No evidence to support the addition of methylnaltrexone to regular laxatives for the treatment of opioid-induced constipation in critically ill patients; however, the confidence interval was wide and a clinically important difference cannot be excluded.

A total of 84 patients were enrolled and randomized (41 to methylnaltrexone and 43 to placebo).

The baseline demographic characteristics of the two groups were generally well balanced.

There was no significant difference in time to rescue-free laxation between the groups.

There were no significant differences in the majority of secondary outcomes, particularly days 1–3. However, during days 4–28, there were fewer median number of bowel movements per day in the methylnaltrexone group, (p = 0.01) and a greater incidence of diarrhoea in the placebo group.

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