Drug Relieves Opioid-Induced Constipation in Critically Ill

Methylnaltrexone improves bowel function compared with conventional rescue laxatives

MONDAY, March 5 (HealthDay News) -- For critically ill patients with opioid-induced constipation, treatment with methylnaltrexone (MNTX) is associated with improved bowel function compared with standard rescue therapy, according to a study published in the March issue of the Mayo Clinic Proceedings.

Sergio B. Sawh, M.B., B.Ch., from Charing Cross Hospital in London, and colleagues investigated whether MNTX improved gastrointestinal function in critically ill patients. Conventional rescue therapy was compared with subcutaneous MNTX in 15 nonsurgical critical care patients receiving fentanyl infusions and having an absence of laxation within 72 hours of intensive care unit admission, despite receiving treatment with senna and sodium docusate. Eight patients received conventional rescue therapy and seven received MNTX.

The researchers found that, within 24 hours of treatment, laxation occurred for six of the seven patients treated with MNTX, but for none of the patients receiving conventional treatment (P = 0.001). There was a 3.5-day median difference in time to laxation between the two groups (P < 0.001). Four patients treated with conventional therapy and all patients treated with MNTX progressed to full enteral feeding, although the difference was not significant (P = 0.08). There was no significant difference in intensive care unit mortality between the groups (P = 0.61).

"We found MNTX to be very effective in producing laxation when compared with conventional rescue laxatives in our critically ill patients," the authors write. "Our observations demonstrate a potential role for MNTX in managing opioid-induced constipation in critically ill patients and suggest that a larger controlled study in the intensive care unit environment is merited."

One of the authors disclosed financial ties to Salix Pharmaceuticals, which has acquired the license for the development of MNTX.

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