Post operative ileus

Adverse reactions-

Hematologic -  anemia 4%

GI -       constipation   3%  dyspepsia  4%   flatulence 4%

GU -    urinary retension  2%

Metabolic/nutriontional -    hypokalemia   8%

Musculoskeletal -  back pain 1%

Special precautions-
Opiod tolereance and GI adverse reactions-  patients exposed to opiods are more sensitive
to effects of mu-opiod receptors antagonists.

Because alvimopan acts pripherally clinicalsigns and symptoms of increased sensitivity
would be limited to GI tract  eg abdominal pain,  diarrhea, nausea and vomiting.
 Administer avimopan 12mg capsules to these patients with  caution

Bowel obstruction- use amimopan in patients undergoing surgery for correction of complete
bowel obstruction is not recommended

Renal function impairment- patients with mild to severe renal function impairment  do not
require dosage adjustments, but closely monitor these patients for adverse reactions.
eg cramping, diarrhea, GI pain.

Hepatic function impairment - alvimpoan is not recommended for use in patients with severe
hepatic impairment.

Pregnancy -use this drug during pregnancy only if clearly needed

Lactation- excercise caution when administering alvimopan to breast feeding women.

Children- safey and efficacy in children have not been established

Elderly- no dosage adjustment based on age is required on elderly patients

Indication-
Post operative ileus

Dosage-
Maximum dose - 12mg twice daily for no more than 15 doses

1. Inform patients that they must disclose long term or intermittant opoid pain therapy, including
   any use of opiods in the week prior to receiving alvimopan

2. Inform them  that the recent use of opiods may make them more susceptible to adverse
reactions of alvimopan

3. Inform patients that alvimopan is meant for hospital use only for more 7 days after bowel
   resection surgery.

4. Inform patients that most common adverse reactions with alvimopan in patients
   undergoing bowel rescetion are constipation, dyspapsia and flatulence

Pregnancy -
Use this drug during pregnancy only if clearly needed

Lactation-
Excercise caution when administering alvimopan to breast feeding women.

Children-
Safey and efficacy in children have not been established

Elderly-
No dosage adjustment based on age is required on elderly patients