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HEATHER R. BREAM-ROUWENHORST, PHARM.D., BCPS, is Clinical Pharmacy Specialist—Internal Medicine, Veterans Affairs Medical Center (VAMC), Iowa City, IA, and Clinical Assistant Professor, College of Pharmacy, University of Iowa, Iowa City. MATTHEW A. CANTRELL, PHARM.D., is Clinical Pharmacy Specialist, VAMC, and Clinical Assistant Professor, College of Pharmacy, University of Iowa.

Address correspondence to Dr. Bream-Rouwenhorst at the Pharmacy Service (119), Veterans Affairs Medical Center, 601 Highway 6 West, Iowa City, IA 52246-2208 (heather-bream{at}uiowa.edu).

Purpose. The efficacy, safety, pharmacology, pharmacokinetics, drug–drug interactions, and administration of alvimopan for postoperative ileus are reviewed. Summary. Alvimopan is a selective µ-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 µ-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. Index terms: Alvimopan; Dosage; Drug administration; Drug interactions; Hospitals; Ileus; Mechanism of action; Opiate antagonists; Pharmacoeconomics; Pharmacokinetics; Postoperative complications; Toxicity

 

Related articles in Am J Health-Syst Pharm:

Alvimopan for postoperative ileus: Only one piece of the puzzle

Michael D. Kraft
Am J Health-Syst Pharm 2009 66: 1309-1310. [Full Text]  

This article has been cited by other articles:

				M. D. Kraft Alvimopan for postoperative ileus: Only one piece of the puzzle Am. J. Health Syst. Pharm., July 15, 2009; 66(14): 1309 - 1310. [Full Text] [PDF]