Constipation And Pregnancy

Constipation Medicine For Babies

Accurate, unbiased women's health information. Questions and answers on PMS, pregnancy, breastfeeding, birth control, weight, wellness, menopause and more..Whether you're looking to lose weight or just want a way to get rid of that nasty cold, eHow has all the answers you're looking for.. The 30 Day Diabetes Cure By Dr Stefan Ripich :: how to treat diabetic dry skin - The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days..Medical news and health news headlines posted throughout the day, every day.TODAY Parents is the premiere destination for parenting news, advice community. Find the latest parenting trends and tips for your kids and family on TODAY.com..Does Type 2 Diabetes Go Away Does Type 2 Diabetes Go Away :: diabetic cure for bad breath - The 3 Step Trick that Reverses Diabetes Permanently in As Little .Symptom Checker. Health Concern On Your Mind? What Diabetes Come From What The Cause Of It ::The 3 Step Trick that Reverses Diabetes Permanently in As Little .

Constipation Medicine For Babies

Baby Magic Ingre Nts Tea

TODAY Parents is the premiere destination for parenting news, advice community. Find the latest parenting trends and tips for your kids and family on TODAY.com..Does Type 2 Diabetes Go Away Does Type 2 Diabetes Go Away :: diabetic cure for bad breath - The 3 Step Trick that Reverses Diabetes Permanently in As Little .Medical news and health news headlines posted throughout the day, every day. The 30 Day Diabetes Cure By Dr Stefan Ripich :: how to treat diabetic dry skin - The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days..Accurate, unbiased women's health information. Questions and answers on PMS, pregnancy, breastfeeding, birth control, weight, wellness, menopause and more..Symptom Checker. Health Concern On Your Mind? What Diabetes Come From What The Cause Of It ::The 3 Step Trick that Reverses Diabetes Permanently in As Little .Whether you're looking to lose weight or just want a way to get rid of that nasty cold, eHow has all the answers you're looking for..

Opioids And Constipation

Today's post from medicalnewstoday.com (see link below) talks about a problem that takes many people by surprise after they are prescribed opioids for neuropathic pain and that is constipation. Almost everybody who needs to take opioid medication suffers from constipation and it's often difficult to treat properly. Your doctor will very often give you a side prescription to help with the constipation but if not, you will need to find something that helps you best. It's important to note that if diet change and exercise don't work then you may need laxatives of one sort or another but you should be careful to follow the instructions very carefully. You shouldn't take laxatives on a permanent basis, they can damage your bowels and make them dependent on the laxative. Best to work with your doctor on this one.

All About Opioids and Opioid-Induced Constipation (OIC) 
This Opioid-Induced Constipation (OIC) information section was written by Peter Crosta (MA) for Medical News Today,

Although opioids are very effective for treating and managing pain, their use frequently results in opioid-induced constipation (OIC). Treatment options for OIC may be as simple as changing diet or as complicated as requiring several medicines and laxatives.
How can changing lifestyle factors treat OIC?

Changing lifestyle factors is usually the first recommendation that physicians make for the prevention or treatment of constipation. This includes:
Increasing dietary fiber
Increasing fluid intake
Increasing exercise or physical activity
Increasing time and privacy for toileting

Changes in lifestyle, however, may not be possible for many patients. In addition, these changes may be ineffective in treating OIC. If there is a concurrent underlying disease or medicine that is causing constipation, the disease may need to be treated separately or another treatment regimen may have to be considered. 

What drugs or medicines treat OIC?

OIC treatment usually requires additional medicines to be prescribed along with the opioid painkillers that are causing the constipation. Withholding the opioid treatment is ill-advised because it results in a decrease in the patient's quality of life. Often, laxatives and/or cathartics are prescribed at the same time as the opioid painkillers so that treatment for the constipation beings immediately. A cathartic accelerates defecation, while a laxative eases defecation, usually by softening the stool; some medicines are considered to be both laxatives and cathartics.

For the treatment of OIC, doctors may prescribe:
Osmotic laxatives - increase the amount of water in the gut, increasing bulk and softening stools.
Emollient or lubricant cathartics - soften and lubricate stools.
Bulk cathartics - increase bulk and soften stools.
Stimulant cathartics - directly counteract the effect of the opioid medications by increasing intestinal motility, helping the gut to push the stools along.
Prostaglandins or prokinetic drugs - change the way the intestines absorb water and electrolytes, and they increase the weight and frequency of stools while reducing transit time.
Other medicines block the effects of opioids on the bowel to reverse opioid-induced constipation.

