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Drug Interactions between alvimopan and methylnaltrexone

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

methylnaltrexone alvimopan

Applies to: methylnaltrexone and alvimopan

GENERALLY AVOID: Concomitant use of peripherally-acting mu-opioid receptor antagonists, such as methylnaltrexone, naldemedine and naloxegol, with other opioid antagonists may result in additive pharmacologic effects and increased risk of opioid withdrawal. Symptoms consistent with opioid withdrawal including hyperhidrosis, chills, diarrhea, abdominal pain, nausea, vomiting, anxiety, irritability, increased lacrimation, rhinorrhea, and yawning have occurred in patients treated with peripherally-acting mu-opioid receptor antagonists. Patients with disruptions to the blood-brain barrier may be at increased risk.

MANAGEMENT: Concomitant use of peripherally-acting mu-opioid receptor antagonists with other opioid antagonists should generally be avoided.

References (3)
  1. (2008) "Product Information. Relistor (methylnaltrexone)." Wyeth Laboratories
  2. (2014) "Product Information. Movantik (naloxegol)." Astra-Zeneca Pharmaceuticals
  3. (2017) "Product Information. Symproic (naldemedine)." Shionogi USA Inc

Drug and food interactions

Moderate

methylnaltrexone food

Applies to: methylnaltrexone

ADJUST DOSING INTERVAL: Food may reduce the rate and extent of absorption of methylnaltrexone following oral administration. When a single 450 mg oral dose of methylnaltrexone was administered with a high-fat breakfast (approximately 800 to 1000 calories; 60% from fat, 25% from carbohydrate, and 15% from protein) in healthy study subjects, methylnaltrexone peak plasma concentration (Cmax) and systemic exposure (AUC) decreased by 60% and 43%, respectively, while time to reach Cmax delayed by 2 hours.

MANAGEMENT: Oral methylnaltrexone should be taken with water on an empty stomach at least 30 minutes before the first meal of the day.

References (1)
  1. (2008) "Product Information. Relistor (methylnaltrexone)." Wyeth Laboratories
Minor

alvimopan food

Applies to: alvimopan

Coadministration with a high-fat meal may decrease the rate and extent of alvimopan absorption. According to the product labeling, alvimopan peak plasma concentration (Cmax) and systemic exposure (AUC) were decreased by approximately 38% and 21%, respectively, and the time to reach peak plasma concentration (Tmax) was prolonged by approximately 1 hour when taken with a high-fat meal. The clinical significance is unknown. In postoperative ileus clinical trials, the preoperative dose of alvimopan was administered in a fasting state, and subsequent doses were given without regard to meals.

References (1)
  1. (2008) "Product Information. Entereg (alvimopan)." GlaxoSmithKline

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Peripheral opioid receptor antagonists

Therapeutic duplication

The recommended maximum number of medicines in the 'peripheral opioid receptor antagonists' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'peripheral opioid receptor antagonists' category:

  • alvimopan
  • methylnaltrexone

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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