Relistor medication guide

Criteria for Subcutaneous Use in Adults:

• Restricted to use in the treatment of opioid induced constipation unrelieved by at least 1 day of treatment with at least 2 selected agents in non-cancer pain or chronic pain palliative care patients

o   Selected agents: bisacodyl, erythromycin, glycerin suppository, lactulose enema, magnesium citrate or hydroxide, metoclopramide, mineral oil enema, senna, and sorbitol

• Pharmacists automatically add a duration of 3 doses if ordered without a duration or stop time specified

o   Prescribers may order for methylnaltrexone to continue further than 3 doses if desired

• Pharmacists automatically perform renal dose adjustments based on indication and CrCl < 60 mL/min:

o   Opioid-induced constipation with advanced illness: SubQ:

• • <38 kg: 0.075 mg/kg every other day (round dose up to nearest 0.1 mL of volume)
  • 38 to <62 kg: 4 mg every other day
  • 62 to 114 kg: 6 mg every other day
  • >114 kg: 0.075 mg/kg every other day (round dose up to nearest 0.1 mL of volume)

o   Opioid-induced constipation with non-cancer pain:

• • Oral: 150 mg once daily
  • SubQ: 6 mg once daily

Pharmacists should discontinue methylnaltrexone when opiates are discontinued.

Reviewed: July 29, 2008

Reviewed: 22 September 2015 (Expanded use), November 2019 (Oral Formulation)

Updated: March 2021 (Relistor Subcutaneous Adults)

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• Lippincott Advisor