Opioid-induced constipation (OIC)
- Start bowel regimen when opioid starts
- Osmotic ± stimulant laxative first
- Persistent OIC → PAMORA
- naldemedine/naloxegol/methylnaltrexone
- Lubiprostone is another option
- Avoid bulk fiber if severe hypomotility
- Rule out obstruction before aggressive therapy
Use at a glance
- Start bowel regimen when opioid starts
Treatment options
- Rule out obstruction before aggressive therapy
Practical pearls
- Osmotic ± stimulant laxative first
- Persistent OIC → PAMORA
- naldemedine/naloxegol/methylnaltrexone
- Lubiprostone is another option
Safety / pitfalls
- Avoid bulk fiber if severe hypomotility
Self-check
- When should an opioid bowel regimen start?
When the opioid starts. - Which fiber is avoided with severe OIC hypomotility?
Bulk fiber.
Drugs used for this (4)
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