Pharmacological Treatments for Constipation and Opioid-Induced Constipation

This article addresses the management of chronic constipation and opioid-induced constipation. Apart from increasing dietary fiber, there are several classes of medications that can be used for treatment of constipation, and these include osmotic and secretory laxatives, agents that impede the re-absorption of endogenous bile acids resulting in stimulation of motor and secretory functions in the colon, and agents that stimulate the motor function of the colon thereby propelling stool towards the rectum. Several drug classes are also available for the treatment of opioid-induced constipation including peripherally active mu-opioid receptor antagonists, and some of the same secretory agents and prokinetics that are used for chronic constipation. For both of these indications, there have recently been studies that compared efficacy and safety of the available drugs through network meta-analyses, which are also summarized in this article.