Methylnaltrexone bromide, (17s)- (methylnaltrexone bromide), a quaternary amine of the pure narcotic antagonist naltrexone, is a peripherally-acting selective mu-opioid antagonist. Methylnaltrexone antagonizes opioid binding at mu-opioid receptors, half-maximal inhibitory concentration (IC50) of 70 nM. It has a relatively lower affinity for κ-opioid receptors (IC50 575 nM), and it does not interact with δ-receptors or orphanin FQ receptors. Approved by FDA in the United States under the trade name Relistor, methylnaltrexone bromide is indicated for the treatment of opioid-induced constipation in patients with advanced illness who are receiving palliative care, when the response to laxative therapy has not been sufficient. Restricted ability to cross the blood-brain barrier allows methylnaltrexone bromide to function in tissues such as the gastrointestinal tract, decreasing the constipating effects of opioids without impacting opioid-mediated analgesic effects on the central nervous system.