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Methylnaltrexone for Opioid-Induced Dysmotility in Critically Ill Infants and Children: A Pilot Study
Christina J Smith1, Caroline M Sierra2, Joanna Robbins1
1Department of Pharmacy (CJS, JR, NYC), Loma Linda University Children's Hospital, Loma Linda, CA.
Insights
Methylnaltrexone effectively treated opioid-induced dysmotility in critically ill children, improving bowel movements and enteral nutrition with minimal side effects. This study highlights its potential as a safe and effective option for pediatric intensive care units.
Area of Science:
- Pediatric critical care medicine
- Pharmacology
- Gastroenterology
Background:
- Critically ill pediatric patients frequently experience opioid-induced dysmotility, impacting their recovery.
- Methylnaltrexone, a peripherally acting mu-opioid receptor antagonist, is a potential treatment for this condition.
- Limited data exists on methylnaltrexone's use in critically ill pediatric populations.
Purpose of the Study:
- To evaluate the effectiveness of methylnaltrexone in treating opioid-induced dysmotility in critically ill infants and children.
- To assess the safety profile of methylnaltrexone in this specific patient group.
Main Methods:
- Retrospective analysis of pediatric patients (<18 years) receiving subcutaneous methylnaltrexone in pediatric intensive care units.
- Data collected on bowel movement incidence, enteral nutrition volume, and adverse drug events.
- Included patients receiving opioids for a median of 13 days prior to methylnaltrexone administration.
Main Results:
- Bowel movements occurred within 24 hours in 81% of methylnaltrexone administrations.
- Enteral nutrition volume increased by 81% post-administration (p=0.002).
- Low incidence of adverse events, with no significant changes in sedation or pain scores; withdrawal scores and opioid MMEs decreased.
Conclusions:
- Methylnaltrexone demonstrates effectiveness in treating opioid-induced dysmotility in critically ill pediatric patients.
- The treatment appears to have a low risk of adverse effects in this population.
- Methylnaltrexone shows promise as an adjunct therapy for managing gastrointestinal complications in pediatric intensive care.
Objective:
Critically ill pediatric patients commonly experience opioid-induced dysmotility. Methylnaltrexone, a subcutaneously administered, peripherally acting mu-opioid receptor antagonist, is a compelling adjunct to enteral laxatives in patients with opioid-induced dysmotility. Data for methylnaltrexone use in critically ill pediatric patients are limited. The purpose of this study was to determine the effectiveness and safety of methylnaltrexone for opioid-induced dysmotility in critically ill infants and children.
Methods:
Patients younger than 18 years who received subcutaneous methylnaltrexone from January 1, 2013, through September 15, 2020, in the pediatric intensive care units at an academic institution were included in this retrospective analysis. Outcomes included incidence of bowel movement, enteral nutrition feeding volume, and adverse drug events.
Results:
Twenty-four patients, median age 3.5 years (IQR, 0.58-11.1), received 72 methylnaltrexone doses. The median dose was 0.15 mg/kg (IQR, 0.15-0.15). Patients were receiving a mean ± SD of 7.5 ± 4.5 mg/kg/day of oral morphine milligram equivalents (MMEs) at methylnaltrexone administration and received opioids for median 13 days (IQR, 8.8-21) prior to methylnaltrexone administration. A bowel movement occurred within 4 hours following 43 (60%) administrations and within 24 hours following 58 (81%) administrations. Enteral nutrition volume increased by 81% (p = 0.002) following administration. Three patients had emesis and 2 received anti-nausea medication. No significant changes in sedation or pain scores were observed. Withdrawal scores and daily oral MMEs decreased following administration (p = 0.008 and p = 0.002, respectively).
Conclusions:
Methylnaltrexone may be an effective treatment for opioid-induced dysmotility in critically ill pediatric patients with low risk of adverse effects.
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