The following is the summary of “Management of Opioid-induced Constipation in Older Adults” published in the January 2023 issue of Clinical Gastroenterology by Horrigan, et al.
Opioid-induced constipation (OIC), is a disease that occurs rather frequently in senior individuals. Unfortunately, some patients do not respond to the traditional treatment with laxatives. OIC is defined as new or worsening constipation symptoms that appear with the initiation of or adjustment in the dose of opioid analgesia. This can occur at any time during the course of opioid treatment. This is something that can occur regardless of whether or not the dose was altered.
Adult patients who suffer from OIC and pain caused by conditions other than cancer should, in their opinion, give consideration to nonpharmacologic therapies (such as dietary changes, increased physical activity, and biofeedback training), as well as over-the-counter laxatives. If the over-the-counter and traditional laxatives don’t work, the next step should be to attempt opioid receptor antagonists, which require a prescription (such as methylnaltrexone, naloxegol, and naldemedine). There are more options, such as lubiprostone, linaclotide, plecanatide, and prucalopride; however, these drugs have not been specifically examined in older people, nor are they indicated for the treatment of OIC.
Every medicine that is used to treat OIC needs to be reviewed on an individual basis and then reevaluated as patients continue to become older. This is because of the complex nature of the changes that occur in absorption, distribution, metabolism, and excretion as a result of aging. The findings of this analysis will serve as the foundation for the OIC treatment protocol used in older patients.