Managing Constipation on Suboxone (Buprenorphine)
Start a stimulant laxative immediately—bisacodyl 10-15 mg daily or senna 2 tablets twice daily—combined with polyethylene glycol (PEG) 17g in 8 oz water once or twice daily, aiming for one non-forced bowel movement every 1-2 days. 1, 2
Why This Matters
Buprenorphine (the active component in Suboxone) causes less constipation than full opioid agonists, but constipation still occurs and requires proactive management. 3 The good news is you're not vomiting, which means you can take oral medications effectively and don't need to worry about antiemetic therapy. 1
First-Line Treatment Approach
Stimulant Laxatives (Primary Treatment)
- Bisacodyl: Start with 10-15 mg daily, can increase to 2-3 times daily if needed 1, 2, 4
- Senna: Alternative option at 2 tablets twice daily 4
- These work by stimulating bowel contractions and are safe for long-term use despite outdated concerns about colon damage 4
Osmotic Laxatives (Add or Combine)
- Polyethylene glycol (PEG): 17g (one heaping tablespoon) mixed in 8 oz water once or twice daily—this has an excellent safety profile 2, 4
- Lactulose or sorbitol: Alternative osmotic agents if PEG is unavailable 1
- Magnesium-based products: Avoid if you have any kidney problems due to hypermagnesemia risk 4
Critical: What NOT to Use
- Avoid docusate (stool softeners) alone—they have no proven benefit and won't work for opioid-induced constipation 2, 4
- Avoid fiber supplements or psyllium—these can actually worsen constipation when gut motility is reduced by opioids 2, 4
Supportive Measures
- Increase fluid intake significantly—this is essential for laxatives to work effectively 1, 2, 5
- Increase physical activity within your limitations 1, 2
- Don't delay when you feel the urge—establish regular toilet times if possible 5, 6
If First-Line Treatment Fails After 3-5 Days
Escalate Laxative Dosing
- Increase bisacodyl to 10-15 mg two to three times daily 2, 4
- Ensure you're taking adequate fluids with the laxatives 1
Add Rectal Interventions for Severe Cases
- Glycerin suppository: First-line rectal option, acts as mild stimulant 2, 4
- Bisacodyl suppository: 10 mg rectally once or twice daily 4
- These can provide relief within 1-4 hours 7
Consider Advanced Therapies (Requires Prescription)
If standard laxatives fail after aggressive titration, peripherally acting mu-opioid receptor antagonists may be appropriate:
- Naloxegol: 25 mg oral daily 1
- Naldemedine: 0.2 mg daily 1
- Methylnaltrexone: 0.15 mg/kg subcutaneously every other day 2, 4
These medications block opioid effects in the gut without reversing pain relief, though some patients report 10-15% reduction in analgesia that can be managed by slight opioid dose adjustment. 7
Red Flags Requiring Immediate Medical Evaluation
- Severe abdominal pain or distension 2
- Absent bowel sounds 2
- Vomiting develops (could indicate obstruction) 1
- No bowel movement for more than 5-7 days despite treatment 1
Common Pitfalls to Avoid
- Starting too conservatively: Opioid-induced constipation requires aggressive upfront treatment, not gradual escalation 2, 5
- Using stool softeners as primary therapy: This is ineffective for opioid-related constipation 2
- Stopping treatment too soon: Maintenance therapy is often needed as long as you're on Suboxone 5, 6
- Inadequate fluid intake: Laxatives won't work optimally without sufficient hydration 1, 5
Practical Starting Regimen
Day 1 onward:
- Bisacodyl 10-15 mg every morning 1, 2
- PEG 17g in 8 oz water twice daily (morning and evening) 2, 4
- Increase water intake to at least 8 glasses daily 1, 5
- Walk or move around as much as possible 1, 2
Goal: One comfortable bowel movement every 1-2 days 1, 2
If no bowel movement within 3 days, increase bisacodyl to twice daily and consider adding a glycerin suppository. 2, 4 If still no improvement after 5-7 days of aggressive treatment, contact your prescriber about peripherally acting opioid antagonists. 1, 5