Thursday November 9, 2006
Oral Narcan for opioid induced constipation !

Constipation / ileus is a major issue in ICU since many intubated patients stays on narcotic drips for analgesia. Different meds like dulcolex (bisacodyl), lactulose, enema etc. can be used but if patient on narcotic drip like fentanyl, morphine or dilaudid doesn't get relief from conventional constipation relief agents, oral Narcan (naloxone) can be tried. It provides only local effect - without systemic effect. It is found to have a pretty good margin of safety as when given orally, hepatic metabolism limits systemic bioavailability.

Usual dose noted in palliative literature is 2- 4 mg every 6 hours. Later, if needed either dose can be increased upto 8 mg or frequency can be increased upto every 4 hours. Another recommendation (only for morphine) is to give 10 - 20% of total morphine in previous 24 hours.

If you suspect systemic effect of narcane (consistent with opioid withdrawal) - hold narcane and increase narcotic dose.

It can similarly be used in opioid induce pruritis, common with epidural drips.



References: click to get abstract

1. Opioid antagonists in the treatment of opioid-induced constipation and pruritus. Ann Pharmacother. 2001;35(1):85–91
2. Opioid antagonists: a review of their role in palliative care, focusing on use in opioid-related constipation. J Pain Symptom Manage. 2002;24(1):71–90.
3. Oral naloxone reverses opioid-associated constipation. Pain. 2000;84(1):105–109
4. Low-dose oral naloxone reverses opioid-induced constipation and analgesia. J Pain Symptom Manage . 2002;23(1):48–53.