Abstract
Peripheral mechanisms may be involved in opioid actions on the urinary bladder. This double-blind study investigated whether opioid inhibition of bladder function is reversed by methylnaltrexone, a peripheral opioid antagonist. Thirteen healthy male volunteers received an intravenous (i.v.) infusion of remifentanil, 0.15 mcg/kg/min, then a single i.v. dose of study medication (methylnaltrexone 0.3 mg/kg, naloxone 0.01 mg/kg, or saline). Urodynamics were measured with indwelling bladder and rectal catheters, and pupil size was assessed with infrared pupillometry. Remifentanil decreased detrusor pressure in 21/25 sessions and caused complete urinary retention in 18/25. Voiding was possible in 7/7, 5/12, and 0/6 sessions after naloxone, methylnaltrexone, and saline, respectively (P=0.0013). Remifentanil caused marked miosis that was reversed by naloxone, but not methylnaltrexone or placebo (P<0.0001). The pupil data confirm that methylnaltrexone did not reverse central opioid effects. Reversal of urinary retention by methylnaltrexone indicates that peripheral mechanisms may play a role in opioid-induced bladder dysfunction.
Publication types
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Randomized Controlled Trial
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Research Support, Non-U.S. Gov't
MeSH terms
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Adult
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Analgesics, Opioid / administration & dosage
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Analgesics, Opioid / adverse effects*
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Cross-Over Studies
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Double-Blind Method
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Humans
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Infusions, Intravenous
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Male
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Middle Aged
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Miosis / chemically induced
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Miosis / drug therapy
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Muscle Contraction / drug effects
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Naloxone / administration & dosage
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Naloxone / therapeutic use*
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Naltrexone / administration & dosage
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Naltrexone / analogs & derivatives*
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Naltrexone / therapeutic use
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Narcotic Antagonists / administration & dosage
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Narcotic Antagonists / therapeutic use*
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Piperidines / administration & dosage
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Piperidines / adverse effects*
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Quaternary Ammonium Compounds / administration & dosage
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Quaternary Ammonium Compounds / therapeutic use
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Remifentanil
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Treatment Outcome
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Urinary Bladder / drug effects*
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Urinary Bladder / physiopathology
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Urinary Retention / chemically induced
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Urinary Retention / drug therapy*
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Urinary Retention / physiopathology
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Urination / drug effects
Substances
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Analgesics, Opioid
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Narcotic Antagonists
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Piperidines
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Quaternary Ammonium Compounds
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methylnaltrexone
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Naloxone
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Naltrexone
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Remifentanil