Sometimes the local pharmacists get feedback from patients (as well as visits from some drug reps) and are able to provide you with additional insights. I’ve become great friends with our two pharmacists at the local pharmacy nearest my folks’ house. They will share insights about various medications and answer any questions anyone has.
@Nrdsb4, I don’t have any experience with Movantik, since my patients (kids!) are very seldom on opioids chronically. I do know it’s hella expensive, as are all new drugs. It will be interesting to see how patients do on this med.
How long does it take to develop opioid constipation? A few days? A week? A family member is scheduled for a surgery, but I was not aware of this problem. Thanks!
In general, in people who aren’t on opioids chronically, the constipation after surgery is both due to anesthesia and possibly from the pain meds. That’s why you can’t eat til you pass gas, and you sometimes can’t go home til you’ve pooped. The surgeon and the hospital will try to make sure your family member is fine after surgery. That kind of constipation is usually short-lived.
What Movantik is for is the chronic intestinal standstill that can result from long-term opioid use, either for chronic pain, of from illicit use.
Thanks for asking this question, @mycupoftea. l am finally scheduled for knee replacement surgery (much delayed due to an unrelated medical issue that was discovered in pre-op medical screening before the original surgery date scheduled for last December!) and it’s so hard to predict what it will be like to recover from that!
I had open gallbladder surgery in March followed by 5 days in the hospital. I used the morphine button liberally and went home with a prescription for dilaudid but the constipation wasn’t so bad and didn’t last very long.
I had two surgeries in the last month. BeneFiber didn’t work. It was suggested I try Senokot or Dulcolax. Senokot worked, but it wasn’t pleasant.
It’s not unusual for constipation to set in quickly after surgery. It starts because of immobility as well as pain meds. And at least at our hospital, it doesn’t seem to be an issue that’s on the surgeons’ radar, so it can get bad fairly quickly.
OPIOID- induced constipation is caused by the opioid binding to certain receptors in the gut causing decreased peristalsis and inhibiting fluid secretion into the gut.
Ideally, laxative therapy should start simultaneously when opioids are first prescribed. It’s gonna happen. 90 percent of people on chronic opioid meds have constipation.
To increase peristalsis the best thing is to take either senna (1 or 2 tablets twice daily)
OR Bisacodyl (1 or 2 tabs daily).–daily–not just when you feel like you need it.
To get more water into the bowel there is Polyethlene Glycol (Miralax ,Glycolax) OR Magnesium salts (Magnesium Citrate, or Magnesium Hydroxide (400-800mg daily). There is also lactulose but it tastes awful.
AVOID BULK-FORMING laxatives like psyllium (Metamucil, flax seed). It may actually be HARMFUL in this instance.
Stool softeners have been shown to have NO effect in this case. They simply don’t work.
There are other drugs that also contribute to constipation–Ca channel blockers, some antihistamines, some anti-depressants, anti-psychotics, oral iron (and probably many others). If you take a number of meds and have to take opioids then have doc or pharmacist go over the list–maybe something can be changed.
Just in the past year some prescription alternatives have been introduced if nothing else works
Movantik is for non-cancer patients (although I can’t find specific reasons–maybe they weren’t studied or it depends on the cancer). It runs 11 dollars per pill (330 a month) so it is definitely not a cheap option.