Although the treatments listed above are usually successful in treating OIC, sometimes a physician will recommend rectal intervention. As discussed, prophylaxis with laxatives are/or cathartics is considered usual - as some clinicians assume [constipation] to be virtually universal in patients who are prescribed opioid analgesics1.

Rectal interventions are indicated if the appropriate oral measures have been ineffective2. Rectal intervention means the following treatments:
Suppositories
Enemas (micro and larger volume)
Rectal irrigation (sometimes known as colonic irrigation)
Manual evacuation

The first choice rectal intervention for uncomplicated constipation is glycerine suppositories2. If these are ineffective, then a stimulant enema might be administered. Oral and rectal stimulant laxatives should be avoided if there is possible or proven bowel obstruction. Gentle rectal measures can sometimes be effective in emptying the rectum and lower colon. Oral softening agents are useful if the obstruction is incomplete. It should be remembered that constipation can cause bowel obstruction.

If none of the rectal laxatives above prove adequate to remove impacted faeces, rectal irrigation with normal saline can be performed3. Manual evacuation should be used as a last resort when all other methods of bowel management have been shown to be ineffective.
Combination therapy

Constipation is a known side effect of opioid analgesics and should be addressed before opioid therapy begins. As opioid-induced constipation can be severe and adversely impact quality of life and compliance with therapy, prophylaxis with laxatives is considered to be the best approach. A British Pain Society survey conducted in March 2009 showed that nearly half of GPs (44%) surveyed believe that the negative impact of such side effects is the key factor in patient non-compliance with prescribed opioid treatments.

Concurrent management on initiation of opioids frequently includes recommending certain lifestyle or dietary adjustments (as listed above) and initiating a scheduled regimen of laxatives. Laxative and cathartic therapy may be needed throughout opioid therapy and beyond. Effective management requires a composite of strategies, including behavioral and lifestyle changes (diet, activity, and fluid intake, as appropriate).

However medications used to manage opioid-induced constipation, such as laxatives, do not address the underlying opioid receptor-mediated cause of constipation and are often ineffective4.
Newer targeted treatments for opioid induced constipation

Methylnaltrexone (available as Relistor(R)) helps restore bowel function in patients who have advanced illness and receive opioids for pain relief. Methylnaltrexone is delivered via subcutaneous injection and specifically targets opioid-induced constipation. When given alongside opioid therapy, it is designed to displace the opioid from binding to peripheral receptors in the gut, decreasing the opioid's constipating effects and inducing laxation.

Methylnaltrexone is a peripherally acting mu-opioid receptor antagonist that decreases the constipating effects of opioid pain medications in the gastrointestinal tract without diminishing their ability to relieve pain.

Methylnaltrexone blocks peripheral opioid receptors in the gut and unlike other opioid antagonists has restricted ability to cross the blood-brain barrier. As a result, it antagonizes only the peripherally located opioid receptors in the GI tract, so it's action reverses opioid-induced constipation without precipitating withdrawal symptoms or affecting or reversing the central analgesic effects of opioids5.

Another new medication for severe pain (long-term pain that can be experienced as a result of conditions such as back pain, arthritis and osteoarthritis)6, are tablets combining prolonged release oxycodone, an opioid which treats pain, and prolonged release naloxone, a compound which counteracts the potential negative effects of the opioid on the GI function (available as TarginactTM). This novel combination has been proven to provide equivalent pain relief to oxycodone alone, whilst significantly improving bowel function7. Naloxone is an opioid receptor antagonist that, when taken orally, has negligible systemic bioavailability8 providing a full inhibitory effect on local opioid receptors in the gut - counteracting opioid-induced constipation - without impacting on the centrally acting analgesic efficacy of oxycodone.




* Image borrowed from Wyeth library

1. Hanks G, Cherny N, Fallon M. Symptom Management. The management of pain: Opioid Analgesic Therapy. In Oxford textbook of Palliative Medicine, 3rd Ed. Oxford University Press, 2003.

