Methylnaltrexone bromide
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Free air, elevated lactic acid and frank bowel perforation: 3 case reports A single center, retrospective chart review of all pediatric and adult patients, who were treated with methylnaltrexone bromide between 1 January 2009 and 31 December 2016, described three women, aged 57–84 years, who developed free air (n=1), elevated lactic acid (n=1) or fatal frank bowel perforation (n=1) during treatment with methylnaltrexone bromide for opioid induced constipation [dosages not stated; not all outcomes stated]. Three women had underlying pancreatic cancer with peritoneal carcinomatosis. Additionally, the women had opioid induced constipation. Therefore, the women received SC methylnaltrexone bromide [methylnaltrexone]. Two of these three women developed free air 9 days after methylnaltrexone bromide administration in the setting of worsening distention, Clostridium difficile infection and cecostomy (n=1) or elevated lactic acid at 1 day after methylnaltrexone bromide administration (n=1). The remaining woman developed bowel perforation 1 day post methylnaltrexone bromide [methylnaltrexone] administration, that eventually resulted in death. In this woman methylnaltrexone bromide was administered for clinical and radiographic evidence of prominent stool burden throughout the colon despite unspecified laxatives, with resultant worsening abdominal pain and distention. A CT-scan showed a new frank bowel perforation with large volume pneumoperitoneum, fecal material in the peritoneal cavity and diffusely thickened small bowel with enhancing peritoneal reflections consistent with peritonitis. She was treated with unspecified broadspectrum antibiotics. However, due to poor overall prognosis, she received comfort care and died within 36 hours. Nelson KK, et al. Methylnaltrexone is safe in cancer patients with peritoneal carcinomatosis. Scientific Reports 9: No. 1, 2019. Available from: URL: http://doi.org/10.1038/ 803518232 s41598-019-44864-2
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Reactions 28 Nov 2020 No. 1832
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