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Best laxatives for constipation caused by medicationMedically reviewed by Alan Carter, Pharm.D.
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— By Rachel Ann Tee-Melegrito on August 30, 2022Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and antidepressants, may cause constipation. Laxatives can help relieve and counteract the effects of constipation these drugs cause. One of the most common digestive complaints people of all ages in the United States and other western countries experience is constipation.
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Every year, doctors get at least 2.5 million visits for constipation. Some medicines taken orally can affect a person’s digestive system. This can make it hard for people to empty their bowels or pass hard, dry stools.
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This article explores the medications that cause constipation, constipation’s potential causes, and the best laxatives that relieve medication-related constipation. What is constipation
Share on PinterestNathan Griffith/Getty ImagesAccording to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), constipation is when a person has fewer than three bowel movements weekly.
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Doctors characterize it by hard, dry, lumpy stools that can be difficult and even painful to pass. A person may also feel that they have not passed all of their stool even when they can have a bowel movement. The following may also accompany constipation:abdominal painbloatinglethargy
Learn more about constipation.
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Too much straining due to constipation may also lead to complications, such as anal fissures, hemorrhoids, and rectal prolapse. Causes
Anything that disrupts typical bowel function can cause constipation.
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Several medications may contribute to constipation:
Opioids or pain medications
Between 40–60% of people without cancer who take opioids get opioid-induced constipation. Doctors typically prescribe laxatives along with opioids to prevent constipation. Opioids affect certain receptors in the gut wall, which slow down the peristaltic movement of the muscles that move food along the tract.
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They may also suppress the secretion of water and electrolytes in the intestines and increase fluid absorption by the intestines, removing moisture from the stool. Examples of opioids include:acetaminophen-hydrocodonemorphinecodeineoxycodonehydromorphone
NSAIDs
Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) may cause gut problems.
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Constipation is also a side effect of NSAIDs, such as ibuprofen (Advil) and naproxen (Aleve). Moreover, using them in higher doses may also lead to constipation.
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Anticholinergics
Anticholinergics are a large drug class present in many over-the-counter (OTC) and prescription medications. These drugs prevent activity by the neurotransmitter acetylcholine, which enables muscles to move, and may cause constipation.
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Examples of anticholinergics include:Calcium-channel blockers: These include medications include amlodipine (Norvasc) and diltiazem (Cardizem, Tiazac).Certain nausea medications: These include ondansetron, which doctors usually prescribe after chemotherapy or surgery.Medicines for bladder incontinence: Doctors commonly prescribe oxybutynin (Ditropan) and tolterodine (Detrol) for incontinence issues.Antihistamines or allergy medications: These include medications, such as cetirizine (Zyrtec) and diphenhydramine (Benadryl). Learn more about anticholinergic drugs. Tricyclic antidepressants
Tricyclic antidepressants (TCAs) are a class of medications doctors prescribe to treat depression.
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These medications increase a person’s norepinephrine and serotonin levels by blocking acetylcholine. Some examples of TCAs include amitriptyline (Elavil) and desipramine (Norpramin). One of the most common side effects of TCAs includes constipation.
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Another class of antidepressants, serotonin specific reuptake inhibitors (SSRIs), can also cause constipation. Citalopram and fluoxetine are examples of SSRIs.
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Iron
A person can take iron on its own or with multivitamins. Aside from causing darker-than-usual stools, it may also cause constipation. Learn more about iron supplements.
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Which laxative is best
There are different types of laxatives available on the market. Each can have different effects on a person’s body.
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The effectiveness of each type may also vary from person to person. Below is a table comparing the different types of laxatives, including how they work and their potential side effects.Type of laxativeGeneric and brand namesMode of actionSide effectsStimulant laxativessenna (Senokot), bisacodyl (Dulcolax)Stimulates intestinal muscles to help stool move more quicklyBelching, diarrhea, cramping, nausea, changes in urine colorOsmotic laxatives (liquid, powder, suppository, saline)Polyethylene glycol or PEG (MiraLAX), lactulose, milk of magnesiaDraws water into the intestines to allow stool to pass easierBloating, cramping, gas, nausea, increased thirst, diarrheaEmollient laxatives (stool softeners)docusate sodium (Colace)Makes stool softer by allowing fat and water to soften stoolElectrolyte imbalance if used too longBulk formersPsyllium (Metamucil), methylcellulose (Citrucel)Absorbs liquid in the intestines to form bulkier stools that are softer and easier to pass Gas, bloating, and cramping worsen constipation if not taken with enough fluids
Read more about stool softeners vs.
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laxatives here. Doctors typically give stimulant laxatives for opioid-induced constipation. They may also ask a person to take osmotic laxatives daily.
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Learn more about laxatives for constipation here. For people with chronic constipation, a doctor may recommend a person take one of the following prescription drugs:serotonin agonists, such as prucalopride (Motegrity)secretagogues, such as linaclotide (Linzess)osmotic agentsbile acid-modifying agents, such as elobixibat — currently only approved in Japan and Thailand
In people with opioid-induced constipation, doctors will likely suggest lifestyle changes and OTC medications. However, if these do not work, they will prescribe medications, which include:naloxegol (Movantik)naldemdine (Symproic)methylnaltrexone (Relistor)lubiprostone (Amitiza)
Before trying laxatives
A person experiencing constipation may want to manage their discomfort by stopping their medications or taking other medications.
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However, they should speak with a healthcare professional before taking action. It is also important to note that the frequency of bowel movements varies from person to person.
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People may experience constipation if they pass stools less frequently than what is typical for them. Before taking laxatives, making specific lifestyle changes may help. These include:eating more fiber-rich foodsexercising regularlydrinking enough waterlimiting the intake of pain relievers and laxatives
Laxatives to avoid
All types of laxatives can help a person with medication-induced constipation except for bulk-forming laxatives.
