New Treatment May Reduce Opioid-Induced Constipation in Critical Care Patients
Promising results reported in Mayo Clinic Proceedings
Rochester, MN, March 1, 2012 – Opioids are a mainstay of care in the critical care unit, but their use frequently causes constipation which can lead to adverse outcomes including delayed feeding and later discharge from the ICU. Researchers from London, UK, and Chicago, IL, have found that methylnaltrexone (MNTX), a peripheral opioid antagonist, may restore bowel function in critically ill patients. Their retrospective study appears in the March issue of Mayo Clinic Proceedings.
“We found MNTX to be very effective in producing laxation when compared with conventional laxatives in our critically ill patients. MNTX was well tolerated and did not demonstrate any signs of reversing the effects of centrally mediated analgesia or precipitate withdrawal,” says lead author Parind B. Patel, MBBS, FRCA, Critical Care Medicine, Hammersmith Hospital, London. MNTX was developed at the University of Chicago by Dr. Jonathan Moss.
Researchers reviewed 88 nonsurgical critical care patients in their ICU during a 10-week period. 15 of the patients suffered from opioid induced constipation (OIC) within 72 hours of admission to the ICU. 7 were managed with MNTX and 8 were managed with conventional therapy consisting of sodium picosulfate and glycerin suppositories.
The most striking result was the immediate effect of MNTX. Laxation occurred within 24 hours in 6 of the 7 patients, compared with none of the 8 patients in the conventional therapy group. MNTX was ineffective in one patient with a large intra-abdominal hematoma. When this patient was excluded from the analysis, the MNTX-treated patients laxated within 7.8 hours vs. 96.0 hours for patients who received conventional treatment.
“We observed a clinically significant improvement in feeding and decreased gastric residual volumes in our patients with MNTX treatment,” notes Dr. Patel. “Although our study was too small to demonstrate statistical significance, the improvement in enteral feeding suggests that further study is merited. The reduction in residual volumes following MNTX was dramatic and facilitated early target enteral feeding. There is a trend toward improved outcome, but our study was too small to document this statistically.”
The lack of suitable therapy has hampered study of bowel function in the ICU. “Our findings demonstrate a potential role for MNTX in managing OIC in critically ill patients and suggest that a larger controlled study in the ICU environment is merited,” Dr. Patel concludes.
# # #
Notes for editors
The article is “Use of Methylnaltrexone for the Treatment of Opioid-Induced Constipation in Critical Care Patients,” by Sergio B. Sawh, MA, MB BCh, BAO, AFRCSI; Ibrahim P. Selvaraj, MBBS, MD, FRCA; Akila Danga, MBBS, BSc; Alison L. Cotton, PGDipClinPharm, MRPharmS; Jonathan Moss, MD, PhD; and Parind B. Patel, MBBS, FRCA. Mayo Clinic Proceedings, Volume 87, Issue 3 (March 2012), DOI: 10.1016/j.mayocp.2011.11.014, published by Elsevier.
Full text of the article is available to credentialed journalists upon request. Contact Eileen Leahy at +1 732 238 3628or email@example.com to obtain copies. Journalists wishing to set up interviews with the authors should contact Dr. Parind Patel at firstname.lastname@example.org.
About Mayo Clinic Proceedings
The flagship journal of Mayo and arguably one of the premier peer-reviewed clinical journals in general medicine, Mayo Clinic Proceedings is among the most widely read and highly cited scientific publications for physicians, with a circulation of approximately 124,000. While the Journal is sponsored by Mayo Clinic, it welcomes submissions from authors worldwide, publishing articles that focus on clinical medicine and support the professional and educational needs of its readers. www.mayoclinicproceedings.org
About Mayo Clinic
Mayo Clinic is a nonprofit worldwide leader in medical care, research, and education for people from all walks of life. For more information visit www.mayoclinic.org/about / and www.mayoclinic.org/news.
Elsevier is a world-leading provider of scientific, technical and medical information products and services. The company works in partnership with the global science and health communities to publish more than 2,000 journals, including The Lancet and Cell, and close to 20,000 book titles, including major reference works from Mosby and Saunders. Elsevier’s online solutions include ScienceDirect, Scopus, SciVal, Reaxys, ClinicalKey and Mosby’s Suite, which enhance the productivity of science and health professionals, helping research and health care institutions deliver better outcomes more cost-effectively.
A global business headquartered in Amsterdam, Elsevier employs 7,000 people worldwide. The company is part of Reed Elsevier Group plc, a world leading provider of professional information solutions. The group employs more than 30,000 people, including more than 15,000 in North America. Reed Elsevier Group plc is owned equally by two parent companies, Reed Elsevier PLC and Reed Elsevier NV. Their shares are traded on the London, Amsterdam and New York Stock Exchanges using the following ticker symbols: London: REL; Amsterdam: REN; New York: RUK and ENL.Media contact
+1 732 238 3628