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To the Editor: Constipation is a common adverse effect of opioid pain medication used to treat cancer patients.¹ Conventional therapy may not provide sufficient relief of constipation, which can be severe enough to limit opioid use or dose.² We previously reported that intravenous methylnaltrexone (N-methylnaltrexone bromide; Mallinckrodt Specialty Chemicals, St Louis, Mo), the first quaternary ammonium opioid receptor antagonist that does not cross the blood-brain barrier in humans, reversed chronic opioid-induced constipation in patients in a methadone maintenance program.³ However, oral medication is a safer and more convenient way to deliver the drug. In this study, we evaluated the efficacy of oral methylnaltrexone for patients receiving long-term methadone therapy.

Methods

With approval from the University of Chicago Institutional Review Board, 12 constipated adults (2 stools per week) undergoing methadone treatment were enrolled. Their mean (SD [range]) daily methadone dosage was 73.3 (16.2 [41-100]) mg. On day 1 at . . . [Full Text of this Article]

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