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Codeine is a very valuable drug, but a high percentage of patients
(especially the elderly) will find themselves severely constipated within
a couple of days of starting to take it.
The two most common uses for codeine are pain and severe coughing.
For those who are in pain, their usual physical activity is often absent
as may be their appetite. People with severe, constant coughing may have
lowered blood oxygen levels obstructing their thinking. All of these can
contribute to the problem.
Severe constipation can be a disastrous event in the elderly, leading
to bowel obstruction, impaction or slow-healing anal tears. Straining at
stool can cause internal injuries or internal bleeding if the person is
taking anti-coagulants.
This is an easily preventable side-effect. When prescribing codeine,
all doctors should enquire about the patient's usual method of dealing
with constipation. If this method is dietary modification, stool
softeners or a mild laxative, the patient can be advised to institute
their usual constipation therapy on the same day that they start taking
codeine and to continue until several days after the end of treatment
(unless they experience loose stools). Patients who are normally very
active or claim they never experience constipation need special attention
as they are the least likely to know how to cope with it or have what they
need at home; they are also the most likely to remain in denial until they
have major problems.
Increasing fibre intake through diet or the use of psyllium products
may be enough for some people. Others, particularly elderly people or
those who rarely take analgesics may need Colace, Senekot or some other
product that does not conflict with their physical condition or with other
medications.
People who are in pain or have lowered blood oxygen levels are unable
to think clearly. They need clear, WRITTEN instructions. Doctors, nurses
and pharmacists must all endeavour to be alert and avoid the assumption
that patients who are in pain (or taking drugs to treat pain) will be able
to spot the onset of side-effects or know what to do.
Most people who are either injured or ill are actually in an altered
state of consciousness compared to their usual level of competency. Those
of us who are not, have a duty to try to anticipate potential problems and
do our best to prevent or treat them rather than allowing them to become
worse off than necessary.
Thinking Ahead to Prevent Codeine Side-Effects
Codeine is a very valuable drug, but a high percentage of patients
(especially the elderly) will find themselves severely constipated within
a couple of days of starting to take it.
The two most common uses for codeine are pain and severe coughing.
For those who are in pain, their usual physical activity is often absent
as may be their appetite. People with severe, constant coughing may have
lowered blood oxygen levels obstructing their thinking. All of these can
contribute to the problem.
Severe constipation can be a disastrous event in the elderly, leading
to bowel obstruction, impaction or slow-healing anal tears. Straining at
stool can cause internal injuries or internal bleeding if the person is
taking anti-coagulants.
This is an easily preventable side-effect. When prescribing codeine,
all doctors should enquire about the patient's usual method of dealing
with constipation. If this method is dietary modification, stool
softeners or a mild laxative, the patient can be advised to institute
their usual constipation therapy on the same day that they start taking
codeine and to continue until several days after the end of treatment
(unless they experience loose stools). Patients who are normally very
active or claim they never experience constipation need special attention
as they are the least likely to know how to cope with it or have what they
need at home; they are also the most likely to remain in denial until they
have major problems.
Increasing fibre intake through diet or the use of psyllium products
may be enough for some people. Others, particularly elderly people or
those who rarely take analgesics may need Colace, Senekot or some other
product that does not conflict with their physical condition or with other
medications.
People who are in pain or have lowered blood oxygen levels are unable
to think clearly. They need clear, WRITTEN instructions. Doctors, nurses
and pharmacists must all endeavour to be alert and avoid the assumption
that patients who are in pain (or taking drugs to treat pain) will be able
to spot the onset of side-effects or know what to do.
Most people who are either injured or ill are actually in an altered
state of consciousness compared to their usual level of competency. Those
of us who are not, have a duty to try to anticipate potential problems and
do our best to prevent or treat them rather than allowing them to become
worse off than necessary.
Competing interests:
None declared
Competing interests: No competing interests