Methylnaltrexone for Opioid-Induced Constipation in Pediatric Oncology Patients

Background Pediatric oncology patients can experience opioid-induced constipation, which may not respond to laxative treatment. Methylnaltrexone is an opioid receptor antagonist that can reverse opioid-induced constipation without affecting analgesia. Published literature on the use of methylnaltrexone in children is very limited. This retrospective review describes the effectiveness and safety of methylnaltrexone for opioid-induced constipation in pediatric oncology patients. Procedure A retrospective review of health records was conducted for pediatric oncology in-patients who were prescribed methylnaltrexone between May 2008 and September 2012 at The Hospital for Sick Children. Demographic, clinical, efficacy, and safety data were collected, including; opioid, laxative, and methylnatrexone dosing and frequency. Results Fifteen patients (median age: 14 years, range: 4-17 years) received methylnaltrexone; 12 received a single dose while three received multiple doses. At the time of methylnaltrexone administration, patients were receiving a median oral morphine dose equivalent of 5.7mg/kg/day (range: 1.5-29.2mg/kg/day) and had not had any bowel movements for several days despite treatment with multiple laxatives. Methylnaltrexone was given at a mean dose of 0.15 +/- 0.02mg/kg/dose (range: 3-12mg/dose) as a subcutaneous injection. After 14 of 19 doses administered, patients had a bowel movement within 4hours. Three patients had documented mild gastrointestinal upset following methylnaltrexone administration. None reported a reduction of pain control or opioid withdrawal symptoms. Conclusion This case series suggests that methylnaltrexone is safe and may be effective when given subcutaneously as a 0.15mg/kg single dose to pediatric oncology patients with opioid-induced constipation. Pediatr Blood Cancer 2013;60:1667-1670. (c) 2013 Wiley Periodicals, Inc.