Skip to main content
Top
Published in: Journal of Gastrointestinal Surgery 1/2021

Open Access 01-01-2021 | Naloxegol | Review Article

Peripherally Acting μ-Opioid Receptor Antagonists in the Management of Postoperative Ileus: a Clinical Review

Authors: Karim Chamie, Vishnukamal Golla, Andrew T. Lenis, Patrick M. Lec, Siamak Rahman, Eugene R. Viscusi

Published in: Journal of Gastrointestinal Surgery | Issue 1/2021

Login to get access

Abstract

Postoperative ileus (POI) and constipation are common secondary effects of opioids and carry significant clinical and economic impacts. μ-Opioid receptors mediate opioid analgesia in the central nervous system (CNS) and gastrointestinal-related effects in the periphery. Peripherally acting μ-opioid receptor antagonists (PAMORAs) block the peripheral effects of opioids in the gastrointestinal tract, while maintaining opioid analgesia in the CNS. While most are not approved for POI or postoperative opioid-induced constipation (OIC), PAMORAs have a potential role in these settings via their selective effects on the μ-opioid receptor. This review will discuss recent clinical trials evaluating the safety and efficacy of PAMORAs, with a focus on alvimopan (Entereg®) and methylnaltrexone (Relistor®) in patients with POI or postoperative OIC. We will characterize potential factors that may have impacted the efficacy observed in phase 3 trials and discuss future directions for the management and treatment of POI.
Literature
1.
go back to reference Venara A, Neunlist M, Slim K, et al. Postoperative ileus: pathophysiology, incidence, and prevention. J Visc Surg. 2016;153:439–446.PubMed Venara A, Neunlist M, Slim K, et al. Postoperative ileus: pathophysiology, incidence, and prevention. J Visc Surg. 2016;153:439–446.PubMed
2.
go back to reference Barletta JF, Asgeirsson T, Senagore AJ. Influence of intravenous opioid dose on postoperative ileus. Ann Pharmacother. 2011;45:916–923.PubMed Barletta JF, Asgeirsson T, Senagore AJ. Influence of intravenous opioid dose on postoperative ileus. Ann Pharmacother. 2011;45:916–923.PubMed
3.
go back to reference Bragg D, El-Sharkawy AM, Psaltis E, Maxwell-Armstrong CA, Lobo DN. Postoperative ileus: recent developments in pathophysiology and management. Clin Nutr. 2015;34:367–376.PubMed Bragg D, El-Sharkawy AM, Psaltis E, Maxwell-Armstrong CA, Lobo DN. Postoperative ileus: recent developments in pathophysiology and management. Clin Nutr. 2015;34:367–376.PubMed
4.
go back to reference Kraft MD. Methylnaltrexone, a new peripherally acting mu-opioid receptor antagonist being evaluated for the treatment of postoperative ileus. Expert Opin Investig Drugs. 2008;17:1365–1377.PubMed Kraft MD. Methylnaltrexone, a new peripherally acting mu-opioid receptor antagonist being evaluated for the treatment of postoperative ileus. Expert Opin Investig Drugs. 2008;17:1365–1377.PubMed
5.
go back to reference Gan TJ, Robinson SB, Oderda GM, Scranton R, Pepin J, Ramamoorthy S. Impact of postsurgical opioid use and ileus on economic outcomes in gastrointestinal surgeries. Curr Med Res Opin. 2015;31:677–686.PubMed Gan TJ, Robinson SB, Oderda GM, Scranton R, Pepin J, Ramamoorthy S. Impact of postsurgical opioid use and ileus on economic outcomes in gastrointestinal surgeries. Curr Med Res Opin. 2015;31:677–686.PubMed
6.
go back to reference Delaney CP, Chang E, Senagore AJ, Broder M. Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg. 2008;247:819–824.PubMed Delaney CP, Chang E, Senagore AJ, Broder M. Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg. 2008;247:819–824.PubMed
7.
go back to reference Delaney CP, Marcello PW, Sonoda T, Wise P, Bauer J, Techner L. Gastrointestinal recovery after laparoscopic colectomy: results of a prospective, observational, multicenter study. Surg Endosc. 2010;24:653–661.PubMed Delaney CP, Marcello PW, Sonoda T, Wise P, Bauer J, Techner L. Gastrointestinal recovery after laparoscopic colectomy: results of a prospective, observational, multicenter study. Surg Endosc. 2010;24:653–661.PubMed
8.
