A middle aged man p/w constipation x4days, no n/v/fever. He is on methadone 120mg PO qday, chronically, 2/2 h/o IVDU. He has tried lots of OTCs, as well as prune juice and metamucil w/o relief. How can you help?
Give him 2mg PO naloxone; only 0.04mg is actually bioavailable. Also do a manual dis-impaction, give an enema, and give PEG 17g PO.
PO naloxone only works on the bowel, so he won’t withdraw.
http://blog.ercast.org/2012/02/the-constipation-manifesto/ (check this out, it’s a great bit on constipation tx)