![]() Increase in magnesium, causing lethargy, hypotension, respiratory depression 20 Peripherally acting mu-opioid antagonists are effective for opioid-induced constipation but are expensive.ġ tsp or 1 packet one to three times per dayīloating, abdominal distension in 4% to 18% 16, 17īloating and cramping nausea in up to 20% 19ġ50 to 300 mL, single dose or short-term daily dose If symptoms do not improve, a trial of linaclotide or lubiprostone may be appropriate, or the patient may be referred for further diagnostic evaluation. Long-term use of magnesium-based laxatives should be avoided because of potential toxicity. The next step in the treatment of constipation is the use of an osmotic laxative, such as polyethylene glycol, followed by a stool softener, such as docusate sodium, and then stimulant laxatives. Fiber intake should be slowly increased over several weeks to decrease adverse effects. Additional fiber intake in the form of polycarbophil, methylcellulose, or psyllium may improve symptoms. Most patients are initially treated with lifestyle modifications, such as scheduled toileting after meals, increased fluid intake, and increased dietary fiber intake. Fecal impaction should be treated with mineral oil or warm water enemas. Secondary constipation is associated with chronic disease processes, medication use, and psychosocial issues. Primary constipation is also referred to as functional constipation. Chronic constipation is common in adults older than 60 years, and symptoms occur in up to 50% of nursing home residents.
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