Opioid-Induced Constipation in Advanced Illness: Safety and Efficacy of Methylnaltrexone Bromide

• Published in: Clinical Medicine Insights. Oncology Vol. 2011; no. 5; pp. 201 - 211
• Main Authors: Bader, S., Jaroslawski, K., Blum, H.E., Becker, G.
• Format: Journal Article Book Review
• Language: English
• Published: London, England Libertas Academica 01.01.2011; SAGE Publishing; SAGE Publications; Sage Publications Ltd. (UK); Sage Publications Ltd
• Subjects: Care and treatment; Complications and side effects; Constipation; Review; advanced illness; opioid-antagonist; μ-receptor antagonist; methylnaltrexone; palliative care; opioid-induced constipation
• ISSN: 1179-5549; 1179-5549
• DOI: 10.4137/CMO.S4867

Constipation, one of the major side effects of opiates used in palliative care, can impair patients’ quality of life to a point where it prevents sufficient pain control. Methylnaltrexone is a novel μ-receptor antagonist, which does not pass the blood brain barrier. It is licensed to treat opiate induced constipation for patients with advanced diseases. This review article presents an overview of pharmacology and safety of its application, evidence of its efficacy and economic aspects of its use in clinical practice. Available data are limited but strongly suggest that methylnaltrexone causes laxation in less than 24 hours for at least half of those patients over the first two weeks of usage without impairing pain control or causing serious adverse effects. To avoid danger of gastrointestinal perforation it is contraindicated for patients at risk for that complication. More research is needed to evaluate its long-term efficacy and economic impact.