Opioid-induced constipation (OIC) is a common adverse effect among cancer patients receiving opioid analgesics, particularly morphine, which can significantly affect quality of life and treatment compliance. Bisacodyl is a commonly used stimulant laxative for prevention and management of OIC. Ayurveda emphasizes maintaining digestive health, and Icchabhedirasa is a classical formulation traditionally used for its virechana (purgative) action. This study aimed to compare the efficacy of Icchabhedirasa with bisacodyl in preventing and treating OIC among cancer patients receiving oral morphine sulphate for pain management.

A double-blinded randomized comparative clinical study was conducted among opioid-naïve cancer patients requiring morphine sulphate. Participants were allocated into two groups, receiving either bisacodyl or Icchabhedirasa, and bowel functions were assessed using the validated Bowel Function Index (BFI). Secondary parameters including nausea, vomiting, abdominal cramps, appetite, and sense of wellbeing were also evaluated.

The results showed that Icchabhedirasa demonstrated comparable laxative efficacy to bisacodyl in improving bowel function and reducing opioid-induced constipation. Both groups showed significant improvement in BFI scores during the study period. Icchabhedirasa showed additional improvement in appetite with minimal adverse effects. The study suggests that Icchabhedirasa can be considered a safe and effective Ayurvedic alternative for preventing and managing opioid-induced constipation in palliative care patients.

Keywords: Icchabhedirasa, Opioid-induced constipation,  Cancer pain,  Bisacodyl,  Ayurveda.