Alvimopan (trade name Entereg) is a drug which behaves as a peripherally acting μ-opioid receptor antagonist. With the limited ability to cross the blood–brain barrier and reach the μ-opioid receptors of the central nervous system, the clinically undesirable effects of centrally acting opioid antagonists (like reversal of opioid-mediated analgesia) are avoided without affecting the intended blockade of μ-opioid receptors in the gastrointestinal tract. It is currently only Food and Drug Administration approved for the treatment of postoperative ileus which it received in May 2008. Medical uses
Alvimopan is indicated in people to avoid postoperative ileus following partial large or small bowel resection with primary anastomosis. Alvimopan accelerates the gastrointestinal recovery period as defined by time to first bowel movement or flatus. Adverse effects
There is a potential risk of myocardial infarction in patients using alvimopan long-term.The most common side effects associated with alvimopan are:

Contraindications
Alvimopan is absolutely contraindicated in patients who have taken therapeutic doses of opioids for more than seven consecutive days immediately prior to when alvimopan would be initiated because individuals with recent exposure to opioids are expected to be more sensitive to the effects of μ-opioid receptor antagonists. The peripheral site of action of alvimopan suggests that such a heightened sensitivity would precipitate gastrointestinal effects beyond dyspepsia. Interactions
Alvimopan is not a substrate for the cytochrome P450 enzyme system. Therefore, no interactions are expected with hepatically metabolized drugs. Alvimopan is substrate for P-glycoprotein. Thus, interactions are to be expected with known P-glycoprotein inhibitors such as amiodarone, bepridil, diltiazem, ciclosporin, itraconazole, quinine, quinidine, spironolactone, and verapamil.
They credited this change to a change in the posterior positioning of the tongue due to the crib therapy.Some of the side-effects of using a tongue-crib therapy is that this appliance may trap food,  causing inflammation around the appliance. Repeated contact of the tongue with the appliance may lead to an imprint on the tongue which will self-resolve when the appliance is removed. It is important to note that this type of therapy will only work in patients who do not have a skeletal open bite tendency. A skeletal open bite tendency may be addressed via surgery or other treatment. Blue Grass appliance
Its a type of appliance which is similar to Nance appliance, but instead of acrylic pad that rests on the anterior palate, this appliance has a plastic roller that patient can use their tongue to break their habit. This appliance is banded to the upper 1st molars and bars extend the appliance to anterior palate where the plastic roller is placed. Vertical pull chin cup
Hakan Iscan and others used vertical pull chin cup in 17 patients for 9 months where they applied 400g of force on each side. Compared to controls, they found that patients included in the experimental group had increased eruption of the mandibular incisors, decrease of the ramal inclination, decrease of the mandibular plane, increase of the overbite, decrease of the gonial angle and increase of the mandibular corpus inclination were found. They stated that vertical chin cup maybe effective in treating skeletal open bite patients. However, Pedrin et al.