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 | | Subject: OIC: Opiate Induced Constipation Part 2 Sat 06 Mar 2010, 12:40 pm | |
|  What drugs or medicines treat OIC? OIC treatment usually requires additional medicines to be prescribed along with the opioid painkillers that are causing the constipation. Withholding the opioid treatment is ill-advised because it results in a decrease in the patient's quality of life. Often, laxatives and/or cathartics are prescribed at the same time as the opioid painkillers so that treatment for the constipation beings immediately. A cathartic accelerates defecation, while a laxative eases defecation, usually by softening the stool; some medicines are considered to be both laxatives and cathartics.For the treatment of OIC, doctors may prescribe:
- Osmotic laxatives - increase the amount of water in the gut, increasing bulk and softening stools.
- Emollient or lubricant cathartics - soften and lubricate stools.
- Bulk cathartics - increase bulk and soften stools.
- Prostaglandins or prokinetic drugs - change the way the intestines absorb water and electrolytes, and they increase the weight and frequency of stools while reducing transit time.
- Other medicines block the effects of opioids on the bowel to reverse opioid-induced constipation.
Although the treatments listed above are usually successful in treating OIC, sometimes a physician will recommend rectal intervention. As discussed, prophylaxis with laxatives are/or cathartics is considered usual - as some clinicians assume [constipation] to be virtually universal in patients who are prescribed opioid analgesics1. Rectal interventions are indicated if the appropriate oral measures have been ineffective2. Rectal intervention means the following treatments:
- Enemas (micro and larger volume)
- Rectal irrigation (sometimes known as colonic irrigation)
The first choice rectal intervention for uncomplicated constipation is glycerin suppositories2. If these are ineffective, then a stimulant enema might be administered. Oral and rectal stimulant laxatives should be avoided if there is possible or proven bowel obstruction. Gentle rectal measures can sometimes be effective in emptying the rectum and lower colon. Oral softening agents are useful if the obstruction is incomplete. It should be remembered that constipation can cause bowel obstruction.
If none of the rectal laxatives above prove adequate to remove impacted faeces, rectal irrigation with normal saline can be performed3. Manual evacuation should be used as a last resort when all other methods of bowel management have been shown to be ineffective.Combination therapyConstipation is a known side effect of opioid analgesics and should be addressed before opioid therapy begins. As opioid-induced constipation can be severe and adversely impact quality of life and compliance with therapy, prophylaxis with laxatives is considered to be the best approach. A British Pain Society survey conducted in March 2009 showed that nearly half of GPs (44%) surveyed believe that the negative impact of such side effects is the key factor in patient non-compliance with prescribed opioid treatments.
Concurrent management on initiation of opioids frequently includes recommending certain lifestyle or dietary adjustments (as listed above) and initiating a scheduled regimen of laxatives. Laxative and cathartic therapy may be needed throughout opioid therapy and beyond. Effective management requires a composite of strategies, including behavioral and lifestyle changes (diet, activity, and fluid intake, as appropriate).
However medications used to manage opioid-induced constipation, such as laxatives, do not address the underlying opioid receptor-mediated cause of constipation and are often ineffective4. Note:
If you are suffering from Opiate Induced Constipation please speak with your provider to discuss which therapies would be best for you. Each individual is different and what works for someone else may not necessarily work for you. Don't take risks. When in doubt always call your doctor.
Don't let constipation go on for too long. It can not only be very painful but hazardous to your health as well.
For additional information on constipation, please visit our sister website Medical Assisted Treatment of America Inc. @ http://medicalassistedtreatment.org/35901/496626.html
Facts on OIC taken from:
Medical News Today/ OICPosted by: Dee | |
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