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
IX. Resources
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Related Studies
Definition (NCI) | A synthetic trans-3,4-dimethyl-4-(3-hydroxyphenyl) piperidine with peripherally selective opioid mu receptor antagonist activity. Alvimopan is a selective and competitive antagonist at mu-opioid receptors, found in myenteric and submucosal neurons and the immune cells of the lamina propria in the human gut. Upon administration, this agent binds to mu-opioid receptors in the gut, thereby reversing opioid-related disturbances in gut motility. Alvimopan is approximately three to nine times more potent than naloxone. |
Definition (PDQ) | A synthetic trans-3,4-dimethyl-4-(3-hydroxyphenyl) piperidine with peripherally selective opioid mu receptor antagonist activity. Alvimopan is a selective and competitive antagonist at mu-opioid receptors, found in myenteric and submucosal neurons andthe immune cells of the lamina propria in the human gut. Upon administration, this agent binds to mu-opioid receptors in the gut, thereby reversing opiod-related disturbances in gut motility. Alvimopan is approximately three to nine times more potent than naloxone. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=453551&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=453551&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C49096" NCI Thesaurus) |
Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
MSH | C419502 |
SnomedCT | 437917007, 437886007 |
English | Alvimopan, Alvimopan (substance), Alvimopan (product), ALVIMOPAN, alvimopan [Chemical/Ingredient], trans-3,4-dimethyl-4-(3-hydroxyphenyl) piperidine, alvimopan |
Spanish | alvimopán (producto), alvimopán, alvimopán (sustancia) |