Constipation from long-term opioid pain medicine, online

Common symptoms

• Hard or lumpy stools
• Straining to pass stool
• Fewer than 3 bowel movements a week
• Not feeling empty after a bowel movement

May fit online care

• Adults 18 and older
• You are 18 or older
• You take an opioid pain medicine that another clinician prescribes
• The pain is long-term and is not from active cancer
• You have taken the opioid for at least 4 weeks, and you do not expect it to stop soon
• Your constipation started or got worse on the opioid
• You used PEG or another osmotic laxative, and a stimulant laxative such as senna or bisacodyl, for at least 1 week each
• You are still constipated
• You have none of the warning signs below

Look for another care setting

• If more than one of these fits, follow the first one.
• Severe belly pain, or belly pain that keeps getting worse. Call 911 or go to the ER now.
• A belly that is swollen, hard, or rigid. Call 911 or go to the ER now.
• Green or bloody vomiting, vomiting that will not stop, or vomiting blood. Call 911 or go to the ER now.
• No stool and no gas passing at all. Call 911 or go to the ER now.
• A lot of blood from your rectum (bottom), or black, tarry stool. Call 911 or go to the ER now.
• A fever of 100.4 F (38 C) or higher, together with belly pain. Call 911 or go to the ER now.
• Fainting, confusion, or feeling very ill. Call 911 or go to the ER now.
• New weakness in a leg, or new loss of control of your bladder or bowels. Call 911 or go to the ER now.
• Signs of an overdose in you or someone near you now: very sleepy and cannot be woken, slow or stopped breathing, blue or gray lips, or tiny pupils in a person who is hard to wake. Call 911 or go to the ER now.
• Trouble breathing or wheezing, or swelling of the lips, face, tongue, or throat, after the tablets start. Call 911 or go to the ER now.
• Many more tablets than the plan says, even if you feel fine. Call 911 or go to the ER now.
• Belly pain that does not go away, after the tablets start. Call 911 or go to the ER now.
• Do not drive yourself. Do not wait for our reply. If the person is hard to wake or not breathing well and you have naloxone, give it.
• Blood in your stool, more than a small streak. Go to the ER or urgent care today.
• A fever of 100.4 F (38 C) or higher. Go to the ER or urgent care today.
• Vomiting that keeps coming back. Go to the ER or urgent care today.
• New pain in the lower back. Go to the ER or urgent care today.
• No stool for a week or more, or a hard blockage of stool that will not pass. Go to the ER or urgent care today.
• Weight loss you cannot explain. Go to the ER or urgent care today.
• Ribbon-like or very thin stools. Go to the ER or urgent care today.
• A weak immune system. Go to the ER or urgent care today.
• Belly pain that does not go away, before the tablets start. Go to the ER or urgent care today.
• Two or more of these together after you take a tablet: sweating, chills, tearing eyes, flushing, sneezing, fever, feeling cold, belly pain, diarrhea, nausea, vomiting, anxiety, or yawning. See a doctor in person today.
• Diarrhea that is severe or does not stop. See a doctor in person today.
• A new rash or hives after the tablets start. See a doctor in person today.
• You are under 18. See a doctor in person today.
• A small amount of blood on the toilet paper or on the stool. See a doctor in person within 7 days.
• Iron-deficiency anemia (a low blood count caused by low iron) that a clinician already told you about. See a doctor in person within 7 days.
• You are 45 or older and your constipation began in the last 12 months. See a doctor in person within 7 days.
• A stool test, CT colon scan, or flexible sigmoidoscopy for colon cancer that was positive or abnormal, with no colonoscopy after it. See a doctor in person within 7 days.
• You are pregnant, might be pregnant, or plan to become pregnant. This tablet may cause opioid withdrawal in an unborn baby. See your pregnancy doctor.
• Before you start the tablets, see your own doctor if any of these is true.
• You do not take an opioid that a clinician prescribes for you.
• Your opioid is for short-term pain, such as pain after surgery or an injury.
• Your opioid is for pain from active cancer or an advanced illness.
• Your opioid is a treatment for opioid use disorder (addiction), such as methadone or buprenorphine taken for addiction.
• Your opioid is buprenorphine (Butrans, Belbuca), butorphanol, or pentazocine for pain.
• You have taken your opioid for less than 4 weeks.
• Your opioid dose is being raised often, about every week.
• Your opioid is being stopped, or you expect it to stop soon.
• Your constipation started before the opioid and has not changed, or you are not sure.
• You have fewer than two of the usual signs of constipation: fewer than 3 bowel movements a week, straining, hard or lumpy stools, or not feeling empty.
• You have not used both kinds of laxatives for at least 1 week each, or your constipation is now gone or much better.
• A bowel blockage or a narrowed bowel, now or in the past. See your own doctor.
• Crohn's disease or ulcerative colitis. See your own doctor.
• Diverticulitis or diverticular disease. See your own doctor.
• A stomach or bowel ulcer. See your own doctor.
• Poor blood flow to the bowel (ischemic colitis). See your own doctor.
• Cancer of the stomach, bowel, or belly. See your own doctor.
• Chemotherapy or radiation treatment. See your own doctor.
• Surgery on the stomach or bowel, at any time. See your own doctor.
• A colonoscopy, an endoscopy, or another scope procedure on the stomach or bowel in the last 30 days. See your own doctor.
• Ogilvie syndrome. See your own doctor.
• Ehlers-Danlos syndrome or another connective tissue disease. See your own doctor.
• Before you start the tablets, see your own doctor if any of these is true.
• A parent, brother, sister, or child had colon or rectal cancer, inflammatory bowel disease, or celiac disease.
• You are 45 or older and you are not up to date on colon cancer screening, or you do not know.
• A condition that can cause constipation, such as an underactive thyroid, celiac disease, diabetes, Parkinson's disease, multiple sclerosis, or a spinal cord problem.
• Loose or watery stools often, when you have not taken a laxative.
• Your constipation began after another new medicine or supplement, or a dose change, that was not your opioid.
• Liver disease, such as cirrhosis or hepatitis. See your own doctor.
• You are allergic to naldemedine (Symproic). See your own doctor.
• You already take naldemedine (Symproic) that another prescriber gave you, or you take naloxegol (Movantik) or methylnaltrexone (Relistor). See your own doctor.
• You are breastfeeding. The label says not to breastfeed during treatment and for 3 days after the last tablet. See your own doctor.
• You have or had a brain tumor, brain surgery, a stroke, a serious head injury, or an infection of the brain. A brain problem can raise the risk of opioid withdrawal and can lower your pain relief. See your own doctor.
• Before you start the tablets, see your own doctor if you take any of these. Some medicines change how this tablet works.
• You take rifampin, carbamazepine, phenytoin, or St. John's wort.
• You take naltrexone on a regular basis.
• You take fluconazole, itraconazole, or ketoconazole.
• You take clarithromycin or erythromycin.
• You take ritonavir, saquinavir, or atazanavir.
• You take amiodarone, captopril, diltiazem, verapamil, or quinidine.
• You take aprepitant (Emend), cyclosporine, or quercetin.
• You take bevacizumab (Avastin).
• Naloxone that you keep for an emergency is fine.
• Your usual pain is clearly worse since the tablets started. The doctor who prescribes your opioid decides about your opioid. See your own doctor.
• If you are taking naldemedine (Symproic) tablets from us, stop them.