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).