General

Genetic Implications: Genetic Implications

Pronunciation:
nal-ox-ee-gol


Trade Name(s)

  • Movantik

Ther. Class.
laxatives

Pharm. Class.
opioid antagonists

Indications

Treatment of opioid-induced constipation (OIC) in patients receiving chronic opioids for chronic non-cancer pain when traditional laxatives have failed.

Action

Acts peripherally as a mu receptor antagonist, blocking opioid receptors in the GI tract.

Therapeutic Effect(s):

Blocks constipating effects of opioids on the GI tract without loss of analgesia.

Pharmacokinetics

Absorption: Systemic absorption follows oral administration. A high-fat meal ↑ absorption.

Distribution: Does not cross the blood-brain barrier.

Metabolism and Excretion: Metabolized primarily by the CYP3A4 enzyme system; 68% excreted in feces, 16% in urine mostly as metabolites.

Half-life: 6–11 hr.

TIME/ACTION PROFILE (spontaneous bowel movement)

ROUTEONSETPEAKDURATION
POwithin 24 hrunknownunknown

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity;
  • Known/suspected/history of gastrointestinal obstruction;
  • Severe hepatic impairment;
  • Concurrent use of strong CYP3A4 inhibitors, strong CYP3A4 inducers, other opioid antagonists, or grapefruit/grapefruit juice;
  • Severe hepatic impairment;
  • Lactation: May precipitate opioid withdrawal in infant.

Use Cautiously in:

  • Patients with disruption of the blood-brain barrier (may precipitate opioid withdrawal);
  • Geri: Genetic implication Blood levels are ↑ in elderly Japanese patients;
  • OB: May precipitate fetal opioid withdrawal (use only if potential benefit justifies potential risk to fetus);
  • Pedi: Safety and effectiveness not established.

Adverse Reactions/Side Effects

CNS: headache

GI: GASTROINTESTINAL PERFORATION, abdominal pain, diarrhea, flatulence, nausea, vomiting

Derm: sweating

Misc: opioid withdrawal

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

  • Concurrent use of strong CYP3A4 inhibitors including clarithromycin and ketoconazole ↑ risk of toxicity/adverse reactions and is contraindicated.
  • Concurrent use of moderate CYP3A4 inhibitors including diltiazem, erythromycin, and verapamil may also ↑ risk of toxicity/adverse reactions; dose reduction and careful monitoring recommended.
  • Concurrent use of strong CYP3A4 inducers including rifampin may ↓ blood levels/effectiveness and is contraindicated.
  • Concurrent use of other opioid antagonists may precipitate opioid withdrawal and is contraindicated.
  • Concurrent use of methadone for pain ↑ risk of stomach pain and diarrhea.

Drug-Food:

Grapefruit/grapefruit juice may ↑ blood levels and the risk of toxicity/adverse reactions and should be avoided.

Route/Dosage

PO: (Adults) 25 mg once daily, if poorly tolerated ↓ dose to 12.5 mg once daily; Concurrent use of moderate CYP3A4 inhibitors– 12.5 mg once daily (careful monitoring recommended).

Renal Impairment
PO: (Adults) CCr <60 mL/min– 12.5 mg once daily initially, may be cautiously ↑ to 25 mg once daily if necessary with careful monitoring.

Availability

Tablets: 12.5 mg, 25 mg

Assessment

  • Assess bowel sounds and frequency, quantity, and consistency of stools periodically during therapy.
  • Monitor pain intensity during therapy. Naloxegol does not affect pain or effects of opioid analgesics on pain control. Discontinue naloxegol if opioid analgesic is discontinued.
  • Monitor for signs and symptoms of gastrointestinal perforation (severe, persistent or worsening abdominal pain) periodically during therapy. Discontinue naloxegol if symptoms occur.

Potential Diagnoses

Implementation

  • Discontinue all maintenance laxative therapy before starting naloxegol. If a suboptimal response occurs with naloxegol, laxatives may be used after 3 days.
  • PO: Administer on an empty stomach at least 1 hr before first meal in morning or 2 hrs after meal. Tablet may be crushed to a powder, mixed with 4 ounces of water (120 mL) for patients with difficulty swallowing. Drink mixture immediately; refill glass with 120 mL water, stir and drink contents.
    • May be administered by NG tube. Flush the NG tube with 1 ounce (30 mL) of water using a 60 mL syringe. Crush tablet to a powder and mix with 2 ounces (60 mL) of water. Draw up mixture using the 60 mL syringe and administer through the NG tube. Add 2 ounces (60 mL) of water to rinse container and administer to flush NG tube and any remaining medicine from NG tube into stomach.
    • Avoid grapefruit and grapefruit juice during therapy.

Patient/Family Teaching

  • Instruct patient to take naloxegol on an empty stomach as directed. Laxatives should be stopped before starting naloxegol, but may be restarted after 3 days if needed. Advise patient to read Medication Guide prior to starting therapy and with each refill in case of changes.
  • Caution patient to avoid grapefruit and grapefruit juice during therapy.
  • Advise patient to notify health care professional immediately if stomach pain that does not go away occurs.
  • Advise patient to notify health care professional if signs and symptoms of opioid withdrawal (sweating, chills, diarrhea, stomach pain, anxiety, irritability, yawning) occur. Patients taking methadone for pain are at increased risk for stomach pain and diarrhea.
  • Instruct patient to stop taking naloxegol if they stop taking opioid medications.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
  • Advise female patients to notify health care professional if pregnancy is planned or suspected and avoid breast feeding during therapy.

Evaluation/Desired Outcomes

Relief of opioid induced constipation, especially if opioid therapy has been for 4 wks or more.

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Citation

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TY - ELEC T1 - naloxegol ID - 110153 A1 - Quiring,Courtney, AU - Sanoski,Cynthia A, AU - Vallerand,April Hazard, BT - Davis's Drug Guide UR - https://im.unboundmedicine.com/medicine/view/Davis-Drug-Guide/110153/all/naloxegol PB - F.A. Davis Company ET - 16 DB - Medicine Central DP - Unbound Medicine ER -