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A World of (Bladder) Hurt

Paper Chase #3 - AGA Guideline on Opioid-Induced Constipation

Steve Biederman, MD and Tom Robertson, MD
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Tag Evidence based medicine EBM

To present official recommendations for the medical management of opioid-induced constipation.

 

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Chris -

Interesting to hear about the PAMORAs, but I was a struck by the passing mention of docusate at the end as a "standard go to." Though it does still seem to get a lot of use in clinical practice, my understanding was that docusate has questionable efficacy as a laxative. From the CADTH review:
"Docusate does not increase stool frequency or soften stools compared with placebo.
Docusate does not improve the symptoms of constipation.
Docusate does not improve the difficulties or completeness of stool evacuation in patients taking opioids."

(https://www.cadth.ca/dioctyl-sulfosuccinate-or-docusate-calcium-or-sodium-prevention-or-management-constipation-review)

Neda F., MD -

Hi Chris! We were just having this same conversation on the PC RAP team about docusate. We'll be covering this review in the future.

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A World of (Bladder) Hurt Full episode audio for MD edition 186:36 min - 88 MB - M4AHippo Primary Care RAP - March 2019 Written Summary 1 MB - PDF

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