2. Cancer - a cpomprehensive clinical guide, By David L. Morris, John Henry Kearsley, Christopher John Hacon Williams

3. Oxford textbook of palliative medicine, By Derek Doyle, Geoffrey Hanks, Nathan I. Cherny, Kenneth Calman

4. Reimer K, Hopp M, Zenz M, Maier C, Holzer P, Mikus G, Bosse B, Smith K, Buschmann-Kramm C, Leyendecker P: Meeting the Challenges of Opioid-Induced Constipation in Chronic Pain Management - A Novel Approach.

Pharmacology 2009;83:10-17 (DOI: 10.1159/000165778)

5. Ho et al. 2003; Kurz and Sessler 2003; Schmidt 2001; Foss 2001

6. Severe pain, which can be adequately managed only with opioid analgesics

7. Vondrackova D, Leyendecker P, Meissner W. et al. Analgesic efficacy and safety of oxycodone in combination with naloxone as prolonged release tablets in patients with moderate to severe chronic pain.J Pain. 2008; 9(12): 1144-1154.

Meissner W, Leyendecker P, Müller-Lissner S, et al. A randomised controlled trial with prolonged-release oral oxycodone and naloxone to prevent and reverse opioid-induced constipation. Eur J Pain. 2008; doi:10.1016/j.ejpain.2008.06.012.

Simpson K, Leyendecker P, Hopp M, et al. Fixed-ratio combination oxycodone/naloxone compared with oxycodone alone for the relief of opioid-induced constipation in moderate-to-severe non-cancer pain. Curr Med Res Opin. 2008; 24(12): 3503-3512.

8. Nadstawek J, Leyendecker P, Hopp M, et al. Patient assessment of a novel therapeutic approach for the treatment of severe, chronic pain. Int J Clin Pract. 2008; 62: 1159-116.

http://www.medicalnewstoday.com/info/oic/treatment-for-opioid-induced-constipation.php

---

HOMOEOPATHIC REMEDIES FOR CONSTIPATION

Constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer.

Constipation is generally described as having fewer than three bowel movements a week.

Though occasional constipation is very common, some people experience chronic constipation that can interfere with their ability to go about their daily tasks. Chronic constipation may also cause excessive straining to have a bowel movement and other signs and symptoms.

HOMOEOPATHIC REMEDIES

1.    Alumina  6—Constipation in infants , old people and women with sedentary habits. Dilated and paralysed rectum. No desire for stools. Great straining

2.    Bryonia alb. 30 – Stool large , hard and dry

3.    Cascara sagrada Q—Specific remedy for constipation. A tonic for proper bowel movements

4.    Coca Q—Chronic constipation due to inactivity of rectum. Flatus from bowels smells like burnt un powder. Distension of abdomen

5.    Hydrastis can. Q – Constipation during pregnancy and abuse of purgatives. Constipation with dull headache with foul tongue and with piles

6.    Nux vomica 30—Constipation in sedentary people. Ineffectual urging and frequent desire for stool

7.    Opium 200- Constipation due to inactivity of the intestines. Stool small, hard, round like black balls

8.    Silicea 30—Constipation before and during menses. Stool comes down with difficulty and when partially expelled recedes again

9.    Sanicula 30 – Stool large and hard impossible to evacuate. After great straining it is partially expelled and a portion recedes

10.Merc dulcis 3x—As a palliative for costipation

Opioids Constipation And Chronic Pain

Today's post from washingtonpost.com (see link below) talks about opioid induced constipation and I dare say that many of you who take opioids regularly as the only means of keeping your neuropathic pain under control, will be fully and painfully aware of this unwanted side-effect. Please read the article, it will open up a whole new world of suffering thanks to nerve damage and the treatments used to suppress the pain and discomfort. Yet more pills needed to achieve the same effect then - sad but true!
 

The drug industry’s answer to opioid addiction: More pills
By Ariana Eunjung Cha October 16 2016

UNNATURAL CAUSES SICK AND DYING IN SMALL-TOWN AMERICA: Since the turn of this century, death rates have risen for whites in midlife, particularly women. In this series, The Washington Post is exploring this trend and the forces driving it. Read the other stories in this series here.

