Document Detail

Alvimopan for postoperative ileus.
MedLine Citation:
PMID:  19574601     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The efficacy, safety, pharmacology, pharmacokinetics, drug-drug interactions, and administration of alvimopan for postoperative ileus are reviewed.
SUMMARY: Alvimopan is a selective mu-opioid receptor antagonist with no central nervous system activity. When orally administered after partial small- or large-bowel resection in patients with primary anastomosis, alvimopan shortened the return of bowel function and time to discharge by approximately one day without compromising analgesia. Alvimopan was not shown to be beneficial on these same outcomes after hysterectomy and has not been studied in other surgical populations. Alvimopan is generally well tolerated, with the frequency of adverse events being similar to placebo when used postoperatively for one week or less. Long-term studies of alvimopan in opioid-induced bowel dysfunction have shown an association with adverse cardiovascular outcomes, neoplasms, and fractures. Because of these concerns, the Entereg Access Support and Education program was developed. The recommended dosage of alvimopan is 12 mg administered with a sip of water 30 minutes to five hours before surgery, followed by 12 mg twice daily beginning the day after surgery for a maximum of seven days, 15 total doses, or until discharge. There is a limited amount of pharmacoeconomic analysis concerning alvimopan.
CONCLUSION: Alvimopan, a peripherally acting mu-opioid receptor antagonist, is a novel agent for the treatment of postoperative ileus. It appears to decrease the duration of postoperative ileus and hospitalization by approximately one day, theoretically offsetting its acquisition costs. Unresolved long-term safety issues, a limited indication, and its restricted-access program are likely to hinder its widespread use in the surgical population.
Heather R Bream-Rouwenhorst; Matthew A Cantrell
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists     Volume:  66     ISSN:  1535-2900     ISO Abbreviation:  Am J Health Syst Pharm     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-03     Completed Date:  2010-03-11     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  9503023     Medline TA:  Am J Health Syst Pharm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1267-77     Citation Subset:  IM    
Pharmacy Service (119), Veterans Affairs Medical Center, 601 Highway 6 West, Iowa City, IA 52246-2208, USA.
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MeSH Terms
Ileus / drug therapy*,  etiology,  metabolism
Piperidines / pharmacokinetics,  therapeutic use*
Postoperative Complications / drug therapy*,  etiology,  metabolism
Receptors, Opioid, mu / antagonists & inhibitors,  metabolism
Reg. No./Substance:
0/Piperidines; 0/Receptors, Opioid, mu; 677C126AET/alvimopan
Comment In:
Am J Health Syst Pharm. 2009 Jul 15;66(14):1309-10   [PMID:  19574607 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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