Abstract

Opioid-induced constipation is a major problem for patients with advanced medical illness despite aggressive use of bowel regimens. Methylnaltrexone is an opioid antagonist with limited ability to cross the blood–brain barrier and thus is thought to induce opioid withdrawal at the level of the gastrointestinal tract without causing central withdrawal and flare of pain. This chapter describes and evaluates a randomized controlled trial of methylnaltrexone versus placebo and an open label extension study for patients with advanced illness and opioid-induced constipation. Primary outcomes are efficacy and safety. The chapter concludes with a discussion of the possible role of methylnaltrexone in the therapeutic armamentarium of opioid induced constipation.

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