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Constipation is common among people who take opioids chronically. In a randomized manufacturer-sponsored study, the peripheral opioid antagonist methylnaltrexone was investigated as therapy for opioid-induced constipation among 133 terminally ill patients who were treated at nursing homes, hospices, or palliative-care centers. All patients were taking opioids (median morphine equivalent doses, 100–150 mg) and had fewer than three bowel movements per week; they received every-other-day injections of methylnaltrexone or placebo.
Within 4 hours of the first dose, defecation occurred in 48% of methylnaltrexone patients and in 15% of the placebo patients. Similarly, after two or more of the first four study-drug doses, defecation within 4 hours o…