Constipation from Opioids (Narcotics)

Constipation is a common opioid side effect. This medicine slows bowel movements moving through the intestine. The stool becomes hard. Constipation may last as long as you are taking this medicine. This handout will review how to prevent and treat constipation.

Ways to Prevent Constipation

You will need a plan to avoid constipation at home. Follow this plan as long as you are taking opioids. Review your plan with your doctor or nurse. Here are some things to include in your plan:

• Eat foods that have helped you to relieve constipation in the past.

• Drink plenty of liquids. This means eight to ten 8-ounce glasses of fluid each day unless told otherwise by your doctor. Warm liquids often help your bowels move. Try prune juice.

• Exercise every day or at least every other day. Increase the amount you walk. Check with your doctor or nurse about the exercises that are best for you.

• Set aside time for sitting on the toilet or commode the same time each day. The best time is after a meal.

• Eat foods high in fiber or roughage. This includes uncooked fruits, raw vegetables, and whole grain breads and cereals. Buy some unprocessed bran and add 1 or 2 tablespoons to your food. Keep a shaker of bran on your table to add to food as you eat it. If you are not hungry, do not force yourself to eat fiber.

High Fiber Foods

• Cereals and flours: Bran cereals, whole-wheat bread, rye bread and crackers, wheat germ, corn, cornmeal, wild rice, brown rice, barley, popcorn

• Fruits: Fresh, canned, or dried fruits, try those with skin or seeds (apples, plums, prunes, pears, peaches, tomatoes, berries, raisins, and dates)

• Vegetables: Any raw or cooked vegetable (not overcooked) such as carrots, cabbage, peas, dry beans, and lentils
  

See the next page for high fiber recipes.

Stool Softeners and Laxatives

Stool softeners help with constipation. They may be needed while taking opioids. A gentle laxative may also be needed. Check with your doctor or nurse before taking either. There are many types and brands of stool softeners and laxatives. Most do not need a prescription. Talk to your doctor or pharmacist about which may work best for you, and at the best price. These are some examples:

• Senna-docusate 8.5/50mg per tablet (Senna S®): 1-2 tablets 2 times per day, increase or decrease dose based on effect. Do not take more than 4 tablets daily. Takes 6-24 hours to work.

• Polyethylene glycol (Miralax®): 17 grams dissolved in 8 ounces of water or juice. Drink 1-2 times per day, as needed. Do not take more than 34 grams/day.

• Magnesium hydroxide 400mg/5mL suspension (Milk of Magnesia®): 15-30mL 1 to 2 times per day as needed. Takes 1-6 hours to work.

• Magnesium citrate solution: Take one-half to one bottle. Drink 1-2 cups of water after to prevent dehydration. Takes 30 minutes to 6 hours to work.
  

Bulk laxatives and fiber like Metamucil absorb water. It expands, increasing bulk and moisture in the stool. These products are not the best to use for constipation from narcotics. Only use these options if you are able to drink plenty of fluids during the day.

Suppositories and Enemas

Both can be used as an added option to treat . It is not a good idea to rely on enemas as part of a regular plan to avoid constipation. Talk to your doctor or nurse before using either of these options.

• Example: Bisacodyl 10mg suppository (Dulcolax®): 10mg rectally once as single dose. May use up to 3 times per week. Takes 15-60 minutes to work.
  

Important Points

• Make a plan to prevent constipation while taking your opioids.

• Aim for a bowel movement every 2-3 days.

• Call your doctor before taking any stool softeners or laxatives.

• Talk to your doctor or nurse about your pain medicine plan. Do not stop taking your pain medicine without speaking with your provider.
  

High Fiber Recipes

Fruit Pudding

1-2 tablespoons one to three times a day

Pudding Recipe
In a blender combine:
3 oranges, peeled
4 apples, sliced with skins
2 cups raisins and dates
2 cups prunes
Add prune juice to consistency of sauce or pudding

Can be kept in fridge for 7-10 days and can be frozen.

Bran Muffins

Enjoy 1-2 muffins daily.

Bran Muffin Recipe:

2 ½ teaspoons. baking soda
½ quart buttermilk
2 ½ cups flour (1 ½ whole wheat; 1 white)*
1 cup sugar
½ package (15 oz.) Raisin Bran cereal
1 teaspoon. salt
2 eggs slightly beaten or 1 cup egg substitute
½ cup oil
* ½ cup wheat germ may be substituted for ½ cup whole-wheat flour

Combine all ingredients. Bake in greased muffin pans at 400 degrees for 18-20 minutes. Makes two dozen muffins.