Candy, B., Jones, L., Goodman, M.L., Drake, R., & Tookman, A. (2011). Laxatives or methylnaltrexone for the management of constipation in palliative care patients. Cochrane Database of Systematic Reviews, 1, CD003448.

To update the information available on the effectiveness of laxatives and methylnaltrexone for constipation management in palliative care patients.

Databases searched were MEDLINE and the Cochrane Central Register of ControlLed Trials (Central).

Search keywords were laxatives, methylnaltrexone, and palliative care.

Studies were included in the review if

• They reported on adults receiving palliative care.
• Patients used laxatives or methylnaltrexone for constipation.

Studies were excluded if they reported on healthy volunteers, drug misuse–related constipation, or bowel obstruction.

A total of 186 references were retrieved. If citation screening did not identify whether a study was eligible, the full text was reviewed for acceptability. Two authors independently screened studies and discussed differences of opinion. Randomized controlled clinical trials were evaluated for inclusion.

• Seven studies comprising a total of 616 patients were included.
• Key characteristics were use of lactulose, senna, co-danthramer, misrakasneham,  and magnesium hydroxide with liquid paraffin.

• Patients were undergoing the end-of-life phase of care.
• The study has clinical applicability for palliative care.

• The best laxative for this patient population is unclear.
• Methylnaltrexone is effective in patients with opioid-induced constipation.

Well-designed clinical trials are needed to help identify which laxatives are most effective for palliative care patients with constipation.

Very few clinical trials effectively evaluated the use of laxatives in this patient population.