Opioids, acting via mu (µ), delta (δ) and kappa (κ) receptors, are well-known potent analgesic drugs.

Their use in daily clinical practice has significantly increased in Western countries, including Italy, as a result of progressive aging of the general population and an increase in the prevalence of chronic diseases with severe pain.

Although extremely effective, opioids are associated with a number of adverse effects including opioid-induced bowel dysfunction and opioid-induced constipation (OIC). These influence patients’ quality of life and cause possible life-threatening complications.

Thus, patients with OIC should be appropriately managed with an integrated strategy based on improving dietary fibre, fluid intake, and exercise, as well as by restoring bowel function without altering the antinociceptive power of opioid drugs.

In line with the international recommendations, our panel indicates the use of either osmotic (i.e. polyethylene glycol) or stimulant laxatives (i.e. anthraquinone) as first-line pharmacological treatment for OIC. Should this approach be inadequate, a second laxative can be added.

For second-line treatment, peripherally acting μ opioid receptor antagonists (PAMORAs), i.e. methylnaltrexone, naloxegol or naldemedine, are recommended being target therapies for patients with OIC unresponsive to combination of laxatives.

Prokinetics or intestinal secretagogues, i.e. lubiprostone, are off-label for OIC in Italy and their use should be restricted to specialist centres and clinical trials.