alvimopan

Therapeutic Classification: gastric stimulant

Pharmacologic Classification: opioid antagonists

Indications ⬆ ⬇

REMS

Speed time to upper/lower GI recovery following partial bowel resection surgery with primary anastomosis.

Action ⬆ ⬇

Acts peripherally as μ-opioid receptor antagonist which speeds recovery of bowel function after to partial large or small bowel resection surgery with anastomosis surgery.

Therapeutic effects:

Accelerated time to bowel recovery following primary anastomotic surgery.

Pharmacokinetics ⬆ ⬇

Absorption: 6% absorbed following oral administration.

Distribution: Does not cross the blood-brain barrier.

Protein Binding: alvimopan: 80% bound to albumin; metabolite: 94% bound to albumin.

Metabolism/Excretion: Converted by bacterial flora in the GI tract to an active metabolite; elimination is mostly via biliary secretion, followed by conversion by bacterial flora. Elimination of unabsorbed drug and metabolites is via feces and urine.

Half-Life: alvimopan: 10–17 hr; metabolite: 10–18 hr.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	2 hr	12 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Therapeutic doses of opioid analgesics for more than 7 consecutive days before initiation of alvimopan;
Severe hepatic impairment or end-stage renal disease;
Complete gastrointestinal obstruction;
Pancreatic or gastric anastomoses.

Use Cautiously in:

More than 3 doses of opioids within the wk prior to surgery (↑ sensitivity to effects and adverse reactions including abdominal pain, nausea, vomiting and diarrhea);
Mild to moderate hepatic or renal impairment (↑ risk of adverse reactions);
Japanese patients (may have ↑ risk of adverse reactions);
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children.
Geri: Older adults may have ↑ sensitivity to effects.

Adv. Reactions/Side Effects ⬆ ⬇

CV: MI

F and E: hypokalemia

GI: constipation, dyspepsia, flatulence

GU: urinary retention

Hemat: anemia

MS: back pain

Interactions ⬆ ⬇

Drug-drug:

Previous (within 1 wk) opioid use ↑ risk of adverse reactions (avoid if therapeutic opioid doses used during prior wk, use cautiously if more than 3 doses have been used).

Route/Dosage ⬆ ⬇

PO (Adults ): 12 mg for 30 min–5 hr prior to surgery, then 12 mg twice daily for up to 15 doses.

Availability ⬆ ⬇

(Generic available)

Capsules: 12 mg

Assessment ⬆ ⬇

Assess bowel sounds and frequency, quantity, and consistency of stools periodically during therapy.

Lab Test Considerations:

May cause anemia and hypokalemia.

Implementation ⬆ ⬇

Must be administered only during hospitalization. Only available in hospitals enrolled in the Alvimopan REMS Program.
PO: Administer twice daily without regard to food for no more than 7 days.

Patient/Family Teaching ⬆ ⬇

Explain purpose of alvimopan to patient and that it is only to be used during hospitalization.
Advise patient to notify health care professional if they have taken long term or intermittent opioid pain therapy, including any use of opioids in the wk prior to receiving alvimopan.
Rep: Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