You are right. It varies a lot though by different opioids and dosage plays a major role, too.
Morphine causes more constipation than oxycodone does, for example (not to mention IR vs ER formulations), and in some people morphine causes more sedation and oxycodone might be more stimulant-ish, so they may be opioids / opiates, but they can be significantly different.
That said, constipation can indeed be a major issue, especially in the elderly, but they are most likely are already taking or being given laxatives.
For adults without any GI problems, they can safely be on a better diet and take magnesium citrate before they want to defecate (if they have no kidney issues either). It takes 4-12 hours for magnesium citrate to work. There is an even better form of magnesium, but magnesium citrate should be fine, along with prunes or prune jam, lots of hydration and so forth.
I take opiates for pain, and the way I manage constipation (which is indeed frustrating) is through diet (fibre, prune jam, and so forth) and skipping two days (of the ER formulation) if I have no stool for a few days, along with taking magnesium citrate. I would not recommend taking opiates AND laxatives all the time (or rather, I do not recommend treating OIC with regular consumption of laxatives). Constipation would not be a problem with lower doses and IR formulations though, or much less so.
Just FWIW, if you can pass gass, your bowels are not obstructed, and it is a good sign, so if you take opiates, pay attention to that. If you cannot pass gas and you have abdominal pain, then it can easily become a medical emergency. You should not get to this point though, either by taking less, switching to a different formulation (ER -> IR), or switching to a different opioid, along with a better diet.
Additionally, if you do not take opioids (especially ER ones) on a regular basis (similarly to how some people only take NSAIDs once in a while), then constipation is not going to be an issue at all.
I hope this answers your concerns regarding opioid-induced constipation.
Some people have it. Some do not. I have taken very large amounts of opiates before and I have never ever experienced nausea from them. I think you are not likely to experience it at lower doses from say, codeine or hydrocodone either, but honestly, it varies by individuals.
It would suck if I experienced nausea, and it would equally suck if I experienced euphoria from opiates, because I have an addictive personality. Thankfully I do not experience euphoria at all from opiates.
BTW I remember having ulcers from NSAIDs before, that is yuck, too. I ended up vomiting blood and I had to be admitted to the hospital. I think I would choose constipation (which can be managed) over this. But yeah, if opiates caused nausea for me, I would not take them for sure.
Ultimately, people should figure out what works for them and stick to it. Unfortunately it might work until it does not, i.e. causes harm. Some people get no ulcers from taking NSAIDs on the daily, and I did just from a few days of taking it (and it was not even naproxen!). :| I am also allergic to metamizole which is the most common painkiller around here (Algopyrin, Optalgin). For my grandma, it seems to work best for her, although she may want to try pregabalin, as her pain is neuropathic (too). She was given tramadol not that long ago and she got somewhat delirious. They probably gave it to her deliberately because she was making a scene at the hospital.
I would say it is not so silent, bowel obstruction is very painful which you feel even if you are on opiates. In any case, I hope my other comment proves to be helpful to those taking opiates if they do not already know what to do or pay attention to.
You are right. It varies a lot though by different opioids and dosage plays a major role, too.
Morphine causes more constipation than oxycodone does, for example (not to mention IR vs ER formulations), and in some people morphine causes more sedation and oxycodone might be more stimulant-ish, so they may be opioids / opiates, but they can be significantly different.
That said, constipation can indeed be a major issue, especially in the elderly, but they are most likely are already taking or being given laxatives.
For adults without any GI problems, they can safely be on a better diet and take magnesium citrate before they want to defecate (if they have no kidney issues either). It takes 4-12 hours for magnesium citrate to work. There is an even better form of magnesium, but magnesium citrate should be fine, along with prunes or prune jam, lots of hydration and so forth.
I take opiates for pain, and the way I manage constipation (which is indeed frustrating) is through diet (fibre, prune jam, and so forth) and skipping two days (of the ER formulation) if I have no stool for a few days, along with taking magnesium citrate. I would not recommend taking opiates AND laxatives all the time (or rather, I do not recommend treating OIC with regular consumption of laxatives). Constipation would not be a problem with lower doses and IR formulations though, or much less so.
Just FWIW, if you can pass gass, your bowels are not obstructed, and it is a good sign, so if you take opiates, pay attention to that. If you cannot pass gas and you have abdominal pain, then it can easily become a medical emergency. You should not get to this point though, either by taking less, switching to a different formulation (ER -> IR), or switching to a different opioid, along with a better diet.
Additionally, if you do not take opioids (especially ER ones) on a regular basis (similarly to how some people only take NSAIDs once in a while), then constipation is not going to be an issue at all.
I hope this answers your concerns regarding opioid-induced constipation.
And nausea. Yuck.
Some people have it. Some do not. I have taken very large amounts of opiates before and I have never ever experienced nausea from them. I think you are not likely to experience it at lower doses from say, codeine or hydrocodone either, but honestly, it varies by individuals.
It would suck if I experienced nausea, and it would equally suck if I experienced euphoria from opiates, because I have an addictive personality. Thankfully I do not experience euphoria at all from opiates.
BTW I remember having ulcers from NSAIDs before, that is yuck, too. I ended up vomiting blood and I had to be admitted to the hospital. I think I would choose constipation (which can be managed) over this. But yeah, if opiates caused nausea for me, I would not take them for sure.
Ultimately, people should figure out what works for them and stick to it. Unfortunately it might work until it does not, i.e. causes harm. Some people get no ulcers from taking NSAIDs on the daily, and I did just from a few days of taking it (and it was not even naproxen!). :| I am also allergic to metamizole which is the most common painkiller around here (Algopyrin, Optalgin). For my grandma, it seems to work best for her, although she may want to try pregabalin, as her pain is neuropathic (too). She was given tramadol not that long ago and she got somewhat delirious. They probably gave it to her deliberately because she was making a scene at the hospital.
> I have taken very large amounts of opiates before
> I have an addictive personality
I take it this means: "I was a heroin junkie"?
The risk of NSAID ulcers can be vastly reduced by Pantoprazole (Protonix®)
You can see blood that you vomit, But NSAIDs also cause kidney damage, which you don't realize until it is extensive. Lost nephrons don't come back.
I know, and there is something called Venter (sucrate). Combining both works best.
The silent killer
I would say it is not so silent, bowel obstruction is very painful which you feel even if you are on opiates. In any case, I hope my other comment proves to be helpful to those taking opiates if they do not already know what to do or pay attention to.