Prevention of opioid-induced constipation in palliative care

When prescribing an opioid, always instigate nonpharmacological measures to prevent constipation and consider prescribing a regular laxative; see Prevention of constipation in palliative care.

A laxative may not be needed in some patients, such as a patient with an ileostomy or a malabsorption syndrome. Bulk-forming laxatives (eg bran, ispaghula husk, psyllium, sterculia) have no role in preventing opioid-induced constipation.

The degree of opioid-induced constipation depends on a range of factors, including the patient’s comorbidities, the choice of opioid (including the route of administration and dosage), and the patient’s diet and lifestyle. Oral formulations may be more likely to cause constipation. There is no strong clinical evidence that the oral combination formulation of modified-release oxycodone+naloxone is less constipating compared with modified-release oxycodone alone.