effect.
Fakata KL, et al. In: Handbook of Opioid Bowel Syndrome. Binghamton, NY: Haworth Medical Press; 2005:101-118.
Swegle JM, Logemann C. Management of common opioid-induced adverse effects. Am Fam Physician. 2006;74(8):1347-1354.
Herndon CM, Jackson KC 2nd, Hallin PA. Management of opioid-induced gastrointestinal effects in patients receiving palliative care. Pharmacotherapy. 2002;22(2):240-250.
MiraLAX (polyethylene glycol) [product information]. Schering-Plough HealthCare Products;
www.miralax.com. Accessed May 9, 2007.
Table 2. Newer Agents
Product (Brand) | Starting Dose | Onset | Side Effects | Comments |
---|---|---|---|---|
Peripheral μ-Antagonists | ||||
Alvimopan Entereg ® | 12 mg PO | < 8h |
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Methylnaltrexone Relistor ® | q2d subcut < 84 lbs – 0.15 mg/kg 84-136 lbs – 8 mg 136-251 lbs – 12 mg > 251 lbs – 0.15 mg/kg | < 4h |
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Type II Chloride Channel Activator | ||||
Lubiprostone Amitiza ® | 8 or 24 mcg bid PO | < 48h |
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