Common Medications That Can Cause Constipation
When counseling a patient with constipation, it is important to review the patient’s medication list to determine the potential cause.
When counseling a patient with constipation, it is important to review the patient’s medication list to determine the potential cause.
Some of the most common drugs that cause constipation include:
Opioids
Opioid pain medications such as oxycodone and hydrocodone cause constipation and hardening of the stool. Most patients with opioid-induced constipation (OIC) experience straining and incomplete emptying. OIC may occur immediately or may appear gradually during opioid treatment. Other gastrointestinal (GI) adverse effects (AEs) may occur, including nausea, vomiting, bloating, pain, and straining. OIC is a reason that many patients discontinue opioid treatment.
Treatment for OIC may include:1
- Nonpharmacological treatment: Increasing fiber, fluids, and exercise can help prevent OIC1
- Pharmacological treatment
- Over the counter: Preventive laxatives should begin when opioid therapy begins. Any laxative is sufficient except for bulk-forming laxatives like psyllium. The most common preventive treatment for OIC is a stimulant such as senna or bisacodyl with or without a stool softener (docusate), or daily polyethylene glycol.1
- Rx: A prescription drug can be used for refractory cases of OIC. Methylnaltrexone bromide subcutaneous injection (Relistor) is the most effective. Other options are lubiprostone (Amitiza; Sucampo Pharmaceuticals), naloxegol (Movantik; AstraZeneca), naldemedine (Symproic; Shionogi), or methylnaltrexone bromide oral tablets.1
Besides opioids, there are several other medications and supplements that can cause constipation.2,3
- Antidepressants, especially tricyclic antidepressants, selective serotonin reuptake inhibitors, and monoamine oxidase inhibitors
- Blood pressure medications, notably calcium channel blockers such as verapamil
- Anticholinergic medications, such as diphenhydramine (Benadryl), oxybutynin, and benztropine
- Iron supplements
- Antacids (aluminum or calcium)
- Non-steroidal anti-inflammatory drugs
- Long-term use of cholestyramine or stimulant laxatives (may develop a dilated colon, which turns into a cycle of more laxative use and less efficacy)
In terms of nonpharmacological treatment, counsel patients to increase intake of fiber and fluids. Good sources of dietary fiber include:4
- Vegetables: cruciferous vegetables like broccoli, brussels sprouts, and cauliflower; asparagus; carrots
- Fruits: avocados, apples, berries
- Nuts and seeds: almonds, walnuts, chia seeds
- Beans and peas: navy, pinto, and kidney beans; split peas; lentils
- Whole grains: barley; quinoa; oats; popcorn
A fiber supplement or laxative can be helpful, too. Pharmacists can help patients select an appropriate product based on symptoms, medical conditions, and potential drug interactions.
Patients should be encouraged to keep an open line of communication with their prescriber about the medications they take, making them aware of constipation so that laxative treatment (or possibly changing the offending medication) can be discussed.
What prescription drugs are available for constipation?
If OTC medications do not help constipation, a prescription drug may be another option. Prescription drugs for constipation include the following.
Linaclotide (Linzess; Ironwood and Allergan plc)
- Dose: 72 or 145 mcg by mouth once daily on an empty stomach
- Most common AEs: diarrhea, bloating, abdominal pain, gas, headache5
Plecanatide (Trulance; Synergy Pharmaceuticals Inc)
- Dose: 3 mg once daily with or without food
- Most common AE: diarrhea. Other, less common AEs include sinus or upper respiratory tract infection, bloating, gas, and abdominal tenderness6
Prucalopride (Motegrity; Takeda Pharmaceuticals U.S.A, Inc)
- Dose: 2 mg once daily with or without food
- Most common AEs: headache, abdominal pain, nausea, diarrhea, bloating.
- Warning: Patients must be monitored for suicidal thoughts and behavior while taking this medication.7
Lactulose
- Dose: 2 or 3 tablespoons by mouth 3 or 4 times daily
- Most common AEs: bloating, gas, belching, cramping. Excess dosage can cause diarrhea with complications (fluid loss, electrolyte imbalance)8
Lubiprostone
- Dose: 24 mcg twice daily with food and water (for constipation, or OIC)
- Most common AEs: nausea, diarrhea, abdominal pain, bloating, gas, headache9
With our knowledge and expertise, pharmacists can play an important role in identifying drug-related causes of constipation, counseling the patient, and referring to the physician if necessary.
Karen Berger, PharmD, from the University of Pittsburgh School of Pharmacy, and her experience includes chain and independent pharmacy as well as medical writing and reviewing.
References
1. Sizar O, Genova R, Gupta M. Opioid-Induced Constipation. NCBI StatPearls [Internet]. Updated November 20, 2020. Accessed April 28, 2021. https://www.ncbi.nlm.nih.gov/books/NBK493184/
2. What to do when medication makes you constipated. Harvard Health Publishing. Updated October 22, 2019. Accessed April 28, 2021. https://www.health.harvard.edu/staying-healthy/what-to-do-when-medication-makes-you-constipated
3. Basson MD Anand BS. Which medications can cause constipation? Medscape. Updated March 30, 2020. Accessed April 28, 2021.https://www.medscape.com/answers/184704-23256/which-medications-can-cause-constipation
4. High-fiber foods. Metamucil website. Accessed April 28, 2021. https://www.metamucil.com/en-us/articles/fiber-101/high-fiber-foods
5. Label: Linzess- linaclotide, capsule, gelatin coated. DailyMed. Updated April 12, 2021. Accessed April 28, 2021.https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=09beda19-56d6-4a56-afdc-9a77b70b2ef3
6. Label: Trulance immediate release- plecanatide tablet. DailyMed. Updated April 1, 2021. Accessed April 28, 2021.https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fe2895bf-71a6-493a-b0ca-e06b2dfefc82
7. LabeL: Motegrity- prucalopride tablet, film coated. DailyMed. Updated March 22, 2021. Accessed April 28, 2021.https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bca1e4c6-4b2b-4876-8ab3-654629c4ff1b
8. Label: Lactulose- lactulose solution. DailyMed. Updated December 31, 2019. Accessed April 28, 2021. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a89835c9-8ce5-4627-8d7d-70ff175b2e07
9. Label: Amitiza- lubiprostone capsule, gelatin coated. DailyMed. Updated April 25, 2021. Accessed April 28, 2021. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1b632d92-a05b-42d3-88a6-b3e345d11fe4
