Methylnaltrexone

Class Opioid antagonist
Chemistry

Phenanthrene

Routes of administration

IV, S/C, IM

Absorption

Poorly absorbed; oral bioavailability <1%

Solubility

pKa = 9.9; practically insoluble in water

Distribution

VOD = 1.1 L/kg; 11-15% protein-bound

Metabolism

About 15% of the dose is metabolised in the liver, into abot 5 metabolites

Elimination

About 85% is eliminated as unchanged drug, 50% via urine and 35% in faeces

Time course of action

Half-life is approximately 8 hours

Target receptor

μ, δ- and κ-opioid receptors in the myoenteric plexus of the intestine

Mechanism of action

Peripherally acting opioid receptor antagonist which does not penetrate the blood-brain barrier; exerts its effect by reversing the sustained increase in smooth muscle tone which results from opioid use

Clinical effects

Relatively free from adverse effects; could develop peripheral syptoms of opioid withdrawal (poerection, tremor, shivering, etc)

Literature reference

FDA data sheet

CICM details of understanding Not specifically listed in the CICM syllabus
Mentioned around Deranged Physiology
Related SAQs