alvimopan, methylnaltrexone and post op ileus

[drhemi70]

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All,
I have been looking at this issue since methylnaltrexone came out. What I am wondering is the following:
1. is post op ileus significant in terms of cost/pain to patient/hospital?
2. is the 14-24 hour faster bowel recovery time of alvimopan significant in these terms or should we just encourage early ambulation and fluid intake.
3. is methylnaltrexone a possibility for this condition, or do you think that bowel recovery would be too quick and cause problems with those who have had some sort of bowel surgery.
Thanks,
DR

 

[nikkai]

All,
I have been looking at this issue since methylnaltrexone came out. What I am wondering is the following:
1. is post op ileus significant in terms of cost/pain to patient/hospital?
2. is the 14-24 hour faster bowel recovery time of alvimopan significant in these terms or should we just encourage early ambulation and fluid intake.
3. is methylnaltrexone a possibility for this condition, or do you think that bowel recovery would be too quick and cause problems with those who have had some sort of bowel surgery.
Thanks,
DR

For 1 & 2, depends on who you're talking to. Surgeon? Rehab? GI? Pharmacist? Patient? How would you like not being able to drop the kids off?

re: alvimopan

Check the contraindication: use of opioids at therapeutic doses for more than 7 consecutive days immediately prior to taking alvimopan

Pretty... unrealistic.

re: methylnaltrexone

The studies are using a different route and dose for post-op ileus - so as it stands right now, FDA is only approving for opioid-induced constipation.

Future in it? Cost effective? Can only speculate - Right now, for constipation, costs ~$40/2 days w/ no kickbacks.

 

[ItsOverZyvox]

I posted something about this topic months ago....I don't feel like looking it up...

 

[Priapism321]

Offer them a stick of sugar free gum, I think the evidence says it stacks up to alvimopan's "benefits" quite nicely.