DEVTOME.COM HOSTING COSTS HAVE BEGUN TO EXCEED 115$ MONTHLY. THE ADMINISTRATION IS NO LONGER ABLE TO HANDLE THE COST WITHOUT ASSISTANCE DUE TO THE RISING COST. THIS HAS BEEN OCCURRING FOR ALMOST A YEAR, BUT WE HAVE BEEN HANDLING IT FROM OUR OWN POCKETS. HOWEVER, WITH LITERALLY NO DONATIONS FOR THE PAST 2+ YEARS IT HAS DEPLETED THE BUDGET IN SHORT ORDER WITH THE INCREASE IN ACTIVITY ON THE SITE IN THE PAST 6 MONTHS. OUR CPU USAGE HAS BECOME TOO HIGH TO REMAIN ON A REASONABLE COSTING PLAN THAT WE COULD MAINTAIN. IF YOU WOULD LIKE TO SUPPORT THE DEVTOME PROJECT AND KEEP THE SITE UP/ALIVE PLEASE DONATE (EVEN IF ITS A SATOSHI) TO OUR DEVCOIN 1M4PCuMXvpWX6LHPkBEf3LJ2z1boZv4EQa OR OUR BTC WALLET 16eqEcqfw4zHUh2znvMcmRzGVwCn7CJLxR TO ALLOW US TO AFFORD THE HOSTING.

THE DEVCOIN AND DEVTOME PROJECTS ARE BOTH VERY IMPORTANT TO THE COMMUNITY. PLEASE CONTRIBUTE TO ITS FURTHER SUCCESS FOR ANOTHER 5 OR MORE YEARS!

Opioid Constipation Treatment

Effective management of constipation included by opioid includes using stool softening and or bowel stimulating agents (1). The choice of the agents used depends on the severity of the constipation (1). Switching to a less constipating opioid such as fentanyl or methadone may also be an option (1). While on opioids, patients should start an outpatient bowel protocol to prevent constipation (1). The first step would be to use sennosides such as senokot (1). The dose is 2 laxatives at bedtime (1). If there is no bowel movement 2 days after starting the laxatives, the number of laxatives should be increased to 4 (2 at breakfast, 2 at bedtime) (1). If there is no bowel movement after 1 more day, the number of laxatives should be increased to 6 (2 at breakfast, 2 at lunch, and 2 at bedtime) (1). If there is no bowel movement after one more day, the laxatives should be increased to 9 (3 at breakfast, lunch, and bedtime) (1). If constipation is still present for another day, bisacodyl suppository should be used (1).

Bisacodyl is a stimulant laxative that is used to treat constipation (2,3). For the relief of constipation, a single oral dose of 5-15 mg is recommended or a 10 mg single dose suppository is used (2,3). This medication needs to be administered with a glass of water on an empty stomach in order to have a rapid effect (2,3). The proposed mechanism of action is due to directly stimulating the peristaltic movement of the intestine via local mucosal irritation, which will increase motility (2,3). This is due to a stimulation of the mucosal nerve plexus of the colon (2,3). Recent studies indicate that bisacodyl may promote evacuation of the colon due to altering the intestinal fluid and electrolyte absorption, which causes a net intestinal fluid accumulation and thus will result in laxation (2,3). Bisacodyl is not recommended for routine daily use (2,3). Instead it has to be used intermittently (once every few weeks) to treat constipation (2,3). This is because it may cause severe abdominal cramping and significant fluid and electrolyte imbalances with chronic use (2,3). The onset of action for an oral dose is 6-8 hours and the onset of action of the rectal dose is 15-60 minutes after administration (2,3). This medication should not be taken within 1 hour of milk, dairy products or an antacid as this is to protect the enteric coating and increase stomach irritation (2,3). Side effects can include electrolyte and fluid imbalance (metabolic acidosis, or alkalosis, hypocalcemia); mild abdominal cramps, nausea, vomiting or rectal burning (2,3). This medication is minimally absorbed. Any medication that is absorbed will be metabolized in the liver and then excreted in the urine (2,3).

