BMJ Support Palliat Care 3:103-105 doi:10.1136/bmjspcare-2012-000291
  • Case report

Paediatric palliative care: intravenous methylnaltrexone relieves constipation

  1. Anton Mayer3
  1. 1Department of Paediatric Oncology, Sheffield Children's Hospital, Sheffield, UK
  2. 2Pharmacy Department, Sheffield Children's Hospital, Sheffield, UK
  3. 3Bluebell Wood Children's Hospice, Sheffield, UK
  1. Correspondence to Dr Daniel Yeomanson, Department of Paediatric Oncology, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, UK; Daniel.Yeomanson{at}


Methylnaltrexone, a peripheral opioid μ-receptor antagonist is licensed for subcutaneous administration for the treatment of severe opioid-induced constipation in adults. We describe the use of intravenous methylnaltrexone in a 3-year-old boy receiving a subcutaneous diamorphine infusion for palliation from widely metastatic alveolar rhabdomyosarcoma. The patient, who had not opened his bowels for 3 weeks despite use of regular conventional laxatives, was given a 150 mcg/kg dose via indwelling central venous catheter. Constipation was relieved within minutes of the injection. There were no side effects noted during or following injection, and no clinically apparent reduction in analgesia. Intravenous methylnaltrexone may provide a valuable additional treatment option in paediatric palliative care, especially for those with an oncological diagnosis, the majority of whom will have indwelling central venous access devices.

  • Received 25 May 2012.
  • Revision received 11 September 2012.
  • Accepted 17 September 2012.
  • Published Online First 1 November 2012

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