Methylnaltrexone in the Management of Opioid-Associated Urinary Retention in Children

Author:

Suchovsky Skyler B.1,Reiter Pamela D.2,Lewis Hannah E.1,Clevenger Amy C.3

Affiliation:

1. Department of Pharmacy (SBS, HEL), Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO

2. Department of Pharmacy and Division of Pediatric Critical Care (PDR), Children's Hospital Colorado

3. Clinical Professor, Skaggs School of Pharmacy and Pharmaceutical Sciences (Anschutz Medical Campus), Aurora, CO; Department of Pediatrics and Division of Pediatric Critical Care (ACC), Children's Hospital Colorado and University of Colorado Denver, Anschutz Medical Campus, Aurora, CO.

Abstract

OBJECTIVE To evaluate the association between methylnaltrexone and urine output (UOP) in critically ill children with opioid-associated urinary retention. METHODS This retrospective study included patients admitted to the pediatric intensive care unit between December 1, 2019, and November 30, 2020, who received methylnaltrexone for opioid-associated oliguria (spontaneous UOP below 1 mL/kg/hr and at least 1 dose of an opioid within the preceding 6 hours). RESULTS Twenty-five patients (median age = 5.5 years, IQR 1.7–16.4; median weight = 19 kg, IQR 9–45) were included. Mean methylnaltrexone dose was 0.15 ± 0.006 mg/kg. A statistically significant increase in UOP from baseline to 6 hours following methylnaltrexone was observed (p = 0.001), but not all patients responded. Fourteen patients (56%) had no UOP following methylnaltrexone administration, while 11 (44%) demonstrated a robust increase (median = 0 mL/kg/hr at baseline [IQR 0–0] to 1.96 mL/kg/hr [IQR 1.08–2.22; p = 0.001]) within 6 hours following methylnaltrexone administration. Younger patients responded better than older patients (responder age = 2.5 years [IQR 0.8–7]) versus 11.4 years [IQR 1.75–17.5] for non-responders) (p = 0.04). Both intravenous (IV) and subcutaneous (SQ) routes were associated with an increase in UOP (IV, p = 0.04; SQ, p = 0.02). The effect persisted for up to 24 hours after administration. Sixty-four percent of patients required urinary catheter placement. Pain scores (averaged 6 hours before and after methylnaltrexone) remained unchanged (p = 0.44). CONCLUSIONS Methylnaltrexone may increase spontaneous UOP in some children with opioid-associated urinary retention, but urinary catheterization rates remain high.

Publisher

Pediatric Pharmacy Advocacy Group

Subject

Pharmacology (medical),Pediatrics, Perinatology and Child Health

Reference11 articles.

1. Acute urinary retention in children;Gatti;J Urol,2001

2. Drug-induced urinary retention: incidence, management and prevention;Verhamme;Drug Safety,2008

3. Patterns of off-label prescribing in the pediatric intensive care unit and prioritizing future research;Czaja;J Pediatr Pharmacol Ther,2015

4. Centers for Disease Control and Prevention. Catheter-associated urinary tract infections (CAUTI). 2017. Accessed April 5, 2021. https://www.cdc.gov/hai/ca_uti/uti.html

5. Delirium;Mattison;Ann Intern Med .,2020

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