Use of selective opiate receptor inhibitors to prevent postoperative ileus.
Ileus is a common postoperative complication after major abdominal surgery. Surgical manipulation of the bowel and stimulation of opiod receptor are the main causes of ileus. An investigational drug (ADL 8-2698, Alvinopam) a selective opioid antagonist with a very low oral absorption was recently introduced to clinical medicine. Unlike other opioid antagonist its activity is restricted to GI tract, it is potent, has a long duration of action, is orally effective, does not readily cross the blood-brain barrier even after intravenous administration in animals. Two randomized controlled clinical studies tested its effects in humans. Liu et al.'s study confirmed peripheral restriction of ADL 8-2698 by its lack of central effect on morphine analgesia and pupil miosis. They also showed that ADL 8-2698 prevents increases in gastrointestinal transit time. Taguchi et al. concluded that high dose (6 mg) of ADL 8-2698 archived fast recovery of gastrointestinal function, without antagonising analgesic efficacy of systemic opioid. In summary, selective inhibition of gastrointestinal opioid receptor by a peripherally restricted oral antagonist speeds recovery of bowel function, shortens times of hospitalization and preserves the analgesic effects of opiods.
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Neurosciences ICU, Outcomes Research Institute, University of Louisville, Louisville, KY, USA. ozan.akca@louisfville.edu
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D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D007415:Intestinal Obstruction / Q000517:prevention & control*; D008875:Middle Aged; D009292:Narcotic Antagonists; D010880:Piperidines / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
D009292:Narcotic Antagonists; D010880:Piperidines; C419502:alvimopan