Details
Stereochemistry | ABSOLUTE |
Molecular Formula | C25H32N2O4 |
Molecular Weight | 424.5326 |
Optical Activity | UNSPECIFIED |
Defined Stereocenters | 3 / 3 |
E/Z Centers | 0 |
Charge | 0 |
SHOW SMILES / InChI
SMILES
C[C@H]1CN(C[C@H](CC2=CC=CC=C2)C(=O)NCC(O)=O)CC[C@@]1(C)C3=CC=CC(O)=C3
InChI
InChIKey=UPNUIXSCZBYVBB-JVFUWBCBSA-N
InChI=1S/C25H32N2O4/c1-18-16-27(12-11-25(18,2)21-9-6-10-22(28)14-21)17-20(24(31)26-15-23(29)30)13-19-7-4-3-5-8-19/h3-10,14,18,20,28H,11-13,15-17H2,1-2H3,(H,26,31)(H,29,30)/t18-,20-,25+/m0/s1
DescriptionCurator's Comment: Description was created based on several sources, including
https://www.ncbi.nlm.nih.gov/pubmed/8057274 | http://adisinsight.springer.com/drugs/800003539
Curator's Comment: Description was created based on several sources, including
https://www.ncbi.nlm.nih.gov/pubmed/8057274 | http://adisinsight.springer.com/drugs/800003539
Alvimopan (LY246736, ADL 8-2698, trade name Entereg) is a potent, peripherally selective mu-opioid receptor antagonist. Alvimopan was developed by Adolor Corporation (now Cubist Pharmaceuticals) and GlaxoSmithKline for the treatment of postoperative ileus. Postoperative ileus is the impairment of gastrointestinal motility after intra-abdominal surgery or other non-abdominal surgeries. This may potentially delay gastrointestinal recovery and hospital discharge until its resolution. Morphine and other mu-opioid receptor agonists are universally used for the treatment
of acute postsurgical pain; however, they are known to have an inhibitory effect on gastrointestinal motility and may prolong the duration of postoperative ileus. Following oral administration, alvimopan antagonizes the peripheral effects of opioids on gastrointestinal motility and secretion by competitively binding to gastrointestinal tract mu-opioid
receptors.
CNS Activity
Originator
Sources: http://adisinsight.springer.com/drugs/800003539
Curator's Comment: # Eli Lilly
Approval Year
Targets
Primary Target | Pharmacology | Condition | Potency |
---|---|---|---|
Target ID: CHEMBL233 Sources: https://www.ncbi.nlm.nih.gov/pubmed/8057274 |
0.77 nM [Ki] |
Conditions
Condition | Modality | Targets | Highest Phase | Product |
---|---|---|---|---|
Preventing | ENTEREG Approved UseENTEREG is a peripherally acting μ-opioid receptor antagonist indicated to accelerate the time to upper and lower gastrointestinal recovery following partial large or small bowel resection surgery with primary anastomosis. Launch Date2008 |
Cmax
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
10.98 ng/mL |
12 mg 2 times / day multiple, oral dose: 12 mg route of administration: Oral experiment type: MULTIPLE co-administered: |
ALVIMOPAN plasma | Homo sapiens population: HEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
AUC
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
40.2 ng × h/mL |
12 mg 2 times / day multiple, oral dose: 12 mg route of administration: Oral experiment type: MULTIPLE co-administered: |
ALVIMOPAN plasma | Homo sapiens population: HEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
T1/2
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
13.5 h |
12 mg 2 times / day multiple, oral dose: 12 mg route of administration: Oral experiment type: MULTIPLE co-administered: |
ALVIMOPAN plasma | Homo sapiens population: HEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
Funbound
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
20% |
12 mg 2 times / day multiple, oral dose: 12 mg route of administration: Oral experiment type: MULTIPLE co-administered: |
ALVIMOPAN plasma | Homo sapiens population: HEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
Doses
Dose | Population | Adverse events |
---|---|---|
120 mg single, oral Highest studied dose Dose: 120 mg Route: oral Route: single Dose: 120 mg Sources: |
healthy, adult Health Status: healthy Age Group: adult Sources: |
|
48 mg 1 times / day multiple, oral Highest studied dose Dose: 48 mg, 1 times / day Route: oral Route: multiple Dose: 48 mg, 1 times / day Sources: |
healthy, adult Health Status: healthy Age Group: adult Sources: |
|
12 mg 2 times / day multiple, oral Recommended Dose: 12 mg, 2 times / day Route: oral Route: multiple Dose: 12 mg, 2 times / day Sources: |
unhealthy, adult Health Status: unhealthy Age Group: adult Sources: |
|
12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Other AEs: Ascites, Ileus... Other AEs: Ascites (serious, 1 patient) Sources: Ileus (serious, 1 patient) Electrolyte imbalance (serious, 1 patient) Failure to thrive (serious, 1 patient) Syncope (serious, 1 patient) Wound infection (serious, 2 patients) Wound complication (serious, 1 patient) Mania (serious, 1 patient) Hypertension (below serious, 3 patients) Constipation (below serious, 18 patients) Diarrhea (below serious, 6 patients) Dyspepsia (below serious, 1 patient) Nausea (below serious, 20 patients) Vomiting (below serious, 9 patients) Anorexia (below serious, 4 patients) Esophagitis (below serious, 1 patient) Gastroparesis (below serious, 1 patient) Weight loss (below serious, 3 patients) Leukocytosis (below serious, 4 patients) International normalized ratio increased (below serious, 1 patient) Electrolyte imbalance (below serious, 8 patients) Hypomagnesemia (below serious, 2 patients) Elevated liver enzymes (below serious, 2 patients) Delirium (below serious, 3 patients) Insomnia (below serious, 1 patient) Sensory neuropathy (below serious, 3 patients) Cystostomy (below serious, 1 patient) Pelvic abscess (below serious, 1 patient) Urinary tract obstruction (below serious, 1 patient) Allergic reaction to chemotherapy (below serious, 1 patient) Pneumonitis (below serious, 2 patients) Pneumothorax (below serious, 2 patients) Wound infection (below serious, 7 patients) Skin infection (below serious, 2 patients) |
