Methylnaltrexone for Opioid‐Induced Constipation in Pediatric Oncology Patients
Bibliographic record
Abstract
BACKGROUND: Pediatric oncology patients can experience opioid-induced constipation, which may not respond to laxative treatment. Methylnaltrexone is an opioid receptor antagonist that can reverse opioid-induced constipation without affecting analgesia. Published literature on the use of methylnaltrexone in children is very limited. This retrospective review describes the effectiveness and safety of methylnaltrexone for opioid-induced constipation in pediatric oncology patients. PROCEDURE: A retrospective review of health records was conducted for pediatric oncology in-patients who were prescribed methylnaltrexone between May 2008 and September 2012 at The Hospital for Sick Children. Demographic, clinical, efficacy, and safety data were collected, including; opioid, laxative, and methylnatrexone dosing and frequency. RESULTS: Fifteen patients (median age: 14 years, range: 4-17 years) received methylnaltrexone; 12 received a single dose while three received multiple doses. At the time of methylnaltrexone administration, patients were receiving a median oral morphine dose equivalent of 5.7 mg/kg/day (range: 1.5-29.2 mg/kg/day) and had not had any bowel movements for several days despite treatment with multiple laxatives. Methylnaltrexone was given at a mean dose of 0.15 ± 0.02 mg/kg/dose (range: 3-12 mg/dose) as a subcutaneous injection. After 14 of 19 doses administered, patients had a bowel movement within 4 hours. Three patients had documented mild gastrointestinal upset following methylnaltrexone administration. None reported a reduction of pain control or opioid withdrawal symptoms. CONCLUSION: This case series suggests that methylnaltrexone is safe and may be effective when given subcutaneously as a 0.15 mg/kg single dose to pediatric oncology patients with opioid-induced constipation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".