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Methylnaltrexone use in a seventeen-month-old female with progressive cancer and rectal prolapse
Jamie E Laubisch1, Justin N Baker
1Department of Oncology, St. Jude Children's Research Hospital , Memphis, Tennessee.
Insights
Methylnaltrexone effectively treated opioid-induced constipation and rectal prolapse in a pediatric patient. This intervention offers a promising solution for children with severe symptoms unresponsive to other treatments.
Area of Science:
- Pediatric Gastroenterology
- Palliative Care
- Pharmacology
Background:
- Opioid-induced constipation (OIC) is a significant challenge in pediatric palliative care.
- Managing OIC becomes difficult as patients' conditions decline, complicating enteral treatments.
Observation:
- A 17-month-old girl with progressive leukemia experienced severe OIC and rectal prolapse.
- Standard laxation regimens were insufficient, and enteral treatments were challenging due to her condition.
Findings:
- Subcutaneous methylnaltrexone (0.12 mg/kg) rapidly resolved OIC and rectal prolapse within one hour.
- The μ-opioid-receptor antagonist methylnaltrexone demonstrated safety and efficacy in this pediatric case.
- No adverse effects were reported following the administration of methylnaltrexone.
Implications:
- Methylnaltrexone may be a valuable option for managing severe OIC in pediatric patients who cannot tolerate oral laxatives.
- Earlier consideration of methylnaltrexone could alleviate significant distress in critically ill children.
- Further prospective research is warranted to establish optimal dosing and usage parameters for methylnaltrexone in pediatric populations.
Background:
Opioid-induced constipation is commonly seen in pediatrics, especially at the end of life. As patients clinically decline, constipation often leads to increased pain and distress, while its enteral treatment becomes more challenging.
Method:
There is little information about the safety and use of methylnaltrexone in children. We present the case of a 17-month-old girl with progressive leukemia who was at the end of her life and whose severe opioid-induced constipation and rectal prolapse was successfully treated with the μ-opioid-receptor antagonist methylnaltrexone. We selected a lower dose based on our lack of experience with methylnaltrexone in this age group and concern for potential complications given her rectal prolapse.
Discussion:
Opioid-induced constipation, abdominal distention, and rectal prolapse caused our patient's most distressing symptoms, even in the context of advanced cancer. A single dose of subcutaneous methylnaltrexone (0.12 mg/kg) resolved her constipation and rectal prolapse within one hour. Although evidence is limited, the drug has successfully been used in pediatric patients with no reported side effects to date. We recommend its use earlier in the course of severe opioid-induced constipation in children unable to tolerate an oral laxation regimen. Prospective research is needed to establish the parameters for use of this effective agent in children who cannot tolerate other regimens.
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