Opioids Counteracting opioid induced constipation with naloxone?
- Thread starter Artificial Emotion
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manboychef
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Im glad I don't experience constipation anymore. 5:30am everyday like clockwork.
Subutex was the worst for constipation for me. Like I said. Plenty of water, senna (not always) and milk of magnesia. I used miralax quite a bit, but you need to drink lots of water with it.
Whatever you do, do not take fiber pills or metamucil. This will just make your feces harder, and as it is harder, harder to pass.
As a joke, I used to call having a bowel movement when I was on opiates having an avalanche.
Subutex was the worst for constipation for me. Like I said. Plenty of water, senna (not always) and milk of magnesia. I used miralax quite a bit, but you need to drink lots of water with it.
Whatever you do, do not take fiber pills or metamucil. This will just make your feces harder, and as it is harder, harder to pass.
As a joke, I used to call having a bowel movement when I was on opiates having an avalanche.
Artificial Emotion
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^ I don't know how well milk of magnesia works for opioid constipation but it seems to work for you so I guess it might be okay over the short term but if you're taking it regularly for extended periods it can be harmful and can cause some form of addiction. Senna can be harmful if taken for extended periods, so it's something to keep in mind. I would advise taking a regular osmotic laxative like lactulose, which is just a type of sugar that works as an osmotic and on top of that if you run into bouts of constipation you could take short courses of senna, milk of magnesia or dulcolax though, so in that scenario it would work.
I agree though with your point that opioid constipation can be made much worse with fibre supplements. Unfortunately a lot of doctors are not hot on this and they hand out sachets of psyllium husk to their patients which just ends up making the problem worse.
I have to say, my Amitiza (lubiprostone) seems to be working really well in combination with my lactulose. I haven't blocked a toilet in a while which is real progress as I don't have to plan my day around my bowel movement lol. This drug is actually meant for people suffering from constipation on opioids and it works by modulating calcium channels, causing chloride-rich secretions in the bowels which softens stools, increases motility and encourages spontaneous bowel movements (SBM). Based on my experience I would urge anyone on long term opioid prescriptions or methadone OST prescriptions to at least try this drug because it works and the side effects are minimal. About 30% of people experience varying degrees of nausea on this drug but this can be avoided for most people if they take it with food rather than an empty stomach.
Like I said I was taking polyethylene glycol (Movicol sachets) but the dose of four sachets a day was too impractical. It's far easier to take the two 15ml lactulose doses a day morning and evening at home than it is to carry sachets around with me and hope I don't forget to bring it along with a cup and some water and a spoon.
I agree though with your point that opioid constipation can be made much worse with fibre supplements. Unfortunately a lot of doctors are not hot on this and they hand out sachets of psyllium husk to their patients which just ends up making the problem worse.
I have to say, my Amitiza (lubiprostone) seems to be working really well in combination with my lactulose. I haven't blocked a toilet in a while which is real progress as I don't have to plan my day around my bowel movement lol. This drug is actually meant for people suffering from constipation on opioids and it works by modulating calcium channels, causing chloride-rich secretions in the bowels which softens stools, increases motility and encourages spontaneous bowel movements (SBM). Based on my experience I would urge anyone on long term opioid prescriptions or methadone OST prescriptions to at least try this drug because it works and the side effects are minimal. About 30% of people experience varying degrees of nausea on this drug but this can be avoided for most people if they take it with food rather than an empty stomach.
Like I said I was taking polyethylene glycol (Movicol sachets) but the dose of four sachets a day was too impractical. It's far easier to take the two 15ml lactulose doses a day morning and evening at home than it is to carry sachets around with me and hope I don't forget to bring it along with a cup and some water and a spoon.
Artificial Emotion
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It says on the back of the pack of the one of the leading brand in Boots chemist that it's for short term use only but I'm sure someone else can chime in just to confirm it for you rather than just taking my word for it.
source:drugs.com
Kittycat5
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http://www.researchgate.net/publication/8076273_Myths_and_Misconceptions_About_Chronic_Constipation
This is a good quick read about certain fallacies of laxative use and constipation. The whole laxative dependency/rebound constipation thing for stimulant laxatives has fallen out of favor for chronic and perhaps even acute constipation. Laxative abuse is a real thing though and while it certainly can occur in patients with chronic constipation (opioid induced or not), it is more prevalent in those with mental disease (especially institutionalized ones), eating disorders, and to a lesser extent athletes who need to lose weight.
I believe that is what the warning on the Boots docusate is refering to, as that list includes features of laxative abuse. Dependency is probably the wrong word there. So Senna away all.
This is a good quick read about certain fallacies of laxative use and constipation. The whole laxative dependency/rebound constipation thing for stimulant laxatives has fallen out of favor for chronic and perhaps even acute constipation. Laxative abuse is a real thing though and while it certainly can occur in patients with chronic constipation (opioid induced or not), it is more prevalent in those with mental disease (especially institutionalized ones), eating disorders, and to a lesser extent athletes who need to lose weight.
