title: Pharmacological treatment of constipation in palliative care.
abstract: OBJECTIVE
  The prevalence of constipation in palliative care patients varies. There is uncertainty about the choice from varying recommendations for pharmacological management of constipation and a varying clinical practice in palliative care settings. The purpose of the review was to evaluate the current recommendations of therapy guidelines and to determine the effectiveness and safety of laxative administration for the management of constipation in palliative care patients.
  
  
  RESULTS
  Despite the clinical importance, there are limited data on the efficacy and safety of laxatives in palliative care patients. The social acceptability varies from country to country, but overall, oral laxatives should, where possible, be used in preference. Systemic opioid antagonists, such as naloxone and methylnaltrexone have been studied in few clinical trials. There is a paucity of well designed, prospective, randomized controlled trials with large enough numbers of patients suffering from constipation and treated with pharmacological methods.
  
  
  CONCLUSIONS
  There are limited data available on the conventional pharmacological treatment of constipation in palliative care patients due to insufficient randomized controlled trials. However, subcutaneously administered methylnaltrexone was found to be effective in aiding of laxation and well tolerated with limited or transient side effects in palliative care patients.
authors.affiliation: Clinic of Palliative Medicine, MediClin Robert Janker Klinik, Germany. elina.clemens@mediclin.de
authors.forename: Katri E
authors.initials: KE
authors.lastname: Clemens
authors.forename: Markus
authors.initials: M
authors.lastname: Faust
authors.forename: Birgit
authors.initials: B
authors.lastname: Jaspers
authors.forename: Gerd
authors.initials: G
authors.lastname: Mikus
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects; D003248:Constipation / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007279:Injections, Subcutaneous; D054368:Laxatives / Q000494:pharmacology / Q000627:therapeutic use*; D009271:Naltrexone / Q000031:analogs & derivatives / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D010166:Palliative Care; D017410:Practice Guidelines as Topic; D000644:Quaternary Ammonium Compounds / Q000627:therapeutic use
chemical_list: D000701:Analgesics, Opioid; D054368:Laxatives; D009292:Narcotic Antagonists; D000644:Quaternary Ammonium Compounds; C032257:methylnaltrexone; D009271:Naltrexone