Senna is used for the relief of constipation and has been reported useful in reversing the constipating effects of opiate analgesics (2,3). The mechanism of action is the direct stimulation of the smooth muscle in the colon (2,3). More reports have suggested that the changes in electrolyte absorption and fluid balance are also contributing factors (2,3). The permeability of the cell walls in the colon can be altered due to the increase in cyclic 3,5’-adenosine monophosphate (which regulates active ion secretion) (2,3). The net result is fluid accumulation in the colon and laxative action (2,3). This medication is administered orally or rectally (2,3). There is minimal GI absorption after oral administration (2,3). Laxative effect from oral dosing occurs in 6-12 hours but can take up to 24 hours (2,3). Laxative effects of rectal dosing are seen in 30 to 120 minutes (2,3). Abdominal cramps, diarrhea, nausea and vomiting are common side effects. (2,3)

Docusate is a stool softener that is used to prevent constipation and fecal impaction (2,3). The mechanism of action is through its anionic surfactant properties (2,3). It lowers the surface tension at the oil and water interface of the fecal matter (2,3). This allows the water and lipids to immerse and penetrate the stools (2,3). The fecal matter will then be softened and hydrated, which will allow natural defecation to occur (2,3). The onset of action is about 1-3 days after oral docusate administration (2,3). Because little of this medication is absorbed, and their effects are exerted locally, the standard pharmacokinetic parameters do not apply (2,3). Any drug that is absorbed systemically will be excreted (2,3). Side effects can include intestinal obstruction, diarrhea, and abdominal cramping (2,3). Prolonged or excessive use may result in electrolyte imbalance (2,3).

Lactulose is used for the treatment of constipation (2,3). It is a synthetic product that is not able to be hydrolyzed by any gastrointestinal enzyme (2,3). Because of this the oral doses of the drug will reach the colon unmodified (2,3). The normal bacteria in the flora in the colon will degrade lactulose and increase the osmotic pressure (2,3). This will cause fluid accumulation that will soften the stool and distend the colon and enhance peristalsis (2,3). A normal bowel movement may take 1-2 days to occur (2,3). This medication is administered orally or rectally (2,3). This medication may cause electrolyte imbalance if used for more than 6 months in patients that are predisposed to developing electrolyte abnormalities (elderly) (2,3). This medication should also be used with caution in diabetes as the solution contains lactose and galactose (2,3). The serum ammonia, and serum electrolytes should be monitored while on this drug (2,3). Excretion is done via feces mostly (2,3) . Glycerin is used rectally as a laxative (2,3). It has an onset of 15-30 minutes and works on the colon directly (2,3). It is a local irritant and thus induces a hyperosmotic action (2,3). Thus, it draws fluid into the colon and stimulates the evacuation of the bowels (2,3). Adverse effects can include cramping pain, rectal irritation, and diarrhea (2,3).

Naloxone administered orally may be used to antagonize the constipating effects of opioids as it is and opioid antagonist (4). It has been used for the treatment of opioid induced constipation (4). When given in low but slowly escalating doses, naloxone has a laxative effect (4). However, its use is associated with adverse reactions such as withdrawal and the return of pain at various dosing levels (4). Because it can cross the blood brain barrier, the analgesic effects of opioids will be reversed (4). It is not recommended for routine use and should be avoided in outpatients (4).

References

  1. Clemens KE, Klaschik E. Management of constipation in palliative care patients. Curr Opin Support Palliat Care 2008;2:22.
  2. Repchinsky C, editor. Bisacodyl, Senna, Lactulose, Glycerin. In: Compendium of Pharmaceuticals and Specialties [online version (e-CPS)]. Ottawa: Canadian Pharmacists Association; 2005 [cited 2012 Jan 27]. Available from: URL: http://e-cps.pharmacists.ca/CPHA/main.htm
  3. Tramonte Sm, Brand MB, Mulrow CD, et al. The treatment of chronic constipation in adults. A systematic review. J Gen Intern Med. 1997;12:15-17.
  4. Sykes NP. An investigation of the ability of oral naloxone to correct opioid-related constipation in patients with advanced cancer. Palliat Med. 1996;10:135-44.

Disclaimer

This information is presented for informational purposes only and is not meant to be a substitute for advice provided by qualified health care professionals. You should contact your qualified health care provider if you have or suspect any health problems. This article is not intended to provide medical advice for its readers


QR Code
QR Code opioid_constipation_treatment (generated for current page)
 

Advertise with Anonymous Ads