Abstract
This systematic review investigates the effectiveness of laxatives and methylnaltrexone for the management of constipation in patients receiving opioids. It updates the 2006 Cochrane Review. Seven studies involving 616 participants were included. In four studies the laxatives lactulose, senna, co-danthramer, misrakasneham and magnesium hydroxide with liquid paraffin were evaluated. In studies comparing the different laxatives the evidence was inconclusive. Using the combined data from three studies (covering 287 participants) investigating subcutaneous methylnaltrexone in comparison with a placebo, it was found that methylnaltrexone significantly induced laxation at four hours, with no difference in the proportion experiencing side effects. However, these patients suffered more flatulence and dizziness and one person had severe diarrhoea, subsequent dehydration and then cardiovascular collapse.
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