4 Medications for opioid induced constipation – meds requiring a prescription

Prescription medications for opioid induced constipation

Some medications for opioid induced constipation (OIC)  may require a prescription whereas over the counter medications for constipation regardless of the cause usually do not.  OIC is a common side effect of opioid use, which affects up to 80% of patients in our clinic. Fortunately, there are several prescription medications for opioid induced constipation, including naloxegol (Movantik), methylnaltrexone (Relistor), lubiprostone (Amitiza), and naldemedine (Symproic). Each of these medications works in a different way and has its own potential side effects.  Over the counter (OTC) options were discussed in our last article.

1) Naloxegol (Movantik) 

is a peripherally acting mu-opioid receptor antagonist, meaning it blocks the effects of opioids on the digestive system. It works by binding to opioid receptors in the gut, which reduces the constipating effects of opioids. Naloxegol has been shown to improve bowel movements in patients with OIC. The most common side effects of naloxegol include abdominal pain, diarrhea, nausea, and vomiting.

2) Methylnaltrexone (Relistor)

is another peripherally acting mu-opioid receptor antagonist that is used to treat OIC. It works by blocking the effects of opioids on the digestive system, but unlike naloxegol, it does not cross the blood-brain barrier, meaning it does not interfere with the pain-relieving effects of opioids. Methylnaltrexone has been shown to improve bowel movements in patients with OIC. The most common side effects of methylnaltrexone include abdominal pain, flatulence, and nausea.

3) Lubiprostone (Amitiza)

is a chloride channel activator that works by increasing fluid secretion in the intestines, making it easier for stools to pass. Lubiprostone has been shown to improve bowel movements in patients with chronic constipation and OIC. The most common side effects of lubiprostone include nausea, diarrhea, and abdominal pain.

4) Naldemedine (Symproic)

is a peripherally acting mu-opioid receptor antagonist that works by blocking the effects of opioids on the digestive system. It has been shown to improve bowel movements in patients with OIC. The most common side effects of naldemedine include abdominal pain, diarrhea, and nausea.

Final Thoughts

Naloxegol, methylnaltrexone, lubiprostone, and naldemedine are all prescription medications available for the treatment of OIC. Each medication works in a different way to alleviate the constipating effects of opioids. Patients should work with their healthcare provider to determine which medication is best suited for their individual needs and discuss potential side effects before starting any new medication.