Movantik = Epic Fail

Really?

 

I'm a chronic pain patient. Constipation from OIC is nothing like that from lack of fiber or somewhat dry stools.

The gut's muscles literally shut down, and the only way you can get stool out is via pressure from up above, and gravity. All the while, without stool moving thru the colon the small intestine fills up, causes pronounced bloating and even males may start to appear pregnant. You might start throwing up once stuff can't leave the stomach. You can't use fiber - it just makes the situation worse when you have more bulk that your gut muscles can't move. The pressure buildup may result in acid reflux and food reflux. Neither Nexium nor antibiotics will help, and the refluxed matter may go down the windpipe, with a sensation of burning and perhaps some coughing. The excess pressure may overpower the internal anal sphincter, resulting in having fecal incontinence despite being constipated!

No, OIC is far from "ordinary constipation" or IBS.

The best solution up till now was "Goliitely", a concentrated solution of PEG-3300 with electrolytes. Miralax may work if you quadruple the dosage, but it lacks the electrolyes that Golytely has, so you end up dehydrated.

Then . . . Along came Movantik. Within an hour of taking my first tablet, I had a strong urge to move my bowels. (I couldn't remember when I previously had had a bowel urge). When I did so, the size of the stool was hard to believe... nearly an arm length that occupied a large portion of the toilet! About four hours later, I had another urge, and released a stool nearly as large as the first one. That evening, I had a third bowel movement, this time of more normal size. After each of the movements, I noted a marked failure to experience a sense of incomplete evacuation. That is a good thing!

Needless to say, I have purchased stock in Astra Zeneca and two companies doing one of the other peripheral opioid antagonists. I had previously bought shares of Salix, considering how profitable Oxycontin had been for Purdue, and expecting Relistor to be riding on the coat tails of all the opiates being sold. I made a tidy sum when Valeant acquired them.

Competition is a good thing. It drives prices down! Astra-Zeneca's competition for OIC treatment will come from Valeant and Progenix for oral Relistor, and from Shoinogi for naldemedine (no brand name yet, but it has shown to be as effective as the other opioid antagonists that were modified to be unable to cross the blood-brain barrier. I don't see the fact that so many companies will be marketing PAMORAs to be a stumbling block to making money. There are more than enough people with OIC to go around I don't think it is worth while to invest in Daiichi Sankyo (AZ's partner in marketing Movantik. They are too big, and the profit they make from Movantik will enrich them by much less a percentage then the other companies, so my bet is on Progenix. Doctors have had years of hospital based experience with relistor, and know what it can do, but in aid of protecting their license, many have developed an aversion to supplying opiate users with injectables. When Relistor tablets are approved on April 19 (assuming they are), I believe their stock will start climbing. Bad news had dropped their stock from nearly 10 to 6 1/2. Good news and a steadily increasing market share (remember the docs in the hospitals) should bring them back to at least 10. Buy now, sell in April (the opposite of everyone else) and make some good money! The average investor has no concept of the degree to which OIC drugs are needed. They are like the holy graille.

Finally, an interesting editoial from the October 2008 issue of Mayo Clinic Proceedings contains the following story about the origins of Relistor:

In 1978, Leon Goldberg, Chair of the Committee on Clinical Pharmacology at the University of Chicago, was presented with a request and clinical challenge by a colleague experiencing the pain of metastatic prostate cancer. The colleague, who required analgesia but declined morphine because of the extreme discomfort of morphine-induced constipation, asked, “Isn’t there something we can do?” Reasoning that gut opioid agonists without central effects had been developed, Goldberg sought an analogous gut opioid antagonist without central effects. In that era, several pharmaceutical companies had active programs attempting to develop analgesic opioids without peripheral adverse effects. Methylnaltrexone, patented by Boehringer Ingelheim [, a German pharmaceutical company,] in 1963 and synthesized based on the structure of an existing antagonist (naltrexone) that was in turn based on the structure of morphine, had been discarded for lack of analgesic activity. However, Goldberg found methylnaltrexone interesting as a possible peripheral antagonist and, in an academic-industry partnership with Boehringer, patented methylnaltrexone in 1979 to “relieve the intestinal mobility inhibiting side effects of narcotic analgesics without interfering with the analgesic activity of the latter.”