al-VI-mo-pan

Therapeutic Classification: gastric stimulant

Pharmacologic Classification: opioid antagonists

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

• 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.

• Accelerated time to bowel recovery following primary anastomotic surgery.

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.

(plasma concentrations)

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.

CV: MI.

F and E: hypokalemia.

GI: constipation, dyspepsia, flatulence.

GU: urinary retention.

Hemat: anemia.

MS: back pain.

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).

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

(Generic available)

• Capsules: 12 mg;

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

• May cause anemia and hypokalemia.

• 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.

• 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.

• Resolution of postoperative ileus following bowel resection.

Entereg

NDC Code^*

• 67919- Merck Sharp and Dohme Corp.
  • 67919-020- Entereg
    • 67919-020-10- 6 BLISTER PACK in 1 CARTON (67919-020-10) > 5 CAPSULE in 1 BLISTER PACK