Peripherally acting μ-opioid receptor antagonists for treatment of opioid-induced constipation in children

Area of Science:

• Pediatric pharmacology
• Gastroenterology
• Palliative care

Background:

• Opioid-induced constipation (OIC) is a prevalent issue in pediatric critical care, palliative, and postoperative settings.
• Current OIC treatments are often limited by enteral intake and may be ineffective.
• Peripherally acting mu-opioid receptor antagonists (PAMORAs), such as methylnaltrexone and naloxegol, offer a novel therapeutic approach.

Purpose of the Study:

• To evaluate the effectiveness and safety of methylnaltrexone and naloxegol for OIC in hospitalized children.
• To assess PAMORA efficacy in pediatric patients, including those with critical illness.

Main Methods:

• A retrospective study was conducted at Stollery Children's Hospital, Edmonton, Canada.
• Included were all pediatric patients who received methylnaltrexone or naloxegol for OIC.
• The primary outcome measured was the median time to the first bowel movement (BM) post-PAMORA administration.

Main Results:

• Twenty-seven pediatric patients were included in the analysis.
• The median time to the first BM after PAMORA initiation was 15.5 hours.
• Sixty-three percent of patients achieved laxation within 24 hours; no significant adverse events were reported.

Conclusions:

• This study represents the largest evaluation of PAMORA efficacy and safety in pediatric patients to date.
• Findings suggest PAMORAs are a safe and effective treatment option for OIC in hospitalized children.
• Future research should focus on prospective studies with larger cohorts, particularly for critically ill and postoperative pediatric patients experiencing OIC.