Guideline for Managing Opioid-Induced Constipation

Colorectal

Douglas K. Rex, MD, MASGE reviewing Crockett SD, et al. Gastroenterology 2018 Oct 16.

The American Gastroenterological Association issued a guideline for managing opioid-induced constipation (OIC).

Some of the more interesting points and recommendations:

Fentanyl can be less constipating than morphine
Fiber is generally ineffective in OIC
Laxatives are the first line agents for OIC
At least 2 laxatives in combination should be used before peripherally acting mu-opioid receptor antagonists (PAMORAs) are initiated
There was insufficient evidence to recommend lubiprostone or prucalopride for OIC
When patients fail laxatives, either nalmedidine or naloxegol are recommended over no treatment

Comment:

Endoscopists caring for OIC patients should know current recommendations for management. The main message is to utilize PAMORAs after running through other measures.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, MASGE

Bio and Disclosures

Citation(s):

Crockett SD, Greer KB, Heidelbaugh JJ, et al. American Gastroenterological Association institute guideline on the medical management of opioid-induced constipation. Gastroenterology 2018 Oct 16. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2018.07.016)