Opioid-induced constipation

What is the recommended prophylaxis for opioid-induced constipation? 

Prophylactic laxative use is the standard of care when strong opioids are prescribed regularly in chronic pain.1,2 A combined stool softener with stimulant laxative is recommended, such as docusate with senna (Coloxyl with Senna; Soflax), or an osmotic laxative, e.g. lactulose, macrogol or sorbitol. Advise people starting an opioid to increase their fluid and fibre intake and, if possible, their exercise levels, to reduce the risk of constipation.2,3

Most patients with non-cancer pain will need to buy laxatives over the counter, but for chronic constipation or faecal impaction not adequately controlled with first-line interventions, macrogol 3350 (OsmoLax, ClearLax) is available as a PBS restricted benefit.

Counsel patients against using bulk-forming laxatives (e.g. psyllium, ispaghula or sterculia) because of the increased risk of obstruction.2,3