Ramesh 1998.

Methods	RCT, single‐centre, parallel‐group design
Participants	36 male (n = 11) and female (n = 25) participants with advanced cancer in an Indian palliative care unit aged ≥ 15 years who were started on oral morphine for the first time and had opioid‐induced constipation Exclusion criteria: were infants and children aged < 15 years, people with intestinal obstruction, people already taking laxatives, people who were constipated even before the intake of morphine, people already undergoing Ayurvedic therapy as some medicines may have a laxative action Most common cancers were lung, tongue, breast, oesophagus or cervix. Majority of the participants were aged 51‐70 years
Interventions	Oral tablet Drug 1: misrakasneham (an Ayurvedic preparation; starting at 2.5 mL) Drug 2: senna (starting at 24 mg) in 3 steps of doses if previous level failed Maximum doses: senna 72 mg, misrakasneham 10 mL Duration of treatment: 2 weeks Given as a prophylactic when opioids started
Outcomes	Bowel movement
Notes	Trial authors recommended use of misrakasneham based on favourable toxicity profile and cost advantage. This preparation may be difficult to obtain for use in the UK
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomly allocated to the 2 study groups (25 each) by drawing lots (sampling with replacement)
Allocation concealment (selection bias)	Unclear risk	No details provided
Blinding (performance bias and detection bias) All outcomes	High risk	The difference between the physical forms of the 2 drugs necessitated an open trial rather than a double‐blind study
Incomplete outcome data (attrition bias) All outcomes	Low risk	20 (80%) participants in misrakasneham group and 16 (64%) participants in senna group completed the trial. 1 participant from misrakasneham group and 4 participants from senna group dropped out because of irregular laxative administration. 0 dropped out because of inefficacy Unclear if used intention‐to‐treat analysis
Selective reporting (reporting bias)	Unclear risk	No details provided