Oxycodone and laxatives -- how to get the right combination

My husband is having a lot of bone pain and needs to take oxycodone or morphine when the pain gets bad. And then he deals with severe constipation and stomach pain.

Does anyone have any experience with this? Do you take laxatives every time you take an oxycodone (which can be every four hours)? Or just take laxatives twice a day on the days when you are taking the pain meds?

It seems like if it isn't one thing, it's another. We would appreciate any advice or personal experiences.

Thank you so much for always being there and helping during this journey.
Marilyn

My husband is in pain as well and is taking oxycodone. He takes laxatives in the am and pm and is mostly doing well with that sequence. He tries not to take the oxy until evening.
But to answer your question more directly, he started taking the laxative the day he began taking the oxy.
It isn't a fun ride but if it helps, you aren't alone.

Citrucel three times a day has worked well for me when I've been on pain medication. It's a citus flavored powder that is mixed in a glass of water. It actually tastes good.

Dave

Because of some previous colo-rectal surgery, I am simply not allowed to get constipated lest a rough stool tear scar tissue.

My colo-rectal guy put me on a docusate calcium pill in the evening for life. At that level, it just changes the surface tension of the water in the colon, which allows the stools to soften. When the docs reviewed my situation for surgery, they told me to continue that.

Also, a good way to clear constipation (prescribed for me) was a tablespoon of mineral oil before going to bed. It works, but be sure there is an empty throne available in the morning, and get there at the first inkling of a BM. "Crap through a goose" takes on new meaning.

The mineral oil and docusate calcium have to be timed to be taken well apart, as the oil will block the effect if taken first.

Marilyn, the oxycodone can cause nausea, and sometimes those who don't have nausea when they first use oxycodone (or morphine) develop it after a while. If it persists, ask your husband's doctor about an antiemetic. Some people have success with ginger or with an OTC antiemetic; others need a prescription antiemetic. Best wishes, Medved

Marilyn, I have never had much trouble with constipation even with taking pain meds now. My wife has always had problems with constipation and has had success with Miralax. She actually uses the prescirption form because it is cheaper than the over the counter stuff.

If solely discussing Oxycodone I have no clue, but if it’s a combination, then I know it all too well. Percocet (or generic) is a combination of Oxycodone & Acetaminophen (Tylenol) . For many years saw several pain management specialists, for medical issues other than prostate cancer. Long story short, it was  Acetaminophen (Tylenol) in the Percocets, that was causing severe constipation and pain. When taking Oxycodone without the Acetaminophen (Tylenol) there were no issues.   When reading labels, i t was discovered that cough syrup and Nyquil had mega doses of Acetaminophen, which were being taken. location is important, is it stomach pain ? or liver pain ? In addition, when limiting red meat and increasing vegtables in diet,  I go every morning like clockwork without laxatives. Each individual case is different, sharing what worked for me, taking Oxycodone by itself, and not with Acetaminophen added. http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm165107.htm At high levels,  Tylenol (acetminophen) taxes the liver, Motrin (Ibuprofen) taxes the kidneys.

My husband is on Morphine again, but was on the Oxy before. We have added flaxseed oil to certain foods he still likes. He has had problems with voiding as well as loss of appetite. He also takes Colace as needed. Not any easy road to hoe. Good news is that we are becoming grandparents for the first tiem this week!

Susan

Thanks to all of you for your wonderful responses. Marshall's pain is bone pain in his right femur and sometimes the pain is in the whole right leg and he tells me the pain is excruciating. He has been hesitant to take the heavy duty pain meds but he is finally taking them as needed (mostly oxycodone but an occasional morphine). And over the past few days he has been taking 4 laxative tablets (we've tried Senekot and Colace) every time he takes pain pill and that has worked well.

But the pain comes and goes so maybe this combination would be overdoing it if the pain was constant. Thank goodness at this point it is intermittent. We get confused because the oncologist says that if the pain was related to cancer it would be constant and wouldn't be intermittent and then he says it COULD be cancer and we should let him know if it gets worse. So Marshall is doing his best to deal with it until we go back to see the oncologist on March 1st.

Thank you all so much!
Marilyn

UPDATE 3/1/13 -- appointment with oncologist.
First thing on arrival at the hospital, Marshall was sent to radiology for x-rays of the left and right femur to try to see if anything has changed that would cause the leg pain he's been having. We won't get those results until over the weekend or on Monday.