Cancer patients taking high doses of opioid painkillers are often afflicted by a new discomfort: constipation. Researcher Jonathan Moss thought he could help, but no drug company was interested in his ideas for relieving suffering among the dying.

So Moss and his colleagues pieced together small grants and, in 1997, received permission to test their treatment. But not on cancer patients. Federal regulators urged them to use a less frail — and by then, rapidly expanding — group: addicts caught in the throes of a nationwide opioid epidemic.

Suddenly, Moss said, investors were knocking at his door.

“As clinicians, we wanted to help palliative patients,” said Moss, a professor and physician at University of Chicago Medicine. “The company that bought our work saw a broader market.”

Today, Moss’s side project is hailed as the next billion-dollar drug. And the once-disinterested pharmaceutical industry is bombarding doctors and the public with information about a serious, if previously unrecognized, condition common among the millions of Americans who take prescription painkillers. They call it “opioid-induced constipation,” or “OIC.”

The story of OIC illuminates the opportunism of pharmaceutical innovators and the consequences of a heavily drug-
dependent society. Six in 10 American adults take prescription drugs, creating a vast market for new meds to treat the side effects of the old ones.

[In a town where pills are currency, opioid addicts have few options]

Opioid prescriptions alone have skyrocketed from 112 million in 1992 to nearly 249 million in 2015, the latest year for which numbers are available, and America’s dependence on the drugs has reached crisis levels. Millions are addicted to or abusing prescription painkillers such as OxyContin, Vicodin and Percocet. Statistics from the Centers for Disease Control and Prevention show that, from 1999 to 2014, more than 165,000 people died in the United States from prescription-opioid overdoses, which have contributed to a startling increase in early mortality among whites, particularly women — a devastating toll that has hit hardest in small towns and rural areas.

The pharmaceutical industry’s response has been more drugs. The opioid market — now worth nearly $10 billion a year in sales in the United States — has expanded to include a growing universe of medications aimed at treating secondary effects rather than controlling pain.

There’s Suboxone, financed and promoted by the U.S. government as a safer alternative to methadone for those trying to break their dependence on opioids. There’s naloxone, the emergency injection and nasal spray carried by first responders to treat overdoses. And now there’s Relistor, the drug based on Moss’s work, and a competitor, Movantik, for constipation.

In colorful charts designed to entice investors, numerous pharmaceutical makers tout the “expansion opportunity” that exists in the “opioid use disorders population.”

Indivior, a specialty pharmaceutical company listed on the London Stock Exchange, sees “around 2.5m potential patients, the majority of whom are addicted to prescription painkillers,” as opposed to illicit drugs such as heroin. Another company, New Jersey-based Braeburn Pharmaceuticals, highlights “growth drivers” for the market, noting that millions of additional Americans not yet identified are also likely to be dependent on opioid painkillers.

Analysts estimate that each of these submarkets — addiction, overdose and side effects — is worth at least $1 billion a year in sales. These economics, experts say, work against efforts to end the epidemic.

If opioid addiction disappeared tomorrow, it would wipe billions of dollars from the drug companies’ bottom lines. 



A potent product

From a profit-making standpoint, opioids are a potent product. Chronic use can cause myriad side effects that usually are mild enough to keep people taking painkillers but sufficiently uncomfortable to send them back to the doctor.

Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, said this domino effect can turn a patient worth a few hundred dollars a month into one worth several thousand dollars a month.

“Many patients wind up very sedated from opioids, and it’s not uncommon to give them amphetamines to make them more alert. But now they can’t sleep, so they get Ambien or Lunesta. The amphetamines also make them anxious, paranoid and sweaty, and that means even more drugs,” said Kolodny, who also serves as chief medical officer to Phoenix House, a nonprofit organization that offers drug and alcohol treatment in 10 states and the District.

Women, in particular, are ideal customers. About 57 percent of working-age women who take opioids have four or more prescriptions, according to a Washington Post analysis of participants in the latest National Health and Nutrition Examination Survey. Among working-age women who don’t take opioids, 14 percent have four or more prescriptions, the analysis shows.

Among men, the numbers are significantly lower. About 41 percent of working-age men on prescription opioids have at least four prescriptions. Among men who don’t take opioids, 9 percent have four or more.

