Population: Adults with opiate-induced constipation.
Organization
AGA 2019
Recommendations
–Use laxatives as first-line agents.
–For patients with laxative refractory opiate-induced constipation (OIC), use 1 of 3 peripherally acting μ-opioid receptor antagonists (PAMORAs). Avoid these agents in conditions that compromise blood-brain barrier, such as CNS infections, stroke, and traumatic brain injury, to avoid precipitating withdrawal or reversing analgesic effect. Available PAMORAs:
• Naldemedine (high-quality evidence).
• Naloxegol (moderate-quality evidence).
• Methylnatrexone (low-quality evidence).
–Not enough evidence to recommend for or against using lubiprostone (intestinal secretagogue) or prucalopride (selective 5-HT agonist).
Practice Pearls
• Traditional laxatives are divided into four categories: osmotic (eg, PEG/lactulose/magnesium citrate), stimulant (eg, bisacodyl/senna/sodium picosulfate), stool softener (eg, docusate), or lubricant (eg, mineral oil).
• There is limited evidence that routine use of stimulant laxatives for OIC is harmful to the colon despite previous concerns.
• Fiber has limited effect on OIC, except in patients with fiber-deficient diets.
• Enemas can sometimes be used as rescue therapy when OIC is refractory to oral treatments.
Source