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Opioid-induced constipation — GPhC CRA MCQ

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ModerateGI TherapeuticsOpioid-induced constipationGPhC CRA

A 63-year-old woman has started modified-release morphine for cancer pain and now has no bowel movement for 4 days. She is drinking normally, has mild abdominal discomfort and no vomiting. Her prescription includes morphine and metoclopramide but no laxative. What is the most appropriate alternative?

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Correct answer: E — contact the prescriber to add regular stimulant and osmotic laxative treatment

Opioid-induced constipation is predictable and usually needs prophylactic and ongoing laxative treatment. A stimulant laxative, often with an osmotic laxative, is commonly used. Bulk-forming laxatives can worsen symptoms if fluid intake or gut motility is inadequate and are not preferred here. Stopping analgesia abruptly is inappropriate without clinical review, especially in cancer pain.

Reference: BNF; NICE CKS: Palliative care constipation