Methylnaltrexone for opioid-induced constipation in pediatric oncology patients.

Abstract

BACKGROUND:

Pediatric oncology patients can experience opioid-induced constipation, which may not respond to laxative treatment. Methylnaltrexone is an opioid receptor antagonist that can reverse opioid-induced constipation without affecting analgesia. Published literature on the use of methylnaltrexone in children is very limited. This retrospective review describes the effectiveness and safety of methylnaltrexone for opioid-induced constipation in pediatric oncology patients.

PROCEDURE:

A retrospective review of health records was conducted for pediatric oncology in-patients who were prescribed methylnaltrexone between May 2008 and September 2012 at The Hospital for Sick Children. Demographic, clinical, efficacy, and safety data were collected, including; opioid, laxative, and methylnatrexone dosing and frequency.

RESULTS:

Fifteen patients (median age: 14 years, range: 4-17 years) received methylnaltrexone; 12 received a single dose while three received multiple doses. At the time of methylnaltrexone administration, patients were receiving a median oral morphine dose equivalent of 5.7 mg/kg/day (range: 1.5-29.2 mg/kg/day) and had not had any bowel movements for several days despite treatment with multiple laxatives. Methylnaltrexone was given at a mean dose of 0.15 ± 0.02 mg/kg/dose (range: 3-12 mg/dose) as a subcutaneous injection. After 14 of 19 doses administered, patients had a bowel movement within 4 hours. Three patients had documented mild gastrointestinal upset following methylnaltrexone administration. None reported a reduction of pain control or opioid withdrawal symptoms.

CONCLUSION:

This case series suggests that methylnaltrexone is safe and may be effective when given subcutaneously as a 0.15 mg/kg single dose to pediatric oncology patients with opioid-induced constipation.

• Authors: Amelia Rodrigues, Cherie Wong, Andrea Mattiussi, Sarah Alexander, Elaine Lau, L Lee Dupuis
• Journal: Pediatric blood & cancer (Pediatr Blood Cancer) Vol. 60 Issue 10 Pg. 1667-70 (Oct 2013) ISSN: 1545-5017 [Electronic] United States
• PMID: 23766091 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Copyright © 2013 Wiley Periodicals, Inc.

Chemical References

• Analgesics, Opioid
• Narcotic Antagonists
• Quaternary Ammonium Compounds
• methylnaltrexone
• Naltrexone

Topics

• Adolescent
• Analgesics, Opioid (administration & dosage, adverse effects)
• Child
• Child, Preschool
• Constipation (chemically induced, drug therapy, physiopathology)
• Female
• Humans
• Male
• Naltrexone (administration & dosage, analogs & derivatives)
• Narcotic Antagonists (administration & dosage)
• Neoplasms
• Pain (drug therapy, etiology)
• Quaternary Ammonium Compounds (administration & dosage)
• Retrospective Studies