Management of Opioid-induced Constipation in Older Adults

Opioid-induced constipation (OIC) is a common condition in older adults who may not be responsive to traditional laxative therapy. OIC is defined as new or worsening constipation symptoms that occur with initiation of or altering the dose of opioid analgesia. For adult patients with OIC and noncancer pain, we recommend considering nonpharmacologic interventions (eg, dietary measures, increased physical activity, and biofeedback training) and over-the-counter laxatives, followed by prescription opioid receptor antagonists (methylnaltrexone, naloxegol, and naldemedine) if traditional over-the-counter laxatives fail. Other options may include lubiprostone, linaclotide, plecanatide, and prucalopride; however, these are not indicated for OIC specifically or studied in older adults. Because of the complex nature of absorption, distribution, metabolism, and excretion in the aging population, all agents used to treat OIC must be evaluated individually and reevaluated as patients continue to age. This review will serve as a guide to managing OIC in older adults.

Automated summary

Opioid-induced constipation is a common condition in older adults, and traditional laxative therapy may not be effective. Nonpharmacologic interventions and over-the-counter laxatives are recommended as initial treatment options, followed by prescription opioid receptor antagonists if necessary. Other medications like probiotics and promotility agents can be considered, but their effectiveness in older adults is not well-studied. Due to the complexity of drug metabolism in the aging population, individual evaluation and reevaluation of treatment options is important.