Which of the following statements about the treatment of opioid-induced constipation (OIC) is true?
a. A high-fiber diets is the cornerstone for treating OIC.
b. Senna is an effective osmotic laxative commonly used in treating OIC.
c. The use of stimulant laxatives like bisacodyl may be limited by abdominal cramping and pain in the setting of OIC.
d. Saline enemas containing sodium phosphate are safer than mineral oil enemas in patients with OIC and renal insufficiency.
The correct answer: C.
Opioid-induced constipation affects most patients who are using opioids. The use of stimulant laxatives like senna and bisacodyl are effective in treating OIC by producing intestinal contractions to counteract the GI-slowing effects of the opioids. This increased motility can be perceived as abdominal cramping and pain, which may create a barrier to their use. A high fiber diet is a cornerstone of treating other causes of constipation, but does not have a clearly established role in treating OIC. Psyllium fiber, for example, may actually be unsuitable for treatment of OIC, as the delayed transit in OIC may result in exacerbation of abdominal pain when fiber is used. Answer B is incorrect because senna is a stimulant laxative, not an osmotic one. Lastly, sodium phosphate enemas should be used with caution in the setting of renal insufficiency, as acute phosphate nephropathy may result.
Fast Fact #294 Opioid Induced Constipations