Entereg (alvimopan) / Merck (MSD) - LARVOL DELTA

Multidisciplinary Postoperative Ileus Management: A Narrative Review. (PubMed, Medicina (Kaunas)) - "Adjuvant interventions such as alvimopan, caffeine, and chewing gum have demonstrated efficacy in modulating the neurogenic and inflammatory components of postoperative ileus. Minimally invasive approaches, comprehensive perioperative management, and adjuvant therapies hold promise for prevention. Current management relies heavily on supportive care, underscoring the need for research into the underlying neurogenic and inflammatory mechanisms to guide the development of targeted treatments."

Journal • Review • Inflammation

Alvimopan as a Rescue Treatment of Postoperative Ileus (clinicaltrials.gov) - P4 | N=65 | Completed | Sponsor: Scott Steele | Recruiting ➔ Completed

Trial completion

Perioperative Naloxegol use in prevention of post-operative ileus in open radical cystectomy (UAA 2025) - "Among these, Alvimopan is well-studied and has demonstrated reductions in postoperative ileus, length of hospital stay (LOS), and associated healthcare costs, particularly in procedures such as radical cystoprostatectomy. In this retrospective cohort, perioperative Naloxegol use did not confer a measurable benefit in accelerating gastrointestinal recovery following open radical cystectomy. Despite similar baseline characteristics, Naloxegol was associated with a significantly longer hospital stay and showed no reduction in time to flatus, bowel motion, resumption of diet or complication rate. These findings question the routine use of Naloxegol in this setting and underscore the need for prospective studies to better define its role in enhanced recovery protocols."

Ileus After Colectomy in the Modern Era: A Population-Based Analysis. (PubMed, Dis Colon Rectum) - "The low observed rate of ileus may reflect the modern era of enhanced recovery and minimally invasive colectomy. Total colectomy is associated with high rate of ileus compared to partial colectomy. Increased implementation of minimally invasive surgery, perioperative alvimopan, and early ambulation might further reduce ileus rates. See Video Abstract."

Journal • Chronic Obstructive Pulmonary Disease • Gastrointestinal Disorder • Immunology • Obstructive Sleep Apnea • Pulmonary Disease • Respiratory Diseases • Sleep Apnea • Sleep Disorder

A Prospective Randomized Controlled Trial of the Effectiveness of Alvimopan as a Rescue Treatment of Postoperative Ileus Following Colorectal Surgery (ASCRS 2025) - "GI: GastrointestinalTable 1. Patient characteristics and demographics"

Clinical • Surgery • Gastrointestinal Disorder

Ileus after colectomy in the modern era: a populationbased analysis (ASCRS 2025) - "Total colectomy is associated with a high rate of ileus compared to segmental colectomy. Increased implementation of minimally-invasive surgery, perioperative alvimopan, and early ambulation might further reduce ileus rates.Bivariate Analysis - No Ileus vs IleusOdds Ratios Plot"

Clinical • Colorectal Cancer • Gastrointestinal Cancer • Oncology • Solid Tumor

Ileus after robotic colectomy: A single institution comparison in enhanced recovery (ASCRS 2025) - "Alvimopan (p=0.107) and TAP blocks (p=0.257) were not associated with decreased ileus. There was no significant difference in ileus between right and left colectomy (p=0.422).Conclusion/ Postoperative opioids were the only modifiable risk factor for ileus after robotic segmental colectomy. Increasing emphasis on opioid-sparing and other targeted enhanced recovery pathway options should focus on further decreasing the incidence of this vexing postoperative complication.Patient CharacteristicsMultivariable Analysis"

Clinical • Gastrointestinal Disorder • Oncology

O-Desmethyltramadol Enhanced Anti-Cancer Efficacy over Tramadol Through Non-μ-Opioid Receptor and Differential Cellular Contexts of Human Breast Cancer Cells. (PubMed, Int J Mol Sci) - "The presence of a μ-opioid receptor antagonist Alvimopan did not alter the cytotoxic effects of tramadol and O-desmethyltramadol, indicating a non-opioid receptor-mediated mechanism...Overall, our findings indicated that O-desmethyltramadol exerted potent anti-cancer effects through multiple non-opioid mechanisms, with distinct response from tramadol depending on breast cancer subtype. These findings not only highlight the therapeutic potential of O-desmethyltramadol as a novel adjunct in breast cancer treatment, but also emphasize the need for further investigation into its safety and clinical applicability in oncology."

Journal • Breast Cancer • Oncology • Pain • Solid Tumor • ATF4 • CHAC1 • DDIT3 • IL6

ALVIMOPAN ADDITION TO ENHANCED RECOVERY PROGRAM SPEEDS RECOVERY FOLLOWING COLORECTAL SURGERY (SSAT 2025) - "The addition of Alvimopan to an existing ERAS protocol in patients undergoing colorectal surgery is associated with significant additional reductions in both LOS and rates of postoperative ileus. Maintaining a high quality of care requires ongoing attention to existing protocols, adaptations where necessary, and continuous outcomes assessment to demonstrate improvement with those adaptations"

Surgery • Cardiovascular • Infectious Disease • Renal Disease

ALVIMOPAN ADDITION TO ENHANCED RECOVERY PROGRAM SPEEDS RECOVERY FOLLOWING COLORECTAL SURGERY (DDW 2025) - No abstract available

Surgery

Underutilization of Alvimopan in Radical Cystectomy: A National Perspective on Benefits and Low Adoption Rates (AUA 2025) - "This study provides a nationally representative view of alvimopan use for radical cystectomy, finding that only 39.3% of patients received the medication despite widespread evidence supporting its use. We are able to highlight the median time to alvimopan discontinuation (five doses), suggesting return of bowel function at 60 hours after RC. Further, we associate alvimopan use with decreased antinausea medication need and less GI morbidity to highlight the patient-centered improvement in peri-cystectomy care with alvimopan use."

