II. Indications
- Promotion of upper and lower gastrointestinal recovery following partial bowel resection with primary anastomosis
- Approved only for short-term management (15 doses) of post-operative ileus
- Only hospitals FDA approved may dispense Alvimopan
III. Contraindications
- Continuous Opioids at therapeutic dosess >7 days
- Severe hepatic dysfunction
- Severe renal dysfunction
IV. Mechanism
- Synthetic piperidine that is peripherally, a selective and Competitive Antagonist at the Opioid mu receptor
- Active at the myenteric and submucosal Neurons and the immune cells of the lamina propria in the Gastrointestinal Tract
- Alvimopan is more potent than Naloxone by a factor of 3 to 9
- Block Opioid binding in the intestinal tract
- Decreases mu-Opioid receptor mediated bowel paralysis
V. Dosing: Perioperative
- Start 12 mg orally 30 min to 5 hours prior to surgery (partial bowel resection with primary anastomosis)
- Next: 12 mg orally twice daily on the day after surgery for up to 7 days (15 doses)
VI. Pharmacokinetics
- Serum concentrations may be 2 fold higher in patients of Japanese descent
VII. Adverse Effects
-
Myocardial Infarction risk
- FDA enforces restricted prescribing of Alvimopan
VIII. Safety
- Pregnancy Category B
- Unknown safety in Lactation