Then blood was drawn to see where the PSA stands today. Before we could talk about the clinical study for GTX-758 (an estrogen treatment), the PSA needed to be rising. If it went down, he would not be eligible for the clinical study and we would have to go a different direction. Well, the PSA was 31.06 ... almost tripled in six weeks. Kind of a downer, but on the plus side, it definitely makes him eligible to apply for the clinical study. (Note: today's tests showed that the testosterone level, which is the hormone that feeds the prostate cancer, has gone down to less than 20ng/dL. I just did some quick research and if I understood what I was reading correctly, the castration level of testosterone is right at 20 or below, so to me that is progress.)

But also, in order for Marshall to be eligible for the clinical study, he needed to meet certain criteria, one of which was a BMI of 35 or lower. We knew it was going to be close. When he got weighed when we arrived, they calculated his BMI at 35.1. Bummer.

But we had a really cool nurse and she asked Marshall if he wanted to try again with all his clothing and jewelry off and, of course, he did. So he stripped down, removed all jewelry, put a hospital gown on and went to the scale again and woo-hoo, the BMI worked out to 34.7! So that hurdle was conquered.

They went over the initial paperwork with him and he signed all the consent forms. They took DNA swabs (not sure what that was for but she said they had to sign a release saying they would not send any results to the paternity database!), they took a urine sample, and then they took a bunch of blood. The bloodwork was to assess his propensity to possibly have blood clots. They will get the results of these tests back in the next week or two and then he will be contacted to see if he has been accepted into the study. I know Marshall is going to worry himself silly these next two weeks constantly thinking about a rising PSA, but hopefully he'll also think of the lowered testosterone.

Our oncologist says that he thinks this GTX is going to be the treatment of the future for prostate cancer patients. The initial studies have shown that there are very few side effects and the results have been extremely promising. Marshall suffers from extreme hot flashes now and the GTX is supposed to take away the hot flashes. The GTX also strengthens the bones.

So now we wait. One of the things I love about the clinical trial is that Marshall and the other participants will be monitored very closely (way closer than he is being monitored now) and to me that is very comforting.

In the meantime, over the past several weeks Marshall has slowly but surely come up with a painkiller regimen that has been working rather well. In the morning he takes an anti-nausea pill. Then when he feels the slightest onset of leg pain he takes two oxycodone along with four Senokot laxative pills and 30 minutes later he takes 3 Advil. Last night we even went out to dinner, which we hadn't done in many weeks.

Just wanted to update everyone after all the great support I got.
Marilyn

Passages:

Thank you. Looks like your husband has been fighting quite a while. I am sorry to read some of the bad times, but on the other hand, glad to see how many years he has had and hope very much that my husband gets quite a bit of time and lots of quality of life.

Good luck and best wishes for you, too.
Marilyn

Just my thoughts on oxycodone. 

Not long after my surgery I started taking oxycodone to control extreme pain NOT related to my prostate cancer.  I was suffering from long term back and foot pain, I was 67 years old.  My pain was considered extreme by my physicians.  They prescribed Oxycodone, which I took judicially throughout the day. I figured a dosage something like oxycontin time release...I was in control...  Wow...I was almost pain free and felt good enough to do things like play golf and dance with my wife.

  HOWEVER there was a downside.  I would almost nod off while driving the car, I became irritable and angry without provocation, I slept too much, I could not stop taking my oxycodone.  I showed all of the signs that I had become a narcotic addict.  I was an addict duh...Oh.. in line with this thread, I needed to use stool softeners to take a ....

So I decided to detox all by myself.  I was  too proud or stupid or macho to ask for medical help...I just stopped taking the pain killing drugs.  For those of you who want to know, the next month was HELL.  I was retired so I  could stay home..but had...sweats, nightmares, insomnia,pain ...you name it.  When I later told my doctor his comment was...that was stupid.

I now try to control pain with tylenol or nothing.  I am happier.  This post is all about when you should use narcotics to control pain.  My advice is do not... use addictive drugs unless you are dying.

Hi Marilyn
My comments were mostly about the addictive problems with narcotic pain managment, and not intended specifically for your husband. It is very easy to become chemically addicted to Oxycodone when it is taken regularly. If it is used occasionally for pain, physical addiction usually is not a problem. It is often a blessing to get relief from chronic pain. I took Percocet for about three years and reduced my pain.

My comments were directed at anyone who regularly uses narcotic pain drugs. A person using oxycodone can be a very dangerous driver, and should allow others to drive especially on longer trips. The mood swings can put relationships at risk and should be monitored.

Your husband is lucky to have your support.