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Naloxegol rescue with methylnaltrexone highly effective
  1. Jenny Brocklebank,
  2. Elizabeth Jane Miller and
  3. Samuel Fingas
  1. Palliative care, St Luke's Hospice, Sheffield, UK
  1. Correspondence to Dr Jenny Brocklebank, St Luke's Hospice, Sheffield, Sheffield, UK; jbrocklebank{at}


Opioid-induced constipation (OIC) is common and can significantly affect quality of life. Naloxegol and methylnaltrexone are peripherally acting µ-opioid receptor antagonists (PAMORAs) which are effective for the management of OIC. We report on a case in the palliative care setting where a patient with established OIC had an inadequate response to naloxegol but an effective and immediate response to methylnaltrexone at the dose recommended for her weight. This is the first reported case of two PAMORAs used concomitantly.

  • cancer
  • pharmacology
  • symptoms and symptom management
  • constipation
  • terminal care

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  • Contributors SF managed the patient, conceived the case report, analysed patient data and contributed to critical revision of the report. JB managed the patient, collected and analysed patient data and drafted the case report. EJM managed the patient and provided critical revision of the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.