[Opiods and anti-anxiety medication are killing white American women]

Studies show that constipation afflicts 40 percent to 90 percent of opioid patients. As recently as a few years ago, doctors typically advised people to cut down the dosages of their pain meds, to take them less often, or to try non-drug interventions such as changing their diets or increasing physical activity.

By promoting opioid-induced constipation as a condition in need of more targeted treatment, critics say the drug industry is creating incentives to maintain the painkillers at full strength and add another pill instead.

“The pharmaceutical industry literally created the problem [of OIC],” Kolodny said. “They named it, and they started advertising what a serious issue it is. And now they’ve got the solution for it.” 



A Super Bowl ad

Opioid-induced constipation burst onto the biggest possible public stage in February, when AstraZeneca, maker of Movantik, aired a spot during Super Bowl 50 , one of the most expensive ad opportunities of the year. It featured a middle-aged man wistfully watching another man triumphantly adjusting his belt, a dog peacefully relieving itself under a tree and a woman striding by with a banner of toilet paper trailing victoriously from one high-heeled shoe.

“If you need an opioid to manage your chronic pain, you may be so constipated it feels like everyone can go — except you,” a narrator intones.

'Envy'
Play Video1:03
AstraZeneca's 2016 super bowl ad features a man looking for relief from constipation due to opioid use. (AstraZeneca)

That ad was aimed at men, but many others in the Movantik campaign target women, airing on “Good Morning America,” movies on the Hallmark Channel and specials about former first lady Jacqueline Kennedy, Princess Diana and singer Whitney Houston.

In one, a slightly overweight dark-blonde woman talks about “struggling to find relief.” In another, a giant cartoon pill looms sympathetically over a middle-aged brunette, who complains that opioids really helped with her pain but left her with some “baggage.”

“So awkward,” she sighs.

The Super Bowl ad, aired before an audience of more than 100 million people, quickly became the latest flash point in the country’s war against opioids. Vermont Gov. Peter Shumlin (D) called the ad “a shameful attempt to exploit America’s addiction crisis to boost corporate profits.” White House chief of staff Denis McDonough tweeted: “Next year, how about fewer ads that fuel opioid addiction and more on access to treatment.”

AstraZeneca and its marketing partner Daiichi Sankyo defended the commercials, calling opioid-induced constipation “a legitimate medical condition” affecting millions of Americans.

“The ad has driven good dialogue about OIC, and just as importantly, also added to the increasing and necessary conversation about the appropriate and safe use of opioids,” a spokeswoman said.

Paul Gileno, president of the U.S. Pain Foundation, a patient advocacy group that worked with AstraZeneca on the ads, notes that many people use opioids responsibly.

“People ask, ‘Why are you helping addicts?’ That’s not the case,” Gileno said. “We are trying to help people who are suffering from chronic pain to be able to continue on their medicines and live their lives.” 



A ‘brilliant’ pitch

Each tiny pink pill of Movantik retails for about $10, and most insurance plans cover it. Since the Super Bowl, prescriptions have jumped from 6,600 to 8,800 a week, AstraZeneca recently reported.

Movantik holds the dominant market share, but Canada’s Valeant Pharmaceuticals — one of the companies under fire by Congress for jacking up prices of old drugs — won approval in July from the Food and Drug Administration to sell Relistor, its version of the pill. Analysts estimate that as many as six other drugs may be on the market by 2019.

Investors have been talking about the “blockbuster potential” of these drugs since at least 2008, when Movantik had been tested on only a small number of human subjects, and long before it received FDA approval in 2014. While it is illegal to market a drug before approval, it is fine to market the condition the drug is designed to treat. And so “OIC” was born.

The branding began around 2010, when “OIC” began appearing in papers in some of the top medical journals, in poster presentations and on the lips of panelists speaking at major medical conferences. “Opioid-induced constipation” suddenly replaced what had been a vast vocabulary used to describe the problem, including terms such as “bowel dysfunction” and “gut motility.”

Last year, after it won government approval to sell Movantik, AstraZeneca rolled out a number of free continuing-education classes. Doctors and nurses must take such classes to remain licensed. The titles included: Opioid-induced Constipation: A Neglected Complication and Unmet Needs in Opioid-Induced Constipation.

The companies have also asked pain doctors to show patients a chart about stool “health,” with diagrams to help assess shape and clumpiness.

