Management of Opioid-induced Constipation in Older Adults.

Jamie Horrigan, Sriya Bhumi, David Miller, Mikram Jafri, Micheal Tadros

Journal: Journal of clinical gastroenterology 2022;57(1):39-47

PMID: 36504229

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Abstract

Opioid-induced constipation (OIC) is a common condition in older adults who may not be responsive to traditional laxative therapy. OIC is defined as new or worsening constipation symptoms that occur with initiation of or altering the dose of opioid analgesia. For adult patients with OIC and noncancer pain, we recommend considering nonpharmacologic interventions (eg, dietary measures, increased physical activity, and biofeedback training) and over-the-counter laxatives, followed by prescription opioid receptor antagonists (methylnaltrexone, naloxegol, and naldemedine) if traditional over-the-counter laxatives fail. Other options may include lubiprostone, linaclotide, plecanatide, and prucalopride; however, these are not indicated for OIC specifically or studied in older adults. Because of the complex nature of absorption, distribution, metabolism, and excretion in the aging population, all agents used to treat OIC must be evaluated individually and reevaluated as patients continue to age. This review will serve as a guide to managing OIC in older adults.

Address: Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.; Department of Medicine, University of Connecticut Health Center, Farmington, CT.; Department of Anesthesia, UCLA, Los Angeles, CA.; Department of Geriatric and Internal Medicine, Stratton VA Medical Center.; Division of Gastroenterology, Department of Medicine, Albany Medical College, Albany, NY.

DOI: 10.1097/MCG.0000000000001801

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MeSH Terms: Humans, Aged, Opioid-Induced Constipation, Analgesics, Opioid, Constipation, Laxatives, Aging