SUMAYYA
01 September 2022
Medically reviewed by
Kajal Jain
M. Pharm
tapentadol-cause-constipation
Table of Contents

Do you feel stomach discomfort or bloated? Do you have difficulty passing stool, or is there reduced bowel movement? This condition is none other than stated as constipation. It is a common gastrointestinal condition that affects people of all ages. People usually find difficulty in completely emptying their bowels. Around 4 million people in the U.S. suffer from frequent constipation, resulting in 2.5 million annual doctor visits.

Studies have reported that the prevalence of constipation in the elderly ranges from 24 to 50%. Various things can contribute to constipation, including medications or supplements you might be taking. Iron supplements, opioid medications, and tricyclic antidepressants are common offenders, but many more have the potential to cause constipation as well.

Let us study more to know whether or not one of the opioid analgesics, Tapentadol, leads to constipation. 

What Is Tapentadol?

Tapentadol is a centrally-acting opioid analgesic that helps to relieve moderate to severe acute pain in patients 18 years and older. It works by activating mu-opioid receptors and inhibiting noradrenaline reuptake. It treats moderate to severe pain and musculoskeletal pain, including neuropathic pain associated with diabetic peripheral neuropathy. 

Mechanism Of Tapentadol

Tapentadol is a benzenoid-class opioid prescribed to treat moderate to severe short-term pain. It combines two mechanisms, namely mu receptor agonism and noradrenaline reuptake inhibition. Tapentadol binds to specific opioid receptors, blocking pain signals from reaching the brain. 

Tapentadol also increases levels of norepinephrine in the brain. This property is similar to that of some antidepressants used to treat pain. Norepinephrine is one of the chemical messengers involved in pain signaling.
Tapentadol exhibits analgesia within 32 minutes of oral administration, and the action lasts for 4-6 hours. 

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How Does Tapentadol Cause Constipation?

Constipation can refer to either slow movement of food residues through the colon or difficulty passing bowel movements after they reach the rectum. One of the common adverse effects of Tapentadol is constipation.

Tapentadol may cause constipation in up to 1 in 10 people. Opioids bind to specific receptors in the brain, spinal cord, and gastrointestinal tract. After binding, opioids block the brain’s ability to perceive pain. 

However, opioids also have a depressant or slowing effect on the central nervous system. The central nervous system controls how the body responds to pain along with the involuntary movements of the digestive tract. There is an increase in non-propulsive contractions as well as enhanced fluid absorption. For this reason, taking opioids can cause constipation.

How To Treat Constipation From Tapentadol?

Drinking more water, eating more fiber, and getting exercise where possible may help relieve constipation induced by Tapentadol. Herbal or natural remedies include fiber supplements, senna, and aloe vera. Other medications used include laxatives, stool softeners, enemas, and suppositories.

How To Take Tapentadol?

Start taking Tapentadol only under the direct supervision of your doctor. Tapentadol should not be taken in excess as it can cause serious side effects, such as seizures or respiratory depression. In general, start with the lowest pain-relieving dose.

This product is available in the following dosage forms: immediate-release (IR) and extended-release (ER) tablets.
It is available in 50 mg, 75 mg, and 100 mg.    

It is not suitable for children and adolescents below the age of 18 years.

For oral dosage form (extended-release tablets):

  • For severe pain: 50 mg twice daily.
  • Patients who are not taking narcotic medicines: 50 mg 2 times a day every 12 hours.
  • Patients switching from other narcotic medicines: Take the tablet every 12 hours. The dose per day depends on which narcotic you are using.
  • For nerve pain caused by diabetes: 50 mg twice daily every 12 hours.

Note: The maximum daily dose of Tapentadol should not exceed 500 mg.

Drug Interactions

  • Due to its mu-opioid agonist activity, Tapentadol may have additive effects when used with alcohol, opioids, or illicit drugs that cause central nervous system depression, respiratory depression, profound sedation, hypotension, coma, or death.
  • Concomitant use of Selective Serotonin Reuptake Inhibitors, SNRIs, tricyclic antidepressants, triptans, and drugs that impair the metabolism of serotonin, may result in potentially life-threatening serotonin syndrome.
  • Use Tapentadol with caution in patients with a history of a seizure disorder or any condition that would put the patient at risk of seizures.
  • Concomitant use of MAO inhibitors with this medication may cause a drug interaction. Avoid taking MAO inhibitors when on Tapentadol.
  • Allergy or cough-and-cold products may contain ingredients that cause drowsiness. Always consult your doctor if you are on any of these medications.

Laxatives

  • Bulk-producing agents: Bulking agents work in both small and large bowels with an onset of action of 12 to 72 hours. In this way, peristalsis becomes easy as the stool retains more water. E.g., psyllium, methylcellulose, and dietary fiber
  • Stool softeners: These agents absorb more water from stools, thus making them soft and easy to pass. These work in the colon and take effect in 6-8 hours. E.g., docusate sodium and docusate calcium.
  • Lubricants or emollients: They soften and coat the stool, thus preventing colonic water absorption. E.g., vegetable oil.
  • Stimulants: It stimulates colonic contractions that propel stools forward. E.g., Bisacodyl, Senna, Dulcolax
  • Osmotic laxatives: They soften the stool by helping the colon hold more water; making it easier to pass and increasing the frequency of bowel movements. E.g., magnesium hydroxide (milk of magnesia)

Note: Do not take OTC laxatives for longer than a week without consulting your healthcare provider.

Do All Opioids Cause Constipation?

Constipation is one of the most typical side effects of opiate medication. Most patients develop some degree of constipation after starting opioid use.

Although tolerance to some adverse effects of opioids develops, constipation often persists unless you take corrective measures. Some opioids that cause constipation include substances such as morphine, codeine, fentanyl, oxycodone, tramadol, and methadone. When examining patients taking opioids, ask about their bowel function.

Bottom Line From Practical Anxiety Solutions

While opioids can effectively relieve pain, they may have an undesired effect on the gut, causing constipation. The increased use of opioids has led to a relatively sharp increase in patients affected with opioid-induced constipation (OIC).

Drinking plenty of water, eating high-fiber foods, and exercising, when possible may help reduce the effects. Before starting opioid therapy, discuss with the patient the risk of constipation and the need for taking laxatives.

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