Paediatric palliative care: intravenous methylnaltrexone relieves constipation

Abstract

Methylnaltrexone, a peripheral opioid μ-receptor antagonist is licensed for subcutaneous administration for the treatment of severe opioid-induced constipation in adults. We describe the use of intravenous methylnaltrexone in a 3-year-old boy receiving a subcutaneous diamorphine infusion for palliation from widely metastatic alveolar rhabdomyosarcoma. The patient, who had not opened his bowels for 3 weeks despite use of regular conventional laxatives, was given a 150 mcg/kg dose via indwelling central venous catheter. Constipation was relieved within minutes of the injection. There were no side effects noted during or following injection, and no clinically apparent reduction in analgesia. Intravenous methylnaltrexone may provide a valuable additional treatment option in paediatric palliative care, especially for those with an oncological diagnosis, the majority of whom will have indwelling central venous access devices.

Opioid-induced constipation in palliative care: state of the art

“…Nonetheless, in the label of this drug, there is an observation that safety and efficacy have not yet been established in pediatric patients. And the use of this methylnaltrexone drug should be discouraged in patients with intestinal obstruction and should be used only with a prescription 13,15,17 . Therefore, regarding the use of medicines, it is up to the physician to observe and prescribe.…”

Successful Use of Intravenous Methylnaltrexone for Opioid-Induced Constipation in Critically Ill Pediatric Patients

“…Several case reports and small case series support the safety and efficacy of subcutaneous and intravenous methylnaltrexone in pediatric oncology and palliative care patients with OIC, with minimal impact on analgesia. [11][12][13][14][15] Literature in critically ill pediatric patients with OIC is limited to reports discussing one to two patients describing the use of subcutaneous and intravenous methylnaltrexone based on the adult recommended dosing regimen of 0.15 mg/kg. [16][17][18] Patient-specific factors that may contribute to a critically ill pediatric patient's response to methylnaltrexone are not known at this time.…”