Which medications are associated with causing constipation in long-term care residents, such as Oxycodone, Cyclobenzaprine, and Verapamil?

From the Guidelines

All the medications listed, including Oxycodone, Cyclobenzaprine, and Verapamil, are associated with an increased risk of constipation in long-term care residents. According to the American Gastroenterological Association Institute guideline on the medical management of opioid-induced constipation 1, opioid analgesics like oxycodone can cause constipation by activating enteric m-receptors, leading to increased tonic non-propulsive contractions in the small and large intestine, increased colonic fluid absorption, and stool desiccation. Muscle relaxants such as cyclobenzaprine can also contribute to constipation by slowing intestinal motility, while calcium channel blockers like verapamil can decrease intestinal secretions and affect bowel function.

Some key points to consider:

• Opioid-induced constipation (OIC) is a common side effect of opioid therapy, affecting 40%–80% of patients taking chronic opioid therapy 1.
• The definition of OIC includes new or worsening symptoms of constipation when initiating, changing, or increasing opioid therapy, characterized by straining during defecation, lumpy or hard stools, sensation of incomplete evacuation, or fewer than 3 spontaneous bowel movements per week 1.
• A technical review on the medical management of OIC provides evidence for the use of osmotic or stimulant laxatives, peripherally acting m-opioid receptor antagonists (PAMORAs), secretagogues, and selective 5HT4 agonists in the treatment of OIC 1.
• Preventive measures, such as adequate hydration, fiber-rich diets, regular physical activity, and prophylactic stool softeners or laxatives, should be implemented for long-term care residents taking medications that can cause constipation, and staff should monitor bowel movements regularly to adjust interventions as needed.

From the FDA Drug Label

The possible side effects of oxycodone hydrochloride tablets are: constipation, nausea, sleepiness, vomiting, tiredness, headache, dizziness, abdominal pain Oxycodone causes a reduction in motility associated with an increase in smooth muscle tone in the antrum of the stomach and duodenum Digestion of food in the small intestine is delayed and propulsive contractions are decreased. Propulsive peristaltic waves in the colon are decreased, while tone may be increased to the point of spasm, resulting in constipation. Adverse reactions which were reported in 1% to 3% of the patients were: abdominal pain, acid regurgitation, constipation, diarrhea, dizziness, nausea, irritability, mental acuity decreased, nervousness, upper respiratory infection, and pharyngitis Among the less frequent adverse reactions, there was no appreciable difference in incidence in controlled clinical studies or in the surveillance program Adverse reactions which were reported in 1% to 3% of the patients were: fatigue/tiredness, asthenia, nausea, constipation, dyspepsia, unpleasant taste, blurred vision, headache, nervousness, and confusion

Medications associated with constipation:

• Oxycodone: causes a reduction in motility associated with an increase in smooth muscle tone in the antrum of the stomach and duodenum, resulting in constipation.
• Cyclobenzaprine: constipation is reported in 1% to 3% of patients. The correct answer is b. All choices are associated with increased risk of constipation 2, 2, 3.

From the Research

Medications Associated with Constipation

The following medications are associated with causing constipation in long-term care residents:

• Oxycodone, an opioid analgesic, is known to cause constipation as a side effect 4, 5
• Cyclobenzaprine, a muscle relaxant, can also contribute to constipation 5, 6
• Verapamil, a calcium channel blocker, may cause constipation as a side effect 5, 7

Common Causes of Constipation

Constipation in long-term care residents can be caused by various factors, including:

• Medications, such as those listed above
• Deficient dietary fiber and fluid intake
• Immobility
• Neurologic and endocrine diseases
• Certain medical conditions, such as hypothyroidism and Parkinson's disease 4, 5, 6

Management of Constipation

Treatment of constipation in long-term care residents may involve:

• Supplementing dietary fiber and fluid intake
• Using bulk-forming agents, emollients, and periodic enemas
• Prescribing laxatives, such as stool softeners, saline laxatives, and stimulant/irritant laxatives 5, 6, 8, 7
• Considering individualized care to compensate for deficiencies and health conditions 4, 7