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The following information outlines important safety warnings and contraindications associated with the use of Alvimopan (Entereg). It is crucial to review these details thoroughly and discuss any concerns with your healthcare provider.

• Heart Attack Risk: Long-term use of Alvimopan (Entereg) can increase the risk of a heart attack. However, since this medication is intended for short-term use (typically no more than one week during hospital stays), the likelihood of experiencing this side effect is minimal when used as prescribed.

• Gastrointestinal Issues: Alvimopan (Entereg) may cause stomach pain, nausea, vomiting, and diarrhea, particularly in individuals who have recently used opioid pain medications. It is contraindicated for those who have taken opioids continuously for more than seven days before surgery.

• Liver and Kidney Precautions: As the liver metabolizes Alvimopan (Entereg), individuals with severe liver disease should not use this medication due to the risk of accumulation and increased side effects. Caution is also advised for those with kidney impairments.

• Specific Digestive Conditions: This medication is not recommended for patients with intestinal blockages or those recovering from surgeries addressing such blockages. It should also be avoided if surgical procedures have been performed on the pancreas or stomach, as its safety and efficacy in these populations are not well-established.

Contraindications:

• Alvimopan (Entereg) should not be used by individuals who have taken opioid medications for more than seven consecutive days leading up to surgery, as it may pose serious health risks. Consult your healthcare provider if this applies to you.

Always ensure to follow your healthcare provider's instructions and report any adverse reactions or concerns during your treatment with Alvimopan (Entereg).

Common side effects:

• Mild indigestion

Serious side effects:

• Symptoms of a heart attack (such as chest pain or pressure, cold sweats, lightheadedness, and discomfort radiating to the shoulder, arm, back, neck, jaw, teeth, or upper belly)

When taking alvimopan, it's important to be aware of potential interactions with other medications:

Opioid Medications: Alvimopan is contraindicated in patients who have taken therapeutic doses of opioids for more than seven consecutive days immediately prior to starting alvimopan. Recent opioid use can increase sensitivity to alvimopan, potentially leading to gastrointestinal issues such as abdominal pain, nausea, vomiting, and diarrhea. However, no significant interaction is expected in patients who have used opioid analgesics for seven or fewer consecutive days before initiating alvimopan.

P-glycoprotein Inhibitors: Alvimopan is a substrate for P-glycoprotein, a protein that helps transport substances across cell membranes. Concurrent use of strong P-glycoprotein inhibitors—such as Amiodarone, bepridil, diltiazem, ciclosporin, Itraconazole, quinine, quinidine, Spironolactone, and Verapamil—may increase alvimopan levels in the body. This could enhance the effects and side effects of alvimopan.

Other Medications: Alvimopan is not metabolized by the cytochrome P450 enzyme system, so interactions with drugs processed by this system are not expected. However, always inform your healthcare provider about all medications you're taking, including over-the-counter drugs and supplements, to ensure safe use of alvimopan.

Before starting alvimopan, discuss your full medication history with your doctor to avoid potential interactions and ensure the medication is appropriate for your situation.