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. Author manuscript; available in PMC: 2007 Nov 11.
Published in final edited form as: Clin Gastroenterol Hepatol. 2007 Oct;5(10):1126–1122. doi: 10.1016/j.cgh.2007.06.013

Table 4.

Treatments for Narcotic Bowel Syndrome

Antidepressants

  • - TCAs- Desipramine or nortriptyline: 50mg qhs titrated to 150mg qhs,

  • - SNRIs – Duloxetine: 30mg qd titrated to 60mg qd, Venlafaxine: 37.5mg qd titrated to 225 mg qd

Sympatholytics

  • - Clonidine: Start 0.1–0.2mg q4hrs as titrated by orthostatic blood pressure

Anxiolytic

  • Lorazepam: Start 1mg q6hrs or

  • Clonazapam: Start 0.25mg q8hrs

Spasmolytic

  • - Hyoscyamine: 0.25mg sublingual q4hrs prn

Cathartic

  • - Polyethylene glycol solution (PEG)

  • - Consider Lubiprostone

Psychological Treatment

  • - Cognitive-Behavioral Therapy

  • - Relaxation methods

Future therapies

  • - Alvimopan

  • - N-methylnaltrexone

  • - Atypical antipsychotic?