Can Methylnaltrexone Safely Treat Opioid Related Constipation in the Emergency Department?

Study Overview
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Brief Summary
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The investigators want to prove that people WITHOUT advanced cancer who are taking opioid medications (for problems like back pain) can receive methylnaltrexone (MNTX) safely. Since the FDA has only approved MNTX for advanced cancer patients, the investigators' research is investigating how MNTX can work for NON-cancer patients. This research is being conducted to prove that MNTX can work for non-cancer patients with opioid related constipation.

Official Title
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Can Methylnaltrexone Safely Treat Opioid Related Constipation in the Emergency Department?

Conditions
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Colonic Inertia

Intervention / Treatment
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* Drug: Methylnaltrexone Bromide (MNTX)
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria Age 18 and greater Clinical diagnosis of constipation Any patients that report taking an opioid analgesic for greater than two (2) weeks (eg known oncology patients and chronic pain syndrome patients, including those with low back pain or sciatica) Patients must have previously tried a stable laxative regiment for at least three (3) days prior to study entry. All patients will have a flat and upright abdominal x-ray, and chest x-ray to exclude gastrointestinal (GI) obstruction. Any patients who have radiographic evidence of GI obstruction will need a CT scan of the abdomen to exclude GI obstruction prior to study enrollment. Females of childbearing potential must have a negative pregnancy test and must be encouraged to use appropriate birth control for a period after the study. Willing to comply with study instructions and sign an informed consent Exclusion Criteria: Pregnancy or lactation Recent surgery within six (6) weeks of the emergency department visit Opioid withdrawal syndrome as determined by clinical judgment. Patients with previous history of diabetic gastroparesis. Any patient who has known or suspected gastrointestinal obstruction Any patients with creatinine clearance ≤ 30 mL/min Constipation for which other medical causes cannot be excluded such as anticholinergic medications, botulinum toxin, or botulism. Any patient with SBP ≤ 80 mmHg or DBP ≤ 45 mmHg or unstable vital signs. Inability to understand or follow the instructions associated with the clinical study as determined by clinical judgment. A known history of substance abuse on methadone maintenance therapy > 12 months Allergy or contraindication to use of methylnaltrexone Prior enrollment in study

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Methylnaltrexone Bromide<br> | Drug: Methylnaltrexone Bromide (MNTX)<br>* The recommended dose of MNTX (Relistor) is 8 mg for patients weighing 38 kg to less than 62 kg (84 lbs to less than 136 lbs) or 12 mg for patients weighing 62 kg to 114 kg (136 lbs to 251 lbs). Patients whose weight is below 38 kg or greater than 114 kg, will be dosed at 0.15 mg/kg.<br>* Other names: Relistor;|
| Placebo Comparator: Normal Saline<br> | Drug: Placebo<br>* Normal saline<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Laxation |  | 4 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Opioid withdrawal symptoms |  | 36 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Constipation, opioid