Clinical Medicine Reviews in Therapeutics

Postoperative ileus (POI) increases morbidity and prolongs hospital stay after bowel resection. Alvimopan is a µ-antagonist designed to counteract gastrointestinal side effects of opiates without impairing analgesia due to its inability to pass the blood brain barrier. Because of its association with myocardial events in a long term study where it was applied to treat opiate-induced constipation, approval by the FDA in 2008 for POI is restricted to short term inpatient use. This review gives an overview about pharmacology, efficacy and economic aspects of alvimopan for the treatment of POI. Alvimopan consistently accelerated gastrointestinal recovery in all moderately well designed trials represented by decreasing the time to first bowel movement and tolerance of solid food after surgery. There is limited evidence about its economic impact by shortening the length of hospital stay. Its role in upcoming multimodal perioperative “fast track” programs cannot be defined from currently available data.