AEs
AE | Significance | Dose | Population |
---|---|---|---|
Allergic reaction to chemotherapy | below serious, 1 patient | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Cystostomy | below serious, 1 patient | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Dyspepsia | below serious, 1 patient | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Esophagitis | below serious, 1 patient | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Gastroparesis | below serious, 1 patient | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Insomnia | below serious, 1 patient | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
International normalized ratio increased | below serious, 1 patient | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Pelvic abscess | below serious, 1 patient | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Urinary tract obstruction | below serious, 1 patient | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Constipation | below serious, 18 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Elevated liver enzymes | below serious, 2 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Hypomagnesemia | below serious, 2 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Pneumonitis | below serious, 2 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Pneumothorax | below serious, 2 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Skin infection | below serious, 2 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Nausea | below serious, 20 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Delirium | below serious, 3 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Hypertension | below serious, 3 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Sensory neuropathy | below serious, 3 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Weight loss | below serious, 3 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Anorexia | below serious, 4 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Leukocytosis | below serious, 4 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Diarrhea | below serious, 6 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Wound infection | below serious, 7 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Electrolyte imbalance | below serious, 8 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Vomiting | below serious, 9 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Ascites | serious, 1 patient | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Electrolyte imbalance | serious, 1 patient | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Failure to thrive | serious, 1 patient | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Ileus | serious, 1 patient | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Mania | serious, 1 patient | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Syncope | serious, 1 patient | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Wound complication | serious, 1 patient | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Wound infection | serious, 2 patients | 12 mg 2 times / day steady, oral Dose: 12 mg, 2 times / day Route: oral Route: steady Dose: 12 mg, 2 times / day Sources: |
unhealthy n = 66 Health Status: unhealthy Condition: ovarian cancer Population Size: 66 Sources: |
Overview
CYP3A4 | CYP2C9 | CYP2D6 | hERG |
---|---|---|---|
OverviewOther
Other Inhibitor | Other Substrate | Other Inducer |
---|---|---|
Drug as perpetrator
Drug as victim
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2008/021775_ENTEREG_CAPSULES_BIOPHARMR.pdf Page: 94.0 |
no | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2008/021775_ENTEREG_CAPSULES_BIOPHARMR.pdf Page: 67, 97 |
yes |
Tox targets
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2008/021775_ENTEREG_CAPSULES_PHARMR.pdf Page: 99, 108 |
PubMed
Title | Date | PubMed |
---|---|---|
Selective postoperative inhibition of gastrointestinal opioid receptors. | 2001 Sep 27 |
|
Awakening the sleeping postsurgical abdomen. | 2002 Apr |
|
Methylnaltrexone and alvimopan: economic management of opioid-induced bowel dysfunction. | 2004 Apr |
|
Peripheral opiate action on afferent fibres supplying the rat intestine. | 2004 Oct |
|
Alvimopan. | 2005 Apr |
|
Alvimopan, a selective peripherally acting mu-opioid antagonist. | 2005 Apr |
|
Effect of alvimopan and codeine on gastrointestinal transit: a randomized controlled study. | 2005 Aug |
