laxatives and pain meds

[kathyd]

Hi Does any one have recommendations on what laxatives are best when taking narcotic pain meds like methadone?

I have tried to be proactive by taking some thing with each does of the pain med but I either find myself pooping too much (little bits constantly)
or getting tight and backed up eve tho I am taking plenty oF laxatives ... all this poopin also irritated my bladder issue which is how my problems began a few years back,

I have to add more roughage to diet but due to bladder type symptoms I have had to avoid some fruits and juices etc for fear of bladder flareup

My worst issue is severe rectal throbbing which prevents sitting and even hurts when standing (this part occurred following a peripheral surgery which was wrong for me)

any advice on this laxative vs pain med issue would be great... Trail and error since July... so frustrated.
Thanks!

[Violet M]

Kathy, this page has some good ideas -- http://www.pudendalhope.info/node/32

Violet

[Geraldine]

I am not taking narcotic pain meds but the meds I am taking cause bowel problems. I was recommended Lactulose by a colorectal consultant, he said it was okay to take it long term as it wouldn't stop the muscles having to work. It takes about 3 days from starting to take it to have any affect but I have found it to be very successful and it has not aggravated my bladder. You need to drink plent of fluids with it.

Julia

[calluna]

I am taking oxycodone quite a bit at the moment, and it can sometimes tend to make me constipated.

I react badly to lactulose but Movicol/Miralax is fine. If I have to take oxycodone, then I make sure to take a sachet of Movicol that evening.

[greeneyes]

I have dealt with constipation for many years as I have irritable bowel syndrome. I have tried many laxatives and it took me years to find something that worked but wasn't too harsh. Fiber laxatives have never worked for me as they give me terrible gas. You may not have this problem. I take methadone for pain and it aggravated my constipation problem when I first started it. This stopped after I had been on it for a while. I manage constipation by a combination of stool softener (docusate sodium) and magnesium tablets. My normal regimen is three stool softener tablets before bed every night. If I am constipated the next day then I take magnesium (2 or 3 tablets) that night instead of the stool softener. My husband uses a similar regimen and it works for him as well. Neither the stool softener nor the magnesium is a stimulant laxative. My doctors have said that both are fine to use long term. You will eventually find something that works for you. Unfortunately, it's a trial and error process. Good luck!

Greeneyes

[Violet M]

Kathy, I agree with Greeneyes on magnesium. I take magnesium citrate tablets on a regular basis because if I don't I get into trouble. My physician said it's fine to use them regularly and I've never had a problem in the 6 years that I've been taking them.

Violet

[kathyd]

Thanks everyone for the responses and ideas and the idea list you referred me to ...I will study these tips..
It seems to take a lot to make me feel normal and empty while on methadone...Even if go everyday which i usually do, its more bit by bit rather than one good emptying ...sorrry for details!!
I was on 40mg methadone and it may have finally been helping just a little, but I got so backed up even while taking various laxatives,that I feared getting impacted..Luckily I did not.
So now I am working hard to keep things moving.
My doc dropped me down to my previous dose of 37.5mg, and Im already in worse pain... don't know what to do.

I like the idea of softeners and magnesium rather than the strong stuff, but will see if its enough for me, maybe addmore stool softners? I also take Miralax with each meal etc.
as this Methodone seems to slow things down as soon as I take it!
Has anyone had this experience with Methadone..Also has methadone been helpful to any of you guys ... and with what types of pain..Im not getting much benefit but don't want to go up too high... The doc who started me on it.. has taken a break from practice to pursue other goals..
so I am now working with a new pelvic pain gyn and a new pain doc ...so its scary...
Also sorry for so many questions but is it okay to take magnesium when taking methadone ... (I saw on the box of Phillips Magnesium that it apparently interferes with some meds... it didn't say which ones!
Just wondered as I want to add magnesium to my laxative list

Thanks everyone again!

[calluna]

Hi Kathy, re magnesium and methadone, probably best to run this one past your pharmacist actually. Drug interactions are not to be messed around with.

Having said that, I can't see any reference to interaction with methadone. But please check with your pharmacist.

Magnesium and Miralax/Movicol work in the same way, they are osmotic laxatives, they soften the stool by bringing more water into the bowel. You may also find it helpful to add in a stimulant laxative like sodium docusate or senna. Neither of these are a good idea for long term use, as the bowel gets accustomed to them and increasing doses are needed to get the same effect. This is why the doctor won't usually prescribe more than 4 weeks of senna, for instance.

With regard to being in worse pain now your doctor has decreased the dose of methadone - please, do go straight back and tell him. Doctors do need feedback from us, if we don't get back to them then how will they know that everything isn't perfectly fine?

I think it would be a good idea to talk to the doctor about laxatives, as well - or at the very least, the pharmacist. They will both have dealt with the issue of constipation from methadone before, that's for sure.

No experience with methadone myself, wish I could be of more help.

[kathyd]

Thanks Calluna,
for your response and suggestions..
I will tell my docs about the chg with the lower dose of methadone ...I just dropped 2.5 mg so hubby thinks my perception of the pain is being changed by my anxiety as I have suffered daily for quite some time and my fear of this pain is overwhelming ..tho warranted.... he feels that such a small drop would not affect me..esp since I was only at the new dose for about a week... Any thoughts anyone? All I can go with is what I feel tho I can see his point too.

About the docs and laxatives, I have tried checking with them. I got the usual differences of opinion.. and my feeling is that patients know much more about this stuff than docs,based on personal experience
One doc said take whatever it takes to get the stool out...
Then the pain doc simply suggested daily metamucil ( something I feel is not strong enough to combat daily doses of methadone.. I will be seeing him soon so will address this... I hope to switch to another med or find another way to treat my pain...I don't like this med!

Thanks i will check with the pharmacist... some of them are more helpful than doc.s..
Thx again!

Anyone else know of any interaction between magnesium and methadone.
By the way I take daily mirialax...
Thx all

[calluna]

Wow, unhelpful doctors. Hope the pharmacist is more supportive!

296 meds are known to interact with magnesium oxide, according to drugs.com which is a reliable website. List here - that's both brand names and generics. Methadone is not on the list.

Re your dosage change - good point about the anxiety. I remember being so so scared of the pain at the beginning, and with hindsight the fear definitely made it harder to cope. CBT is what helped me to get my head around it.

Hope things improve, anyway!