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September 20, 2000

Oral Methylnaltrexone for Opioid-Induced Constipation

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(11):1383-1384. doi:10.1001/jama.284.11.1378

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.