Bladder Cancer • Gastrointestinal Disorder • Genito-urinary Cancer • Oncology • Solid Tumor

Comparing Rates of Postoperative Complications after Colorectal Surgery with Naloxegol versus Alvimopan (ASHP 2024) - No abstract available

Surgery

Evaluation of Alvimopan in minimally invasive procedures using ERAS (ASHP 2024) - No abstract available

Evaluation of Adherence to Alvimopan Formulary Restriction Criteria to Improve Patient Safety (ASHP 2024) - No abstract available

Adherence • Clinical

Effect of Alvimopan and Naloxegol for PostOperative Ileus in a Community Hospital (ASHP 2024) - No abstract available

Clinical

Alvimopan Medication Use Management Cost Savings Initiative (ASHP 2024) - No abstract available

HEOR

Postoperative ileus and possibilities of pharmacological intervention. (PubMed, Rozhl Chir) - "Postoperative ileus is still recognized as severe complication. Pharmacological treatment options are limited, only a few substances have evident positive impact (neostigmin for treatment and alvimopan - not registered in the Czech Republic for prevention). More evidence is necessary for positive effect of 5-hydroxytryptamine 4 (5HT4) agonists, and the effect of selective COX-2 inhibitors is still controversial."

Journal • Review • Inflammation

A Study of Surgical Techniques During Cystectomy (clinicaltrials.gov) - P3 | N=530 | Recruiting | Sponsor: Memorial Sloan Kettering Cancer Center

New P3 trial • Bladder Cancer • Genito-urinary Cancer • Oncology • Solid Tumor

Recovery of gastrointestinal functional after surgery for abdominal tumors: A narrative review. (PubMed, Medicine (Baltimore)) - "Interventions that can shorten or prevent such ileus include minimally invasive surgery, early enteral nutrition as well as use of chewing gum, laxatives, and alvimopan. Most of these interventions have been integrated into current guidelines for enhanced recovery of gastrointestinal function after surgery. Future high-quality research is needed in order to clarify our understanding of efficacy and safety."

Journal • Review • Surgery • Gastrointestinal Disorder • Infectious Disease • Oncology • Pain

Alvimopan for postoperative ileus following abdominal surgery: a systematic review. (PubMed, Langenbecks Arch Surg) - "Alvimopan shows promise in reducing POI and hospital stay durations following abdominal surgeries. The incorporation of the recent studies in laparoscopic abdominal procedures further supports these findings. Integrating Alvimopan into perioperative care protocols may enhance patient outcomes and help lower healthcare costs."

Journal • Review • Surgery • Gastrointestinal Disorder • Gynecology

Effect of Alvimopan on Postoperative Ileus and Length of Hospital Stay in Patients Undergoing Bowel Resection: A Systematic Review and Meta-Analysis. (PubMed, Am Surg) - "Robust evidence supports the routine use of alvimopan in patients undergoing open bowel resection as indicated by lower risk of postoperative ileus and shorter length of hospital stay. We support incorporation of alvimopan into enhanced recovery after surgery programs for the procedures involving open bowel resection. The role of alvimopan in minimally invasive bowel resection needs more research."

Journal • Retrospective data • Review

An outline of the management and prevention of postoperative ileus: A review. (PubMed, Medicine (Baltimore)) - "While treatment options such as alvimopan, NSAIDs, and acupuncture have demonstrated efficacy, the use of lidocaine has raised concerns due to associated adverse effects...POI presents a complex challenge in various surgical specialties, necessitating a multifaceted management approach. The integration of preventive and treatment measures within enhanced recovery programs has significantly reduced POI frequency and duration."

Journal • Review

Novel Evaluation of Alvimopan to Prevent Ileus in Live Donor Hepatectomy (ATC 2024) - "There was a trend for lower opiate use postoperatively in the alvimopan group 57.9±39.6 vs. 102.6±107.4mg (oral morphine equivalent) in the control group (p=0.07) and a shorter length of stay 4.5±0.7 vs. 5.1±1.2 days respectively (p=0.06). The novel use of alvimopan in living donor hepatectomy did not accelerate gastrointestinal recovery. Patients who received alvimopan experienced fewer episodes of emesis and there was a trend to lower opiate use and shorter length of hospital stay. Further multicenter work including alvimopan as part of an enhanced recovery pathway are needed to improve donor outcomes."

Gastrointestinal Disorder • Pain • Transplantation

Pharmacologic prevention and therapy of postoperative paralytic ileus after gastrointestinal cancer surgery - systematic review and meta-analysis. (PubMed, Int J Surg) - "Current evidence concerning pharmacological prevention and treatment of POI following gastrointestinal tumor surgery is limited. Opioid-sparing concepts, reduction of sympathetic hyperreactivity, and laxatives should be implemented into multimodal perioperative approaches."

Journal • Retrospective data • Review • Surgery • Gastrointestinal Cancer • Gastrointestinal Disorder • Oncology • Pain • Solid Tumor

Alvimopan as a Rescue Treatment of Postoperative Ileus (clinicaltrials.gov) - P4 | N=58 | Recruiting | Sponsor: Scott Steele | Trial completion date: Feb 2024 ➔ Aug 2024 | Trial primary completion date: Feb 2024 ➔ Aug 2024

Surgery • Trial completion date • Trial primary completion date • Colon Cancer • Gastrointestinal Disorder