Medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and antidepressants, may cause constipation. Laxatives can help treat the effects of constipation these medications cause.
One of the most common digestive complaints people of all ages in the United States and other western countries experience is constipation. 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.
This article explores the medications that cause constipation, constipation’s potential causes, and the best laxatives that relieve medication-related constipation.
According to the
The following may also accompany constipation:
Learn more about constipation.
Too much straining due to constipation may also lead to complications, such as anal fissures, hemorrhoids, and rectal prolapse.
Anything that disrupts typical bowel function can cause constipation. Several medications may contribute to constipation:
Opioids or pain medications
Between
Opioids affect certain receptors in the gut wall, which slow down the peristaltic movement of the muscles that move food along the tract.
They may also
Examples of opioids include:
- acetaminophen-hydrocodone
- morphine
- codeine
- oxycodone
- hydromorphone
NSAIDs
Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) may
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.
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.
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. 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
Another class of antidepressants, serotonin specific reuptake inhibitors (SSRIs), can also cause constipation. Citalopram and fluoxetine are examples of SSRIs.
Iron
A person can take iron on its own or with multivitamins. Aside from causing darker-than-usual stools, it may also
There are different types of laxatives available on the market. Each can have different effects on a person’s body. 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 laxative | Generic and brand names | Mode of action | Side effects |
| Stimulant laxatives | senna (Senokot), bisacodyl (Dulcolax) | Stimulates intestinal muscles to help stool move more quickly | Belching, diarrhea, cramping, nausea, changes in urine color |
| Osmotic laxatives (liquid, powder, suppository, saline) | Polyethylene glycol or PEG (MiraLAX), lactulose, milk of magnesia | Draws water into the intestines to allow stool to pass easier | Bloating, cramping, gas, nausea, increased thirst, diarrhea |
| Emollient laxatives (stool softeners) | docusate sodium (Colace) | Makes stool softer by allowing fat and water to soften stool | Electrolyte imbalance if used too long |
| Bulk formers | Psyllium (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. laxatives here.
Doctors
Learn more about laxatives for constipation here.
For people with chronic constipation, a doctor may recommend a person take
- serotonin agonists, such as prucalopride (Motegrity)
- secretagogues, such as linaclotide (Linzess)
- osmotic agents
- bile 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)
A person experiencing constipation may want to manage their discomfort by stopping their medications or taking other medications. 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. 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
- eating more fiber-rich foods
- exercising regularly
- drinking enough water
- limiting the intake of pain relievers and laxatives
All types of laxatives can help a person with medication-induced constipation
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. The body partially absorbs these, which can harm people with kidney failure.
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.
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. Overuse may lead to dependency and side effects.
It may be possible to improve constipation without taking laxatives. The following lifestyle and diet changes may help improve a person’s bowel movements:
- getting regular exercise
- drinking plenty of fluids
- eating prebiotic and probiotic foods and supplements
- avoiding dairy products
Discover 13 home remedies for constipation here.
Here are some fiber-rich foods a person may add to their diet to
- nuts, including peanuts and pecans
- vegetables, such as carrots and broccoli
- fruits, for example, unskinned apples and pears
- legumes, such as kidney beans and chickpeas
- whole grains, including oatmeal and whole wheat bread
OTC laxatives are generally safe and effective in treating constipation, including constipation caused by certain medications. 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. 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
- constipation with severe abdominal pain
- bloody stools
- unintended weight loss
- unexpected new onset of constipation
Suddenly developing long-standing constipation after having regular bowel movements is also a cause of concern.
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. 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.