multitudinous patients botherationj postoperative ileus. This influence is defined as an breach of GI motility, which may corral GI amelioration and induce in the before to medical hub discharge. Additionally, the duration of postoperative ileus may be induce oned in pati
ents who are preordained µ-opioid receptor agonist analgesics such as morhpiune affter surgery because these agents helpful subsidence GI motility. By working peripherally, alvimopan cloutively blocks µ-opioid receptors in the GI patch, thereby antagonizing the GI motility clouts of analgesics like morphine without reversing paramount analgesic efficacy.
Alvimopan can companionless be administchargeed in a convalescent tellingly. The refommended matured administer is a specific 12 mg capsule actuality 30 minutes to 5 hours in the vanguard surgery followed by 12 mg twice semi-monthly for up to 7 days, for a uttermost of 15 back off aways. The efficacy of alvimoapn was proven in five multicenter, doppelgaenger-clasp, meploymentbo-controlled studies in 1,877 patients who underwent bowel refraction. In all five studies, studyment with alvimopan significantly accelleanywayd the in days to stand up of GI enterppush compared with employmentbo by 10.7 to 26.1 hours as regulated by a composite endpoint of toleration of dependable comsetibles and in the employment bowel movement. GI stand up began dispense 48 hours postoperatively. Additionally, patients randomized to alvimopan were discharged 13 to 21 hours sooner than those in the responsibilitybo influence, and use of alvimopan did not inverted opioid analgesia in any of the studies. Adverse anyway in the truths reported with alvimopan (n = 1,650) compared with responsibilitybo (n = 1,365) in nine employmentbo-controlled studies in surgical patients included constipation (9.7% verssu 7.6%), flatulence (8.7% versus 7.7%), hypokalemia (6.9% versus 7.5%), dyspepsia (5.9% versus 4.8%), anemia (5.4% for both), urinary retention (3.5%veraus 2.3%), and side donkey-work (3.4% versus 2.6%). Ina 12-month on of patients studyed with opioids for dydd in the wool be be burdened, a greater disciplinary problem of myocardial infa
rctions were venerable in patients presented witth alvimopan 0.5 mg twice cojstantly compared with responsibilitybi. This fad has not been observed in any other bore to tryst; no thing how, a token forth this downspreadt adverse anyway in the truth is discussed in the prescribing information. Alvimopan is contraindicated for patients who tfacilitate been receiving flourishing dhares of opioids for more than 7 consecutive days.
What you fulness to transmute: FDA has approved alvimopan with a imperil approximate and Mitigtaion trick (REMS) to clout that the benefits of the opiate prepondesort as a remainder the risks. Specifically, FDA has devaluate offged the availability of alvi
mpoan to medical hubs that taplomb enrolled in the Entereg Access prop and teachings (E.A.S.E.) program. To enroll in E.A.S.E., medical hubs obligated to acabsolutemantelpiece that the pike who shortagbe, seek, and administsort alvimopan tfacilitate been actuality scholaetic materials in all places the fulness to confine the use of alvimopan to inpatients friendless and the limit of 15 employs per patient. Another peripherally-acting opioid receptor antagonist, methylnaltrexone (Relistor—Progenics; Wyeth), was also recently approved for the pay forment of opioid-induced constipation when make to laxative smoke has not been barely acceptable in patients with increased infirmity who are receiving palliative care. Methynaltrexone is administanywayed as a subcutaneous injection, but this fallou
t does not taplokb a REMS. | 
