Constipation is a common symptom in terminally ill patients in palliative care, especially in those receiving opioid treatment. This may cause major symptoms that affect the patient’s psycho-social area and further complications such as faecal
impaction, thus contributing to deterioration of quality of life. The use of laxatives is recommended before severe constipation, starting with stimulant laxatives, such as sennosides, or osmotic laxatives, such as lactulose, and a combination of both when necessary. Next step would be to add an emollient laxative, such as paraffin. When neither of these measures obtain a good response, rescue laxatives, such as suppositories or enemas, may be administered. The use of methylnaltrexone, a peripheral opioid receptor antagonist, is reserved as an alternative for patients treated with opioids when response to laxative therapy has been insufficient.