I believe that is what the warning on the Boots docusate is refering to, as that list includes features of laxative abuse. Dependency is probably the wrong word there. So Senna away all.
manboychef
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Another thing that works for constipation is eating lots of either green leaf, romaine, or iceberg lettuce. It is a helpful tool, however it must be done in conjunction with other remedies.
dognasher
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I take suboxone and man, does that shit back me up more than heroin ever did. I have found a sweet spot with eating AT LEAST two to three cups of leafy greens a day, a cup of fruit a day, 50 oz of water or fluids, and then I take Miralax every other day. It's like I am not on opiates at all. It's a lot of management, and if I forget and go back to old habits, I really pay the piper.
Another thing - I know this is hard, because I love my ass some cheese, but I don't eat it, or really any dairy except probiotic yogurt. If I am going to eat cheese, I eat a slice of good cheese and really enjoy it, I don't melt it all over everything.
Another thing - I know this is hard, because I love my ass some cheese, but I don't eat it, or really any dairy except probiotic yogurt. If I am going to eat cheese, I eat a slice of good cheese and really enjoy it, I don't melt it all over everything.
Sorry for he bump but this is of interest to me and I have some info to add, also plan to add more in the near future. I think its a very important subject, seeing as constipation may be the most physically harmful effect of opioids to the human body. If we could keep it in check I would see opioids as being even more safe to use on a daily basis than toxic drugs like alcohol that are legal, but not addictive so society has deemed them acceptable. But someone who drinks every day, compared to someone who uses opioids everyday (especially if they do not use needles or if they do are safe and use micron filters and new needles as often as possible, but we know addicts often don't have the money, patience, desire, or means to take these precautions)
I tried taking a 2 mg naloxone vial and messed up so only got (tops) .5 mg of the solution ingested orally. That day I woke up and within 30 minutes and a cup of coffee I had a very good bowel movement. Best I've had in months I would say. So it seems to me that it definitely has the potential to be useful in treating constipation. I also remember when I would swallow the saliva from Suboxone when I was taking Subs, that it seemed I would get some anti-constipation effect from that, so that is why I decided to try it with a vial of pure naloxone and it seemed to help. I have noticed if I swallow the spit from the Sub everyday when I am using them daily, that it gives me headaches and nausea, so I only do it if I am backed up. Its not something I think is good to be ingesting on a daily basis but worth it if it clears out the bowels after days(or weeks in some people's cases) of constipation.
I was wondering if it was just a matter of waiting on taking my morning dose so I took some benzos to help feel a little better and waited this morning and did not get the relief I received from the day I took the naloxone in the morning, which further makes me believe the naloxone was the reason I was able to have a normal bowel movement. Both times I woke up, waited about 15-20 minutes, drank a 12 ounce cup of coffee and today I finised the coffee and I had a very small and compact bowel movement. The other day when I took the naloxone, I also had a copacted and small (but larger than today's) bowel movement, like after one sip of coffee, then a little after halfway through the coffee I all of sudden needed to go and it was a very normal BM, not even loose stool surprisingly.
That was about a week ago and since then I have had nothing but small, compacted BMs. So tomorrow morning I am gonna try a full 2 mg of naloxone and see how that works, hopefully clears me out because its Thanksgiving and it'd be a good day to flush the system.
I tried taking a 2 mg naloxone vial and messed up so only got (tops) .5 mg of the solution ingested orally. That day I woke up and within 30 minutes and a cup of coffee I had a very good bowel movement. Best I've had in months I would say. So it seems to me that it definitely has the potential to be useful in treating constipation. I also remember when I would swallow the saliva from Suboxone when I was taking Subs, that it seemed I would get some anti-constipation effect from that, so that is why I decided to try it with a vial of pure naloxone and it seemed to help. I have noticed if I swallow the spit from the Sub everyday when I am using them daily, that it gives me headaches and nausea, so I only do it if I am backed up. Its not something I think is good to be ingesting on a daily basis but worth it if it clears out the bowels after days(or weeks in some people's cases) of constipation.
I was wondering if it was just a matter of waiting on taking my morning dose so I took some benzos to help feel a little better and waited this morning and did not get the relief I received from the day I took the naloxone in the morning, which further makes me believe the naloxone was the reason I was able to have a normal bowel movement. Both times I woke up, waited about 15-20 minutes, drank a 12 ounce cup of coffee and today I finised the coffee and I had a very small and compact bowel movement. The other day when I took the naloxone, I also had a copacted and small (but larger than today's) bowel movement, like after one sip of coffee, then a little after halfway through the coffee I all of sudden needed to go and it was a very normal BM, not even loose stool surprisingly.
That was about a week ago and since then I have had nothing but small, compacted BMs. So tomorrow morning I am gonna try a full 2 mg of naloxone and see how that works, hopefully clears me out because its Thanksgiving and it'd be a good day to flush the system.