|
Molecule of the month. Alvimopan hydrate. | 2005 Jun |
|
Phase III trial of alvimopan, a novel, peripherally acting, mu opioid antagonist, for postoperative ileus after major abdominal surgery. | 2005 Jun |
|
Alvimopan: an oral, peripherally acting, mu-opioid receptor antagonist for the treatment of opioid-induced bowel dysfunction--a 21-day treatment-randomized clinical trial. | 2005 Mar |
|
Basic and clinical pharmacology of new motility promoting agents. | 2005 Oct |
|
Alvimopan for the management of postoperative ileus. | 2005 Sep |
|
[(3)H]Alvimopan binding to the micro opioid receptor: comparative binding kinetics of opioid antagonists. | 2005 Sep 27 |
|
Nurses are everywhere: a practical perspective on the surgical team in managing postoperative ileus. | 2006 Apr |
|
Use of novel prokinetic agents to facilitate return of gastrointestinal motility in adult critically ill patients. | 2006 Aug |
|
Current gut-directed therapies for irritable bowel syndrome. | 2006 Jul |
|
Postoperative upper and lower gastrointestinal recovery and gastrointestinal morbidity in patients undergoing bowel resection: pooled analysis of placebo data from 3 randomized controlled trials. | 2006 Mar |
|
Bench-to-bedside review: Routine postoperative use of the nasogastric tube - utility or futility? | 2007 |
|
Postoperative ileus-related morbidity profile in patients treated with alvimopan after bowel resection. | 2007 Apr |
|
Treatment of opioid-induced gut dysfunction. | 2007 Feb |
|
Meta-analysis: Alvimopan vs. placebo in the treatment of post-operative ileus. | 2007 Jan 1 |
|
Novel and alternative therapies for childhood constipation. | 2007 Jun |
|
The in vitro pharmacology of the peripherally restricted opioid receptor antagonists, alvimopan, ADL 08-0011 and methylnaltrexone. | 2007 May |
|
Mu opioid receptor antagonists: recent developments. | 2007 Nov |
|
Alvimopan accelerates gastrointestinal recovery after bowel resection regardless of age, gender, race, or concomitant medication use. | 2007 Oct |
|
Emerging pharmacologic options for treating postoperative ileus. | 2007 Oct 15 |
|
Alvimopan: a peripherally acting mu-opioid receptor antagonist. | 2007 Sep |
|
Opioid-induced constipation in intensive care patients: relief in sight? | 2008 |
|
The involvement of the mu-opioid receptor in gastrointestinal pathophysiology: therapeutic opportunities for antagonism at this receptor. | 2008 Jan |
|
New drug to restore bowel function approved under new FDA rules. | 2008 Jul 1 |
|
Alvimopan and COX-2 inhibition reverse opioid and inflammatory components of postoperative ileus. | 2008 Jun |
|
Alvimopan (Entereg), a Peripherally Acting mu-Opioid Receptor Antagonist For Postoperative Ileus. | 2008 Oct |
|
Development of peripheral opioid antagonists' new insights into opioid effects. | 2008 Oct |
|
Methylnaltrexone, a new peripherally acting mu-opioid receptor antagonist being evaluated for the treatment of postoperative ileus. | 2008 Sep |
|
New drugs: methylnaltrexone bromide, alvimopan, and rilonacept. | 2008 Sep-Oct |
|
Comment on alvimopan guidelines. | 2009 Sep |
|
Intensive Care Unit-acquired infection as a side effect of sedation. | 2010 |
|
The effects of a short course of antibiotics on alvimopan and metabolite pharmacokinetics. | 2010 Mar |
|
Gastrointestinal recovery after laparoscopic colectomy: results of a prospective, observational, multicenter study. | 2010 Mar |
Sample Use Guides
12 mg administered 30 minutes to 5 hours prior to surgery followed by 12 mg
twice daily for up to 7 days for a maximum of 15 doses
Route of Administration:
Oral
In Vitro Use Guide
Sources: https://www.ncbi.nlm.nih.gov/pubmed/17340127
Curator's Comment: In morphine-naive guinea pig ileum alvimopan increased, the amplitude of electrically evoked contractions and spontaneous mechanical activity.
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Classification Tree | Code System | Code | ||
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NDF-RT |
N0000000154
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WHO-ATC |
A06AH02
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NCI_THESAURUS |
C681
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NDF-RT |
N0000175691
Created by
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m1636
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156053-89-3
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SUB20585
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8245
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100000085983
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Q153V49P3Z
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Q153V49P3Z
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C77377
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7704
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5488548
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1516803
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PRIMARY | RxNorm |
ACTIVE MOIETY
METABOLITE (PARENT)
SALT/SOLVATE (PARENT)