59 year old female who is rehabbing from a knee replacement.  On day 3 following the procedure, the patient is still experiencing a significant amount of pain.  She has been discharged from the hospital and is taking Percocet 2 tablets four times daily for pain management.

Other medications include:

• Lisinopril
• Aspirin
• Omeprazole
• Metoprolol
• Senna 1 tablet daily
• Miralax (as needed)

On days 5-7 post-op, the patient is still requiring some of the Percocet for pain management.  This patient due to the Percocet was beginning to experience some constipation.  She has had a history of constipation in the past even prior to the use of the opioid.

On day 7, she is placed on Senna S 1 tablet twice daily to help relieve the constipation with minimal results.  A day or two later, she was also recommended to try Miralax 17 grams daily on a scheduled basis.  She does begin to have regular bowel movements and the Percocet use is also now on the decline with pain greatly improving.

In cases like this, with the eventual discontinuation of the Percocet, most patients will stop taking the laxatives on their own, but it is important to reassess where, why and when laxatives were initiated as they can linger if patients don’t ask questions.  If you identify patients on chronic laxatives, help make sure that they haven’t been started and continued due to a short term course of a constipating medication.

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