From the Guidelines
The answer is (b) vinca alkaloids. Paralytic ileus is a known complication of vinca alkaloids such as vincristine, vinblastine, and vinorelbine. These chemotherapeutic agents work by binding to tubulin and preventing microtubule formation, which disrupts cell division. However, this mechanism also affects the autonomic nervous system that controls gut motility. Vinca alkaloids can cause neurotoxicity that extends to the myenteric plexus in the intestinal wall, leading to decreased peristalsis and ultimately paralytic ileus. Patients receiving vinca alkaloids should be monitored for symptoms such as abdominal distension, constipation, nausea, and vomiting. Preventive measures include maintaining adequate hydration, using prophylactic laxatives, and careful dose adjustments in patients with pre-existing neuropathy or bowel dysfunction. While other chemotherapeutic agents listed may cause gastrointestinal side effects, paralytic ileus is particularly associated with the neurotoxic effects of vinca alkaloids.
Some key points to consider:
- Vinca alkaloids are derived from the rose periwinkle plant and have been used since 1993, primarily in the treatment of leukemia and lymphoma 1.
- The mechanism of action of vinca alkaloids involves binding to tubulin and preventing microtubule formation, which can lead to neurotoxicity and decreased gut motility 1.
- Paralytic ileus is a serious complication that can occur with the use of vinca alkaloids, and patients should be closely monitored for symptoms such as abdominal distension, constipation, nausea, and vomiting.
- Preventive measures such as maintaining adequate hydration, using prophylactic laxatives, and careful dose adjustments can help reduce the risk of paralytic ileus in patients receiving vinca alkaloids.
- Other chemotherapeutic agents, such as cisplatin, cyclophosphamide, and doxorubicin, can also cause gastrointestinal side effects, but paralytic ileus is particularly associated with the neurotoxic effects of vinca alkaloids 1.
From the Research
Causes of Paralytic Ileus
- Paralytic ileus can be a complication of various factors, including certain medications and medical conditions.
- The provided studies suggest that vinca alkaloids, such as vincristine, can cause paralytic ileus 2, 3, 4.
- Specifically, vincristine has been shown to induce paralytic ileus in patients with hematological malignancies 3 and in patients with Parkinson's disease 4.
- However, there is no direct evidence in the provided studies to suggest that cyclophosphamide, methotrexate, cisplatin, or doxorubicin are common causes of paralytic ileus.
- Other factors, such as spinal surgery, traumatic injury, or lower extremity joint reconstruction, can also contribute to the development of paralytic ileus 5.
- The management of paralytic ileus depends on the underlying cause and may involve minimization of opioids, early patient mobilization, pharmacologic intervention, and multidisciplinary care 5, 6.