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opiate induced constipation can be reversed
bayoucat posted:
I wanted to let everyone know that there is something to get rid of OIC and it does work. I was reminded about this in a post exchange and felt bad that I had not mentioned it.
Relistor (methylnaltrexone) reverses constipation by removing opiates from the mu receptors in the gut. It does not interfere with any pain relief from medication that are taken. It only works in the gut. It is a sub-q injection which works in as little as 10-15 minutes. It is not a controlled substance, does not interfere with other medications and does not create dependency for its use. It is however a prescription and is expensive. I have been using it for quite a while and did not have any problem with getting a script from my PM physician and it was a covered by my insurance.
It has been used for advanced stage CA patients and those with a short life expectancy. It is now being used for constipation in patients taking opiates.
It does not seem to well known as a treatment, as my own physician had to look it up. I discussed this medication with my PCP, GI and Pain Management physicians and none of them had any problems with me using it and all of them were willing to write a script for it. It is one less thing to deal with .If you were like me, having severe constipation, you will also think of it as a godsend.

Hope this helps
Caprice_WebMD_Staff responded:
Thanks for sharing this here, Eve.
We must let go of the life we have planned, so as to accept the one that is waiting for us. ~Joseph Campbell
cweinbl responded:
There is a less expensive orally-administered over the counter medication for opioid-induced constipation. It is called Alophen. Basically, any laxative with the word "stimulant" on the box will do. Of course, it's powerful. So, you'll need to titrate your dosage carefully. Only a stimulant laxative or the type of medication mentioned above will rescue your bowel. Opiates shut down bowel peristalsis. You can eat regular laxatives and stool softeners like candy and they won't help much. You need to restart the bowel and a stimulant laxative will do the job without a prescrition, without an injection and for pennies to the pill.
bayoucat replied to cweinbl's response:

You are correct in that a stimulant laxative will increase peristalsis. It is also true that with continued use, they decrease in effectiveness as the bowel muscles weaken and become more dependent on them. I was at that point and was taking too much senna which in turn caused an irritable bowl and more gas and other known side effects of prolonged use--years for me.

Overuse did bring another visit to my GI who had previously given me peg3350 or Miralax. As the strength of my pain medication increased, I needed to augment more and more with the stimulants which are harsh in how they work, as you well know. Some days, the cramping and sore gut was a bad as my back pain. By using the Relistor, I was able to decrease slowly the stimulants which gave relief to the cramping and spasm. I had damaged my gut by overuse of stimulants. I am hoping that there is no permanent damage. I will be on pain meds of some modality for the rest of my life but using SenoKot as I was, is not an option anymore.
It is fine to use stimulants for a short period of time or an off and on regimen, but several tablets every night for years did cause a problem for me.

I only put the information out there in case others had a similar problem and had exhaused the lax choice options for help.

Here's to a great night with sleep and less pain.
ctbeth responded:
Hi Eve,
Have you actually used Relistor?

I used it for a few months, but had awful adverse effects to it and stopped.

It is injected int the subcutaneous tissue. Personally, I had no problem with the self injection, BUT~ PLEASE- anyone who decides to try it, be aware that you MUST inject it VERY, VERY SLOWLY. It really hurts like hell if you inject it quickly.

My MD assured me that my adverse effects were quite rare. Had I not had bad side effects, I'd not have discontinued it.

The positive effect made me feel like a normal human being again. I lost seven pounds during the first few weeks. My belly was flat! and felt none of that awful distention.

I'd like to read of others experience with Relistor.

ctbeth replied to ctbeth's response:
Oh Eve,

We posted at the same minute, haha.

Yes, I can now clearly see that you are using it.

Best of continued success.

I now take Senekot-S IV tabs twice /day and Miralax.

My opiate dose is pretty low, too.

I look forward to reading more from you.

annette030 responded:
How often must you inject yourself? I do best when I have a BM every day or at least every other day, does that mean daily or nearly daily injections?