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These laxatives, such as psyllium, increase the bulk of the stool and distend the colon but do not help it pass. They may make bowel movements very firm if a person does not take enough fluids, worsening their abdominal pain and contributing to a bowel obstruction. Some osmotic medications contain magnesium and phosphate, such as magnesium citrate (Citroma) and milk of magnesia.
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The body partially absorbs these, which can harm people with kidney failure. How long should I take laxatives
Some laxatives, such as bulk-forming laxatives, are gentle and generally safe to use long term. However, these will not help people with opioid-induced constipation.
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Healthcare professionals do not typically prescribe other laxatives for long-term use. Ideally, a person should only use them occasionally, for up to 1 week.
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Overuse may lead to dependency and side effects. Alternatives to laxatives
It may be possible to improve constipation without taking laxatives.
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The following lifestyle and diet changes may help improve a person’s bowel movements:getting regular exercisedrinking plenty of fluidseating prebiotic and probiotic foods and supplementsavoiding dairy products
Discover 13 home remedies for constipation here. Here are some fiber-rich foods a person may add to their diet to relieve their constipation: nuts, including peanuts and pecansvegetables, such as carrots and broccoli fruits, for example, unskinned apples and pearslegumes, such as kidney beans and chickpeaswhole grains, including oatmeal and whole wheat bread
When to speak with a doctor
OTC laxatives are generally safe and effective in treating constipation, including constipation caused by certain medications.
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However, it is best to speak with a doctor to check for any underlying causes. A person should always follow instructions and read the medication label for proper directions. Overuse can cause the colon to stop responding to the usual dose and require larger doses to get the same effects, leading to dependence.
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Laxative abuse can also cause the intestines to lose nerve and muscle response, resulting in dependency. A person should visit a healthcare professional if they notice any of the following:constipation with severe abdominal painbloody stoolsunintended weight lossunexpected new onset of constipation
Suddenly developing long-standing constipation after having regular bowel movements is also a cause of concern.
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Summary
There are several causes of constipation, including certain kinds of medications. The most common types include drugs for pain, allergies, hypertension, and overactive bladder. Most of the time, lifestyle changes are enough to resolve constipation, but a person can also take OTC laxatives.
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People most commonly use stimulant laxatives to treat their medication-induced constipation. A person experiencing constipation may ask a doctor or pharmacist if laxatives are suitable for them. Last medically reviewed on August 30, 2022ConstipationGastroIntestinal / GastroenterologyDrugs 18 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations.
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We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Argoff, C.
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E., (2020). Opioid-induced constipation: A review of health-related quality of life, patient burden, practical clinical considerations, and the impact of peripherally acting μ-opioid receptor antagonists.https://journals.lww.com/clinicalpain/fulltext/2020/09000/opioid_induced_constipation__a_review_of.10.aspxAvoid using anticholinergic medication to treat overactive bladder in women older than 70 years. (n.d.).https://www.aafp.org/pubs/afp/collections/choosing-wisely/434.htmlChoudhary, C., et al.
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(2022). Constipation and defecation problems. https://gi.org/topics/constipation-and-defection-problems/Constipation.
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(n.d.).https://www.hopkinsmedicine.org/health/conditions-and-diseases/constipationDefinition & facts for constipation. (2018). https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/definition-facts#whatisElobixibat.
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(n.d.).https://albireopharma.com/science-medicine/medicines/elobixibat/Goldstein, J. L., et al.
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(2015). Gastrointestinal injury associated with NSAID use: A case study and review of risk factors and preventative strategies. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4310346/Hussain, Z. H., et al.
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(2015). Treatment of chronic constipation: Prescription medications and surgical therapies.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836568/Laxative use: What to know.
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(2019). https://health.cornell.edu/sites/health/files/pdf-library/LaxativeUse.pdfLeppert, W. (2015). Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction.https://www.dovepress.com/emerging-therapies-for-patients-with-symptoms-of-opioid-induced-bowel--peer-reviewed-fulltext-article-DDDTMoraczewski, J., et al. (2022). Tricyclic antidepressants. https://www.ncbi.nlm.nih.gov/books/NBK557791/NSAIDS. (n.d.).https://www.arthritis.org/drug-guide/nsaids/nsaidsOverview: Laxatives.
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(2019).https://www.nhs.uk/conditions/laxatives/Parvateneni, S., et al. (2020). Ileus due to iron pills: A case report and literature report on the importance of stool softeners. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7331903/Sizar, O., et al. (2022). Opioid induced constipation. https://www.ncbi.nlm.nih.gov/books/NBK493184/Werth, B.
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L., et al. (2021). Laxative use in the community: A literature review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796417/What to do when medication makes you constipated.
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(2019).https://www.health.harvard.edu/staying-healthy/what-to-do-when-medication-makes-you-constipatedYan, Y., et al. (2021). The effect of opioids on gastrointestinal function in the ICU.https://ccforum.biomedcentral.com/articles/10.1186/s13054-021-03793-1FEEDBACK:Medically reviewed by Alan Carter, Pharm.D. — By Rachel Ann Tee-Melegrito on August 30, 2022
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This article looks at some possible natural alternatives to laxatives for people looking to have a bowel movement. We also look at when to see a…READ MOREDifferences between stool softeners and other laxativesMedically reviewed by Alexandra Perez, PharmD, MBA, BCGP
Stool softeners are a type of laxative.
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They work by drawing water into the stool, making it softer and more comfortable to pass. Learn more.READ MOREWhat is opioid-induced constipation?Medically reviewed by Alyssa Peckham, PharmD, BCPP
Opioid-induced constipation (OIC) is a side effect of taking opioid pain relief medication.
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