Alvimopan (entereg) for the management of postoperative ileus in patients undergoing bowel resection

Postoperative ileus (POI) after open abdominal surgery and bowel resection can lead to significant patient discomfort, morbidity, and prolonged length of stay in the hospital. Several factors have been implicated in the pathophysiology of POI, including surgical manipulation of the bowel, inflammation, inhibitory neural reflexes, and endogenous and exogenous opioids. Alvimopan (Entereg), approved by the FDA to accelerate upper and lower gastrointestinal (GI) recovery following partial large-bowel or small- bowel resection with primary anastomosis, represents a potential advance in the care of these patients. In five randomized, double-blind, placebo-controlled, phase 3 clinical trials, alvimopan, compared with placebo, accelerated the time to GI recovery and hospital discharge status after bowel resection. In this article, we review the formulary details of alvimopan for in-hospital management of POI following this procedure.