go back to reference The FO, Bennink RJ, Ankum WM, et al. Intestinal handling-induced mast cell activation and inflammation in human postoperative ileus. Gut. 2008;57:33–40.PubMed The FO, Bennink RJ, Ankum WM, et al. Intestinal handling-induced mast cell activation and inflammation in human postoperative ileus. Gut. 2008;57:33–40.PubMed
9.
go back to reference Senagore AJ. Pathogenesis and clinical and economic consequences of postoperative ileus. Am J Health Syst Pharm. 2007;64(suppl 13):S3-S7.PubMed Senagore AJ. Pathogenesis and clinical and economic consequences of postoperative ileus. Am J Health Syst Pharm. 2007;64(suppl 13):S3-S7.PubMed
10.
go back to reference Murphy MM, Tevis SE, Kennedy GD. Independent risk factors for prolonged postoperative ileus development. J Surg Res. 2016;201:279–285.PubMed Murphy MM, Tevis SE, Kennedy GD. Independent risk factors for prolonged postoperative ileus development. J Surg Res. 2016;201:279–285.PubMed
11.
go back to reference Augestad KM, Delaney CP. Postoperative ileus: impact of pharmacological treatment, laparoscopic surgery and enhanced recovery pathways. World J Gastroenterol. 2010;16:2067–2074.PubMedPubMedCentral Augestad KM, Delaney CP. Postoperative ileus: impact of pharmacological treatment, laparoscopic surgery and enhanced recovery pathways. World J Gastroenterol. 2010;16:2067–2074.PubMedPubMedCentral
12.
go back to reference Guay J, Nishimori M, Kopp S. Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery. Cochrane Database Syst Rev. 2016;7:CD001893.PubMed Guay J, Nishimori M, Kopp S. Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery. Cochrane Database Syst Rev. 2016;7:CD001893.PubMed
13.
go back to reference Herroeder S, Pecher S, Schonherr ME, et al. Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial. Ann Surg. 2007;246:192–200.PubMedPubMedCentral Herroeder S, Pecher S, Schonherr ME, et al. Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial. Ann Surg. 2007;246:192–200.PubMedPubMedCentral
14.
go back to reference Chen JY, Ko TL, Wen YR, et al. Opioid-sparing effects of ketorolac and its correlation with the recovery of postoperative bowel function in colorectal surgery patients: a prospective randomized double-blinded study. Clin J Pain. 2009;25:485–489.PubMed Chen JY, Ko TL, Wen YR, et al. Opioid-sparing effects of ketorolac and its correlation with the recovery of postoperative bowel function in colorectal surgery patients: a prospective randomized double-blinded study. Clin J Pain. 2009;25:485–489.PubMed
15.
go back to reference Lohsiriwat V. Opioid-sparing effect of selective cyclooxygenase-2 inhibitors on surgical outcomes after open colorectal surgery within an enhanced recovery after surgery protocol. World J Gastrointest Oncol. 2016;8:543–549.PubMedPubMedCentral Lohsiriwat V. Opioid-sparing effect of selective cyclooxygenase-2 inhibitors on surgical outcomes after open colorectal surgery within an enhanced recovery after surgery protocol. World J Gastrointest Oncol. 2016;8:543–549.PubMedPubMedCentral
16.
go back to reference Camilleri M, Lembo A, Katzka DA. Opioids in gastroenterology: Treating adverse effects and creating therapeutic benefits. Clin Gastroenterol Hepatol. 2017;15:1338–1349.PubMedPubMedCentral Camilleri M, Lembo A, Katzka DA. Opioids in gastroenterology: Treating adverse effects and creating therapeutic benefits. Clin Gastroenterol Hepatol. 2017;15:1338–1349.PubMedPubMedCentral
17.
go back to reference Viscusi ER, Gan TJ, Leslie JB, et al. Peripherally acting mu-opioid receptor antagonists and postoperative ileus: mechanisms of action and clinical applicability. Anesth Analg. 2009;108:1811–1822.PubMed Viscusi ER, Gan TJ, Leslie JB, et al. Peripherally acting mu-opioid receptor antagonists and postoperative ileus: mechanisms of action and clinical applicability. Anesth Analg. 2009;108:1811–1822.PubMed
18.
