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Trust your gut: Effect of a pharmacist-driven pilot project to decrease alvimopan use past gastrointestinal recovery

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American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
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A pilot alvimopan stewardship program successfully reduced its use past gastrointestinal recovery. This intervention minimized potential risks and costs without negatively impacting patient outcomes.

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Area of Science:

  • Pharmacology
  • Gastroenterology
  • Surgical Recovery

Background:

  • Alvimopan accelerates gastrointestinal (GI) recovery post-surgery but may increase myocardial infarction risk.
  • Evidence suggests potential risks associated with alvimopan use beyond GI recovery.

Purpose of the Study:

  • To evaluate the effectiveness of a pilot alvimopan stewardship program.
  • To assess the program's ability to discontinue alvimopan post-GI recovery.

Main Methods:

  • Retrospective observational study of a 5-month pilot stewardship program.
  • Pharmacy resident assessed GI recovery (solid food tolerance, bowel movement/flatus).
  • Intervention recommended alvimopan discontinuation upon meeting GI recovery criteria.

Main Results:

  • 73 patients undergoing abdominal/urologic surgery were analyzed.
  • Alvimopan was continued post-GI recovery in 35.6% of patients.
  • Stewardship recommendations for discontinuation were accepted in 92.3% of cases, reducing average doses.

Conclusions:

  • A pharmacy-led stewardship program effectively identified and intervened on prolonged alvimopan use.
  • Decreasing alvimopan use post-GI recovery may reduce risks and costs.
  • The program demonstrated potential benefits without adverse patient outcomes.