Efficacy and side-effect profiles of lactulose, docusate sodium, and sennosides compared to PEG in opioid-induced constipation: a systematic review

Can Oncol Nurs J. 2013 Autumn;23(4):236-46. doi: 10.5737/1181912x234236240.
[Article in English, French]


Opioid-induced constipation (OIC) is a side effect of opioid therapy that can affect quality of life, adherence to treatment, and morbidity and possibly mortality.

Objectives: To investigate whether docusate sodium, sennosides, and lactulose have equal efficacy and side effect profiles compared to PEG in the management of OIC in adults.

Methods: A systematic review was undertaken. Randomized controlled trials of adults taking opioids for cancer or non-cancer pain were considered if they met inclusion criteria.

Conclusions: Statistical pooling was not possible as no studies met inclusion criteria. Large, well-powered, randomized controlled trials are feasible. Standard definitions of OIC would assist with the execution of these studies and contribute to their internal and external validity. Further research is strongly encouraged.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Analgesics, Opioid / adverse effects*
  • Cathartics / adverse effects
  • Cathartics / pharmacology
  • Cathartics / therapeutic use
  • Constipation / chemically induced
  • Constipation / drug therapy*
  • Dioctyl Sulfosuccinic Acid / adverse effects
  • Dioctyl Sulfosuccinic Acid / pharmacology
  • Dioctyl Sulfosuccinic Acid / therapeutic use
  • Humans
  • Lactulose / adverse effects
  • Lactulose / pharmacology
  • Lactulose / therapeutic use
  • Laxatives / adverse effects
  • Laxatives / pharmacology
  • Laxatives / therapeutic use*
  • Polyethylene Glycols / adverse effects
  • Polyethylene Glycols / pharmacology
  • Polyethylene Glycols / therapeutic use
  • Senna Extract / adverse effects
  • Senna Extract / pharmacology
  • Senna Extract / therapeutic use
  • Surface-Active Agents / adverse effects
  • Surface-Active Agents / pharmacology
  • Surface-Active Agents / therapeutic use


  • Analgesics, Opioid
  • Cathartics
  • Laxatives
  • Surface-Active Agents
  • Dioctyl Sulfosuccinic Acid
  • Polyethylene Glycols
  • Lactulose
  • Senna Extract