Opioid-Induced Constipation Treatment: Function, Consequences, and Potential Hazards
In the battle against opioid-induced constipation (OIC), prescription medications like Relistor, naloxegol, naldemedine, and lubiprostone are commonly used. However, for those seeking natural alternatives, lifestyle changes and over-the-counter remedies can provide some relief.
A fiber-rich diet, while beneficial for overall health and constipation prevention, may not be effective alone in addressing OIC. Bulk-forming laxatives like Metamucil and Psyllium, although they add bulk to the stool, do not stimulate bowel movements and could potentially worsen medication-induced constipation.
Over-the-counter laxatives such as stimulant laxatives (e.g., senna, bisacodyl) and osmotic laxatives (e.g., polyethylene glycol/Miralax) can be helpful. Osmotic laxatives, like lactulose, tend to have fewer side effects and may take longer to work, but they are commonly used before prescription drugs for OIC. Lactulose, a synthetic sugar used as an osmotic laxative, has shown positive results for chronic constipation and may be used as an over-the-counter option.
Hydration, physical activity, and maintaining a regular bowel routine are crucial natural lifestyle changes to manage constipation. However, these measures typically do not fully resolve opioid-related constipation without additional interventions.
If natural approaches prove insufficient, it is advisable to consult a healthcare provider for medications specifically designed to counteract opioid-induced constipation.
Methylnaltrexone, marketed as Relistor, is one such medication. Developed in 1978 by a team at the University of Chicago, Relistor targets opioid receptors in the intestines, allowing muscles to process feces normally and alleviating constipation without reducing the pain-relieving effects of opioid drugs.
In a clinical trial, 34.1% of Relistor injections prompted a bowel movement within 4 hours. By the fifth week of treatment, around 70% of participants experienced three or more rescue-free bowel movements per week. The drug was approved by the Food and Drug Administration (FDA) in 2008 for the treatment of OIC.
Relistor's only adverse effects in a 48-week trial were mild to moderate nausea, abdominal pain, and diarrhea. It does not enter the brain, ensuring that morphine continues to act as a painkiller.
In 2005, Boehringer Ingelheim, a German pharmaceutical company, produced MNTX, the compound from which Relistor is derived. If bowel movements become more difficult, adding daily doses of a herbal extract called senna may provide additional relief.
In conclusion, while there is no direct natural alternative that replicates Relistor's opioid receptor-targeting mechanism, a combination of lifestyle changes, dietary fiber (with caution), and over-the-counter laxatives such as osmotic laxatives (polyethylene glycol, lactulose) and stimulant laxatives can be used as natural or non-prescription approaches before or alongside prescription treatments for OIC. If symptoms persist despite these measures, consulting a healthcare provider is recommended.
A fiber-rich diet, while beneficial for overall health and wellness, may not fully address Opioid Use Disorder-induced constipation (OIC). Hydration, physical activity, and maintaining a regular bowel routine are crucial natural lifestyle changes for managing chronic diseases like constipation, but they might not be sufficient to resolve OIC without additional interventions. Senna, an herbal extract, could provide additional relief when bowel movements become more difficult, but it is not a replacement for prescription drugs designed specifically to counteract opioid-induced constipation, such as Relistor. Developed in 1978 and derived from MNTX by Boehringer Ingelheim, Relistor targets opioid receptors in the intestines, alleviating chronic constipation without reducing the pain-relieving effects of opioids. If natural approaches or over-the-counter remedies prove insufficient, it is advisable to consult a healthcare provider.
