How to treat opioid related constipation

How to treat opioid related constipation?

Strong evidence for efficacy has been established for stimulant (senna, bisacodyl) and osmotic laxatives (milk of magnesia). Opioid-induced constipation is predominantly mediated by gastrointestinal µ-opioid receptors. Selective blockade of these peripheral receptors might relieve constipation without compromising centrally mediated effects of opioid analgesia or precipitating withdrawal. Treat with peripherally restricted µ-opiate receptor antagonists if conservative treatment failed (subcutaneous methylnaltrexone or alvimopan).

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