Methylnaltrexone

Specialties Hospice

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Specializes in Hospice, Palliative Care, Gero, dementia.

Methylnaltrexone, is a peripherally acting opioid antagonist (it blocks the mu-opioid receptor peripherally but does not cross the blood brain barrier so has no effect on opioids central effects - analgesia, sedation, etc.). It is being commercially developed in the US for intractable constipation, and the latest results look really good. It's given IV or subcutaneously. It seems to work really well, and possibly be helpful for nausea too.

The biggest issue, I would think is cost. I think it's expected to cost about $40/dose -- a lot more than what we usually use for constipation.

So, I'm wondering -- has anyone heard discussion of the use of this w/i their agency/institution?

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we've used it...

relistor sc.

amazing results but so far, not covered by insurance.

leslie

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Specializes in Hospice, Palliative Care, Gero, dementia.

What was the dosing? Was it a one-time thing, or did you need to repeat? Any side effects? As I said, I have a feeling the cost/lack of coverage is going to keep it from reaching common use.

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What was the dosing? Was it a one-time thing, or did you need to repeat? Any side effects? As I said, I have a feeling the cost/lack of coverage is going to keep it from reaching common use.

it's supposed to be given qod, but no more than qd.

dosing is 8mg for approx 80-130 lbs:

and 12mg for 130-250lbs

250 = .15mg/kg

renal dosing = 1/2 dose

contraindicated w/gi obstxn

most common se's - abd pain, gas, nausea, diarrhea, dizziness

although, mostly very well tolerated

i see results from 1/2 hr to a few hrs.

ours comes in a kit w/7 trays.

and yes, we need to keep them on this regimen since we use it as a last resort and have been dx'd with refractory oic.

leslie

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Specializes in Hospice, Palliative Care, Gero, dementia.

Thanks for the responses Leslie. now, possibly stupid question: OIC? sorry, not getting the abbreviation Miriam

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OIC? sorry, not getting the abbreviation Miriam

oic = opioid induced constipation

leslie

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Specializes in Hospice, Palliative Care, Gero, dementia.
oic = opioid induced constipation

leslie

ah, thanks. I think some abbreviations have become very context-driven. (Granted, this was the context, but maybe not the context my head was in) :D

miriam

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