go back to reference Leppert W. Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction. Drug Des Devel Ther. 2015;9:2215–2231.PubMedPubMedCentral Leppert W. Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction. Drug Des Devel Ther. 2015;9:2215–2231.PubMedPubMedCentral
19.
go back to reference Schwenk ES, Grant AE, Torjman MC, McNulty SE, Baratta JL, Viscusi ER. The efficacy of peripheral opioid antagonists in opioid-induced constipation and postoperative ileus: a systematic review of the literature. Reg Anesth Pain Med. 2017;42:767–777.PubMed Schwenk ES, Grant AE, Torjman MC, McNulty SE, Baratta JL, Viscusi ER. The efficacy of peripheral opioid antagonists in opioid-induced constipation and postoperative ileus: a systematic review of the literature. Reg Anesth Pain Med. 2017;42:767–777.PubMed
20.
go back to reference Liu M, Wittbrodt E. Low-dose oral naloxone reverses opioid-induced constipation and analgesia. J Pain Symptom Manage. 2002;23:48–53.PubMed Liu M, Wittbrodt E. Low-dose oral naloxone reverses opioid-induced constipation and analgesia. J Pain Symptom Manage. 2002;23:48–53.PubMed
21.
go back to reference Yuan CS, Foss JF. Antagonism of gastrointestinal opioid effects. Reg Anesth Pain Med. 2000;25:639–642.PubMed Yuan CS, Foss JF. Antagonism of gastrointestinal opioid effects. Reg Anesth Pain Med. 2000;25:639–642.PubMed
22.
go back to reference Skolnick P. On the front lines of the opioid epidemic: rescue by naloxone. Eur J Pharmacol. 2018;835:147–153.PubMed Skolnick P. On the front lines of the opioid epidemic: rescue by naloxone. Eur J Pharmacol. 2018;835:147–153.PubMed
23.
go back to reference Becker G, Blum HE. Novel opioid antagonists for opioid-induced bowel dysfunction and postoperative ileus. Lancet. 2009;373:1198–1206.PubMed Becker G, Blum HE. Novel opioid antagonists for opioid-induced bowel dysfunction and postoperative ileus. Lancet. 2009;373:1198–1206.PubMed
24.
go back to reference Holzer P. New approaches to the treatment of opioid-induced constipation. Eur Rev Med Pharmacol Sci. 2008;12 (suppl 1):119–127.PubMedPubMedCentral Holzer P. New approaches to the treatment of opioid-induced constipation. Eur Rev Med Pharmacol Sci. 2008;12 (suppl 1):119–127.PubMedPubMedCentral
25.
go back to reference Leppert W, Woron J. The role of naloxegol in the management of opioid-induced bowel dysfunction. Therap Adv Gastroenterol. 2016;9:736–746.PubMedPubMedCentral Leppert W, Woron J. The role of naloxegol in the management of opioid-induced bowel dysfunction. Therap Adv Gastroenterol. 2016;9:736–746.PubMedPubMedCentral
26.
go back to reference Goodstein T, Launer B, White S, et al. A retrospective study of patients undergoing radical cystectomy and receiving peri-operative naloxegol or alvimopan: comparison of length of stay. J Surg (N Y N Y). 2018;6:129–134. Goodstein T, Launer B, White S, et al. A retrospective study of patients undergoing radical cystectomy and receiving peri-operative naloxegol or alvimopan: comparison of length of stay. J Surg (N Y N Y). 2018;6:129–134.
27.
go back to reference Entereg [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2015. Entereg [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2015.
