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 firstname.lastname@example.org to obtain copies. Journalists wishing to set up interviews with the authors should contact Dr. Parind Patel at email@example.com.
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 global information analytics business that helps institutions and professionals progress science, advance healthcare and improve performance for the benefit of humanity. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, more than 35,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com
+1 732 238 3628