Hi, this is Dr. Jeff Gudin, pain anesthesiologist and palliative care specialist at the Englewood Hospital and Medical Center in Englewood, New Jersey. I often discuss some of the newer agents available for opioid-induced constipation, or OIC, but oftentimes forget to talk about the adverse effects these medications can cause. When we think about AEs or adverse effects from medications, let’s think about what these agents are doing. They are promoting forward flow in the bowel, they are stimulating motility, it is trying to enhance forcing the stool out of the intestines. So just think for just a second, if I were to administer a drug to a patient that has not moved their bowels in a number of days, a medication that acts within hours, what would the patient actually experience? So it is no surprise to hear that the common adverse effects of these medications are gas, bloating, spasm, even cramping and pain in the intestines. You can imagine that evacuating the bowels is something that patients might overshoot and they develop diarrhea or persistent bowel movements, so you need to be aware of the common adverse effects of these medications, which only makes sense if you think about their mechanism of action. You would never want to give any of these agents which promote motility to somebody that has a mechanical obstruction, and with the agent lubiprostone, the chloride channel activator, there has actually been reports of dyspnea resulting after even the first dose. So I always tell clinicians, although these agents are quite effective at treating constipation, you certainly need to be on the lookout for the common adverse events.