title: Enteral naloxone for the treatment of opioid-induced constipation in the medical intensive care unit.
abstract: OBJECTIVE
  To determine the safety and efficacy of enteral naloxone for the treatment of opioid-induced constipation in the medical intensive care unit (MICU).
  
  
  METHODS
  This descriptive study included patients aged 18 to 89 years admitted to the MICU between July 1, 2007, and June 30, 2012, who received scheduled opioids and at least 1 dose of enteral naloxone. All data were obtained from electronic charting systems. Efficacy was assessed by evaluating time to bowel movement (BM), number of naloxone doses until BM, and ability to tolerate tube feeds after receipt of enteral naloxone. Safety was assessed by comparing opioid requirements, heart rates, and systolic blood pressures before and during naloxone treatment.
  
  
  RESULTS
  Fifteen of the 16 patients included in the final analysis passed BMs during the study period. The median time to BM was 24.4 hours. The median number of naloxone doses received prior to passing a BM was 3. Seventy-eight percent of patients who were not receiving tube feeds at the time of naloxone administration received continuous tube feeds after naloxone initiation. No adverse effects associated with use of enteral naloxone were noted.
  
  
  CONCLUSIONS
  Enteral naloxone appears safe for the treatment of opioid-induced constipation in the MICU. Enteral naloxone may be effective in treating opioid-induced constipation; however, further studies are warranted.
authors.affiliation: Veterans Affairs North Texas Health Care System/Texas Tech University Health Sciences Center School of Pharmacy, Dallas, TX.
authors.forename: Caitlin M
authors.initials: CM
authors.lastname: Gibson
authors.affiliation: Veterans Affairs North Texas Health Care System/Texas Tech University Health Sciences Center School of Pharmacy, Dallas, TX. Electronic address: steven.pass@ttuhsc.edu.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Pass
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D003248:Constipation / Q000139:chemically induced / Q000188:drug therapy*; D065187:Controlled Before-After Studies / Q000379:methods; D003672:Defecation / Q000187:drug effects; D004750:Enteral Nutrition; D005260:Female; D006339:Heart Rate; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage* / Q000009:adverse effects; D009292:Narcotic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone
keywords: Constipation; ICU analgesia; Intensive care units; Naloxone; Opioid-induced constipation; Opioids