From the Guidelines
Entereg (alvimopan) should be administered 30 minutes to 5 hours before the start of colostomy reversal surgery, with a recommended dose of 12 mg orally, as it helps accelerate the recovery of gastrointestinal function after surgery without interfering with opioid-based pain management. The guidelines for perioperative care in elective colorectal surgery, as recommended by the Enhanced Recovery After Surgery (ERAS) society in 2018 1, do not specifically address the administration of Entereg. However, the medication's role in accelerating gastrointestinal recovery is crucial in surgeries like colostomy reversal, where postoperative ileus is a significant concern. Key points to consider when administering Entereg include:
- The dose and timing, which should be 12 mg orally 30 minutes to 5 hours before surgery, followed by 12 mg twice daily for up to 7 days after surgery or until discharge, not exceeding a total of 15 doses.
- The mechanism of action as a peripherally acting μ-opioid receptor antagonist that prevents the constipating effects of opioids on the gut without affecting their analgesic benefits in the central nervous system.
- The importance of enrolling patients in the ENTEREG Access Support and Education (E.A.S.E.) program before receiving the medication, and the contraindication in patients who have taken therapeutic doses of opioids for more than 7 consecutive days immediately before starting Entereg. Given the lack of direct recommendations for Entereg in the provided evidence, the decision to administer it before colostomy reversal surgery is based on its known benefits in reducing postoperative ileus and enhancing recovery, prioritizing patient outcomes in terms of morbidity, mortality, and quality of life 1.
From the FDA Drug Label
The FDA drug label does not answer the question.