Alvimopan Guideline Summary

Introduction to Alvimopan

• Alvimopan is a peripherally acting mu-opioid receptor antagonist (PAMORA) that works by binding to GI tract μ-opioid receptors, antagonizing opioid effects on GI motility and secretion, and having restricted ability to cross the blood-brain barrier, thus not affecting opioid analgesia, as reported by the American Gastroenterological Association 1

Indications and Contraindications

• The American Society of Anesthesiologists recommends that alvimopan should be held preoperatively according to perioperative management guidelines 2
• The FDA approves alvimopan specifically for the in-hospital management of postoperative ileus following bowel resection surgery, but it is not FDA-approved for opioid-induced constipation (OIC) in chronic non-cancer pain, as stated by the American College of Gastroenterology 1

Efficacy and Benefits

• Alvimopan significantly improves time to first bowel movement (HR 1.27, 95% CI 1.12 to 1.43) and time to first toleration of solid food (HR 1.22, 95% CI 1.11 to 1.34) in patients after bowel resection, according to the Society of Surgical Oncology 3
• Alvimopan does not interfere with the analgesic properties of mu-opioid agonists when used as directed, as recommended by the American Society of Anesthesiologists 2

Alternative Options

• When considering peripherally acting mu-opioid receptor antagonists for chronic opioid-induced constipation, other FDA-approved options like methylnaltrexone, naloxegol, or naldemedine should be considered instead, as suggested by the American Gastroenterological Association 1