Methylnaltrexone for Opioid‐Induced Constipation in Pediatric Oncology Patients

Rodrigues, Amelia; Wong, C D O Stella; Mattiussi, A.; Alexander, Sarah; Lau, Esther; Dupuis, L. Lee

doi:10.1002/pbc.24615

Cited by 33 publications

(17 citation statements)

References 13 publications

(28 reference statements)

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“…3,7 Our data demonstrate that methylnaltrexone appears to be both safe and effective to use in children and AYA with incurable cancer in both inpatient and outpatient settings as well as longitudinally with repeated dosing. Furthermore, 4 of our patients even received a successful dose through the last week of life.…”

Section: Discussionmentioning

confidence: 93%

“…Although methylnaltrexone is a known and effective treatment option for adults with OIC, 1,2 its safety and efficacy have not been established in pediatric patients. 3 Most regimens to prevent and treat OIC are enteral preparations that become less tolerable as patients clinically decline. 4 Methylnaltrexone can be administered subcutaneously, thereby providing an alternative route of administration for treating OIC.…”

mentioning

confidence: 99%

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Methylnaltrexone for Opioid-Induced Constipation in Children and Adolescents and Young Adults with Progressive Incurable Cancer at the End of Life

Flerlage

Baker

2015

Journal of Palliative Medicine

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Background: Opioid-induced constipation (OIC) is common among children and adolescents and young adults (AYA) with progressive incurable cancer. Although methylnaltrexone is a successful treatment for OIC in adult cancer patients, no case series has established its safety and efficacy in pediatric cancer patients. Objectives: The aim of the study was to describe the safety and efficacy of methylnaltrexone use for OIC in children and AYA with progressive incurable cancer at the end of life in the inpatient and outpatient settings. Methods: We conducted a retrospective review of medical records of children and AYA with progressive incurable cancer who received methylnaltrexone at our institution from May 2008 to June 2013. Pharmacy data were reviewed for each patient and a chart review was performed for documentation of laxation and side effects. Results: Of the 9 patients (age range: 17 months to 21 years) with progressive incurable cancer who developed OIC, 7 (78%) had laxation after methylnaltrexone administration (0.15 mg/kg/dose). Of these 7 patients, 5 (71%) had laxation with the first dose, and 5 (71%) who responded had a continued response to repeated doses. The longest a patient regularly received methylnaltrexone was 9 months. Of 5 patients with intraabdominal disease, 4 (80%) had laxation. There were no negative side effects in any of the patients. Also, there was no increase in pain either qualitatively or by pain score.Conclusions: Methylnaltrexone appears to be safe and efficacious in treating OIC in children and AYA with progressive incurable cancer. Methylnaltrexone was tolerated in both the inpatient and outpatient settings and with repeated dosing.

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Section: Discussionmentioning

confidence: 93%

mentioning

confidence: 99%

Methylnaltrexone for Opioid-Induced Constipation in Children and Adolescents and Young Adults with Progressive Incurable Cancer at the End of Life

Flerlage

Baker

2015

Journal of Palliative Medicine

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“…Clinical studies have demonstrated the effectiveness of MNTX in the treatment of OIC not responding to traditional laxatives in patients with advanced diseases, 33 , 34 , 116 , 117 , 121 , 122 , 126 non-malignant pain, 127 – 129 and in other patient populations. 130 , 131 However, MNTX was ineffective in shortening the duration of postoperative ileus following segmental colectomy. 132 …”

Section: Mntxmentioning

confidence: 99%

Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction

Leppert¹

2015

DDDT

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Opioid-induced bowel dysfunction (OIBD) comprises gastrointestinal (GI) symptoms, including dry mouth, nausea, vomiting, gastric stasis, bloating, abdominal pain, and opioid-induced constipation, which significantly impair patients’ quality of life and may lead to undertreatment of pain. Traditional laxatives are often prescribed for OIBD symptoms, although they display limited efficacy and exert adverse effects. Other strategies include prokinetics and change of opioids or their administration route. However, these approaches do not address underlying causes of OIBD associated with opioid effects on mostly peripheral opioid receptors located in the GI tract. Targeted management of OIBD comprises purely peripherally acting opioid receptor antagonists and a combination of opioid receptor agonist and antagonist. Methylnaltrexone induces laxation in 50%–60% of patients with advanced diseases and OIBD who do not respond to traditional oral laxatives without inducing opioid withdrawal symptoms with similar response (45%–50%) after an oral administration of naloxegol. A combination of prolonged-release oxycodone with prolonged-release naloxone (OXN) in one tablet (a ratio of 2:1) provides analgesia with limited negative effect on the bowel function, as oxycodone displays high oral bioavailability and naloxone demonstrates local antagonist effect on opioid receptors in the GI tract and is totally inactivated in the liver. OXN in daily doses of up to 80 mg/40 mg provides equally effective analgesia with improved bowel function compared to oxycodone administered alone in patients with chronic non-malignant and cancer-related pain. OIBD is a common complication of long-term opioid therapy and may lead to quality of life deterioration and undertreatment of pain. Thus, a complex assessment and management that addresses underlying causes and patomechanisms of OIBD is recommended. Newer strategies comprise methylnaltrexone or OXN administration in the management of OIBD, and OXN may be also considered as a preventive measure of OIBD development in patients who require opioid administration.

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“…In another study, 15 pediatric oncology patients were given a mean dose of 0.15 mg/kg, for a total of 19 doses [ 135 ]. Of the 19 doses, 14 achieved a bowel movement within 4 h. Two other case reports in a 17-month-old and a 3-year-old, both on palliative care for cancer, reported spontaneous bowel movement after a single dose at 0.12 and 0.15 mg/kg, respectively [ 136 , 137 ].…”

Section: Methylnaltrexonementioning

confidence: 99%

Drugs Acting on the Gut: Prokinetics, Antispasmodics, Laxatives

Har¹,

Croffie²

2016

Pediatric Neurogastroenterology

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Methylnaltrexone for Opioid‐Induced Constipation in Pediatric Oncology Patients

Abstract: This case series suggests that methylnaltrexone is safe and may be effective when given subcutaneously as a 0.15 mg/kg single dose to pediatric oncology patients with opioid-induced constipation.

Cited by 33 publications

References 13 publications

Methylnaltrexone for Opioid-Induced Constipation in Children and Adolescents and Young Adults with Progressive Incurable Cancer at the End of Life

Methylnaltrexone for Opioid-Induced Constipation in Children and Adolescents and Young Adults with Progressive Incurable Cancer at the End of Life

Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction

Drugs Acting on the Gut: Prokinetics, Antispasmodics, Laxatives

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