Does Suboxone Cause Constipation?

Suboxone is a powerful medication that can help combat opioid use disorder (OUD). Like many prescription drugs, it can cause side effects. Constipation is one of them. 

Your digestive tract slows in response to Suboxone, and your body produces fewer digestive enzymes. Food sits in your body, and it's harder to push out. You may feel bloated, and you may spend a lot of bathroom time straining. 

Using medications, and making a few simple adjustments to your lifestyle, could help you feel more like yourself. 

Does Suboxone Cause Constipation?

Buprenorphine is the primary component in Suboxone that renders it effective for treating opioid use disorder by reducing withdrawal symptoms, cravings, and the risk of relapse.

Opioids, including partial opioid agonists like buprenorphine, can change your digestive system.

Opioids can do the following:

• Delay the release of hormones that begin digestion
• Hinder gastric emptying and peristalsis, or the wave-like motions that move food through the gastrointestinal tract[1]
• Slow the GI tract, allowing fluids to be absorbed during the digestive process, creating harder stool and constipation
• Increase anal sphincter tone, which means the defecation reflex is impaired, which can lead to blockage due to incomplete bowel movements
• Reduce the emptying of pancreatic juice and bile, so the whole digestive process can be delayed

‍A study surveying patients with cancer who received opioids as part of their treatment plan found that between 40% and 60% of these individuals struggled with constipation due to their prescription painkillers.[2] Opioid-induced constipation reportedly caused the study participants to strain during defecation. 

When Is It Time to Get Help?

If you develop mild or moderate constipation or are concerned about developing constipation, you can take some steps to manage your health while taking Suboxone as directed. Try these tips:

• Increase your dietary fiber by eating more whole grains, fruits, and vegetables.
• Take a supplement with additional fiber.
• Drink more water.
• Exercise more, as this can improve gut motility and overall fitness.

Unmanaged constipation can cause damage to the sphincter, bowel, intestine, and stomach, so it is important to get help from your doctor if you do not experience relief from constipation.

Signs you should contact your doctor include the following:

• No relief from your at-home treatment plan
• Blood in the toilet bowl
• Intense straining to pass very small bowel movements
• Nausea accompanying constipation

Your doctor may discuss your history of Suboxone treatment to understand how this might impact your digestion and overall health. They may also perform a physical exam, which could include a rectal exam, especially if you have more serious symptoms like pain or bleeding.

In most cases, your doctor will recommend some steps to improve gut health. They may prescribe laxatives for as-needed use, such as these:

• Senna: This is a laxative taken once per day, which may contain stool softener. This is often prescribed to older adults who are taking opioids for long-term pain management, as it reduces the risk of constipation, but it does not alleviate existing constipation. If you have a history of constipation problems, your Suboxone physician might recommend this.
  
• Saline laxatives with magnesium citrate: These have an onset of action about 30 to 180 minutes after they are taken. They are good for short-term relief.
  
• Relistor: This brand name for methylnaltrexone bromide is one of the few opioid antagonists prescribed to alleviate constipation. It does not cross the blood-brain barrier, so it will not stop your regular Suboxone dose from working. However, it will remove opioids from gut receptors, so any buprenorphine lingering in your gut will be eliminated.
  
• Amitiza: This brand name for lubiprostone increases fluid secretion in the GI tract, increasing tone and peristalsis.

You might also find over-the-counter laxatives effective, but ask your doctor before taking these. They are not designed for long-term use.

Sources

1. Peristalsis. National Library of Medicine. https://medlineplus.gov/ency/anatomyvideos/000097.htm. January 2022. Accessed January 2023.
2. Opioid Induced Constipation. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK493184/ - :~:. August 2021. Accessed January 2023.