No trials versus other opioid receptor antagonists. The mainstay of treatment remains meticulous dietary management and a tried-and-true laxative. When a patient has opioid-induced constipation that remains troublesome despite laxatives, several opioid receptor antagonists can be considered. Adding subcutaneous methylnaltrexone to a laxative reduces the need for enemas in terminally-ill patients, but offers no proven therapeutic advantages in other patients (1). Oral naloxegol has a beneficial effect on intestinal transit, but provokes gastrointestinal disorders that are probably as troublesome as constipation (1). Naldemedine is another oral opioid receptor antagonist (2). No clinical trials have compared this drug to methylnaltrexone, naloxegol or a laxative in the treatment of opioid-induced constipation (3). The trials on which its marketing authorisation was based were not designed to evaluate naldemedine when laxatives are unsatisfactory (2).
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