There are also side effects in the subQ tissues from constant injections of some meds. How long have you been using this drug? How long has it been in use generally, not in clinical trials?

I will at least read up on it, but I believe that unless I have a problem with the stimulant type lax pills that I currently use, I will stick to them as the least invasive choice.

Thanks for posting an option for those who need it.

Take care, Annette
annette030 replied to ctbeth's response:
I just looked it up in my drug handbook and it lists adverse events by percentages. It lists abdominal pain at 29%, flatulence at 13%, and nausea at 12%. Other side effects all fall below 10% and include dizziness, and sweating at 7% and diarrhea at 6%. I don't consider adverse effects that appear in more than ten percent of users to be "quite rare".

I give great shots according to others, lol, and have self injected Imetrex, Lovenox, and flu vaccine. I agree with you that it is the slow speed of injection that makes a good shot. No one feels the needle go in if you are any good at all, it is when you inject the medicine that people complain, especially if you inject it too fast.

My book also says it is only for those in advanced states of illness who are receiving palliative care. It is not available in generic yet, I would wonder how long it has been used and how often.

Take care of yourself.

Hugs, Annette
ctbeth replied to annette030's response:
Hi Annette and all,

I was the first patient that my MD had prescribed this. It was about three years ago.

My adverse effects were tachycardia, hypotension, extreme nausea and vomiting to the point of dehydration. I was hospitalized (just once) for re-hydration. All other causes were ruled out.

After three episodes of this, when I ended up in the ER via ambulance, a complete "work up" ruled out any other cause.

The company spoke with my MD and, at length, with me.

Since, according to the company and my MD, these side effects were not noted in the R&D, they were considered atypical and quite rare.

I have had no reason to follow up with the literature, so I have no idea if these things have been documented or reported in the literature.

I used it every other day. The pain upon injecting too quickly is worse than lovenox or any other injection I have ever received or self injected. I just pushed it in the first time and freaked out.

Of course, after it hurt like hell, I then read the directions in full.
I was the MD's first patient to use it, so at the time, I was a bit of a guinea pig.

annette030 replied to ctbeth's response:
It seems to me that anything that causes extreme vomiting and nausea can also cause dehydration, and tachycardia and hypotension could go along with the dehydration. I can't believe it got you to the ER though it is not hard to picture that.

I had an adverse reaction to Mirapex once and vomited every hour for a day and a half. After two days, I had a huge argument with my dear husband because I swore it was only one day that had gone by. He finally had to show me the newspaper to convince me what day it was. He had offered to take me to the ER while I was still sick but I told him it was just a reaction to the meds and would pass. Had I realized it had lasted two days already, I might have let him take me.

I also had a long talk with the drug company that manufactured the drug. Filled out a bunch of forms, etc.

You are a brave soul, I would not be the first patient my doctor prescribed anything to, lol.

Hugs, Annette
bayoucat replied to annette030's response:

I have been using Relistor daily for nearly 5 months. It is usually used every other day. The dose is calculated by weight. I am small so my dose fell in the 0.4ml range. My GI thought it would be best for me to use it every day until I could decrease the stimulants. So far, I have been able to decrease somewhat but with the length of time that I have used them, it is a slow titration for me. I rotate injection sites each time, as would a diabetic--thighs, abdomen and upper arm ( that one is given by husband) as it is not easy to do by myself. I saw a new site yesterday which describes use for OIC. It is not like the older sites as it does not use the end stage patient as a model.
The max use is no more than once in 24 hours. It is more a matter of need. Like you, I do better with a BM every day. If you look it up, it states that while it is a prescription, it is not a controlled substance, does not interfere with pain medications or any other medications ( check the DRUG INTERACTION SITES FOR THE MEDICATIONS THAT YOU TAKE ). THERE HAVE BEEN NONE REPORTED.
Annette, I had to find an alternative to the stimulants that I needed. That includes the Alophen that was mentioned by CW as this is another name for dulcolax and the active ingredient bisacodyl is found in some enemas.

