Naloxegol
MOVANTIK
Pronunciation: nal-OX-ee-gol
“Nail locks seagull (for) Movin’ antics”
dilated pupils → opioid antagonist
What it isPeripherally restricted mu antagonist; opioid-induced constipation.
Why this onePEGylation keeps it out of the CNS, so it reverses gut opioid effects without reversing analgesia.
What limits itGI perforation risk, so avoid in known or suspected obstruction. CYP3A4-dependent; take on an empty stomach.
FDA-approved for
- opioid-induced constipation (2014)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Opioid-induced constipation (chronic non-cancer pain) | Adults | 25 mg QD (morning) | 25 mg QD | 25 mg QD |
Renal CLcr <60 mL/min: start 12.5 mg QD, may increase to 25 mg QD if tolerated; no adjustment in mild impairment
Hepatic Mild-moderate: no adjustment; avoid in severe (Child-Pugh C, not evaluated)
If 25 mg not tolerated, reduce to 12.5 mg QD
Instructions
- Take on empty stomach ≥1 h before first meal of day or 2 h after
- Discontinue maintenance laxatives before starting; may resume after 3 days if needed
- If unable to swallow, tablet may be crushed and mixed in water or given via NG tube
- Avoid grapefruit / grapefruit juice
- Discontinue if opioid pain medication is discontinued
Available strengths
- tab 12.5, 25 mg
Contraindications
- Known/suspected GI obstruction or at risk of recurrent obstruction (GI perforation risk)
- Concomitant strong CYP3A4 inhibitors (may precipitate opioid withdrawal)
Cautions
- Opioid withdrawal (esp. with blood-brain barrier disruption)
- Severe abdominal pain and/or diarrhea — discontinue if severe
- GI perforation with peripherally acting opioid antagonists
Adverse reactions
- Abdominal pain
- Diarrhea
- Nausea
- Flatulence
- Vomiting
- Headache
- Hyperhidrosis
Pregnancy May precipitate opioid withdrawal in mother and fetus; human data insufficient
Lactation Breastfeeding not recommended (opioid withdrawal risk in infant)
Cost
| Strength | #/mo | generic $/mo | brand $/mo | CostPlus | |
|---|---|---|---|---|---|
| 12.5 mg | tab | 30 qd | — | $437.96 | not offered |
| 25 mg | tab | 30 qd | — | $438.40 | not offered |
Generic entry2032 est.
NO BOXED WARNINGS
Principal riskGI perforation; opioid withdrawal
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityDiarrhea, dehydration and electrolyte disturbance, especially with excessive or prolonged use.