Bowel Regimen in Chronic Narcotic Use

Aka: Bowel Regimen in Chronic Narcotic Use, Constipation Prophylaxis in Chronic Opioid Use, Narcotic Related Constipation, Opioid Induced Constipation

1. See Also
   1. Constipation in Cancer
   2. Medication Causes of Constipation
   3. Constipation Causes
   4. Constipation Causes in Children
   5. Opioid Adverse Effect Management
2. Pathophysiology
   1. Constipation from Opioids is dose dependent
      1. No tolerance developed to Constipation
   2. Constipation prevention is much easier than treatment
3. Approach
   1. Start with Step 1
   2. Move to next step if no response in 24 hours
4. Protocol: Step 1
   1. Docusate 100 mg PO bid and
   2. Senna 1 tab po qd to bid
5. Protocol: Step 2
   1. Docusate 100 mg PO bid and
   2. Senna 2 tabs po bid and
   3. Bisacodyl rectal suppository 1-2 after breakfast
6. Protocol: Step 3
   1. Docusate 100 mg PO bid and
   2. Senna 3 tabs po bid and
   3. Bisacodyl rectal suppository 3-4 after breakfast
7. Protocol: Step 4
   1. Docusate 100 mg PO bid and
   2. Senna 4 tabs po bid and
   3. Lactulose or Sorbitol 15 ml po bid and
   4. Bisacodyl rectal suppository 3-4 after breakfast
8. Protocol: Step 5 (Indicated for no Bowel Movement in 4 days)
   1. Sodium phosphate enema or
   2. Oil retention enema or
   3. High-colonic tap water enema
   4. Continue until adequate results
9. Protocol: Step 6
   1. Docusate 100 mg PO bid and
   2. Senna 4 tabs po bid and
   3. Lactulose or Sorbitol 30 ml po bid and
   4. Bisacodyl rectal suppository 3-4 after breakfast
10. Protocol: Step 7
    1. Docusate 100 mg PO bid and
    2. Senna 4 tabs po bid and
    3. Lactulose or Sorbitol 30 ml po qid and
    4. Bisacodyl rectal suppository 3-4 after breakfast
11. References
    1. Mt Sinai Pain Card, Palliative Care, MSMC, NY, NY