Effect of alvimopan and codeine on gastrointestinal transit: A randomized controlled study

Jonathan Gonenne, Michael Camilleri, Irene Ferber, Duane Burton, Kari Baxter, Kian Keyashian, Joseph Foss, Bruce Wallin, Wei Du, Alan R. Zinsmeister

Research output: Contribution to journalArticle

96 Scopus citations

Abstract

Background & Aims: Opiate bowel dysfunction is a significant clinical problem. Our aim was to evaluate the ability of a peripheral μ-opioid antagonist, alvimopan, to reverse the effect of codeine on gastric, small-bowel, and colonic transit time in healthy volunteers. Methods: Seventy-four healthy participants (43 women) were randomized in a double-blind, placebo-controlled manner to 1 of 4 groups: alvimopan 12 mg twice daily in the presence and absence of codeine sulfate 30 mg 4 times/day, or codeine or placebo alone. Gastric emptying, small-bowel, and colonic transit were measured by scintigraphy using a 99m-labeled technetium egg meal and 111-labeled indium charcoal delivered to the proximal colon via a delayed-release capsule. The primary end points for colonic transit were geometric center of the colonic counts at 24 hours and time for 50% ascending colon emptying. Analysis of covariance was used to assess the significance of the primary and secondary end points. Results: Codeine delayed gastric, small-bowel, proximal, and overall colonic transit (P <.05). Alvimopan reversed codeine's effect on small bowel and colon (ascending colon and overall colonic transit). Alvimopan also accelerated overall colonic transit compared with placebo. Thus, the mean colonic geometric center at 24 hours was 2.33 with placebo/placebo, 3.25 with alvimopan/placebo (P <.05), 1.5 with placebo/codeine (P <.05), and 2.63 with alvimopan/codeine. Alvimopan did not reverse codeine's delay of gastric emptying. Conclusions: Alvimopan reverses codeine's inhibitory effect on small-bowel and colon transit and has potential for treatment of opiate bowel dysfunction. Alvimopan alone accelerates colonic transit, suggesting that μ-opiate mechanisms participate in the physiologic control of colonic transit.

Original languageEnglish (US)
Pages (from-to)784-791
Number of pages8
JournalClinical Gastroenterology and Hepatology
Volume3
Issue number8
DOIs
Publication statusPublished - Aug 2005
Externally publishedYes

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ASJC Scopus subject areas

  • Gastroenterology

Cite this

Gonenne, J., Camilleri, M., Ferber, I., Burton, D., Baxter, K., Keyashian, K., ... Zinsmeister, A. R. (2005). Effect of alvimopan and codeine on gastrointestinal transit: A randomized controlled study. Clinical Gastroenterology and Hepatology, 3(8), 784-791. https://doi.org/10.1016/S1542-3565(05)00434-9