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