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

Flerlage, Jamie E.; Baker, Justin N.

doi:10.1089/jpm.2014.0364

Cited by 25 publications

(12 citation statements)

References 9 publications

(8 reference statements)

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“…These results are similar to those found in studies of subcutaneous methylnaltrexone in adult populations with chronic OIC and pediatric oncology patients. [6][7][8][9]16 Our results support the postoperative use of methylnaltrexone in pediatric populations with acute OIC after PSF with no appreciable side effects.…”

Section: Discussionsupporting

confidence: 69%

Improved Bowel Function With Oral Methylnaltrexone Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Lin

Costandi

Kim

et al. 2021

Journal of Pediatric Orthopaedics

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Background: Methylnaltrexone, a peripheral opioid antagonist, is used to decrease opioid-induced constipation; however, there is limited evidence for its use in children. The primary objective of the study is to assess the efficacy of per os (PO) methylnaltrexone in inducing bowel movements (BMs) in patients with adolescent idiopathic scoliosis who underwent a posterior spinal fusion and instrumentation (PSFI). Secondary outcomes include hospital length of stay, postoperative pain scores, and postoperative opioid usage. Methods: Retrospective chart review identified all adolescent idiopathic scoliosis patients above 10 years of age who underwent PSFI with a minimum of 24 hours of postoperative opioid analgesia after the initiation of the new bowel regimen protocol. The bowel regimen included daily administration of PO methylnaltrexone starting on postoperative day 1 until BM is achieved. A case-matched cohort was obtained with patients who did not receive PO methylnaltrexone and otherwise had the same bowel function regimen. Case-matched controls were also matched for age, sex, body mass index, and curve severity. t Tests and Pearson χ 2 tests were used for statistical analysis. Results: Fifty-two patients received oral methylnaltrexone (14 ± 2.6 y) and 52 patients were included in the case-matched control group (14 ± 2.1 y). The methylnaltrexone group had a significantly shorter hospital length of stay (3.09 ± 0.66) compared with controls (3.69 ± 0.80) (P < 0.01). 59% (31 of 52) of the methylnaltrexone group had a BM by postoperative day postoperative day 2, compared with 30% (16 of 52) of the control group (P < 0.01). In the methylnaltrexone group, 44% (23 of 52) of the patients required a Dulcolax (bisacodyl) suppository and 11% (6 of 52) required an enema, compared with 50% (26 of 52) and 33% (12 of 52) of the control group respectively (P = 0.43 and 0.12). In addition, significantly less patients had abdominal distension during their postoperative stay in the methylnaltrexone group (17%, 9 of 52) compared with the control group (40%, 21 of 52) (P < 0.01). There was no significant difference in selfreported average FACES pain score (P = 0.39) or in opioid morphine equivalents required per hour (P = 0.18). Conclusions: Patients who received PO methylnaltrexone after PSFI had decreased length of stay and improved bowel function. Administration of methylnaltrexone did not increase maximum self-reported FACES pain values or opioid consumption compared with controls. The use of oral methylnaltrexone after PSFI reduces postoperative constipation, which has implications for reducing hospital length of stay and overall morbidity.

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Section: Discussionsupporting

confidence: 69%

Improved Bowel Function With Oral Methylnaltrexone Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Lin

Costandi

Kim

et al. 2021

Journal of Pediatric Orthopaedics

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“…Although methylnaltrexone has proven to effectively treat OIC in both adult and pediatric patients, it is relatively contraindicated in cases of peritoneal carcinomatosis due to reported cases of perforation with intestinal obstruction 5,6 . While the exact mechanism of GI perforation associated with methylnaltrexone use is not clear, it is possibly due to a prokinetic effect that goes beyond reversing opioid-induced hypomotility combined with compromised integrity of the GI tract.…”

Section: Discussionmentioning

confidence: 99%

Methylnaltrexone is safe in cancer patients with peritoneal carcinomatosis

Nelson

Schattner

Mendelsohn

2019

Sci Rep

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Opioid-induced constipation (OIC) has become increasingly prevalent with the rise of prescription opioid use and can significantly impact quality of life, especially in patients with advanced illness. Methylnaltrexone has proven effective in treating cancer patients with OIC who have not responded adequately to conventional laxative therapy, though use is relatively contraindicated in those with peritoneal carcinomatosis due to theoretical risk and reported cases of perforation. The aim of this study was to evaluate the safety of methylnaltrexone in patients with carcinomatosis. We performed a retrospective review of 3058 pediatric and adult patients who received methylnaltrexone at Memorial Sloan Kettering Cancer Center from 2009–2016. Data collected included age, cancer diagnosis, history of abdominal surgery, prior radiation therapy, evidence of peritoneal carcinomatosis, and complications. Charts were reviewed for any complications at 24 hours, 72 hours, and one week following drug administration, as well as at present. We identified 3058 patients (median age 56, range 1–95) who received a total of 3995 doses of methylnaltrexone. Three hundred thirty three (median age 55, range 4–88) had peritoneal carcinomatosis. The most common primary malignancies included pancreatic (17.7%), ovarian (13.5%), colon (7.2%), and lung (6.6%). 228/333 (68.4%) had a history of abdominal surgery and 85/333 (25.5%) underwent prior radiation therapy. Three patients had adverse outcomes or complications, with only one (0.3%) thought to be related to methylnaltrexone use. To our knowledge, this is the largest study to evaluate the outcomes of patients with carcinomatosis receiving methylnaltrexone and the first to include pediatric patients. We found one perforation attributed to methylnaltrexone. Methylnaltrexone should be considered for treatment of refractory OIC in cancer patients with peritoneal carcinomatosis due to low risk of complications.

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“…We believe that more studies are needed to confirm findings of higher prevalence rates of OIC among patients without cancer who are female [ 71 , 72 , 92 , 93 ]; treated in certain healthcare settings [ 62 , 67 , 69 , 71 ]; treated with specific opioids, formulations or routes of administration [ 64 , 66 , 68 – 70 , 72 , 92 ]; or are less than 18 years of age [ 94 – 96 ].…”

Section: Epidemiologymentioning

confidence: 99%

Management of Opioid-Induced Constipation and Bowel Dysfunction: Expert Opinion of an Italian Multidisciplinary Panel

et al. 2021

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The prescribing and use of opioid analgesics is increasing in Italy owing to a profusion in the number and types of opioid analgesic products available, and the increasing prevalence of conditions associated with severe pain, the latter being related to population aging. Herein we provide the expert opinion of an Italian multidisciplinary panel on the management of opioid-induced constipation (OIC) and bowel dysfunction. OIC and opioid-induced bowel dysfunction are well-recognised unwanted effects of treatment with opioid analgesics that can profoundly affect quality of life. OIC can be due to additional factors such as reduced mobility, a low-fibre diet, comorbidities, and

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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

Cited by 25 publications

References 9 publications

Improved Bowel Function With Oral Methylnaltrexone Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Improved Bowel Function With Oral Methylnaltrexone Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Methylnaltrexone is safe in cancer patients with peritoneal carcinomatosis

Management of Opioid-Induced Constipation and Bowel Dysfunction: Expert Opinion of an Italian Multidisciplinary Panel

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