28.
go back to reference Ludwig K, Enker WE, Delaney CP, et al. Gastrointestinal tract recovery in patients undergoing bowel resection: results of a randomized trial of alvimopan and placebo with a standardized accelerated postoperative care pathway. Arch Surg. 2008;143:1098–1105.PubMed Ludwig K, Enker WE, Delaney CP, et al. Gastrointestinal tract recovery in patients undergoing bowel resection: results of a randomized trial of alvimopan and placebo with a standardized accelerated postoperative care pathway. Arch Surg. 2008;143:1098–1105.PubMed
29.
go back to reference Buchler MW, Seiler CM, Monson JR, et al. Clinical trial: alvimopan for the management of post-operative ileus after abdominal surgery: results of an international randomized, double-blind, multicentre, placebo-controlled clinical study. Aliment Pharmacol Ther. 2008;28:312–325.PubMed Buchler MW, Seiler CM, Monson JR, et al. Clinical trial: alvimopan for the management of post-operative ileus after abdominal surgery: results of an international randomized, double-blind, multicentre, placebo-controlled clinical study. Aliment Pharmacol Ther. 2008;28:312–325.PubMed
30.
go back to reference Viscusi ER, Goldstein S, Witkowski T, et al. Alvimopan, a peripherally acting mu-opioid receptor antagonist, compared with placebo in postoperative ileus after major abdominal surgery: results of a randomized, double-blind, controlled study. Surg Endosc. 2006;20:64–70.PubMed Viscusi ER, Goldstein S, Witkowski T, et al. Alvimopan, a peripherally acting mu-opioid receptor antagonist, compared with placebo in postoperative ileus after major abdominal surgery: results of a randomized, double-blind, controlled study. Surg Endosc. 2006;20:64–70.PubMed
31.
go back to reference Delaney CP, Weese JL, Hyman NH, et al. Phase III trial of alvimopan, a novel, peripherally acting, mu opioid antagonist, for postoperative ileus after major abdominal surgery. Dis Colon Rectum. 2005;48:1114–1125.PubMed Delaney CP, Weese JL, Hyman NH, et al. Phase III trial of alvimopan, a novel, peripherally acting, mu opioid antagonist, for postoperative ileus after major abdominal surgery. Dis Colon Rectum. 2005;48:1114–1125.PubMed
32.
go back to reference Wolff BG, Michelassi F, Gerkin TM, et al. Alvimopan, a novel, peripherally acting mu opioid antagonist: results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial of major abdominal surgery and postoperative ileus. Ann Surg. 2004;240:728–734.PubMedPubMedCentral Wolff BG, Michelassi F, Gerkin TM, et al. Alvimopan, a novel, peripherally acting mu opioid antagonist: results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial of major abdominal surgery and postoperative ileus. Ann Surg. 2004;240:728–734.PubMedPubMedCentral
33.
go back to reference Herzog TJ, Coleman RL, Guerrieri JP, Jr., et al. A double-blind, randomized, placebo-controlled phase III study of the safety of alvimopan in patients who undergo simple total abdominal hysterectomy. Am J Obstet Gynecol. 2006;195:445–453.PubMed Herzog TJ, Coleman RL, Guerrieri JP, Jr., et al. A double-blind, randomized, placebo-controlled phase III study of the safety of alvimopan in patients who undergo simple total abdominal hysterectomy. Am J Obstet Gynecol. 2006;195:445–453.PubMed
34.
go back to reference Lee CT, Chang SS, Kamat AM, et al. Alvimopan accelerates gastrointestinal recovery after radical cystectomy: a multicenter randomized placebo-controlled trial. Eur Urol. 2014;66:265–272.PubMed Lee CT, Chang SS, Kamat AM, et al. Alvimopan accelerates gastrointestinal recovery after radical cystectomy: a multicenter randomized placebo-controlled trial. Eur Urol. 2014;66:265–272.PubMed
35.
go back to reference Delaney CP, Senagore AJ, Viscusi ER, et al. Postoperative upper and lower gastrointestinal recovery and gastrointestinal morbidity in patients undergoing bowel resection: pooled analysis of placebo data from 3 randomized controlled trials. Am J Surg. 2006;191:315–319.PubMed Delaney CP, Senagore AJ, Viscusi ER, et al. Postoperative upper and lower gastrointestinal recovery and gastrointestinal morbidity in patients undergoing bowel resection: pooled analysis of placebo data from 3 randomized controlled trials. Am J Surg. 2006;191:315–319.PubMed
36.
