Abstract
SummaryThis article is a brief overview of drugs, which are of use in the treatment of constipation and diarrhoea in palliative care. Whereas most of the drugs mentioned are widely used and known, the aspect of gastrointestinal symptoms as side effect of pharmacological treatments is often underestimated. Therefore, the article highlights the approach of deprescribing, as a tool to reduce both, pill burden and symptoms.
Highlights
Gastrointestinal symptoms at the end of life may have different causes and are stressful for patients
Causal therapy is rarely possible, symptom relief can be achieved with medication management
The possible causes for constipation are multiple: primary illness, immobility, dietary, pharmacological, e.g. opioids, 5HT3-antagonists, anticholinergic drugs. For those patients where nonpharmacological approaches, such as increased mobility, abdominal massage and other lifestyle factors, do not provide sufficient relief, a combination of oral osmotic and stimulating laxatives is recommended
Summary
Gastrointestinal symptoms at the end of life may have different causes and are stressful for patients. Adding drugs to bring relief to patients in a palliative care setting often seems to be an intuitive approach, but it should not be overlooked that de-escalating or discontinuing of inadequate medication can be a more appropriate strategy, especially when controlling gastrointestinal side effects. Constipation, defined as the slow movement of faeces through the large intestine, resulting in infrequent bowel movements and the passage of dry, hard stools [1], is a very common symptom in patients receiving palliative care.
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