Can a postoperative patient take Hydrocodone (hydrocodone) for pain and Relistor (methylnaltrexone), a subcutaneous injection, concurrently to prevent constipation, given their propensity for significant constipation?

From the Guidelines

Yes, a post-operative patient can take hydrocodone for pain management while simultaneously using Relistor (methylnaltrexone) subcutaneous injections to prevent opioid-induced constipation. This combination is particularly appropriate for patients with a history of significant constipation. Relistor works specifically in the gut to block opioid effects on the intestines without interfering with pain control, making it an effective option for preventing constipation while maintaining pain relief. The typical dosing for Relistor is 12 mg subcutaneously once daily, but this may vary based on weight and kidney function 1. It's essential to note that Relistor should be initiated when traditional constipation remedies (increased fluids, fiber, stool softeners, and laxatives) have proven insufficient. Patients should be aware that Relistor may cause abdominal pain, nausea, diarrhea, or gas as side effects. This medication works quickly, often producing a bowel movement within 30 minutes to 4 hours after administration, which can be particularly beneficial in the post-operative setting where early mobilization and normal bowel function are important recovery goals 1. Additionally, studies have shown that methylnaltrexone is effective and well-tolerated in patients with opioid-induced constipation, with a low incidence of adverse events 1. In the context of post-operative pain management, opioids like hydrocodone are effective for moderate-to-severe pain, but it's crucial to monitor for side effects and consider alternative analgesics when possible 1. Overall, the combination of hydrocodone and Relistor can be a safe and effective approach for managing post-operative pain and preventing opioid-induced constipation, especially in patients with a history of significant constipation. Key points to consider include:

• Relistor's mechanism of action and its ability to prevent constipation without interfering with pain control
• The importance of monitoring for side effects and adjusting the dosing of Relistor as needed
• The potential benefits of early mobilization and normal bowel function in the post-operative setting
• The need to consider alternative analgesics and monitor for opioid-related side effects in post-operative pain management.

From the FDA Drug Label

Discontinue RELISTOR if treatment with the opioid pain medication is also discontinued.

The patient can take Hydrocodone for pain and Relistor subcutaneous injection at the same time to prevent constipation, but it is crucial to monitor the patient's response to both medications and adjust the treatment plan as needed. Relistor should be discontinued if the opioid pain medication, Hydrocodone, is also discontinued. Additionally, patients should be advised to be within close proximity to toilet facilities once Relistor is administered and to discontinue Relistor if they experience severe or persistent diarrhea or abdominal pain 2.

From the Research

Postoperative Pain Management and Constipation Prevention

• Hydrocodone is an opioid analgesic commonly used for pain management, but it can cause constipation as a side effect 3, 4, 5, 6.
• Relistor (methylnaltrexone) is a peripherally acting mu-opioid receptor antagonist that can help prevent constipation caused by opioid use without affecting analgesia 3, 4, 5, 6.

Efficacy of Methylnaltrexone for Constipation Prevention

• Studies have shown that methylnaltrexone is effective in inducing laxation and reversing opioid-induced constipation in patients taking opioids for pain management 3, 4, 5, 6.
• Methylnaltrexone has been found to increase the frequency of bowel movements and reduce the need for rescue laxatives in patients with opioid-induced constipation 5, 6.

Safety of Methylnaltrexone

• Methylnaltrexone is generally well-tolerated, but it can cause adverse events such as abdominal cramping, nausea, and diarrhea 3, 4, 5, 6.
• The risk of abdominal pain is higher in patients taking methylnaltrexone compared to those taking placebo 6.

Clinical Implications

• Patients taking hydrocodone for postoperative pain management may benefit from concomitant use of methylnaltrexone to prevent constipation 3, 4, 5, 6.
• Healthcare providers should monitor patients for adverse events and adjust treatment as needed 3, 4, 5, 6.