go back to reference Steele SR, Brady JT, Cao Z, et al. Evaluation of healthcare use and clinical outcomes of alvimopan in patients undergoing bowel resection: a propensity score-matched analysis. Dis Colon Rectum. 2018;61:1418–1425.PubMed Steele SR, Brady JT, Cao Z, et al. Evaluation of healthcare use and clinical outcomes of alvimopan in patients undergoing bowel resection: a propensity score-matched analysis. Dis Colon Rectum. 2018;61:1418–1425.PubMed
37.
go back to reference Al-Mazrou AM, Baser O, Kiran RP. Alvimopan, regardless of ileus risk, significantly impacts ileus, length of stay, and readmission after intestinal surgery. J Gastrointest Surg. 2018;22:2104–2116.PubMed Al-Mazrou AM, Baser O, Kiran RP. Alvimopan, regardless of ileus risk, significantly impacts ileus, length of stay, and readmission after intestinal surgery. J Gastrointest Surg. 2018;22:2104–2116.PubMed
38.
go back to reference Nemeth ZH, Bogdanovski DA, Paglinco SR, Barratt-Stopper P, Rolandelli RH. Cost and efficacy examination of alvimopan for the prevention of postoperative ileus. J Investig Med. 2017;65:949–952.PubMed Nemeth ZH, Bogdanovski DA, Paglinco SR, Barratt-Stopper P, Rolandelli RH. Cost and efficacy examination of alvimopan for the prevention of postoperative ileus. J Investig Med. 2017;65:949–952.PubMed
39.
go back to reference Brenner DM, Chey WD. An evidence-based review of novel and emerging therapies for constipation in patients taking opioid analgesics. Am J Gastroenterol Suppl. 2014;2:38–46. Brenner DM, Chey WD. An evidence-based review of novel and emerging therapies for constipation in patients taking opioid analgesics. Am J Gastroenterol Suppl. 2014;2:38–46.
40.
go back to reference Relistor [package insert]. Bridgewater, NJ: Salix Pharmaceuticals; 2018. Relistor [package insert]. Bridgewater, NJ: Salix Pharmaceuticals; 2018.
41.
go back to reference Anissian L, Schwartz HW, Vincent K, et al. Subcutaneous methylnaltrexone for treatment of acute opioid-induced constipation: phase 2 study in rehabilitation after orthopedic surgery. J Hosp Med. 2012;7:67–72.PubMed Anissian L, Schwartz HW, Vincent K, et al. Subcutaneous methylnaltrexone for treatment of acute opioid-induced constipation: phase 2 study in rehabilitation after orthopedic surgery. J Hosp Med. 2012;7:67–72.PubMed
42.
go back to reference Viscusi ER, Rathmell JP, Fichera A, et al. Randomized placebo-controlled study of intravenous methylnaltrexone in postoperative ileus. J Drug Assess. 2013;2:127–134.PubMedPubMedCentral Viscusi ER, Rathmell JP, Fichera A, et al. Randomized placebo-controlled study of intravenous methylnaltrexone in postoperative ileus. J Drug Assess. 2013;2:127–134.PubMedPubMedCentral
43.
go back to reference Yu CS, Chun HK, Stambler N, et al. Safety and efficacy of methylnaltrexone in shortening the duration of postoperative ileus following segmental colectomy: results of two randomized, placebo-controlled phase 3 trials. Dis Colon Rectum. 2011;54:570–578.PubMed Yu CS, Chun HK, Stambler N, et al. Safety and efficacy of methylnaltrexone in shortening the duration of postoperative ileus following segmental colectomy: results of two randomized, placebo-controlled phase 3 trials. Dis Colon Rectum. 2011;54:570–578.PubMed
44.
45.
go back to reference Webster L, Jansen JP, Peppin J, et al. Alvimopan, a peripherally acting mu-opioid receptor (PAM-OR) antagonist for the treatment of opioid-induced bowel dysfunction: results from a randomized, double-blind, placebo-controlled, dose-finding study in subjects taking opioids for chronic non-cancer pain. Pain. 2008;137:428–440.PubMed Webster L, Jansen JP, Peppin J, et al. Alvimopan, a peripherally acting mu-opioid receptor (PAM-OR) antagonist for the treatment of opioid-induced bowel dysfunction: results from a randomized, double-blind, placebo-controlled, dose-finding study in subjects taking opioids for chronic non-cancer pain. Pain. 2008;137:428–440.PubMed
46.
