Key Points
ÎÎOpioid bowel dysfunction (OBD) is the term used to define the
constellation of gastrointestinal (GI) adverse events related to opioid
therapy.
ÎÎOBD and opioid-induced constipation (OIC) are interchangeable terms.
ÎÎOpioid medications more than double the need for laxative therapy.
ÎÎOIC can occur with the first opioid dose given.
ÎÎSeverity of OIC is not related linearly to the dosage.
ÎÎTolerance to the constipating effects of opioids does not develop.
ÎÎNearly half of patients with OIC find laxatives ineffective.
ÎÎReversal of opioid effects in the GI system is possible without loss of
analgesia.
Selecting a Treatment Regimen
Strategies for Treating Opioid-Induced Constipation
First Line:
Prevention or Treatment
Stimulant + stool softener
Second Line:
Prevention or Treatment
Sugar alcohols (sorbitol, lactulose)
Second Line:
Prevention
Macrogols (polyethylene glycol)
Peripheral Acting
Mu-Opioid Antagonists
Methylnaltrexone
Third Line: Treatment
Saline laxatives, enemas
Lubiprostone
Third Line: Prevention
Lubiprostone
Fourth Line:
Prevention or Treatment
Oral naloxone
