The Medical Letter on Drugs and Therapeutics
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Alvimopan (Entereg) for Postoperative Ileus

The FDA has approved the marketing of alvimopan (Entereg – Adolor/GlaxoSmithKline), a selective muopioid receptor antagonist, for oral treatment of postoperative ileus after bowel resection. The only other drug in this class available in the US is subcutaneously injected methylnaltrexone (Relistor), which is approved for treatment of opioid-induced constipation in patients with advanced illness receiving palliative care.1

MECHANISM OF ACTION — Following a bowel resection, postoperative pain management regimens typically include an opioid, which is one of the causes of postoperative ileus. Taken orally, alvimopan blocks the gastrointestinal (GI) effects of opioids by binding to mu-opioid receptors in the GI tract. It does not interfere with the central analgesic effects of these drugs.

PHARMACOKINETICS — Alvimopan is poorly absorbed from the GI tract, with ... more      

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