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Constipation is a distressing side effect of opioid therapy. Researchers investigated
the safety and efficacy of subcutaneous methylnaltrexone for treating constipation
in patients with advanced illness taking opioids.
One hundred and thirty-three patients on opioids for 2 or more weeks, who were
on stable opioid doses and laxatives for 3 or more days without constipation
relief, were randomly assigned to receive subcutaneous methylnaltrexone or placebo
every other day for 2 weeks. In the methylnaltrexone group, 48% of patients
had relief within 4 hours of the first dose, compared with only 15% in the placebo
group. Fifty-two percent had relief without the use of a rescue laxative within
4 hours after two or more doses, compared with only 8% in the placebo group.
The median time to laxation was shorter in the methylnaltrexone group than in
the placebo group. Abdominal pain and flatulence were the most common adverse
events.
The researchers concluded that subcutaneous methylnaltrexone was very effective
in relieving opioid-induced constipation in patients with advanced illness.
Thomas J, Karver S, Cooney GA, Chamberlain BH, Watt CK, Slatkin NE, Stambler
N, Kremer AB, Israel RJ. Adapted from N Engl J Med. 2008 May 29;358(22):2400-2.
Full text:
http://content.nejm.org/cgi/content/full/358/22/2332
PMID: 18509120
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