Mills Kimberly P, McPherson Christopher C, Said Ahmed S, Lahart Michael A
Department of Pharmacy, St. Louis Children's Hospital, St. Louis, Missouri, United States.
Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States.
J Pediatr Intensive Care. 2021 Oct 7;13(1):25-31. doi: 10.1055/s-0041-1736335. eCollection 2024 Mar.
Methylnaltrexone is U.S. Food and Drug Administration (FDA) approved as a subcutaneous injection for adults with opioid-induced constipation (OIC). Case series have described the use of methylnaltrexone for OIC in the pediatric oncology population. There are limited data describing its intravenous use in critically ill pediatric patients. We conducted a retrospective observational study at St. Louis Children's Hospital. Patients less than 18 years old who received at least one dose of intravenous methylnaltrexone while admitted to an intensive care unit between January 2016 and August 2019 were included. The primary outcome was documented laxation within 24 hours of methylnaltrexone administration. Sixteen patients received a total of 34 doses of intravenous methylnaltrexone. Patients received a median of 1.69 (interquartile range [IQR], 0.9-4.86) morphine milligram equivalents per kilogram per 24 hours, over a median of 14 days (IQR, 11-30), before methylnaltrexone administration. The median dose of methylnaltrexone was 0.15 mg/kg (IQR, 0.15-0.16). Ten patients (63%) responded to the first dose of methylnaltrexone, and 14 patients (88%) responded to at least one dose. Overall, 26 doses (76%) led to patient response. Four patients (25%) experienced adverse events (emesis, abdominal pain) after methylnaltrexone administration. No signs or symptoms of opioid withdrawal were documented. Intravenous methylnaltrexone appears to be safe and effective in treating OIC in critically ill pediatric patients. No serious adverse events or signs of opioid withdrawal were observed after single and repeat dosing. Patients responded to methylnaltrexone with varying opioid dosing and durations prior to administration.
甲基纳曲酮已获美国食品药品监督管理局（FDA）批准，可用于皮下注射治疗成人阿片类药物引起的便秘（OIC）。病例系列研究描述了甲基纳曲酮在儿科肿瘤患者中用于治疗OIC的情况。关于其在重症儿科患者中静脉使用的数据有限。
我们在圣路易斯儿童医院进行了一项回顾性观察研究。纳入2016年1月至2019年8月期间入住重症监护病房时接受至少一剂静脉注射甲基纳曲酮的18岁以下患者。主要结局是在甲基纳曲酮给药后24小时内有排便记录。
16例患者共接受了34剂静脉注射甲基纳曲酮。在使用甲基纳曲酮之前，患者每24小时每公斤接受的吗啡毫克当量中位数为1.69（四分位间距[IQR]，0.9 - 4.86），中位时间为14天（IQR，11 - 30）。甲基纳曲酮的中位剂量为0.15mg/kg（IQR，0.15 - 0.16）。10例患者（63%）对第一剂甲基纳曲酮有反应，14例患者（88%）对至少一剂有反应。总体而言，26剂（76%）导致患者有反应。4例患者（25%）在甲基纳曲酮给药后出现不良事件（呕吐、腹痛）。未记录到阿片类药物戒断的体征或症状。
静脉注射甲基纳曲酮在治疗重症儿科患者的OIC方面似乎是安全有效的。单次和重复给药后未观察到严重不良事件或阿片类药物戒断的体征。患者在给药前使用不同剂量和持续时间的阿片类药物时对甲基纳曲酮均有反应。