go back to reference Rollason V, Samer C, Piguet V, Dayer P, Desmeules J. Pharmacogenetics of analgesics: toward the individualization of prescription. Pharmacogenomics. 2008;9:905–933.PubMed Rollason V, Samer C, Piguet V, Dayer P, Desmeules J. Pharmacogenetics of analgesics: toward the individualization of prescription. Pharmacogenomics. 2008;9:905–933.PubMed
47.
go back to reference Webster LR, Michna E, Khan A, Israel RJ, Harper JR. Long-term safety and efficacy of subcutaneous methylnaltrexone in patients with opioid-induced constipation and chronic noncancer pain: a phase 3, open-label trial. Pain Med. 2017;18:1496–1504.PubMedPubMedCentral Webster LR, Michna E, Khan A, Israel RJ, Harper JR. Long-term safety and efficacy of subcutaneous methylnaltrexone in patients with opioid-induced constipation and chronic noncancer pain: a phase 3, open-label trial. Pain Med. 2017;18:1496–1504.PubMedPubMedCentral
48.
go back to reference Janku F, Johnson LK, Karp DD, Atkins JT, Singleton PA, Moss J. Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer. Ann Oncol. 2016;27:2032-2038.PubMedPubMedCentral Janku F, Johnson LK, Karp DD, Atkins JT, Singleton PA, Moss J. Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer. Ann Oncol. 2016;27:2032-2038.PubMedPubMedCentral
49.
go back to reference McLaughlin PJ, Stucki JK, Zagon IS. Modulation of the opioid growth factor ([Met(5)]-enkephalin)-opioid growth factor receptor axis: novel therapies for squamous cell carcinoma of the head and neck. Head Neck. 2012;34:513–519.PubMed McLaughlin PJ, Stucki JK, Zagon IS. Modulation of the opioid growth factor ([Met(5)]-enkephalin)-opioid growth factor receptor axis: novel therapies for squamous cell carcinoma of the head and neck. Head Neck. 2012;34:513–519.PubMed
50.
go back to reference Boehncke S, Hardt K, Schadendorf D, Henschler R, Boehncke WH, Duthey B. Endogenous mu-opioid peptides modulate immune response towards malignant melanoma. Exp Dermatol. 2011;20:24–28.PubMed Boehncke S, Hardt K, Schadendorf D, Henschler R, Boehncke WH, Duthey B. Endogenous mu-opioid peptides modulate immune response towards malignant melanoma. Exp Dermatol. 2011;20:24–28.PubMed
51.
go back to reference Nguyen J, Luk K, Vang D, et al. Morphine stimulates cancer progression and mast cell activation and impairs survival in transgenic mice with breast cancer. Br J Anaesth. 2014;113 (suppl 1):i4-i13.PubMedPubMedCentral Nguyen J, Luk K, Vang D, et al. Morphine stimulates cancer progression and mast cell activation and impairs survival in transgenic mice with breast cancer. Br J Anaesth. 2014;113 (suppl 1):i4-i13.PubMedPubMedCentral
52.
go back to reference Mathew B, Lennon FE, Siegler J, et al. The novel role of the mu opioid receptor in lung cancer progression: a laboratory investigation. Anesth Analg. 2011;112:558–567.PubMed Mathew B, Lennon FE, Siegler J, et al. The novel role of the mu opioid receptor in lung cancer progression: a laboratory investigation. Anesth Analg. 2011;112:558–567.PubMed
53.
go back to reference Movantik [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals; 2018. Movantik [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals; 2018.
54.
go back to reference Symproic [package insert]. Florham Park, NJ: Shionogi Inc.; 2018. Symproic [package insert]. Florham Park, NJ: Shionogi Inc.; 2018.
Metadata
Title
Peripherally Acting μ-Opioid Receptor Antagonists in the Management of Postoperative Ileus: a Clinical Review
Authors
Karim Chamie
Vishnukamal Golla
Andrew T. Lenis
Patrick M. Lec
Siamak Rahman
Eugene R. Viscusi
Publication date
01-01-2021
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 1/2021
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-020-04671-x

Other articles of this Issue 1/2021

Journal of Gastrointestinal Surgery 1/2021 Go to the issue