I have not had problems with its use or any side effects from it. Everyone is different and someone may have a reaction. A pharmacist can sometimes help. Maybe something someone feels is a side effect may be due to another reason for not having a BM. All meds are subjective in how we rate them.

have a good day, Eve
bayoucat replied to bayoucat's response:

You said you reacted to mirapex, which is for parkinsons and like. I'm sure you meant Miralax. I paid a call on the ER because of it, too. It cause severe dehydration and vomiting. I decrease the amount and made sure it was COMPLETLEY dissolved and made sure to drink as much fluids during the day as I could. I use it, but I still don't like the bloating and fullness it causes. I did not have extreme diarrhea, but so much fluid was pulled into my gut, I did dehydrate. After some IV fluids, then I started having the diarrhea. I became more mindful of Miralax from then on.

There is a new site for Relistor which states its use for OIC and does not mention end stage patients only for relief of oic in patients using opioids.

To Beth,
Three years ago is quite a long time ago. Perhaps the dose was different or if the injection somehow was not given sub-q, but went directily into the blood stream or the site was not a good one for several reasons. Too bad that happened.

Relistor has been around for a good while--years. I was surprised that your physician had you use it when you are on, as you said, a low opiate dose.

I can only repeat that I put the info out there. Reading the information and using it is up to you. I just wanted others to know how much it helped me.

later, on the flip side, Eve
annette030 replied to bayoucat's response:
Thanks for all the good information. I hope it continues to work well for you. Never inject any medicine in an area that is red, hot or lumpy. You won't get as good absorption of the drug.

Do not get complacent either about rotating injection sites, often diabetics will find a place that is easier to get to, or just more comfortable for them, and stop rotating sites. Sometimes a chart of possible sites is helpful and you can check off each site as you use it. Nurses often do that as we change patients often.

Take care, Annette
annette030 replied to bayoucat's response:
No, it was not Miralax, it was Mirapex. There had been a study showing that using it for FMS might work. They did not include nausea and vomiting as side effects. It was a slightly larger dose than for other uses. My pharmacist was not surprised though, he said folks who take it often complain of nausea and vomiting, just not as bad as I had it.

It is used for Parkinson's and also for RLS and FMS.

Take care, Annette

PS, Beth is a nurse, like me, and knows how to give injections. We always check for blood by aspirating the syringe slightly before injecting the drug. If you get a flash of blood in the syringe you know you are in a blood vessel and should not inject the medicine there.
ctbeth replied to bayoucat's response:
Hi Eve,

Actually, your point is valid and correct regarding dosage of opiates vs Relistor.

I now have a spinal cord stimulator and my MSContin is FAR less than it was then.

Re: oic, I've been taking senekot-S 4 tabs twice/day. I have not had acceptable result with that. I was recently prescribed Miralax 1-2 caps fuls/day. This is day three of this regimen and so far all I have is bloating.

I think that I have tried just-about everything for oic. A few months back there was a discussion and lots of good thoughts and ideas.

I am a vegetarian so eat plenty of fruit and vegetables, drink only water and watered-down fruit juice during the day- no soda, and hot tea. I cannot imagine how much worse the oic would be if I didn't eat right.

For me, as others, I am sure, it is not just the opiate, but spinal cord injury that adds to neurogenic bowel problems.

Annette, regarding being the first for whom my PM prescribed a med~ I was so eager for relief that I was willing to try just-about anything. As a rule, which I broke with Relistor, I am in 100% agreement with you about trying new meds.

The Relistor worked so well that I've been tempted to try again, but the memory of how ill I was is just too frightening.

Re: the ER- my daughter called 911. I was THAT sick. It was violent projectile vomiting and I could feel my BP dropping. I was white as a ghost with dark circles under my eyes. Not a pretty sight and my daughter panicked.

A few doses of Compazine and a few litres of IV fluid and that was that.

I wish I could tolerate it: it worked consistently and effectively.

Eve, do you find that you have to infuse very, very slowly? It just could be my perception.

The problem was with ME, not with Relistor.


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