Adriane Fugh-Berman, a researcher at Georgetown University Medical Center who studies drug marketing, called the Movantik strategy “brilliant.” She compared it to other recent “disease awareness” campaigns focused on “premenstrual dysphoric disorder” (treatable with a new version of Prozac packaged in pink instead of blue) and “binge-eating disorder” (for which there is a new pill called Vyvanse).

The OIC campaign created the perception of great need for the drug when the market should be “vanishingly small,” Fugh-Berman said — certainly not big enough to justify ads during the Super Bowl.

“The best way to treat opioid-induced constipation,” she said, “is to prevent it in the first place by not overusing opioids.”

Moss reluctantly continued to test a constipation-easing drug he was developing on opioid addicts, rather than cancer patients, at the behest of the Food and Drug Administration. It became Valeant’s Relistor. (Lucy Hewett)

William Chey, director of the Gastrointestinal Physiology Laboratory at the University of Michigan, helped design and execute the first large-scale human study for a competing drug that became Movantik, the first drug on the market specifically approved to treat opioid-induced constipation. (Nick Hagen)
Potential for good and bad

Constipation is different for people on opioids. Opioids bind to a receptor that makes the gastrointestinal tract go awry, decreasing the secretion of fluids and inhibiting the muscle contractions that propel waste. As a result, stool gets “stuck.”

While mostly a nuisance, the condition can be serious, especially among people already weakened by end-stage cancer. Some patients have been rushed to the emergency room to have the material removed from their bodies.

In the early 1990s, Moss and his colleagues at the University of Chicago began working on a drug that would block what are known as mu opioid receptors, which are responsible for the side effect. The drug showed promise, and Moss was devastated when investors told him the potential profits were too small to be worth the risky investment.

“If you’re a drug company, who wants to make a drug for people who weren’t going to be around in a couple of months? They wanted to aim for something people could take for 10, 20 years,” recalled Moss, who specializes in anesthesiology and critical care.

The researchers decided to fund the work without industry help but ran into another roadblock: The FDA said it was too risky to continue testing the experimental drug on cancer patients. Regulators suggested a different population: opioid addicts being treated with methadone.

Moss was reluctant. He considered the idea a detour that would slow down his work. “Our hearts really sank,” he said.

Thinking that he had no choice, Moss began the testing, and the results were published in JAMA, the Journal of the American Medical Association, in 2000. Pharmaceutical companies immediately came calling.

Moss’s drug was picked up by a biotech company and, after changing hands a few times, eventually became Valeant’s Relistor. Nearly all the profits will go to the companies. The licensing deal through the University of Chicago calls for Moss and four colleagues to receive a modest initial payment in the thousands of dollars, plus a tiny slice of sales royalties. They also get “milestone payments” when the drug reaches a certain stage of approval or a certain market size.

Parallel efforts took off at other companies. Nektar Therapeutics, a small San Francisco firm specializing in drug research and development, had been working on a drug known as NKTR-118, which was aimed at limiting opioid penetration of the central nervous system and reducing side effects such as dizziness and sleepiness. But researchers found that it also helped with constipation.

In 2009, AstraZeneca bought the rights for the drug and recruited William Chey, director of the Gastrointestinal Physiology Laboratory at the University of Michigan, to help design and execute the first large-scale human study. The results, published in the New England Journal of Medicine in 2014, were a crucial part of pushing Movantik over the FDA finish line. Last year, it became the first drug on the market specifically approved to treat opioid-induced constipation.

Chey said that he has seen many patients with cancer and other serious illnesses suffering from the condition and that he believes Movantik can improve their quality of life. However, Chey said he also recognizes the concern that Movantik could enable chronic opioid use and worsen the nation’s epidemic of addiction.

“I’ve thought a lot about the potential good and bad,” he said. “Used responsibly, this is an incredibly valuable drug. Hopefully, people will use it that way.”

Dan Keating contributed to this report.

Ariana Eunjung Cha is a national reporter. She has previously served as the Post's bureau chief in Shanghai and San Francisco, and as a
correspondent in Baghdad.

https://www.washingtonpost.com/national/the-drug-industrys-answer-to-opioid-addiction-more-pills/2016/10/15/181a529c-8ae4-11e6-bff0-d53f592f176e_story.html